This week The Pelvic Rehab Report sat down with some of our favorite Occupational Therapists to discuss the role of OTs in the field of pelvic rehabilitation. The following blog is provided by Tiffany Ellsworth Lee MA, OTR, BCB-PMD, PRPC, Lindsey Vestal, MS, OT, and Laura Rowan OT/L.
Most people associate pelvic health with PTs- so many are surprised to see OTs in this specialty. Herman and Wallace faculty and instructor Tiffany Ellsworth Lee MA, OTR, BCB-PMD, PRPC, LPF-CT has been an OT for 28 years and has spent the last 20 years specializing in pelvic health. She recalls, “My first Herman and Wallace course was PF1 11 years ago. I was the only OT in a class of 50. I was so appreciative of H&W’s foresight to include OTs in the course offerings. A PT sat down next to me and said, “Why are you here? I didn’t know OTs could treat pelvic health!” Yes, we can! It is within our scope of practice and the majority of therapist specialized learning comes post-graduation.
Lindsey Vestal, OTR/L has been an OT for 11 years and her private practice focuses on pre and postnatal people. She is a moderator of the Facebook group “OTs for Pelvic Health” with over 3,100 members. She is bringing awareness to the PH specialty by educating OTs on the best way to treat and collaborate with PTs and other providers in the field. She says, “ Just as OTs and PTs work side-by-side in other fields of rehab, there's a huge need for us to work collaborating in pelvic health. In grad school, OTs study motivational interviewing, nonverbal communication, we have mental health classes and a strong background in sensory approaches, energy conservation, self-regulation strategies, the involvement of the nervous system, time management, working with trauma, habits, routines, ADLs, the musculoskeletal system, functional movement, and activity grading. Pelvic floor function is a crucial part of a much broader functional task of toileting and intimacy, both of which have broader connections within a person’s emotional, cognitive, and social abilities. It's also important to consider the social implications for people with pelvic floor issues such as withdrawal from social and recreational activities, social isolation, disempowerment, lack of self-esteem, anxiety, depression, and the impact on close relationships such as with our spouse, our friends, and our children. This OT-specific background has given me a great foundation to serve my PF population.”
Another seasoned PHOT is Laura Rowan, OT/L who has been an OT for 21 years and the last 14 years has dedicated her practice to pelvic health. She works with all gender diversities across the lifespan with a focus on complex pain patients and athletes. Laura provides manual therapy courses and mentorship for OTs starting in this specialty. She says, “OTs are great at analyzing how the client is executing functional tasks and offering new strategies, adaptations, and compensation techniques for a less provoking and safer way to accomplish the task at hand. OT’s will often see progress using a whole person approach where a client may have plateaued with a less holistic treatment plan”
Laura shares about her start in the PH journey - “My success did not come without challenges. The vast majority of PTs did not share the same acceptance of OTs as Herman and Wallace. Due to a lack of understanding that continues to exist today, OTs struggle to begin their career in pelvic health. It took me 8 years after PF1 to officially break into the field. I felt like a lone OT in a PT world due to the lack of OT presence and support. I didn’t understand the roadblocks I was facing as pelvic health seemed a natural fit for OTs. OT practitioners have long been lending our expertise in the areas of functional restoration, psychosocial considerations, behavioral modifications, time management, stress management, coping strategies, and task analysis. These are major components of a comprehensive plan of care for individuals with pelvic health dysfunction in relation to their Activities of Daily Living (ADL’s) and Instrumental Activities of Daily Living (IADL’s). I am thankful for the many PTs that mentored me along the way. I was hired by a PT clinic with mentorship and continuing education opportunities. This provided strong foundations for me to later branch out and start a successful private practice. I have further developed into an educator and mentor role to provide the emerging OT practitioners the support I received starting out but through the unique lens of an OT.”
Tiffany adds, “OTs and PTs working collaboratively is a winning combination. We can share patients and focus on treating the whole person. For example, a patient with constipation, dyspareunia, SI dysfunction, and urinary incontinence can work with both OT and PT. I may address their constipation and UI using behavioral therapy, biofeedback, and lifestyle modifications while my PT co-worker addresses the spine, hip, and back dysfunction. If you work in an outpatient setting, you are able to bill separately and treat the same patient. We are taking the same courses side-by-side and learning the same skills. Our backgrounds are diverse and we can serve our patients with a multidisciplinary approach. Instead of being divisive and noninclusive, we should be supporting each other and collaborating. There is plenty of business to go around and PH therapists are some of the most compassionate and empathetic people I have ever met!”
Laura agrees and says, “Pelvic Health is too large of a specialty to be a generalist and have all the answers. It’s always beneficial to have a second set of eyes and even better to have a diverse background for a comprehensive whole-person approach to client-centered care. It’s not about the therapist and their discipline, rather taking a multisystem approach to meet the needs of our clients and how we can better serve them with an interdisciplinary team. We often run out of time to address all of the underlying impairments contributing to the client’s symptoms. OTs and PTs working together allow for all of the contributing factors to be addressed with the appropriate amount of attention required for successful outcomes.”
Lindsey chimes in, “It can take a village to care for pelvic health clients, so why not lean on our colleagues for their areas of strength? I mean isn’t that why we are rehab professionals? To ultimately serve our clients the best way possible? Pelvic health is a very underserved population and in my opinion, there's space for us all.”
Tiffany, Lindsey, and Laura have thriving private practices serving the PH population and each has PH continuing education companies that offer courses and mentoring. They are passionate about spreading awareness of the OT's role in pelvic health and the many benefits of working alongside PTs to meet the needs of this underserved population. By bridging the gap in understanding the valuable role of the PHOT, we can start to decrease extensive waitlists, and open up jobs to qualified passionate OT’s eager to begin their pelvic health careers. You can reach them through email -
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