CE credits are given through California’s Board of Behavioral
Sciences.
Objectives: Provide a basic understanding of pelvic
floor functions and structures along with clinical etiologies of
pelvic floor disorders treated by behavioral interventions.
Provide sufficient information on research supporting behavioral
interventions, and clinical protocols for behavioral interventions
to bring health care providers to the point where they have the
knowledge base needed to provide these interventions to their
clients within their scopes of practice and expertise after the
providers gain hands-on experience by working with experienced
practitioners. You may wish to contact the Foundation for
information about hands-on training.
Format: Interactive distance based home study supported
by e-mail chats after each unit is completed. The CD based lecture
portion of the course is presented through a series of audiovisual
lectures profusely illustrated by power-point slides. You start
the course whenever you wish and work at your own pace. You will
receive CDs containing both the audiovisual lectures and a copy of
the slide sets upon which the lectures are based so you can make
notes on your copy of the slides as you attend the lecture. After
watching each lecture and reading the corresponding material in
the assigned texts, protocols, and articles, you will answer a
brief series of essay questions. The answered questions are then
e-mailed to the instructor. You and the instructor will discuss
each unit via e-mail chat after your answers are assessed. Ample
opportunity for personalized discussion of questions, plans, etc.
is available.
Required Reading:
a. Schwartz M and Andraskik F: Biofeedback a Practitioner’s
Guide. All of section VIII (elimination disorders), Guilford
Press, New York, 2003. ISBN 1-57230-845-1 b. Laycock J and Haslam
J: Therapeutic Management of Incontinence and Pelvic Pain.
Springer, New York, 2002. ISBN 1852332247 (soft cover). c.
Compendium of articles and protocols provided on the course CD.
Optional:
a. Dorey G: Conservative treatment of male urinary incontinence
and erectile dysfunction. Whurr Publishers, Phhiladelphia &
London, 2001. ISBN 1-86156-302-7. (Note: If you work with males,
it is very worth your while to get this small book!) b. Newman D:
Managing and treating urinary incontinence. Health Professions
Press, Maryland, 2002. ISBN 1-878812-82-3 (Very good book but you
can get similar material from the two required texts.) c. Brubaker
L and Saclarides T: The female pelvic floor. F.A. Davis,
Philadelphia, 1996. ISBN 0-8036-0075-5 (Excellent book but you can
get similar material from the two required texts.)
Topic Overview:
(A detailed list of subtopics with reading assignments is at
the end of this outline.) 1. Overview of behavioral assessment and
intervention for pelvic floor disorders including a brief
discussion of credibility. 2. Anatomy and Physiology of the Pelvic
Floor 3. Principles of applied psychophysiology biofeedback as
applied to the pelvic floor 4. Know what is normal before you try
to fix it 5. Assessments and interventions for urinary
incontinence 6. Assessments and interventions for bowel
dysfunctions 7. Principles of pain assessment and intervention
from a psychophysiological perspective 8. Assessments and
interventions for pelvic pain syndromes 9. Assessments and
interventions for erectile dysfunction 10. Ethical considerations
in performing behavioral assessments and interventions for pelvic
floor disorders
Getting started:
Purchase the text books on your own (usually on-line book
sellers are far less expensive) and purchase the course. You can
begin at your convenience and progress through the course at your
own pace.
Schedule: Begin the course any time you want to and proceed at
your own pace.
Payment: The course costs $550 (exclusive of the texts).
Course Credit:
CE Credit: This is a continuing education, not an accredited
course. CE credits are given through the state of California’s
Board of Behavioral Sciences (Approval # PCE1895).
Certificate of Training: The Foundation will issue a
certificate of training in behavioral treatments of pelvic floor
disorders at the completion of this course only after the
participant provides evidence of at least ten hours of hands-on
training using a biofeedback device for treatment of urinary
incontinence.
