Pediatric Pelvic Health Summit
Date: November 9th, 2024 (Saturday)
Time: 10:00 AM to 5:30 PM (EST)
Location: Live Online via Zoom
Morning
10:00am EST
Welcome-Quiara and Dawn
10:05-11:05am
Dr. Mary Massery (PT): Pressure systems in pediatrics and pelvic floor function
11:15-12:15 pm
Laura McGucken (PT)- Treating Pediatric Pelvic Pain in Boys: Simple Strategies with Great Results
12:25-1:25 pm
Dr. Ashlee Snyder-Cox (OT)- Retained Primitive Reflexes in the Pediatric Patient and Its Impact on Pelvic Floor Dysfunction
Lunch Break
1:25-1:55 pm EST 30 min
1:55- 2:55 pm
Maureen Bennie: Management of behaviors of Autistic clients during treatment sessions
3:05 - 4:05 pm
Dr. Sarah Fox (PT): Physical anomalies requiring surgical intervention and the role of PT in rehab
4:15-5:15 pm
Anna Miller (OT): Connecting to the Sensation in Pelvic Floor Therapy
5:15- 5:30 pm
Quiara and Dawn Closing remarks/adjourn
PEDIATRIC PELVIC HEALTH VIRTUAL SUMMIT
Hello and a warm welcome to all our incredible attendees! We are thrilled to have you join us today for this exciting 2nd annual Pediatric Pelvic Health Virtual summit. Over the next day you’ll have the opportunity to connect, learn, and collaborate with experts and like-minded peers from around the world.
We encourage you to engage actively in this discussion board to network and also ask your questions for experts speakers here since the live chat in zoom will not be accessible for participants to post to the whole group. We’re so glad you’re here, and we can’t wait to embark on this journey of discovery and growth together.
Thank you for being part of the 2nd Annual Pediatric Pelvic Health Virtual Summit – let’s make this an unforgettable experience!
Yours in pediatric pelvic health,
Quiara and Dawn
Please share about you!
So happy you are here with us Heather!
Fort Collins, Colorado
Outpatient Pediatric OT, generalist, PF/Toileting
I’m excited to hear more connections and learning more about the sensory and primitive reflexes and how they tie to pelvic floor.
So happy you are here with us this year Kathryn!
Hello friends!!!
-I’m in St Petersburg, FL
-I’m a pediatric pelvic floor PT
-I’m excited for the whole day!
1. Washington DC
2. Pediatric Physical Therapy
3. Strategies to manage behaviors within a session
Hi everyone!
I just recently transitioned away from working in an outpatient clinic (seeing kids for OT for all aspects of development) and started my own pediatric pelvic health private/solo practice. I’d love to connect with anyone who is in a similar role!
Courtney, I live in Minnesota, too. I am still pretty new to the pelvic health world.
Awesome! If you want to connect, feel free to email me: courtney@growpelvichealth.com
Would there be any medical questions we can ask specifically for clients that don’t have medical diagnoses that might pique out interest for some of these possible pediatric airway issues? I’m thinking for instance ‘snoring’ or ‘sleeping with the mouth open’ type ideas?
Thank you for your question Haylie!
Perfect – yes agree – assuming that this would be a possible indicator for airway challenges impacting pelvic floor during the day then as well?
Karyn Wagner, PT from Indy. Hoping to get more perspective of thinking outside the box more to help these kiddos.
So happy you are her Karyn I am confident you will hear some pearls of wisdom for outside of the box thinking to support the kiddos that land in your care!
can Mary give clinical examples again of controlled vocalization (ecc) compared to forced voicing (con)?
someone tell me itp vs iap please
IntraThoracic Pressure vs IntraAbdominal Pressure
thoracic pressure vs abdominal pressure
ITP- Intrathoracic Pressure, IAP- Intrabdominal pressure
I would love to hear a short paragraph of how we describe the pressure systems connect the vocal cords to pelvic floor this to parents and kids. thanks you
For Mary- I typically recommend my pregnant patients to emphasize an open glottis to assist in pushing phase of delivery…can you relate to us why this would be effective in affecting ease of birth?
i am not the pelvic floor expert you all are, but from a pressure management perspective, and from the obvious need for women to shift pressure downward during pushing, I would use any type of pursed lip blow activity. That allows for a steady stream of air to escape (controlled air volumes), while minimizing increased ICP (intra-cranial pressure). that is VERY different than a fully open glottal exhalation (“haaaa”) which causes massive air volumes to escape in just a few seconds which compromises the trunk flexors ability to increase IAP (intra abdominal pressure) necessary for pushing the baby out.
