PEDIATRIC INCONTINENCE AND PELVIC FLOOR DYSFUNCTION
Dawn Sandalcidi PT RCMT BCD-PMD
Sept 30-Oct 1, 2017
Embody Physiotherapy & Wellness, Sewickley PA
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), by 5 years of age, over 90% of children have daytime bladder control. What is life like for the other 10% who experience urinary leakage during the day? Bedwetting is another pediatric issue with significant negative quality of life impact for children and their caregivers, with as much as 30% of 4 year-olds experiencing urinary leakage at night. Children who experience anxiety-causing events may have a higher risk of developing urinary incontinence, and in turn, having incontinence causes significant stress and anxiety for children. (Thibodeau et al., 2013) Having bowel dysfunction such as constipation is also a contributor to urinary leakage or urgency, and with nearly 5% of pediatric office visits occurring for constipation, the need to address these issues is great. (Constipation in Children, 2013) As pediatric bladder and bowel dysfunction can persist into adulthood, pelvic rehabilitation providers must direct attention to the pediatric population to improve the health in our patient populations.
The pediatric population is greatly underserved causing undo stress for the child and family as well as development of internalizing and externalizing psychological behaviors. The two most common pelvic floor dysfunctions in the pediatric population are dysfunctional elimination syndrome and bedwetting. This specialty continuing education course focuses on the treatment of children with day or nighttime incontinence, fecal incontinence, and/or dysfunctional voiding habits.
This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. The participant will learn terminology from the International Children's Continence Society, medical evaluation concepts for bowel and bladder dysfunction, and common dysfunctions in voiding and defecation. Common causes of incontinence in the pediatric patient will be covered, and a comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor and surface electromyography (or SEMG, a form of biofeedback) as well as a breathing and bowel massage lab. In order to keep this a 2 day course, there will be an online lecture made available to participants to complete prior to the course.
Cost: $535.00 prior to August 31, 2017
$575.00 after August 31, 2017
or using paper form attached below.
PA PT CEU : 14 hrs pending
Embody PT will provide light snacks, coffee, tea, and water both days. Saturday, lunch on your own (the village of Sewickley has several casual spots to eat within several blocks of Embody). Embody PT will provide lunch on Sunday.
A listing of hotels attached below.
This is an ENTRY level specialty course. There are no prerequisite courses. In an effort to provide you with more video demonstration and lab we are asking that you watch the online lectures and complete the required pre-readings/assignments prior to the class. This includes the online PowerPoint voiceover lectures and bladder diary PRIOR TO COMING TO THE COURSE. This will not be instructed in class and the class will not make sense to you if you have not prepared.
For more information on pelvic floor anatomy you may look into the following resources if you wish;
Functional Applications Part A and Part B covers an introduction to pelvic anatomy, using biofeedback and performing external exams. http://hermanwallace.com/online-continuing-education-courses
The following sources listed below are free.
An in depth video of the PFM anatomy
Pre-course learning (online lectures with voiceover commentary) See Prerequisite notes above.
- Anatomy of the pelvic floor in the young child as compared to the adult
- Development of urinary control from infancy
- Standardization of Terminology of Bladder Function in Children and Adolescents - defines symptoms of increased or decreased frequency, incontinence, urgency and nocturia as it relates to bladder storage and hesitancy, straining, weak stream and intermittency as it relates to voiding symptoms. Includes other symptoms of holding maneuvers, incomplete emptying, post void dribble, and genital pain
- Conditions and diagnoses- Includes bedwetting and daytime conditions of overactive bladder (OAB), urge incontinence, voiding postponement, underactive bladder, dysfunctional voiding, obstruction, stress incontinence, giggle incontinence, vaginal reflux, bowel bladder dysfunction and increased frequency.
- Investigative tools - All invasive investigative tools will be in the voiceover lectures including urodynamic testing procedures, voiding cystourethrogram (VCUG) as well as non-invasive testing to include kidneys, ureters and bladder scan (KUB) – a plain film to look for constipation, ultrasound imaging for bladder wall thickness and post-void residuals (PVRs) and uroflowmetry.
- Neurogenic bladder - causes and bladderr sphincter function based on urodynamic findings
- Surface EMG – biofeedback basics
- Vesicoureteral reflux (VUR): definition, medical-surgical management
8:15 Analysis of bladder diaries
8:45 Physiology of defaecation with practical session - belly breathing with toileting *
9:15 Constipation and encopresis: definitions, treatment, medications part 1
10:15 Constipation and encopresis: definitions, treatment, medications part 2
1:00 Practical session – ILU (I Love U) and connective tissue massage, Valve releases *
12:00 Lunch (on your own Saturday. Enjoy exploring the Village of Sewickley)
1:00 Enuresis (bedwetting): definition, aetiology, medico-behavioural management
2:00 Dysfunctional voiding
3:45 Practical session - SEMG to include proper electrode placement, evaluation and treatment progressions *
5:00 End of day 1
8:00 Common medications
8:15 Psychological considerations
8:30 Medical evaluation
8:45 Video of patient initial evaluation
9:45 Physiotherapy evaluation- subjective and objective
10:45 Physiotherapy assessment and treatment with video treatment sessions*
12:00 Lunch – watch video of initial evaluation (Embody PT will provide lunch this day)
1:30 Double voiding: treatment goals and progressions
2:00 Start up - items to have in the clinic, website, apps and referral sources
2:45 Case studies:
3:45 Questions and answers
4:00 End of course
Indicates Lab sessions
Seminar content is targeted to physical and occupational therapists, physicians and nurses. Content is not intended for use outside the scope of the learner's license or regulation. Clinical continuing education should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.
Dawn Sandalcidi PT, RCMT, BCB-PMD (Board Certified Biofeedback-Pelvic Muscle Dysfunction) specializes in: pelvic muscle dysfunction (incontinence and pain), orthopedic manual therapy, and TMJ treatment. She is the leading expert in the field of pediatric incontinence in physical therapy. She has trained medical professionals in manual therapy since 1992 both nationally and internationally.
Dawn has actively been treating patients for the past 32 years and owns a private practice in Denver, Colorado, develops educational materials for health care providers through Progressive Therapeutics and provides consulting services through Physical Therapy Specialists. She is an affiliate faculty member at Regis University Department of Physical Therapy in Denver, CO where she teaches pelvic muscle dysfunction/ women’s health physical therapy, as well TMJ.
Dawn received her degree in physical therapy in 1982 from SUNY Upstate Medical Center in Syracuse, New York. She participated in extensive international postgraduate studies in manual and manipulative therapy of the spine and extremities in Germany, Switzerland and New Zealand. In 1992, Dawn completed an additional two-year residency to become a certified instructor of the Mariano Rocabado techniques for the spine, pelvis and craniomandibular joints (RCMT). Dawn also received her BCB-PMD Board Certified Biofeedback in Pelvic Muscle Dysfunction.
In 1992, 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 internationally. She has further studied pediatric conditions in post graduate work at Regis University.
Dawn has also lectured on pelvic pain for CPD Health Courses for osteopaths, manual therapists and acupuncturists in Melbourne, Australia.
Dawn has been published in the Journal of Urologic Nursing, the Journal of Manual and Manipulative Therapy, Journal of the Section of Women’s Health and the Journal of International Association of Orofacial Myology.