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Continuing Education (CE) Course for Physical Therapists

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CHAPTER 8: SPECIAL TOPICS

SECTION 1: SEX (NOUN) AND DISORDERS OF SEX DEVELOPMENT (DSD

pages 214-219

MALES vs FEMALES (pages 214-217)

In classical Greek and Latin, sex is the division of humans by their function in producing and providing subsentence to offspring. 

"Males and females not only behave differently in terms of sex, they are evolutionarily programmed to do so" (Oxford News Blog, 2021)

Nojima et al (2021) A sex-specific switch between visual and olfactory inputs underlies adaptive sex differences in behavior.

MALES vs FEMALES (pages 214-217)

In classical Greek and Latin, sex is the division of humans by their function in producing and providing subsentence to offspring. 

"Males and females not only behave differently in terms of sex, they are evolutionarily programmed to do so" (Oxford News Blog, 2021)

Nojima et al (2021) A sex-specific switch between visual and olfactory inputs underlies adaptive sex differences in behavior.

MALES vs FEMALES (pages 214-217)

In classical Greek and Latin, sex is the division of humans by their function in producing and providing subsentence to offspring. 

"Males and females not only behave differently in terms of sex, they are evolutionarily programmed to do so" (Oxford News Blog, 2021)

Nojima et al (2021) A sex-specific switch between visual and olfactory inputs underlies adaptive sex differences in behavior.

MALES vs FEMALES (pages 214-217)

In classical Greek and Latin, sex is the division of humans by their function in producing and providing subsentence to offspring. 

"Males and females not only behave differently in terms of sex, they are evolutionarily programmed to do so" (Oxford News Blog, 2021)

Nojima et al (2021) A sex-specific switch between visual and olfactory inputs underlies adaptive sex differences in behavior.

SECTION 2: PELVIC HEALTH AND WELLNESS

pages 220-225

Author: Dr. Jackie Booth

 Jackie Booth earned her Bachelor of Biology from Stetson University in 2007 and her DPT from the University of Florida in 2014. Following graduation, Jackie underwent specialty training (including Pelvic Floor Level 1, 2A, 2B; Oncology and the female public floor; Oncology and the male pelvic floor, sacroiliac joint evaluation and treatment, mobilization of visceral fascia: the urinary system; Coccyx pain: evaluation and treatment; Balloon catheter – application and clinical reasoning) and has continued to upgrade her skills at the Herman & Wallace Pelvic Rehabilitation Insti-tute.  

INCONTINENCE (pages 233-234)

STRESS INCONTINENCE

Dr Jen, DPT (14 min) 

HOW TO EMPTY BLADDER

Michelle Kenway, DPT (7 min)

SECTION 3: AFRICAN AMERICAN WELLNESS

(pages 221-225)

Author: Dr. LaTasha Blanton

 LaTasha Blanton, a Doctor of Physical Therapy since 2004, has owned and operated multiple private outpatient facilities since 2009. In 2019, she sold her practices and started a travel and tourism company that allows her to live full time in South Africa. To keep up her skills as a physical therapist, she started a virtual physical therapy practice.  

RACIAL DISPARITIES IN MEDICINE

(10 min)

African American Wellness Project (website)
Black Women for Wellness (website)

SECTION 4: PHILOSOPHICAL BELIEFS OF PATIENTS

pages 229-230

WHAT IF YOUR PATIENT'S BELIEF IS DIFFERENT FROM YOURS?

IS IT OKAY TO PRAY WITH PATIENTS?

Brian Schwartz, MD and Pastor Mark Finley (9 min)

SPIRITUAL WELLNESS

(2 min)

WHY ARE SOME PATIENTS ATHEISTS?

Richard Dawkins, PhD (9 min)

BONUS CASE: Madeline

You are employed as a PT in an outpatient clinic. During the first session with your new patient Madeline, she confides in you that immediately prior to her surgery her orthopedic surgeon (Dr Graham) asked if they could pray for a moment. She reports she nodded and then pretended to pray because she felt vulnerable "in a hospital gown on the operating table" and was concerned he wouldn't "do as good of a job" if she said no. She openly shares with you she is an atheist and had considered reporting Dr. Graham to the AMA, but then decided against it. However, she asks you to recommend another orthopedist because she does not want to return to Dr. Graham. What do you do and say?