Thank you, that is helpful !!
So happy you are here Kellie!
Dr. Mary Massery: http://masserypt.com
So happy you are here with us today Tabby!
WOW! you do some pretty cool work, Tabby! And it’s nice to have a fellow Floridian!
Likewise! If you ever make it over to Miami, or if I’m over your side and you’d like to connect, let me know 🙂
Namyata Patel from West palm Beach, Florida
Pelvic pain in boys
hey there, West Palm! 🙂
Hi, Kali, Excited to be here and connect with you
So happy you are here with us Namyata!
Floridian’s unite!
I missed the introduce yourself question!
1. I am tuning in from Saskatoon, SK, Canada
2. I am a physiotherapist
3. I am honestly so excited to learn about each topic and find some clinical pearls to take to my practice next week! I have been consuming a lot of materials on airway/breath control as well as primitive reflexes in the last few years and I am really keen on those topics in particular
So happy you are here with us Haylie, you definitely will be able to integrate some clinical pearls you learn today into your practice next week!
Summit Schedule: Remaining Sessions in EST timezone.
12:25-1:25 pm
Dr. Ashlee Snyder-Cox (OT)- Retained Primitive Reflexes in the Pediatric Patient and Its Impact on Pelvic Floor Dysfunction
Lunch Break
1:25-1:55 pm EST 30 min
1:55- 2:55 pm
Maureen Bennie: Management of behaviors of Autistic clients during treatment sessions
3:05 – 4:05 pm
Dr. Sarah Fox (PT): Physical anomalies requiring surgical intervention and the role of PT in rehab
4:15-5:15 pm
Anna Miller (OT): Connecting to the Sensation in Pelvic Floor Therapy
5:15- 5:30 pm
Quiara and Dawn Closing remarks/adjourn
Hello,
Wondering what type of pelvic assessment are you performing? Specifically with your 18 yo. patient example did you assess the perineum and what type of MFR did you perform? Was it to the pelvic floor?
Thank you!
MFR around hips/adductors/back. PF assessment and stretching through clothing for this particular child.
I have seen several boys with pelvic pain and painful urination and several of them have reported increased pain urinating sitting down versus standing. This is opposite of what I would expect, can you help me understand why this might be?
Use whatever position is most comfortable and that they can relax. Pudendal nerve goes through A’lcock’s canal which could be compressed in sitting which would increase pain. sEMG is helpful for PF relaxation training.
can she go into the pelvic pain conditions in a little more detail (one of first few slides) and some common symptoms she is seeing with those conditions?
Please look up each condition on your own, then if you have any questions, you can reach out by email. In general, the doctor is treating the condition and then we treat the bodies response to the treatment.
Have you ever worked with a patient with pudendal nerve pain while recovery from paralysis associated w/ a virus such as acute flaccid myelitis, guillan barre, etc.?
Dawn responded to this- it was a whole medical team management. Gentle MFR was really important for her recovery.
Go Cougs!
How prevalent in the general population is pelvic pain in boys? I work with children who mostly don’t use verbal communication (they may use signs or talkers, or gestures) and may not be understood by myself or parents when they are in pain. I’m thinking that adding in some of these exercises for these children when they see me for other bowel bladder issues (OAB, constipation) can’t do any harm. These conditions could be painful, should I be assuming “pain could be here” even if I’m not sure? Parents often say “my child has a high pain threshold, but maybe they just can’t communicate the pain?
These exercises would be great for them!
I am using ES for other function like standing and walking. seen improvement in constipation
I hope I didn’t miss this but do your clients/their parents want to know the specific *why* they hurt – do you break it down into the nerve constituents that would be contributing based on your evaluation? I am sure there are some people you can tell that going into details would not be helpful for but in general do you find that helpful to demystify the experience?