BCIA credit: This course meets or exceeds BCIA’s (Biofeedback
Certification Institute of America) requirements for the didactic
portion of their “pelvic muscle dysfunction biofeedback”
certification.
Refund and cancellation policies: Full refund until the CDs are
mailed to you. After the CDs are mailed, there is no refund at all
as the Foundation has committed its resources to you. A course
would only be cancelled due to an extreme emergency on the part of
the course instructor or the Foundation. In the highly unlikely
event a course is cancelled, you would receive a full refund.
Faculty: The course is taught by Richard A. Sherman, Ph.D. Dr.
Sherman has been performing behavioral interventions including
biofeedback for pelvic floor disorders including fecal and urinary
incontinence for over 25 years and has trained dozens of
clinicians (including nurses, physical and occupational
therapists, and psychologists). He is a professional
psychophysiologist with extensive training (his PhD is in biology
/ physiology) and has nearly 30 years of experience in the field.
He has clinical and research publications in urinary incontinence
in addition to over 130 other books and publications. His CV is on
the course CD and is also available upon request.
Practicum and mentored biofeedback training: This course covers
only the didactic portion of the material required to be competent
in performing behavioral interventions for pelvic floor disorders.
It is crucial that everybody intending to perform behavioral
interventions for pelvic floor dysfunctions (1) hands on training
in use of the biofeedback devices, (2) observe patients being
treated for those dysfunctions of interest, and (3) receive
mentoring while performing initial interventions. For BCIA
(Biofeedback Certification Institute of America) certification in
“pelvic muscle dysfunction biofeedback” in addition to a course in
anatomy and physiology, 4 hours of practicum training in use of
biofeedback equipment and observation of patient treatment are
required along with 48 hours of mentored biofeedback. The
mentoring consists of 30 hours of clinical training in EMG and
behavioral interventions, 12 hours of direct clinical supervision,
and 6 hours of case conference.
You may want to contact us for information about getting this
crucial training and mentoring.
Limits to the depth of information provided by this course:
Anatomy and Physiology Course: Anyone intending to perform
behavioral treatments of pelvic floor dysfunctions needs to know
the basic elements of human anatomy and physiology (A&P). For
example, the effects of stress, hormones, bone remodeling, bone
disorders, etc on the dysfunctions to be treated can’t be covered
in sufficient depth in this course. BCIA requires an undergraduate
A&P course for certification. We offer a BCIA approved,
distance based A&P course which emphasizes the material you
need to know to enhance you competence in providing behavioral
interventions.
General Biofeedback Course: This is not a course in general
biofeedback. Thus, although you will learn all you need to about
the correct application of muscle tension and pneumatic
biofeedback to the pelvic floor. But you will not learn (a) how to
perform other types of biofeedback such as temperature and breath
control training which may be needed if the person is
vasoconstricting so much or breathing so incorrectly they can’t
attend to what you are trying to do due to anxiety, etc. or (2)
associated behavioral techniques such as relaxation training which
may be needed to reduce levels of anxiety so high the patient
can’t learn the skills you are trying to teach or may be so tense
all over they may not be able to control the pelvic floor. Thus,
if you haven’t had a general biofeedback course, you may want to
take one.
Pain Course: This is not a general course on pain assessment
and intervention from a psychophysiological perspective. This
course provides an overview of psychophysiological pain assessment
and intervention sufficient for you to do a competent job
assessing and providing interventions for simple pelvic floor
related pain problems but it doesn’t have the depth to give you an
overall picture of how pain in other parts of the body relates to
the pelvic floor, etc. This means you won’t know enough at the end
of this course to competently assess pain problems referring to or
influencing the pelvic floor. Nor will you know the overall
elements of pain assessment and intervention. If you are going to
work with pain in the pelvic floor, you should consider taking a
course in pain psychophysiology.