Abbott DM, Mollen D (2018) Atheism as a concealable stigmatized identity: Outness, anticipated stigma, and well-being. The Counseling Psychologist, 46(6):685-707.

SECTION 5: SEXUAL ORIENTATION AND LGB HEALTH AND WELLNESS

pages 231-232

SEXUAL ORIENTATION AND LGB HEALTH

Sexual Orientation

  •  Sexual orientation is a “sexually differentiated trait (over 90% of mean are attracted to women and vice versa” (Balthazart, 2011, p.2937). 
  • For instance, females are heterosexual if they are romantically attracted to only males, homosexual if attracted to only females, and bisexual if attracted to both females and males. 

Reference

Maternal Steroid surges

  • Pictured is a depiction of a fetus during the 2nd trimester.
  • During the intrauterine period in the second half of pregnancy, there may or may not be maternal surges of steroids, particularly testosterone and its metabolites, on the fetal brain.
  • If there are steroid surges, the brain develops masculine; if there are not steroid surges, the brain develops feminine.
  • If it is a male fetus, there are usually surges. If there are not, then the male may later present with feminine and/or homosexual characteristics.
  • If it is a female fetus, there are usually not surges. If there are, then the female may later present with masculine and/or lesbian characteristics.

Reference (Swaab et al, 2021)

DNA PACKAGING (SEX-SPECIFIC EPI-MARKS)

  • Sex-specific epigenic-marks (epi-marks) originate from embryonic stem cells and they vary in strength.
  • Epi-marks are temporary switches that regulate gene expression. 
  • They are produced early in fetal development to protect the fetus from large natural variations in testosterone exposure in the womb. 
  • However, when they carry over to opposite-sex offspring (father to a daughter or mother to a son), it can cause the masculinization of females or the feminization of males (Rice et al, 2012, 2013)
  • Pictured is an 8-week old fetus.


Reference (Rice et al, 2013)

BONUS: SEX TYPICAL BEHAVIORS

  • The steroid surges, or lack thereof (and perhaps the epi-marks), can also impact the sex-typical behaviors including playmates, toy preferences and athletics (Hines, 2012).
  • This is why some men who are homosexual were perceived to be "girly" when they were young. (Note: Not all boys who are "girly" are gay when they mature into adults.) 
  • And, why some women who are lesbian were perceived to be "tomboys" when they were young. (Note: Not all tomboys are lesbians when they mature into adults.) 

Reference (Hines, 2012)

LGB (Lesbian, Gay, Bisexual)

  • "In the 1990s, the longstanding bonds between the lesbian, gay and bisexual people in both daily life and liberation activism led to the widespread adoption of the LGB acronym" (Blakemore, 2021, para 10) 
  • The LGB "rainbow" flag (pictured) was designed by Gilbert Baker in 1978. 

Reference

LGB HEALTH


  • Compared to heterosexuals, how is the health of lesbians, gay men, and bisexual individuals in terms of 
  • obesity, breast cancer (lesbians), disability, mental illness, substance abuse, and human immunodeficiency virus (HIV)?

BONUS VIDEO: SEXUAL ORIENTATION

(5 min)

SECTION 6: FAMILY WELLNESS

pages 232-235

CASE 8-6. MRS. DELAND AND HER FAMILY (page )

Describe how you would interact with Mrs. Deland and her family to achieve a positive, yet realistic outcome. 

SECTION 7: PTs AS WELLNESS ROLE MODELS

pages 236-238

SURVEY: Aerobic Capacity Wellness of PTs & SPTs
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INTERVENTIONS
REFERENCES
SCREENS & TESTS
STAGES OF WELLNESS
STRESS MANAGEMENT STRATEGIES
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