Pain is so complex, and pain science tells us even after tissue has healed, we can still experience pain, so I do explain anatomy but focus on solutions and changing the symptoms, find what feels good and is relieving.
Dawn—-For FES (adductors)- where is placement of electrodes
Eileen, from Susan’s course they are close to the pelvis/groin, wrapping from the hip adductor muscle more posteriorly so that it is on the hamstring mm a little as well.
Would you be able to post MFR and other link that Dawn suggested please?
Posted! Thanks for asking!
Laura, are your pelvic pain patient’s typically referred for that reason and/or do you find a correlation of pelvic pain with other diagnoses like constipation, enuresis etc?
They are referred for pelvic pain typically from the urologist.
Pediatric Myofascial Release – Myofascial Release – John F. Barnes, PT
Therapeutic Value of Visceral Manipulation
With the intervention for the poor body mapping that parents do at home, do you trace each body part 2-3x or do for a certain amount of minutes?
I have the family do each body part and combination x1, but if the kiddo wants more they can do it more. It won’t hurt to do more, but it also won’t speed up the integration.
Sorry – put my question in the wrong spot at first – Do you do a certain number of attempts for tapping and expect an amount for correct movements to be normal versus abnormal? And do you track the number of correct for a test re-test throughout treatment?
Always love seeing the reflex integration! I was curious your thoughts on any correlation with spinal perez reflex and bowel and bladder dysfunctions/symptoms?
can you provide typical ages of integration for each of these? or did you say by 2 for all?
moro: 4-6 months
ATNR: 4-6 months
Spinal Galant: 3-9 months
STNR: 10 months
TLR: 7-12 months
Does poor body awareness in body mapping, or retained correlate with poor interoceptive awareness of bladder and bowel? Would doing a programme (such as the Kelly Mahler one) to improve interoceptive awareness also help to prepare a child for interventions for primitive reflex integration, or is body mapping a better way as it focuses on more touch/proprioceptive systems?
Also, what if 30 days of practice of body mapping doesn’t improve the child’s body awareness, do we get them to do 30 more days or just move onto the activities for reflex integration?
Hi Tabby!
I found that if a kiddo didn’t know where there body was in space (poor body awareness) that they typically had poor interoception. I don’t think doing an interoception program will facilitate any reflex integration. If the reflexes aren’t integrated or the child is still having difficulties with the tap game, I’ll have them keep working on the activity before moving on.
Do they also have poor emotional regulation?
I often see this is an area of growth for the child with certain retained primitive reflexes.
Difficulty regulating emotion is a common symptom of retained reflexes.
So test them all at once…but start at Moro and treat positive tested areas, one at a time. ?Correct?
answered
Do you see that they have not crawl or delayed in the developmental milestone in this population that are clumpsy?
Almost all the kiddos with retained primitive reflexes didn’t crawl or parents described the crawl as “weird” and were early walkers (9 months).
thank you
When a child has multiple or all reflexes retained, do you start with one set of HEP reflex work with parents or do you try to do them all? I find families get overwhelmed easily but also want to get progress as quickly as possible due to insurance limits and other factors
I treat the reflexes one at a time. Rarely am I only seeing kiddos for reflex integration, so while the family is working on the reflexes at home I can address other goals in sessions. If reflexes are lingering once other goals have been met I’ll see the family monthly to change the HEP for reflexes. I will frequently do a 15 minute telehealth session to check the reflex and then teach the next exercise to save the family drive time and help reduce cost.
Do you write specific reflex integration goals or would you write a goal for the underlying functional impact? For example, __ will show an integrated Moro… OR ___ will show decreased startle…?
As an OT I will write a goal for the functional impact, but will also document the reflex I’m address that’s related to the functional impairment. “Client will complete starfish exercise x5/day to facilitate moro reflex integration in order to decrease over-responsiveness to auditory stimulation.”
Thanks! My clinic has been going back and forth about how to write these goals, so I appreciate your expertise!