Detailed Contents of each topic with associated audiovisual
talks and readings
1. Overview of behavioral assessment and intervention for
pelvic floor disorders
Elimination disorders treated with biofeedback assisted
behavioral therapy, history of biofeedback and behavioral
modalities used for pelvic floor disorders, assessing credibility
of behavioral interventions for pelvic floor disorders, etc.
Audiovisual Lectures 1.1 and 1.2 – Introduction Audiovisual
Lecture 1.3 – Assessing Credibility (Note that people who have
taken the Behavioral Medicine R&T Foundation or UNM’s courses
in either pain assessment or general biofeedback are exempt from
lecture 1.3) Laycock & Haslam 1 Optional Newman 1 and 2 PFD
biofeedback chapter file on CD
2. Anatomy and Physiology of the Pelvic Floor
Audiovisual Lectures 2.1 and 2.2
a. Anatomy and physiology of pelvic floor structures (pelvic
floor muscle, bones, diaphragms, sphincters, smooth vs. striated
muscle)
Laycock & Haslam 2, 5, 28 - 30
A&P of the male lower urinary tract
Optional Newman 2 and 3
Optional Dorey ch 2
Anatomy of the penis / physiology of erections
b. Urological A&P (urine storage and maturation, bladder
anatomy, normal bladder storage and emptying, somatic and
autonomic enervation)
types of urinary incontinence, dyssynergia
Laycock & Haslam 3
differences between male and female urinary incontinence
Optional Dorey Chapter 5
c. Prostate conditions - Optional Dorey ch 4
d A&P of digestive structures and processes, stool
continence, defecation, somatic and autonomic enervation.
Laycock & Haslam 20 - 22 Optional Newman 5
3. Principles of applied psychophysiology biofeedback as
applied to the pelvic floor
Audiovisual Lectures 3.1 – 3.6 (Note: Anyone who took the pain
or general biofeedback course given by either the Behavioral
Medicine R&T Foundation of the UNM is exempt from this
section.)
PFD muscle tension exercise file on CD
a. Introduction to biofeedback (definitions, history, overview
of modalities, concepts of feedback and control in biological
systems, principles of human learning as applied to biofeedback)
b. Surface EMG Instrumentation (terms and concepts, sources of
artifact, sensor placement including skin preparation, distance
between sensors and typical sites, EMG factors affecting
assessment and interpretation such as fat, posture, etc., signal
processing and feedback displays) c. Biofeedback and distress
(stress and the biopsychosocial model of illness, stressful life
events and the risk of illness, psychophysiological reactions to
stressful events) d. Neuromuscular relaxation training (techniques
assisted by EMG biofeedback such as autogenic training, hypnosis,
meditation, etc., integrating relaxation into daily life, overview
of other psychophysiological modalities used for neuromuscular
relaxation such as heart rate variability, thermal biofeedback,
EEG, GSR, etc.)
4. Know what is normal before you try to fix it Lack of
understanding normal levels and patterns of muscle function,
patters and rates of urination, defecation, lubrication, erection
etc. has led many people to think they are abnormal and many
therapists to try changing a normal system resulting in abnormal
functioning and pain.
