The Physiotherapy Forum is an opportunity for physiotherapists, or anyone interested in physiotherapy, to network, enjoy presentations from emerging and established researchers and clinical leaders and most of all, have fun. The Forum programme includes a variety of presentations and the opportunity to attend two workshops of your choice. The preliminary programme can be found below.

Pre-registration to this session is required. Spaces are limited so please register early. Please note you must be registered for the ICS Annual Meeting in order to also register for the Forum session.

All are welcome to stay to the end and join us for a drinks reception. Light food will be provided whilst you chat with friends and network with colleagues from around the world. Tickets are included in your Forum ticket, so why not enjoy an early evening reception with your friends and colleagues. To get a ticket sign up via the online registration system or email Keren Abuhasira.

Workshop Choices

Toilet training: how about stool?
Tinne Van Aggelpoel

During toilet training, a child needs to learn to acquire control over bladder and bowel, but suboptimal training could lead to urinary and/or gastrointestinal dysfunctions. A difficult toilet training process is associated to functional constipation, but it is unclear which one is the cause or the consequence. For instance, hard and painful defecation are important factors in the development of stool toileting refusal, but on the opposite, stool toileting refusal could also be the reason for a child to start retaining stool, leading to harder fecal masses, constipation and encopresis. The prevalence rate of childhood constipation goes up to 29%.

Today, children start and finish toilet training at a significant later age than half a century ago. This means children are very conscious and already gained some independence when they initiate toilet training. In our daily practice, we meet more and more parents of young children who refuse to go to the potty to defecate. Some are fully toilet trained, but keep on asking for a diaper when feeling an urge to defecate. We advise these parents to put their child on the potty several times a day, shortly after the meals, to make use of the gastrocolic reflex and to facilitate the bowel movements.

In this lecture, we will discuss the development of stool problems during toilet training, methods of toilet training and the gastrocolic response in toddlers.

Tackling barriers to the prevention of PFD after childbirth
Hedwig Neels

Although Pelvic Floor Muscle Training (PFMT) has been proven to be effective in the prevention and treatment of Pelvic Floor Dysfunction (PFD) in women during pregnancy and after delivery, the lifetime prevalence of PFD remains high. This raises questions about possible obstacles or barriers to the prevention and treatment of PFD.

The aims of this research were to investigate some of the possible barriers of PFMT in the primary, secondary, and tertiary prevention of PFD: The influence of “Knowledge”, “Perineal pain” and “Common errors made in attempt to contract the pelvic floor muscles” were studied.

This thesis was the first to highlight some of these barriers to the primary, secondary and tertiary prevention of PFD in women. And the results have also shown that low-cost strategies can be used to reduce those barriers. Improving the general knowledge by women, adjusting the timing of pelvic floor education and improving specific knowledge about vaginal flatulence are proposed. Also, reassuring women immediately after childbirth that pain will not be an issue if they start exercising the pelvic floor muscles. In addition, working to reduce common errors made by these women during a pelvic floor muscle contraction by visual observation and verbal feedback, could improve primary, secondary, and tertiary prevention of PFD in women.

These conclusions and the proposed strategies have important clinical implications in that they should raise awareness about PFD, could reduce the taboo about PFD, and could improve help-seeking behavior in women of all ages.

Pelvic Floor Physiotherapy in the Oncologic Population
Carina Siracusa

Cancer survivorship is an increasingly important topic as more people are surviving and thriving after treatment for different types of cancers. Treatment for GI and pelvic cancers can severely impact daily function for patients, especially in the areas of bowel/bladder and sexual functioning. Often patients feel that these issues are a normal side effect of cancer treatment and do not seek help for these issues despite the large impact on their quality of life This session will explore the common side effects of cancer treatment and the need for pelvic floor physiotherapist intervention.

Often patients being treated for prostate and bladder cancers are referred to pelvic floor physical therapy for urinary concerns. However, patients treated for a variety of cancers can experience bladder issues. This session will explore the side effects that can happen with treatment for colorectal, breast, and genitourinary cancers. Participants will learn evaluative physical therapy techniques for this population. Manual therapy, exercise and modalities will also be discussed. Participants will also learn appropriate functional outcome measures for this population to help evaluate the improvement in quality of life measures. The presentation will also discuss common sexual side effects of cancer treatment and the appropriate way to discuss these matters with patients to effectively address all areas of quality of life measures.

Objectives:
1.) Participants will be able to identify common genitourinary side effects of cancer treatments.
2.) Participants will be able to prescribe appropriate exercise and manual therapy treatments for patients with pelvic floor pathology as a result of cancer treatment

Mapping and modulating brain networks of pelvic floor muscle control
Moheb Yani

The central nervous system has several coordinated efferent centres that cause activity in pelvic floor muscles. The involvement of the motor cortex in controlling pelvic floor muscles can be observed in different behaviours such as voiding, urine storage, voluntary switching between voiding and urine storage, as well as during voluntary movements that require activation of pelvic floor muscles. Interestingly, potential dysfunction within the motor cortical representation of the pelvic floor has been described in both chronic pelvic pain and incontinence, making this representation an important area to study. During this talk, Dr. Yani will discuss his PhD dissertation research on characterizing the motor cortical representation of the pelvic floor and how this characterization enables his current research to better understand and treat pelvic-related conditions. Dr. Yani will discuss evidence showing that supplementary motor area (SMA) is implicated in chronic pelvic pain and incontinence, and provide new evidence that SMA does indeed normally function to regulate voluntary PFM activation and automatic PFM activation during voluntary contraction of non-pelvic-floor muscles. Finally, Dr. Yani will provide preliminary evidence that SMA activity can be differentially modulated using non-invasive repetitive transcranial magnetic stimulation (rTMS). This technique may find application to reduce pelvic floor muscle activity in patients with chronic pelvic pain, or to increase pelvic floor muscle activity in appropriate patients with incontinence. Since previous studies have implicated SMA as an important predictor of physical therapy effectiveness for incontinence, this work may provide a path forward for understanding and better treating individuals who do not respond to physical therapy.