Behavioral Assessment &
Treatment of Pelvic Floor Disorders
(This is the APA and BCIA approved course on biofeedback for urinary incontinence, pelvic pain, etc.)
45 Hours of CE Credit / Course Fee $550
Presented by Richard A. Sherman, Ph.D.
Concept and Objectives: This course is set at the level of a typical 3 credit post-licensure, introductory level course. The course is targeted to licensed / certified clinicians such as psychologists, counselors, physical therapists, social workers, nurses, and physicians as well as to graduate students. Students learn by watching audiovisual lectures provided on CDs, watching several movies, reading assignments both from materials provided on the CD and standard texts, and interacting with their instructor via e-mail. They answer short essay questions after each lecture rather than taking exams. Previous students have found that this course takes between 45 and 95 hours of work to perform.
This course provides 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.
Pelvic floor disorders are common among all age groups of women. Behavioral interventions such as biofeedback are very effective for stress and urge urinary incontinence, functional constipation, and muscle related pelvic floor pain. If you want to improve the effectiveness of your pelvic floor treatments, consider adding muscle pattern biofeedback. Recordings give you the ability to see exactly what patterns of tension your patients are exhibiting so you can coach them to use optimal patterns as you and your patient watch the display on your monitor. These techniques are simple to learn and teach.”
Learning objectives: The course objective is to provide the depth of knowledge in pelvic area A&P, psychophysiology, biofeedback equipment, and training techniques which clinicians require to perform psychophysiologically oriented assessments and biofeedback and other behaviorally based interventions for pelvic floor disorders. This information is crucial to effectively adding these techniques to a clinician's practice.
This course is designed to help you (the student):
- Summarize the psychophysiological processes and anatomy underlying each pelvic floor condition covered in the course.
- Use psychophysiological recording and biofeedback devices record and display psychophysiological information about musculoskeletal functioning of the pelvic floor.
- Control the biofeedback display to optimize learning to correct patterns of muscle tension in the pelvic floor.
- Use psychophysiological recording equipment to assess patients with pelvic floor musculoskeletal dysfunctions.
- Use biofeedback equipment to apply specific interventions tailored to each muscle related pelvic floor condition covered in the course.
- Use behavioral techniques learned in the course to assist patients in controlling muscle related dysfunction patterns causing specific pelvic floor problems.
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: (Cost of the texts is not included in the course fee.)
- 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
- Laycock J and Haslam J: Therapeutic Management of Incontinence and Pelvic Pain. Springer, New York, 2002. ISBN 1852332247 (soft cover).
- Compendium of articles and protocols provided on the course CD.
- 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!)
- 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.)
- 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.)
(A detailed list of subtopics with reading assignments is at the end of this outline.)
- Overview of behavioral assessment and intervention for pelvic floor disorders including a brief discussion of credibility.
- Anatomy and Physiology of the Pelvic Floor
- Principles of applied psychophysiology biofeedback as applied to the pelvic floor
- Know what is normal before you try to fix it
- Assessments and interventions for urinary incontinence
- Assessments and interventions for bowel dysfunctions
- Principles of pain assessment and intervention from a psychophysiological perspective
- Assessments and interventions for pelvic pain syndromes
- Assessments and interventions for erectile dysfunction
- Ethical considerations in performing behavioral assessments and interventions for pelvic floor disorders
Purchase the text books on your own (usually on-line book sellers are far less expensive) and purchase the course from the Foundation. Just go to our web site to pay by credit card or send a check in US funds to the above address. See below for discount information. You can begin at your convenience and progress through the course at your own pace.
Payment and discounts: The course costs $550 (exclusive of the texts). You can purchase the course via credit card on our web site (behavmedfoundation.org) or by mailing a check in US funds made out to the Behavioral Medicine Research and Training Foundation to the letterhead address.
Discount for this course if you already took the Foundation's general biofeedback or urinary incontinence courses: People who have taken either the Foundation's general biofeedback or urinary incontinence courses can take this pelvic floor course for half price ($275). People who took general biofeedback courses from other groups can not have a discount because we have no realistic way to judge how much of the information was provided.
Discount for taking the Foundation's general biofeedback course: The Foundation offers a BCIA approved, distancecourse in general biofeedback. Because of the tremendous overlap in information between this and our general biofeedback course, we offer our general biofeedback course to people taking the pelvic floor course at ½ price ($275).
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.
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 over 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. Dr. Sherman is dean of the psychophysiology doctoral program at the University of Natural Medicine and has held numerous positions at the Association for Applied Psychophysiology and Biofeedback (AAPB) including president. 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. Information about the course can be found on our web site.
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. The Foundation's general biofeedback course is available at half price to people taking this course.
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.