Audiovisual Lecture 4
5. Assessments and interventions for urinary incontinence
Audiovisual Lectures 5.1 and 5.2
Protocols and patient handouts on CD
a. Overview of physiological basis for and testing for urinary
disorders (varieties of bladder disorders such as stress and urge
incontinence dyssynergia, etc., overview of medical diagnostic
procedures, urodynamics) Schwartz & Andrasik 26 Laycock &
Haslam 4, 6, and 16 Optional Newman 6 b. Physical assessments
c. Urodynamics
d. Surface EMG pelvic floor muscle assessment (vaginal and
rectal surface EMG placements, infection control, protocols for
evaluation, baselines, phasic and tonic muscle testing, endurance,
dyssynergia testing, data interpretation) e. Exercise and Surface
EMG based pelvic floor training
f. Treatment options not involving biofeedback Laycock &
Haslam 8 , 9, 11 – 15, 17 - 19 Optional Newman 7, 8, 9, and 10
Optional Dorey chapter 8 Exercises, Cones / weights, Electrical
stimulation, Lifestyle changes, Bladder training for urge
incontinence, Medications for urge incontinence, Pads, Appliances,
Penile clamps, Prosthetic devices, inserts, Plugs, Surgery, Fluid
Control, Skin care for incontinence dermatitis, Intermittent
self-catheterization, and Artificial urinary sphincter (d 83/4)
g. EMG instrumentation options (sensors, SEMG instruments, home
training devices) Laycock & Haslam 10
h. Preparation for clinical practice (patient education in
biofeedback and relevant A&P, patient intake, communication
with other health care providers)
i. Medical and behavioral treatment modalities – urologic
(neuromuscular reeducation and exercise assisted by vaginal/rectal
SEMG and other SEMG placements for bladder disorders – uptraining,
downtraining, coordination training), other behavioral techniques
including urge suppression techniques, bladder retraining,
electrical stimulation, etc., non-behavioral techniques including
drugs, surgery, electrical, physical interventions, etc.)
6. Assessments and interventions for bowel dysfunctions
Audiovisual Lectures 6.1 and 6.2
Schwartz & Andrasik 27 & 29
Laycock & Haslam 20 - 22
a. Physiological basis for and testing for GI disorders (GI
disorders including fecal incontinence, constipation, dyssynergia,
irritable bowel syndrome, and colonic inertia, medical diagnostic
procedures including manometric and defocograraphic evaluation and
transit time studies) b. GI Medical and behavioral treatment
modalities (neuromuscular reeducation and therapeutic exercise
assisted by vaginal/rectal surface EMG and other EMG placements
for bowel disorders including uptraining, downtraining,
coordination training, and bowel sensory awareness training, other
behavioral methods specific to bowel disorders, non-behavioral
interventions including surgery medications, physical
interventions)
7. Principles of pain assessment and intervention from a
psychophysiological perspective
Audiovisual Lecture 7.1 – 7.7
(Note: Anyone who took the pain course given by either the
Behavioral Medicine R&T Foundation of the UNM is exempt from
this section.)
Physiological basis of pelvic pain disorders
(psychophysiological basis of pain, basic pain mechanisms related
to pelvic pain, pain – stress – muscle tension relationships,
trauma)
8. Assessments and interventions for pelvic pain syndromes
Audiovisual Lecture 8.1, 8.2, & 8.3
Schwartz & Andrasik 28
Laycock & Haslam 23 - 2
a. Physiological basis of pain syndromes related to pelvic
floor dysfunction (chromic pelvic pain syndromes including
vluvodinia, proctalgia fugax, levator ani; co-morbidities
including irritable bowel syndrome, fibromyalgia, interstitial
cystitis) b. Pelvic pain syndromes unique (mostly) to males:
(prostatitis, orchialgia, penile pain, prostatodynia, perineal
pain, testicular cancer related pain, proctalgia fugax)
Optional Dorey ch 6
c. Medical and behavioral treatment modalities for pelvic area
pain (neuromuscular reeducation, posture, dietary counseling,
drugs, surgery, physical interventions, sexual history taking and
counseling)
9. Assessments and interventions for erectile dysfunction
Audiovisual Lecture 9
a. Overview of erectile dysfunction b. Assessment c. treatment
(1) alternative (electrical stimulation, herbs, acupuncture) (2)
drug based (antianxiety, vasodilators) (3) surgical (repair or
replace) (4) behavioral (education, counseling, fantasizing,
exercises, biofeedback, life style)
10. Ethical considerations in performing behavioral assessments
and interventions for pelvic floor disorders
Overview of ethical principles of biofeedback as well as
practice limitations and referral guidelines.
Audiovisual lectures 10.1 and 10.2
Read file on CD entitled “PFD BCIA ethics document”
