The PRPC Is Getting A Facelift!

In order to ensure that our certification exam, the PRPC, stays current and reflective of the knowledge and skills of the minimally competent pelvic rehab practitioner working in the field today, it is best practice to evaluate the test blueprint every 7-10 years. As PRPC nears its 10th birthday, we have been working for the last year with a team of Subject Matter Experts, made up of members of our Series Faculty, to go through the current exam and analyze the items (questions and answers) to ensure that they are still relevant.

Some of the updates have included changing terminology that has become dated and updating case studies to be less binary and more inclusive of patients across the gender spectrum. This includes doing a deep dive look at the items and deciding which ones to throw out, rework, or keep. The result of this process will be an exam that does not change significantly - items will still cover knowledge and skills for treating pelvic rehab patients throughout the life cycle - but that keeps up with the newest research in that field.

The Subject Matter Experts, which include our Senior Faculty (those who have been teaching for the Institute for over a decade) live and work all over the country, meaning our team members come from diverse backgrounds and regional patient populations (also important for an exam that will be administered worldwide).

By going through this process, we ensure that the PRPC remains a valid and legally defensible distinction of competence in the field.

Sarah Hughes PT, DPT, OCS, CF - L2 has been a practicing physical therapist since 2007 and opened her private practice Arrow Physical Therapy in 2016. She now owns and operates Arrow remotely while residing in the Chicago area and practicing at Outlier Physical Therapy. Her specialties include dance medicine, the CrossFit and weightlifting athlete, and conditions of the hip and pelvis such as femoroacetabular impingement and labral tears. Dr. Hughes earned a BS in exercise science from Gonzaga University and a DPT from the University of Washington, she wrote and instructs Weightlifting and Functional Fitness Athletes.

Modifying exercise, particularly CrossFit and weightlifting exercises, when pregnant is critical to reducing your risk for injury. It’s hard to do for sure. We all want to maintain our fitness and remain competitive. But, the priority during and after pregnancy is the safety and health of both baby and the birthing person.

Remember, just because you aren’t in pain or you are still capable of performing in the way you did pre-pregnancy, you may be doing yourself a disservice by setting yourself up for problems down the line, or at the very least some bad habits as you change your technique with various movements.

The message below is written by HW Senior Faculty Member Jennafer Vandevegte and Elizabeth Akincilar, the Co-Program Directors of the Pelvic Health Physical Therapy Program.
 

 
I am writing to introduce an exciting new initiative that will create scholarship opportunities for Kenyan physical therapists pursuing a degree specializing in pelvic health physical therapy.
 
The Jackson Clinics Foundation was formed in 2012 to fund educational efforts in East Africa. To date, the foundation has sent over 100 faculty members from their clinics and from around the country to teach in East and Central Africa. Some of the best and brightest physical therapists in the United States have volunteered their time to travel to Africa to teach these students and upgrade their education.
 
In 2019 the Pelvic Health Physical Therapy program in Kenya was launched by the Jackson Clinics Foundation and the Kenya Medical Training College with educational content and instructor support from the Herman and Wallace Pelvic Rehabilitation Institute and Pelvic Health and Rehabilitation Center. As you may be aware, pelvic health issues have become increasingly common in Kenya, with millions of people suffering from conditions like urinary incontinence, pelvic organ prolapse, and sexual dysfunction secondary to untreated medical conditions such as vaginal fistulas and the deleterious effects of female genital mutilation and prostate cancer. Unfortunately, there is a lack of trained professionals in this field to provide the necessary care and treatment to those affected. In fact, this program trained the first group of pelvic health physical therapists in all of East Africa.
 
Due to the enormous success of the initial Pelvic Health Physical Therapy program and the growing need for specialized physical therapists, The Jackson Clinics Foundation has created a two-year degree specializing in Pelvic Health. This program will become available to Kenyan physical therapists in 2024. This advanced degree will provide extensive training in assessing and treating various pelvic health conditions for adults and children. Additionally, graduates of this program will also learn how to teach their medical colleagues about pelvic health issues, bringing much-needed attention to the grossly untreated pelvic health conditions in East and Sub-Saharan Africa.

The tuition costs for this program are the primary obstacle preventing therapists from pursuing this advanced degree; therefore, we have established the Pelvic Health Physical Therapy Scholarship Fund. The fund will provide financial assistance to physical therapists in Kenya who are interested in pursuing their specialized training in Pelvic Health.
 
The scholarship fund seeks to raise $36,000 over the next year. We would be honored if you could contribute any amount towards this goal. Your tax-deductible contribution will go directly to the scholarship fund and will be used exclusively for pelvic health program scholarships.
 
