Experience Level: Intermediate
Contact Hours: 15
This two day, remote course is offered on Zoom and is the next step for therapists those who focus on the pediatric pelvic floor patient population. It is designed to expand your knowledge of development of normal bowel patterns in children, introduce the new Rome IV criteria (Zeevenhoovenet al. 2017), and review the anatomy and physiology of the GI system with emphasis pediatric Functional Gastrointestinal Disorders (FGID).
According to van den Berg et al, up to 30 percent of children suffer from constipation and account for approximately 3% to 5% of all visits to pediatricians. Early intervention can avoid stool-withholding patterns with worsening constipation leading to prolonged bowel issues into adulthood (Chase, Lewina, 2017) with psychosocial consequences.
This course will delve into the most common types of functional constipation and tests and measures used to assess it. Special emphasis on constipation with coexistence of fecal incontinence (Nurko, Scott. 2011) and the psychological effects of these disorders will also be presented.
Additionally, participants who have not yet been trained will learn external and internal anorectal PFM evaluation of the pediatric perineum. Indications for rectal balloon training and determining the appropriate patient will be instructed with lab. Functional defecatory positions for breathing and PFM relaxation, manual therapy techniques of the abdominal wall and viscera will be taught. Video demonstrations of pediatric patients are also presented. Treatment techniques and progressions, including management of supplements and dietary influences will be discussed.
This course is appropriate for physical therapists, occupational therapists, pediatric nurse practitioners and medical doctors.
Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.
This course is available to pelvic health physical therapists interested in expanding their practice as well as pediatric therapists. It requires Pediatric Pelvic Floor Dysfunction and Incontinence live class. Participants should also have a basic knowledge of biofeedback and pelvic floor muscle anatomy.
What to Gather before the meeting:
For the lab please bring TheraBand medium resistance 4-5 feet long and 10 cuff pound weight or equivalent.
Be sure to wear loose fitting pants for external PFM palpation. Jeans and tight fitting yoga pants are not acceptable.
References: Zeevenhooven, J, Koppen I, Benninga, M. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatric gastroenterology, Hepatology and Nutrition. January 2017.
Nurko S, Scott S. Coexistence of constipation and incontinence of children and adults. Best practice & research Clinical gastroenterology. 2011;25(1):29-41. doi:10.1016/j.bpg.2010.12.002.
van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006; 101:2401.
Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 2005; 146:359.
Chase J, Lewina S. childhood incontinence and pelvic floor muscle function; can be learned from adult research? JPUrol (2017) 13, 94-101
Pre- Recordings: Watch Before the Live Component of the CourseReview of Handouts and Support Material (15 min)
Digestive anatomy and physiology (25 min)
Development of the diaphragm with the PFM (5 min)
Nerve and Blood Supply to the GI System (15 min)
The Brain-Gut Axis (10 min)
Normal bowel patterns from infancy through early childhood (20 min)
Functional Gastrointestinal Disorders (FGID) Infants to adolescents; abdominal pain, IBS, vomiting disorders; organic causes of constipation –such as Hirschsprung’s disease, neurologic bowel and imperforate anus (75 min)
8:00 Introduction and Review Pre-Course Learning
Day Three:8:00 Questions 8:30 Treatment Techniques and Progressions -Pelvic Floor and Scar Release
10:15 Treatment Techniques and Progressions -Diaphragm and Breathing
11:00 Treatment Techniques and Progressions – The Core and Ribcage
12:30 Case studies, encopresis, constipation, abdominophrenic dyssynergia
2:00 Summary and Review
Upon completion of this continuing education seminar, participants will be able to:
1. Understand normal digestive anatomy and physiology
2. Understand the function of the PFM as it relates to defecation
3. Understand FGID in children and be able to identify potential medical “red flags” requiring referral to the physician.
4. Review tests and measures for FGID and be able to refer back to a physician if therapy is not appropriate or advised.
5. Understand medications used for bowel dysfunction and titration for long term bowel health
6. Distinguish if a patient is taking too much or too little medication
7. Assess bowel diaries to better determine rationale for treatment and differential assessment of bowel disorder type
8. Provide education for diet/medication/supplement titration
9. Recognize the psychosocial and behavioral component for proper referral and rectal balloon treatment and determine if psychological referral is necessary.
10. Observe use of perianal surface electromyography (sEMG) and identify PFM discoordination in the pediatric patient
11. Understand how to use sEMG biofeedback to increase or decrease pelvic floor muscle activity and if contraindicated
12. Complete an evaluation of a pediatric patient diagnosed with bowel disorders and be able to determine if any medical red flags are present for further work up.
