Mary Massery's I Survived, Now What?: Treating the Musculoskeletal Consequences of Maturing with a Chronic Health Condition

COURSE DESCRIPTION: 

Children with medical problems and/or physical disabilities are surviving to adulthood.  Adults with chronic health conditions are living longer.  As these patients “survive” their health conditions, atypical breathing patterns and atypical postural control strategies often develop and cause repetitive stress on the musculoskeletal system.  The consequences can be chronic pain, inefficient motor plans, and/or physical dysfunction, all which limit health and participation.  Current research supports this paradigm, showing a higher incidence of chronic pain and decreased quality of life among children and adults with long-term health conditions.  The focus of this course is on identifying, treating, anticipating/preventing common consequential spinal and rib cage restrictions: thoracic kyphosis, scoliosis, pectus deformities, rib flares, asymmetries, tightness, etc.  These musculoskeletal restrictions can limit breathing (health) and/or shoulder, trunk, and hip/pelvis mobility (participation).  Labs present manual therapy techniques (soft tissue techniques, joint mobilizations) and neuromotor re-education techniques.  While Dr. Massery’s primary focus is on pediatrics and young adults, the material is pertinent across the whole lifespan. 

OBJECTIVES
Upon completion of this course, you will be able to:
Describe the relationship between chronic health conditions (pediatric & adult), atypical motor plans for breathing and/or postural stability, and the development of secondary musculoskeletal deficits.
Screen for musculoskeletal abnormalities, inadequate core stabilization strategies and compensatory breathing patterns that may contribute to the abnormal alignment of the rib cage, trunk and/or spine secondary to pediatric and adult chronic health conditions.
Develop and demonstrate musculoskeletal mobilization and soft tissue techniques of the rib cage, trunk and spine to correct or minimize these deformities.
Develop subsequent treatment plans for neuromuscular retraining that is focused on simultaneously optimizing breathing, core stabilization and postural development across the lifespan in order to minimize long-term secondary postural impairments.

SPEAKER BIOGRAPHY
Nechama Karman, PT, MS, PCS

Nechama Karman received her MSPT from Columbia University in 1994, her Advanced MS in orthopedic PT from Touro College in 1998, and has completed her Health Sciences PhD coursework at Seton Hall University.  Nechama is an APTA board-certified pediatric clinical specialist and the chief clinical educator at Mobility Research for LiteGait nationally and internationally. In addition, Nechama owns a private practice in NYC focusing on complex neurological conditions and complex pelvic conditions.

Nechama has completed two invited Massery faculty apprenticeships.  In 2016, she became Mary’s first certified faculty member for the “Breathing” course!  And in 2019, she was the first certified faculty for Mary’s “I Survived” musculoskeletal course.  Two huge accomplishments!  In addition, she co-authored a new one-day course with Mary: “BRAKING BAD: ECCENTRIC CONTROL FROM TALKING TO WALKING.”  

One of Nechama's proudest “Mary Massery” moments occurred when she treated a man suffering from prostatectomy-related incontinence using Mary’s approach.  She taught him to transfer without incontinence for the first time in 9 months - all in under 15 minutes!  She is passionate about helping other therapists learn these important concepts.

AGENDA:

Friday (8.0 Contact Hours)
Focus: Breathing mechanics and mid-trunk assessment of alignment and function
7:30  -8:00 Registration
8:00  -  8:30 Discussion Overview of course topics
8:30  -  9:45 Lecture Adverse postural development related to maturing around a chronic health condition
9:45  -  10:00 Break
10:00 – 11:30 Lecture/Lab Breathing: I don’t have a clue how to evaluate breathing…Well, now you will!(musculoskeletal support for posture and respiration)
11:30  - 12:30 Lunch
12:30  -  1:30 Lab Core muscles: Assessing mid trunk control: diaphragm, intercostals & abdominals
1:30  -  2:45 Lecture/Lab Assessing breathing patterns and postural relationships
2:45  -  3:00 Break
3:00  -  3:45 Lab Breathing Measurements, wrap up
3:45  -  5:30 Lab Rib cage, shoulders, trunk, pelvis: musculoskeletal assessment and interventions: Screening functional trunk mobility in stance: ribs, spine, shoulders

