Outline of Perry Institute
On-Line Training Program

The following is a tentative outline for the On-Line version of the Perry Institute course.

Between 1986 and 1994 the training was done in 2-, 3-, and 4-Day versions, as well as half-day workshops at AAPB and other professional meetings; we have a lot of material to draw upon. As the various sections of the course are expanded, the Outline items below will be changed to blue hyperlinks which will take you directly to each "chapter". Plans for examinations-by-email are still incomplete. If you are interested in participating in this project, (click here-->) please "pre-register" using our automatic form. Comments about the outline, and requests for early completion of specific sections, can be included there.

Outline

History and Background of Incontinence Treatment

• Joshua Davies, MD (1938) Pelvic Muscle Exercises first advocated
• Arnold Kegel, MD (1948) PME with Pneumatic Biofeedback
• John Perry, PhD (1978) PME with EMG Biofeedback

Censorship and the Awareness of Incontinence

• Congressional rider on Incontinence
• National Agenda to Promote Continence
• National Organizations formed
• October, 1986 - Time Magazine breaks the taboo
• Incontinence Products appear in Drug Stores
• October, 1988 - Consensus Development Conference
• March, 1992 - AHCPR issues Guidelines

The Costs of Incontinence

• Physical and Medical Costs
• Adult Diaper Products - $931 per year
• Nursing Home Admissions & Costs
• Social and Psychological Costs

What is "Biofeedback"?

• Definition
• Signal-to-Noise Ratio
• Nature of Human Proprioception
• "The Ghost in the Box" (Shellenberger & Greene)
• Advantages of Biofeedback

Gasteroenterlogy and Incontinence

• "Normal" colorectal functions
• Colorectal Diagnostic Evaluations
• Colorectal Definitions of Incontinence
• Fecal Incontinence
• Constipation

Colorectal Treatment Issues

• Large-Balloon Manometry
• The NIA Office-only model

Urology and Incontinence

• Basic Anatomy and Physiology of the Urinary System
• Acute Incontinence (temporary, reversible & secondary)
• Chronic Incontinence ("established")
  • Stress Incontinence
  • Urge Incontinence
  • Mixed Incontinence
  • Overflow Incontinence
  • Functional Incontinence
  • Total Incontinence
• Urological Diagnostic Evaluations
  • Physical Exam and History
  • Stress Test
  • Cyuctoscopy
  • Cystometogram
  • Bladder Scan
  • Uroflowmetry
  • EMG (needle)
  • Video Urodynamics

The Behavioral Approach to Incontinence Treatment

• Screening out Medical Problems
• Functional Problems
• Psychodynamic Interpretations of Incontinence

The EMG Evaluation

Biofeedback Practice Session

Home Training Sessions

The Business Side of Treating Incontinence

• Models of Organization and Structure
  • Models of Practice
  • Clinic Location
  • Ideal Clinic Facilities
• Marketing an Incontinence Clinic
  • Advertising your services
  • Referral Sources
• Insurance and Reimbursement
  • Physician billing options
  • Physical Therapist billing options
• Sensors and Home Trainers
  • Sales Options
  • Rental Options

Successful Statistics and Programs

• Criteria for Success
• Our Two Guarantees
• The Free Annual Check-Up
• The Patient's Goals and Our Goals

The Behaviorally-oriented Clinic

• Handling Patient Referrals
• The Initial Interview
• Weekly Patient Assessments

Dealing with Special Populations

• Children
  • Enuretics & The Near-Hyperactive Syndrome
  • Birth Defects: Spina Bifida, Hirshspungs, Inperforate anus
  • Giggle Incontinence
  • Parental Issues
• Child-bearing Women
• Menopausal Women
• Post-Prostate Men
  • Psychological effects more extreme
  • Impotence Complication
• The Elderly and The Frail
  • Alzheimers & Parkinsons
  • Girdles and Wheelchairs

Dealing with Resistant Cases

• Correcting Bad Habits (self-taught kegels)
• Obesity and Awareness
• Increased Sexual Arousal
• Family Resistance (chronic illness syndrome)
• Rape and Incest
• Pregnancy and Childbirth Issues
• Preventing Episiotomies
• Pelvic Muscle Pain
• Dysmenorrhea
• Vaginismus
• Levator Syndrome

Treatment of Sexual Dysfunctions

• The Gräfenberg Spot and Female Ejaculation
• Muscle Atrophy & Orgasm
• Chronic Tension - Vaginitis & UTIs
• The Two Nerve Theory
• Side Effects of PC Muscle Training

Equipment Problems

• Cables and connectors (The weak link)
• Poor Patient Contact (KY Jelly)
• The Wavy Line (problem with fill graphs)
• Use of a multimeter (Radio Shack)

Copyright 2000 by John D. Perry

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