13. Assess and provide exercises and techniques for diastasis recti.
14. Learn techniques to stimulate BM and rectal sensation using rectal balloon training and OTC medications
15. Treatment progressions for children with pediatric bowel disorders using manual therapy and breathing techniques
16. Implement an appropriate plan of care based on a patient’s symptoms and physical examination
Remote courses require Zoom video conferencing software. You can create an account and download the software to your computer at https://zoom.us/
We use the Pacific Time Zone for all of our start and end times. Please make a note of this and set your calendar accordingly.
A Zoom account is free to create. Before the meeting, we recommend having a practice Zoom session with a friend or colleague so you can test your microphone, video, and internet connection. You can participate in any remote course from the comfort of your home, but will need a stable internet connection in order to participate. We recommend downloading the software and practicing a call with a friend or colleague prior to your course with us. Zoom also offers video tutorials on their website at https://support.zoom.us/hc/en-us/articles/206618765-Zoom-Video-Tutorials.
Still have questions about Remote Courses? Check out our Frequently Asked Questions on Remote Courses
Dawn Sandalcidi PT, RCMT, BCB-PMD specializes in orthopedic manual therapy, and pelvic muscle dysfunction (incontinence and pain) treatment. She has trained medical professionals in manual therapy since 1992 both nationally and internationally. She owns a private practice in Denver, Colorado. Dawn received her BS in physical therapy in 1982 from SUNY Upstate Medical Center in Syracuse, New York. Over the next four years, she participated in extensive international postgraduate studies in manual and manipulative therapy of the spine and extremities in Germany, Switzerland and New Zealand. Over 17 years ago, Dawn became the first physical therapist to treat pelvic muscle dysfunction in the Denver area. Since then she has developed a pediatric dysfunctional voiding treatment program in which she lectures on nationally. She has further studied pediatric conditions in post graduate work at Regis University. Dawn has published articles in the Journal of Urologic Nursing, the Journal of Manual and Manipulative Therapy, and the Journal of Women’s Health Physical Therapy.
Attention: We are unable to offer "retro-active" discounts (i.e. applying a discount to a transaction after the transaction takes place), so if you are interested in exploring discount options and you are unsure if your transactions is eligible for a discount, please contact us to inquire.
This 10% discount is available for a single registrant who wishes to enroll in 3 or more courses, and pay in one transaction. Registrants wishing to enroll in 5 or more courses should contact us for a customized quote. We can also apply this discount if 2 therapists from a single clinic/hospital enroll in 3 or more courses (ie Registrant A enrolls in Course X and Course Y, Registrant B enrolls in Course X, and Registrants A and B both work at Clinic Z). This discount cannot be used in combination with any other discounts. Registration and payment must be received at the same time in one credit card payment, one check or one envelop with multiple checks. This type of registration cannot be completed online, if you are wishing to receive the Multi-Course discount please call or email us directly for assistance.
This discount is available for a group of three or more registrants, who all work at the same clinic/hospital, enroll in a single course, and pay in a single transaction or mail in multiple checks in a single envelope. This discount cannot be used in combination with any other discounts.
Groups of 3-5 receive a 10% discount off the combined price of their group's registrations.
Groups of 6 or more should call or Contact Us so that we can properly create an invoice for your registration.
This 10% discount is available to current students who have yet to earn a license to practice at the time of course registration. This discount is not available to those therapists who have previously held a license, and are currently enrolled in a doctoral, or other post-graduate, program. This discount cannot be used in combination with any other discounts.
To get this discount when checking out online, use the code 2020Student. (Note, this code is only valid for non-licensed students. The H&W admin team will verify that registrants signed up with this code are, indeed, current students prior to their attendance of the course).
First-Time Registrant Discount
This $50.00 discount is available to any therapist who has never before taken a Herman & Wallace course (no previous registrations) and can be used towards the registrant's first Herman & Wallace course (not applicable to Pelvic Floor Level 1/2A/2B or Capstone).
To apply this discount, please use the code FirstTimer2020 during check out. (H&W will check records to verify past attendance.)
Any therapist who has already taken a Herman & Wallace course will earn a $50.00 "referral credit" if:
1. A therapist who has never taken a Herman & Wallace course successfully registers for his or her first course(s); AND
2. In the registration process, the first-time registrant gives the name and clinic/hospital of the therapist who referred them to Herman & Wallace.
A therapist who has earned a $50.00 "referral credit" may use this credit toward any course that is eligible for a "referral discount".
Guest Blogger Credit/Discount
Any therapist who completes a qualifying guest blog post on the Herman & Wallace blog will earn a $50.00 "guest blogger credit". This credit may be applied toward any course eligible for a "guest blogger discount".