The Core: Its Role in Women’s Health
October 9th & 10th, 2009 |
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| Conference Description |
The Portuguese Association of Physiotherapists through its interest group of Physiotherapy in
Women’s Health will be hosting the next IOPTWH Conference in Lisbon-Oeiras, in October. Though
a small country and a small interest group we will try to do our best to make your stay worthwhile.
This year we are celebrating our 25th anniversary and have a number of physiotherapists working in
women’s health, and doing a great job. We are still new to some aspects of the specialty. We started 25
years ago with pre natal education, and later with post natal education. Ten years ago we started with
incontinence education and then breast surgery rehabilitation. Since 2007, we have had a partnership
with a recognized High School in Health Science and run a Post Graduation in Physiotherapy in
Women’s Health which has been very successful.
Since the very beginning, one of our main goals has been to have an updated and high standard of education.
We are grateful for all the help we have received from our colleagues all over the world and
those that have contributed to our growth.
We have always believed that we learn more and enhance our knowledge if we are able to enjoy the
exchange and sharing of experiences and expertise.
I hope to see you all in Portugal next year and I am sure you will enjoy your stay as much as we shall enjoy you coming.
See you in October 2009!
Fátima Sancho
President of the Portuguese Interest Group of Physiotherapy in Women’s Health
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| Conference Sponsors |
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| Conference Pricing |
- On or Before July 14th 2009
- €150 (include all coffee breaks, lunches and conference dinner on the evening of Friday 9th October)
- €115 (to include just coffee breaks)
- July 14th 2009 - September 27th 2009
- €175 (include all coffee breaks, lunches and conference dinner on the evening of Friday 9th October)
- €140 (to include just coffee breaks)
- After September 27th 2009
- €175 (option not available)
- €140 (to include just coffee breaks)
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| About the Speakers |
Kari Bø, Norway - click to expand
Professor Kari Bø is a physical therapist and exercise scientist at the Norwegian School of Sport Sciences, Oslo. She holds an MSc on body posture and a PhD on pelvic floor muscle training and was appointed professor of exercise science at the Norwegian University of Sport and Physical Education in 1997, achieving the status of vice chancellor from 1999-2001. She was the first vice president of IOPTWH and has been the vice president of the Norwegian Council for Physical Activity for 8 years, directly advising the Norwegian Minister of Health. Kari has written numerous scientific papers and systematic reviews as well as articles, videos/DVDs and books for the lay public.
Her main area of interest and research is pelvic floor function and dysfunction, exercise science and women’s health. She is in the Cochrane review group for conservative treatment of incontinence, has been a member of the first two International Consultations on Incontinence (conservative treatment) and is an appointed member of the World Confederation for Physical Therapy evidence based practice advisory group as well as an elected member of the International Continence Society scientific committee. Kari is a renowned and popular presenter worldwide.
Susan Mercer, Australia - click to expand
Susan Mercer has a broad background to her approach to teaching and research in physiotherapy. She has a Bachelor of Physiotherapy (Honours - Ergonomics) from the University of Queensland, Australia, a Masters of Science (Health Behaviour – Chronic Pain) from the University of Waterloo, Canada and a PhD (Functional Morphology) from the University of Pittsburgh, USA.
She is currently employed as an Associate Professor in the School of Biomedical Sciences at the University of Queensland, Australia where she contributes to the undergraduate and postgraduate Physiotherapy programmes. Her research is concerned with clinical anatomy of the musculoskeletal system, in particular the anatomy underlying common assessment and treatment techniques. In addition, she is interested in the fascicular architecture of muscles.
Augusto Gil Pascoal, Portugal - click to expand
Augusto Gil Pascoal PhD, PT is currently a teacher at the Technical University of Lisbon, Faculty of Human Kinetics (UTL-FMH) and a researcher at the Interdisciplinary Centre of Human Performance Studies (CIPER). He graduated in Physical Education and Sport Exercise from the UTL-FMH, and in Physiotherapy from the Alcoitão High School of Health (ESSA). In 1992 he completed an MSc, and in 2001, a PhD in Human Movement Sciences.