Please visit our website to donate to this fund. Click on the dropdown menu to select Pelvic Heath. We appreciate any support you can offer us.
 
Thank you for considering this request. The infrastructure is in place, and the programs are ever-expanding and improving. These initiatives have one purpose: To improve human lives. We function under one premise, "Teach One - Treat Many." Together, we can create a healthier and more vibrant future for Kenyan communities.
 
 
Sincerely,
 
Elizabeth Akincilar                                                      Jennafer Vandevegte
Co-Program Director                                                  Co-Program Director

Faculty member Christine Stewart, PT, CMPT began her career specializing in orthopedics and manual therapy and became interested in women’s health after the birth of her second child. Christine joined Olathe Health in 2010 to further focus on women’s health and obtain her CMPT from the North American Institute of Manual Therapy. She also went through Diane Lee's integrated systems model in 2018. Her course, Menopause Transitions and Pelvic Rehab is designed for the clinician that wants to understand the multitude of changes that are experienced in the menopause transition and how they affect the aging process.

What was your motivation for creating this course?
As I was entering my mid-40s, I started to experience some physiological symptoms that were a bit unnerving.  My sleep was inconsistent.  My menstrual cycle which used to be every 35 days now was every 21 – and it changed. It lasted longer and was much heavier than before.  I also started to experience heart palpitations.  I sought out care from my primary care doctor, who ran labs and referred me to a cardiologist.  I was placed on a halter monitor and underwent a cardiac ultrasound.  The tests all came back..... normal.  But I didn’t feel normal.  What was happening with my body and why didn’t any of the health professionals that I consulted seem to have any answers?  That was where my journey began.  I started reading and researching.  What I soon learned was that these symptoms, while bothersome and a little unnerving, were common.  They often begin as the ovary is changing in its ability to produce hormones.  I learned there are ways to manage symptoms through lifestyle choices and treatments that can help in a stage of life that can last for over 20 years.  I then started to listen, really listen, to what my patients were telling me about their bodies.  I had answers for them about what they were experiencing and could offer some solutions and referrals to the appropriate healthcare providers.  While they were all very grateful, I kept hearing the same frustrations. Why don’t more healthcare providers know about perimenopause and menopause?  Why am I being told that I must live with my symptoms?  Why aren’t more providers well-versed in treatment options?  That was my “aha” moment.  If more healthcare providers knew about these changes and the symptoms that manifest as a result, hundreds if not thousands of patients could get the care that they need.  I wrote Menopausal Transitions and Pelvic Rehab in an effort to bridge the gap in knowledge that currently exists for many of the health care providers treating this patient population.  It is a culmination of hours of research into hormones, physiology, health impacts, and treatment options during this time.

Tara Sullivan, PT, DPT, PRPC, WCS, IF has specialized exclusively in pelvic floor dysfunction treating bowel, bladder, sexual dysfunctions, and pelvic pain since 2012. Alyson N. Lowrey, PT, DPT, OCS became involved with pelvic rehabilitation through working in a clinic with Tara and is a board-certified orthopedic specialist and primarily works with the ortho patient population. Tara brought along the pelvic floor population to the clinic where she and Alyson joined forces. Alyson, with her ortho perspective, is better able to recognize that in some of her orthopedic patients, a lot of their pain was coming from the pelvic floor. The pelvic pain patient population crosses over from physical therapy to the orthopedic and occupational therapy worlds. By treating their patients wholistically Tara and Alyson have been able to make a huge difference to both of their practices.

How do you explain pain to a patient?

Allison Ariail, PT, DPT, CLT-LAANA, BCB-PMD is one of the creators of the Herman & Wallace Oncology of the Pelvic Floor Course Series. Allison Ariail is a physical therapist who started working in oncology in 2007 when she became certified as a lymphatic therapist. She worked with breast cancer, lymphedema patients, head and neck cancer patients, and the overall oncology team to work with the whole patient to help them get better. When writing these courses, Allison was part of a knowledgeable team that included Amy Sides and Nicole Dugan among others.

June is National Cancer Survivor Month. When individuals talk about “survivorship,” they are referring to the process of navigating their life experiences and the difficulties that they have as a result of their cancer diagnosis. Survivorship begins at the time of diagnosis and includes those individuals that are undergoing treatment, those after treatment with no signs of cancer, those undergoing extended treatment to control the cancer, those undergoing extended treatment to reduce the risk of the return of cancer, and those individuals with advanced cancer. According to cancer.net, there were 18 million people in the United States living with a history of cancer.¹ Considering the number of people surviving cancer, and the degree of medical treatment can vary for each of them, there will be a wide range of needs from cancer survivors.  Rehabilitation professionals are in a unique position where we can help patients in many different ways to help improve their function, ability to participate in activities that they enjoy and improve their quality of life. 