Saturday (8.0 Contact Hours)
Focus:  The rib cage:  assessment and treatment of consequential problems
7:30 – 8:00 Coffee and ...
8:00 – 8:30 Discussion Review, synthesis and Q&A
8:30 – 9:00 Lecture Matthew Case Study: Long term management of spine, posture & breath support
9:00 – 10:00 Lab Detailed trunk mobility screening in sidelying
10:00 - 10:15 Break
10:15 - 12:00 Lab Rib mobilizations & soft tissue techniques
12:00 - 1:00 Lunch
1:00 - 1:45 Lecture Trent Case Study: Scars and restricted fascia
1:45 - 3:00 Lab Quadratus lumborum & other manual techniques
3:00 - 3:15 Break
3:15 - 4:30 Lab Trunk/postural control:  Therapeutic exercises
4:30 - 5:30 Demo Patient demonstration (if available)


Sunday (5.0 Contact Hours)
Focus:  The thoracic spine: assessment and treatment of consequential problems
7:30 – 8:00 Coffee and ...
8:00 – 8:30 Discussion Review, synthesis and Q&A
8:30  -  9:45 Lecture The Spine
9:45 – 10:00 Break
10:00 – 11:30 Lab Thoracic spine mobilizations
11:30 – 12:15 Lunch
12:15 – 1:30 Lab Thoracic spine mobilizations & dynamic neuromotor re-education techniques
1:30 – 2:00 Lecture Kristy Case Study: Long term consequences of survival
and course wrap up

1. 1. Describe how trunk pressures link breathing and postural control using the Soda Pop Can Model. (Part 1)
2. 2. Describe the multiple, simultaneous roles of the diaphragm as related to breathing, postural control, gastroesophageal reflux, constipation, and venous return. (Part 1)
3. 3. Demonstrate the role of the vocal folds in normal postural stability responses (balance) and make the case for using speaking valves for patients with tracheostomies. (Part 1)
4. 4. Position patients for optimal physiological and biomechanical support of breathing with simple equipment (towels, pillows, etc.). (Part 1)
5. 5. Use a ventilatory strategy algorithm presented in class to optimally match breathing with movements from bed mobility to athletic endeavors. (Part 1)
6. 6. Use a multi-system approach to evaluating motor impairments. (Part 2)
7. 7. Identify the variations of “normal” breathing patterns and discuss the efficiencies/inefficiencies for individual patient conditions. (Part 2)
8. 8. Evaluate need for, and demonstrate, appropriate neuromotor retraining techniques for patients with ineffective breathing/postural control strategies (health or participation deficits). (Part 2)
9. 9. Participate in a live patient demonstration (if a patient is available) and suggest possible evaluation and treatment ideas based on the course material. (Part 2)
10. 10. Design a targeted airway clearance program using the principles of mobilization, expectoration and oral management. (Part 2)
11. 11. Demonstrate airway clearance techniques, with an emphasis on manual assistive cough techniques, and apply an airway clearance algorithm to specific patient conditions. (Part 2)
12. 12. Identify thoracic cage/spine restrictions as they pertain to breathing mechanics and postural control (a very brief introduction of chest wall restrictions). (Part 2)
13. 13. Evaluate the need for, and demonstrate, neuromotor retraining techniques to improve breath support for voicing and postural control (eccentrics). (Part 2)
14. 14. Suggest immediate ways to incorporate the concepts into therapy activities in your clinical setting. (Part 2)
15. Describe the relationship between chronic health conditions (pediatric and adult), atypical motor plans for breathing and/or postural stability, and the development of secondary musculoskeletal deficits.
16. 2. Screen for musculoskeletal abnormalities, inadequate core stabilization strategies and compensatory breathing patterns that may contribute to the abnormal alignment of the rib cage, trunk and/or spine secondary to pediatric and adult chronic health conditions.
17. 3. Develop and demonstrate musculoskeletal mobilization and soft tissue techniques of the rib cage, trunk and spine to correct or minimize these deformities.

As of now, masks provided and required.  If OhioHealth deems the COVID rate as "high", protective eyewear will also be provided and required for lab portions.  All meals will be on your own. 

Cancellation and Refund Policy: OhioHealth reserves the right to cancel or delay this course due to any unforeseen circumstances.  In the event this meeting would have to be canceled, OhioHealth will refund your registration fee.  We are not responsible for any travel, hotel, or other costs incurred.  If a participant cancels, refund of conference fee minus a 25% administrative charge will be made if written notice of cancellation is received no later than 10/14/2022.  If self-cancellation occurs as a result of COVID outbreak and written proof is provided (eg of work/local government travel restrictions, or doctor's note noting high risk), administrative charge may be waived.  No refunds will be granted after 10/14/2022 unless in the case of documented illness.