In the last few years he has collaborated with the Portuguese Physiotherapy Association on several post-graduate courses and workshops, regarding women’s health, on the topics of anatomy, kinesiology and basic research methodology.
His main area of interest and research is musculoskeletal functional assessment, particularly shoulder function and the scapulohumeral rhythm, using 3D kinematics, EMG and modelling approaches. Recently, he has been involved in a wider research project about the effect of biomechanical loading on the musculoskeletal system during pregnancy and the postpartum period, in particular the effectiveness of some common abdominal strengthening exercises on abdominal musculature morphology changes and on diastasis rectus abdominis prevention and resolution.
Talli Rosenbaum, Israel - click to expand
Talli Yehuda Rosenbaum is a private practice physiotherapist and certified sexuality counselor who graduated from Northwestern University in 1984 and is currently completing her Masters in Clinical Sociology and Counseling. Ms. Rosenbaum serves on the board of the International Society for the Study of Women's Sexual Health (ISSWSH) and currently chairs both the International Outreach and the Counselor Certification committees for the American Association of Sexual Educators, Counselors and Therapists (AASECT). She is on the board of the Women's Health Section of the Israeli hysiotherapy Society and is an Israeli delegate to the IOPTWH . She also serves on the Professional Advisory Board of several organizations including the Women's Sexual Health Foundation.
Ms. Rosenbaum has published several book chapters and many peer reviewed and invited journal articles on the topics of the role of the pelvic floor in sexual health, the role of physiotherapy in the treatment of pelvic pain and sexual pain disorders, the treatment of unconsummated marriage, and Judaism and sexuality. In addition to treating patients and couples, she lectures in the Sex Therapy program at Bar Ilan University and participates in the pelvic floor rehabilitation training program in Israel.
Britt Stuge, Norway - click to expand
Britt Stuge is currently a senior researcher at Ullevål University Hospital, Oslo, Norway. She has practised as a physiotherapist since 1982, completing an MSc in 2001 and a PhD in 2005. Britt has worked in clinical practice with women experiencing pregnancy-related pelvic girdle pain for nearly 20 years.
Amongst other published works she is co-author of the European guidelines for the diagnosis and treatment of pelvic girdle pain (2008) having been a member of the European Commission group exploring the subject. Britt has presented and led workshops on pregnancy-related pelvic girdle pain and stabilizing exercises internationally.
The presenters and planning committee reserve the option of changing the presenters
and order of presentations based on speaker needs and travel arrangements.
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| About the Workshop Leaders |
Eva Albuquerque, Portugal - click to expand
Eva has been a physical therapist since 1998, and has undertaken postgraduate study in hydrotherapy. She works in private clinical practice (manual therapy, women’s health, hydrotherapy and exercise) is a clinical instructor, and has been director of the Wellness Center do Hotel do Caracol since 2003. She is the creator of PNF-Chi.
Her workshop is entitled PNF-Chi: A global approach for a specific concern. There will be a short presentation followed by a practical session.
Tamsin Brooks, UK - click to expand
Tamsin is a women’s health specialist physiotherapist with a private practice in Derbyshire, United Kingdom. She has a special interest in pelvic girdle pain and pelvic floor dysfunction. She is a tutor on the Association of Chartered Physiotherapists in Women’s Health workshops on Pilates in Women’s Health and Antenatal Education, and is currently on the ACPWH working group developing a workshop on the musculoskeletal management of pelvic girdle pain. Tamsin has twice been awarded the ACPWH Anne Bird Prize for her involvement in women’s health physiotherapy in the UK.
Her workshop is entitled Clinical application of Pilates in Women’s Health.
"Pilates is an exercise technique widely used within physiotherapy practice, not without its controversy. It has many possible applications within women’s health. Provided the exercises are taught precisely and at the appropriate level it has good rehabilitation value. The links between women’s health physiotherapy, core stability and Pilates will be discussed. There will be a practical element to the workshop which will focus on prescribing Pilates exercises at the correct level, identifying harmful compensations and some useful teaching techniques".
Christine Van de Putte, Belgium - click to expand
Christine has had a special interest in women’s health and paediatrics since the start of her career as a physiotherapist. Thirty years ago she started her own private clinic in Bruges (Belgium) where she still lives and works. Giving birth to 4 children fuelled her interest in the field even more. She studied the relevant literature, acquired clinical experience, and started to give courses, being invited by midwifery schools and maternity units to teach and share her experience.