There are multiple studies that show how rehabilitation can help cancer survivors. The research varies in its focus; it could be examining specific side effects such as chemotherapy-induced peripheral neuropathy, looking at the effects of fatigue after treatment, or to sexual health after cancer diagnoses. In January of this year, a study came out that showed a physical rehabilitation program of moderate intensity promoted a relief of general and physical fatigue.² This is huge for cancer patients! Fatigue is an immense problem that survivors suffer from. Another study from 2019 showed that a 12-week exercise-based training program can negate some of the deficits that occur in strength and physical function that occur from the medical treatment of cancer.³ The exercise program, which included both aerobic and resistance training, helped both middle-aged and older adults improve their physical function and strength. In 2018 Dennet et al performed a qualitative study of cancer survivors’ experiences of an exercise-based rehabilitation program. They determined that an exercise-based cancer rehabilitation program was important in facilitating a ‘return to normal’ and helped patients increase their ability to participate in physical activities.⁴ 

Herman & Wallace is celebrating Memorial Day Weekend! 

Herman & Wallace is offering *for a limited time only* a $50 coupon code for online registration of any specialty course! The special code to use during checkout is 𝗛𝗢𝗡𝗢𝗥. 

What are the top 3 takeaways a practitioner could hope to gain from this class?

NC - 1. Better self-care in and out of the clinic. 2. A more effective and less taxing way to interact with clients, share responsibility, and communicate in more helpful ways for both practitioner and patient. 3. enjoying their life and having more energy for their life outside of work.

Herman & Wallace faculty member Dr. Heather Rader has created an all-inclusive pelvic rehabilitation course for physical and occupational therapists who treat patients in the home health setting Home Health and Pelvic Rehab - External Skills for the Home Environment.

61% of females and 38% of males over the age of 65 have some form of urinary and fecal incontinence, and nearly half of the patients receiving home health care have incontinence¹. Despite these statistics, bladder and bowel symptoms are relegated to being part of the medical history rather than treatable impairments.

Home health therapists are required to ask about the presence of urinary and fecal incontinence as part of the admittance form, known as the OASIS. That’s typically where the conversation ends. This course will teach therapists how to quickly screen for the type of urinary incontinence, constipation, and pelvic pain conditions with simple and unintimidating interview skills. This can open the door to meaningful treatment interventions.

Darla Cathcart, PT, DPT, WCS, CLT  graduated from Louisiana State University (Shreveport, LA) with her physical therapy degree, performed residency training in Women’s Health PT at Duke University, and received her Ph.D. from the University of Arkansas Medical Sciences. Her dissertation research focus was on using non-invasive brain stimulation to augment behavioral interventions for women with lifelong vaginismus, and her ongoing line of research will continue to center around pain with intercourse. Darla is part of Herman & Wallace's core faculty and instructs Pelvic Floor Level 1, Level 2A, and Level 2B, the Pregnancy & Postpartum Series, and recently launched her own course Vaginismus and Vulvovaginal Dyspareunia.

How is this class different from the information in Pelvic Floor 2B?
The main difference is in the questions that these two courses answer: "what treatments can I use" versus "how can I use those treatments effectively?" In Pelvic Floor Level 2B, participants are told about various methods for addressing pain with intercourse (such as using vaginal trainers/dilators and manual therapy techniques), with brief descriptions of how to use some of these tools. In this Vaginismus and Vulvovaginal Dyspareunia course, we go into depth on how to use these treatments specifically based on a patient's examination findings and goals.

What are the top 5 takeaways a practitioner could hope to gain from this class?
1. Vaginal Trainers (dilators) can be more effective when going beyond "just sticking them in."Traditionally, patients have been taught to just insert "dilators" to a point of stretching and discomfort, and to hold that stretch, maybe even distract themselves from the activity by watching TV or reading a book. As with other areas of the body, using active methods to increase tissue flexibility, such as incorporating contract-relax and breathing techniques, can really enhance the treatment! During the labs in this 100% remote course (a combination of self-paced preview videos and live online instruction), participants will be guided through step-by-step instructions for using and progressing through vaginal trainers and other treatments (the same step-by-step instructions you can use with your patients on Monday morning!). Additionally, as in other areas of the body, focusing on the body part that is being worked on is beneficial for increasing motor control, which is also desirable for addressing pelvic floor muscles that have too much tone and tenderness or pain with attempts at insertion. Participants will also be walked through activities that increase the brain's connection with and control of the pelvic floor and genitals, thus tapping into contemporary pain science concepts as well. And speaking of pain science . . .