Thursday, February 12, 2015

Pelvic PT Distance Journal Club CSM Review

Journal club recording

Also check out the outlines provided by speakers in this blog
Untamed memories
Talli Rosenbaum pre con
Mindful dilator exercises

Next call March 4, 2015

Urotrauma: A Pelvic Floor Therapy Approach to Military Trauma

Mary McVearry, PT, DPT, WCS
Carina Siracusa Majzun, PT, DPT
Combined Sections Meeting, February 5, 2015
  • Historically, Genitourinary (GU) injury was a minor battlefield trauma
  • Aggressive use of Improvised Explosive Devices (IEDs) has resulted in frequent combination of:
o   Lower extremity amputation
o   Pelvic injury/fracture
o   Abdominal injury
o   Urogenital injury
o   Termed “dismounted complex battle injury” by a US Army task force
o   This is a new injury of the past 5-10 years; soldiers did not survive previously

Mindful Dilator Exercises - CSM 2015

This protocol is to help you to understand that your boundaries are being respected so that you don’t feel pressure about using dilators.  If you can make using the dilators a more pleasant experience, that helps.  Try to avoid the experience of using the dilators becoming an unpleasant chore.  Try instead to make this a “me time”, a time to pamper yourself.  Consider making it a seductive experience at home, with candles, using some fantasy and possibly using it as a time for arousal and self-stimulation.  Consider using the dilator for clitoral stimulation.  It’s good to remember that they are being used so that you can eventually enjoy intercourse.  So give yourself permission to experiment this way with them, if you’d like.
Remember to stay present and mindful of all your feelings when you do this exercise.  Be aware of and accept anxious feelings.  Do not judge the pain, (just be mindful and aware of it, rather than saying to oneself things such as:  “this is bad” or “I must be a bad case, to feel this way”).  Just say something like: “feeling discomfort and I’ll be gentle with myself and wait for my vagina to open more and allow the dilator in further”.

Quick summary of Talli Rosenbaum’s richly informative pre-con called “Beyond the Physical, an integrated Psychosocial Model for addressing Sexual Issues in pelvic physical therapy practice. Summarized by Elizabeth Lewis, PT, OCS, WCS.

Talli R is an ASSECT trained sex, individual and couple’s therapist, who got interested in the area while working as a pelvic floor PT.

I tried to pull a few pearls:
1.      We work under something called the biopsychosocial model of treating sexual pain, which compartmentalizes different aspects of the problem to different specialties: we PTs and MDs work on the physical aspects and leave the sexual dysfunction aspect to the sex therapists.  This is a problem, because we PT’s are more likely than the sex therapist to witness the anxiety in real time.  PFM hyperactivity isn’t simply an isolated dysfunction, but a physical manifestation of the patient’s emotional state.

Untamed memories - the role of past trauma in the development of chronic pain

Derrick Sueki  PT, DPT, PhD(c), GCPT, OCS, FAAOMPT
Kim Dunleavy  PT, PhD, OCS
 Emilio “Louie” Puentedura  PT, DPT, PhD, OCS, FAAOMPT
Reviewed by Beth Shelly

Input - Sensations, nocieception, memories, emotions are all acting together on the brain
Out put  - motor, ANS, immune, pain

Pain requires cognitive process and engages the memory.
No pain is the same in two different people

Sensations - injury always occurs with other events - smell, sight, sound, feel
Memories - pain is designed to protect us from initial exposure and repeat exposure