For many years she has taught on the postgraduate course at Ghent University, and given courses within the YVLO Institute in the Netherlands, and the CPDO Institute in London. With her Dutch colleagues she has also taught in the Algarve, Portugal and was invited by UNICEF to lead workshops in Kiev, Ukraine. She also teaches at the Centre for Advanced Postgraduate Education (CAPE) with hands on workshops in women’s health, including pre-and postnatal courses, baby massage and baby care, incontinence and pelvic girdle pain.
Her workshop will be on the Awareness of the Pelvic Floor and Pelvic Girdle during the Childbearing Year (including Dynamic Ultrasound Imaging). "We all recognise the importance of body awareness, in particular the pelvic region. My personal experience with the body ball made me realise what a useful tool it is within a pregnancy and childbirth programme; and mothers like it. The body ball can facilitate movement of the pelvis and the ability to "feel" their pelvic muscles. Good knowledge of the muscles in and around the pelvis gives the mother more confidence throughout the childbearing year and especially during labour. After delivery we again try to achieve a balance of tension and letting go - in the right place, and when necessary. A new tool to use is dynamic ultrasound imaging. This way we can have a direct look of the muscles, how she uses them and what happens inside when using them right (or wrong). It is amazing what an advantage this is!
Learning to tighten up and use the natural pelvic girdle again is necessary to regain the woman’s condition. A good post-natal re-education starts during pre-natal guidance. A controlled "strong" and "stable" pelvis forms the basis of everything that is expected of a woman and that she expects of herself"
Britt Stuge, Norway - click to expand
Britt Stuge is currently a senior researcher at Ullevål University Hospital, Oslo, Norway. She has practised as a physiotherapist since 1982, completing an MSc in 2001 and a PhD in 2005. Britt has worked in clinical practice with women experiencing pregnancy-related pelvic girdle pain for nearly 20 years. Amongst other published works she is co-author of the European guidelines for the diagnosis and treatment of pelvic girdle pain (2008) having been a member of the European Commission group exploring the subject. Britt has presented and led workshops on pregnancy-related pelvic girdle pain and stabilizing exercises internationally.
Her workshop is entitled What is an optimal treatment for pelvic girdle pain? and will relate to her presentations on the subject, on day 1 of the conference.
The presenters and planning committee reserve the option of changing the presenters
and order of presentations based on speaker needs and travel arrangements.
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| Course Schedule |
Day One: Friday, October 9, 2009 - click to expand
| 08:30 – 09:00 |
Registration |
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| 09:00 – 09:30 |
Welcome |
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Rebecca Stephenson (IOPTWH President), Gill Brook, Fátima Sancho |
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| 09:30 – 10:30 |
Anatomical and biomechanical evidence for the role of the pelvic floor
muscles as core stabilizers. |
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Associate Professor Susan Mercer, Physiotherapist, Queensland, Australia |
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Anatomical and biomechanical evidence for the role of the pelvic floor muscles as core stabilizers