This is not so much of a question as it is a comment. The outpatient clinic I work at does reflex integration training through MNRI and has been a huge benefit for all of our PTs and OTs. I know from Dawn’s courses with kiddos who like to try to withhold by doing the potty dance, they may transition onto the balls of their feet, or they are naturally toe walkers, I have seen retained trunk extension reflex which is another great reflex that indirectly can help with bowel and bladder management and pelvic floor relaxation. It’s fun to connect the dots thinking about how some of the retained reflexes present and how they may be impacting the child’s pelvic floor coordination, body awareness with urge sensation etc.
That’s really interesting, Nicole!
These kiddos are really a puzzle sometimes and I definitely see value in addressing their reflexes, too.
for reflexes is there a general age we can stop assessing them? 10yo? 15yo? 18yo? Thanks!
Hi April! Primitive reflexes can extend into adulthood, so we should continue to assess for all ages.
For Mary:
I’ve had multiple clients where they only defecate in a standing position. I am an OT and feel confident in supporting the sensory, environment, anxiety, etc. components. However, I’m trying to expand other physiological factors I should be exploring.
Can you share any considerations or treatment approaches for these types of kids when it comes to the body’s pressure systems, core, vocal folds, etc?
I have had a few kiddos like this, too. Including one little friend who leans over armrests to generate his pressure change when he needs to poop. Mary’s lecture got me thinking more ITP instead of obsessing over IAP for that guy for sure, but I am very intrigued to see her insight on your question!
smart kid. haha. He recognized a need for a deep breath and distal stabilization of UEs (weight bearing on arms) in order to — increase ITP to — effectively shift pressure downward to — increase IAP to — aid in bowel evacuation. sequential interactions. Child shouldn’t need to do a full body pressure activation for bowel evacuation all the time, but if the child’s stool is hard, additional trunk pressure like this may be necessary.
i responded yesterday, but maybe i didn’t press post. oops.
RE: a child who prefers standing up for a bowel movement. if they need increase ITP (thoracic pressure) to shift pressures downwar, like when defecating a harder stool, they may hold on to something to increase ITP via accessory muscles (distal stabilization). It could be due to plenty of other reasons, but i would check this out.
Book recommendation from Maureen Bennie:
Is there any guidance you can give for identifying our friends that are undiagnosed autistics (perhaps ‘high functioning’ or ‘high masking’)? Is there a particular way to bring this up to their other healthcare providers and/or parents that you would recommend?
I personally find that my own appointments follow the same pattern regardless of diagnoses for the client, I am looking forward to incorporating some of your other recommendations here on accommodating my clients
Further to this – what is your opinion on PDA and how does this profile impact your therapy session?
I have used a miniature toilet as an object schedule for a child who was not yet understanding/attending to visuals.
Did it help?
Can you provide examples of interoception-based rewards, especially those specific to toilet training? How would these be used in a clinical setting?
So I have a (significantly neurodivergent- not dx with autism) patient who potentially needs tx with a suppository nightly for constipation. He is currently responding with escalated behaviors (fussing, fighting) which leads to choking and vomiting and stress by mother. Recommendations on how to approach this necessary tx to lessen his response. (this may be appropriate to ask Anna Miller???) Did she deal with this with her son?
You have to be a detective and figure out why this behavior is happening because it has a function. https://autismawarenesscentre.com/how-can-we-develop-a-better-understanding-of-behaviors-of-concern/ When we talk about low arousal, most behavior occurs due to something the person supporting them is doing. How does this suppository go in? Does the mother insert it? Is there discomfort? Does the person vomit because they think this is a way of getting the suppository out?
What types of body postures would you recommend we aim for in-clinic with our clients? Seated and reclined vs leaning forward? Sitting on the floor below the client?
Just get on their level. Keep eye contact intermittent as most autistic people find eye contact painful and hard to sustain. Seated with some space between you. Too close can be challenging for autistic people.
What is the best way to move from a compliance based reward system to more interoception based for those kids who have a difficult time without a reward system?
Do you have the Inertia traits and explanations listed somewhere?
https://autismawarenesscentre.com/what-is-autistic-inertia/
Maureen Bennie
Email: maureen@autismawarenesscentre.com
Thank you so much for the incredible information regarding autism. I am a pediatric pelvic floor PT and a parent of a 24 year old autistic daughter who lives at home. I have already found your blog and I’m sure I will have questions regarding patients and parenting. Enjoy your vacation!
Thanks, Ann!