The muscles of the pelvic floor include the levator ani and coccygeus. The levator ani is most commonly described as being comprised of the pubococcygeus (pubovisceralis), and iliococcygeus muscles or of the pubococcygeus, puborectalis and iliococcygeus muscles. Terminology can vary between authors and these muscles are typically depicted in diagrammatic form from a superior or inferior view, not with the pelvis in the erect standing position. Consequently it is difficult to appreciate the morphology of the pelvic floor musculature in situ. Furthermore there is a paucity of information regarding the fascicular architecture and force capabilities of the component muscles yet this information is crucial for the development of accurate clinical and biomechanical models. The coccygeus muscle has been reported to play an important role in sacroiliac joint stability (Richardson et al 2002; Pool-Goudzwaard et al 2004). Via a micro- and macro-anatomical study we have found that the coccygeus muscle and the sacrospinous ligament are co-extensive, primarily composed of fibrous tissue and cannot be considered as two separate structures (Wisemann, 2008). This coccygeus-sacrospinous ligament complex also comprises the posterior wall, not the floor of the pelvis being clearly delineated from the levator ani by bands of fatty connective tissue. Using data from MRI (which does not allow for tissue difference) the force capabilities of coccygeus have been reported between 8-43N. These anatomical findings highlight the dilemma when faced with reports that tension of the sacrospinous ligament aids in stability, yet contraction of the coccygeus muscle (opposite force) contributes to stability. The levator ani muscles are enclosed in sheets of dense fascia. Iliococcygeus is a very thin sheet of muscle interspersed with bands of fatty connective tissue. The muscle passes medially from the posterior obturator fascia to attach via a long aponeurosis to the annococcygeal raphe. The pubococcygeus is thicker and consists of a number of muscle bands. Fascicles pass posteriorly from the pubis to the rectum and posteromedially from the anterior oburator fascia to the annococcygeal raphe. The calculated force capabilities of the fascicles of the levator ani muscles do not support their proposed role as important core stabilizers. |
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| 10:30 – 11:00 |
Coffee Break |
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| 11:00 – 12:00 |
Evidence (or lack of it) to support the role of the pelvic floor muscles in low back pain |
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Professor Kari Bø, Physiotherapist & Exercise Scientist, Oslo, Norway |
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| Details coming soon! |
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| 12:00 – 13:00 |
The core and sexual dysfunction |
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Talli Rosenbaum, Physiotherapist and Sexuality Counsellor, Israel |
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The Core and Female Sexual Dysfunction.
Healthy sexual function requires physical, mental, and emotional well-being. Physical presentations that may limit sexual activity include decreased mobility, alterations in sensation, decreased genital circulation, and pain. Physical therapists play an important role in facilitating optimal sexual function by providing treatment to restore function, improve mobility, and relieve pain.
The core muscles play an important role in sexual function. However, while the sphincteric and supportive functions of the pelvic floor are fairly well understood, it is as yet not completely clear how the pelvic floor contributes to sexual function. It has been proposed that the pelvic floor muscles are active in female genital arousal and orgasm, and that pelvic floor muscle weakness may impact negatively on these phases of function. Pelvic floor hypertonus dysfunction is associated with painful intercourse, which negatively affects sexual function. Urogenital and anorectal conditions also negatively impact sex. Finally, core weakness is associated with musculoskeletal pain, which can restrict intercourse and limit sexual activity.
This presentation will discuss the above and data from the literature will be cited.
Relevant references:
Rosenbaum, TY Musculoskeletal Pain and Sexual Function in Women. J Sex Med (In Press)
Rosenbaum, T., The Role of Physical Therapy in Female Sexual Dysfunction. Current Sexual Health Reports 2008, 5:97-101.
Rosenbaum, T. Owens, A The Role of Pelvic Floor Physical Therapy in the Treatment of Pelvic and Genital Pain Related Sexual Dysfunction. J Sex Med 2008;5:513–523
Rosenbaum TY, Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: A literature review. J Sex Med 2007;4:4-13.
Rosenbaum, TY, The role of physiotherapy in sexual health: Is it evidence based? Journal of the Association of Chartered Physiotherapists in Women’s Health Autumn 2006 pp. 58-71 |
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| 13:00 – 14:00 |
Lunch |
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| 14:00 – 15:00 |
Anatomical and biomechanical evidence to support the role of transversus abdominis as a core stabilizer. |
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Associate Professor Susan Mercer, Physiotherapist, Queensland, Australia |
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Anatomical and biomechanical evidence to support the role of transversus abdominus as a core stabilizer. It has been reported that transversus abdominus has a major effect on lumbopelvic stability due to its direct attachment to the lumbar spine, and via its ability to develop tension in the thoracolumbar fascia, and compression of the sacroiliac joint. But has convincing anatomical evidence been supplied to underpin the anatomical and biomechanical models that are advanced as evidence for transversus abdominus being a core stabiliser? Recent anatomical studies of the transversus abdominus found it to consist of a series of fascicles with posterior attachments to either the costal cartilages, the lateral raphe of the thoraco-lumbar fascia, the iliac crest, or to the inguinal ligament. Anteriorly, its aponeurosis contributed to the rectus sheath and inguinal ligament. Anatomical reports indicate that in about 25% of cadavers transversus abdominus is not present below the ASIS while the short lower fibres, when present, arch inferiorly and have very low force capabilities. Our findings also demonstrate that the lower iliac fibres of both transversus abdominus and internal oblique have a similar fibre orientation and that imaging is complicated by the presence of the accessory internal oblique muscle fascicles. Transversus abdominus does not attach directly to the lumbar spine and only a very small portion of muscle tissue passes between the lateral raphe or ilia and the structurally complex rectus sheath. Such morphology casts doubt on the concept of direct force transmission from transversus abdominus to the lumbar vertebrae. On the basis of its morphology transversus abdominus cannot, as proposed, directly control the lumbar vertebrae. The mechanical effect of transversus abdominus on structures of the lumbopelvic region is complicated by its attachment to the lateral raphe and the rectus sheath which themselves are constrained through other attachments. Furthermore only an exceedingly small portion of transversus abdominus could contribute to the development of tension in the thoracolumbar fascia or compress the sacroiliac joint and so contribute to core stability. |
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| 15:00 – 16:00 |
Pelvic floor muscle exercises in the management of prolapse. |
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Professor Kari Bø, Physiotherapist & Exercise Scientist, Oslo, Norway |
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| Details coming soon! |
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| 16:00 – 18:00 |
Women’s health physiotherapy around the world. |
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Reports from IOPTWH member countries |
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| 18:00 |
Promenade on the beach |
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| 19:30 |
Conference dinner |
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Day Two: Saturday, October 10, 2009 - click to expand
| 09:00 – 10:00 |
Stabilizing exercises for pregnancy-related pelvic girdle pain. |
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Dr Britt Stuge, Senior Researcher and Physiotherapist, Oslo, Norway |
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The European guidelines on the diagnosis and treatment of pelvic girdle pain (PGP). The aim of the guidelines was to increase consistency in the management of non-specific LBP across countries in Europe. Further to provide a set of recommendations that can support future national and international guidelines and lead to prevention of long-term complications, reduction of pain and disability.
A definition of PGP was proposed: PGP generally arises in relation to pregnancy, trauma, arthritis and osteoarthritis. Pain is experienced between the posterior iliac crest and the gluteal fold, particularly in the vincinity of the SIJ. The pain may radiate in the posterior thigh and can also occur in conjunction with/or separately in the symphysis. The endurance capasity for standing, walking, and sitting is dimished. The diagnosis can be reached after exclusion of lumbar causes. The pain or functional disturbances in relation to PGP must be reproducible by specific clinical tests.
Clinical questions such as; What is the most optimal diagnostic process for patients with PGP? What is the most effective treatment for reducing pain and improving disability in patients with PGP?, were raised. Strength of evidence for the recommendations was graded. Recommended treatment: Give adequate information and reassurance of the patients. Individualized exercises for pregnant women. Individualized multifactorial treatment for other patients. Medication (excluding pregnant), if necessary, for pain relief.
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| 10:00 – 10:30 |
The European guidelines on the diagnosis and treatment of pelvic girdle pain |
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Dr Britt Stuge, Senior Researcher and Physiotherapist, Oslo, Norway |
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Stabilizing exercises for pregnancy-related pelvic girdle pain.
Pain in the lumbo-pelvic area is a widespread problem of pregnancy. About 50% of pregnant women suffer from low back pain (LBP) or pelvic girdle pain (PGP) during pregnancy. PGP is stated to be an identifiable form of LBP that can occur separately or in conjunction with LBP. The prevalence of PGP during pregnancy is 20%. Most women recover after delivery, especially in the first month after delivery; however studies indicate that about 7% still suffer from PGP postpartum. Suggestions to help manage the women’s pain and disability are varied and include different kind of treatment regimes, exercises being one of them. The question is on what evidence are the treatments and exercises based? Few randomised controlled trials have examined the effect of exercises for PGP. The methodological quality of the studies for pregnant women tended to be rather poor with potential for bias in the results. Those who participated in an exercise program in addition to their prenatal usual care, regardless of the treatment program, reported less intense pain than those who received usual care alone. However, one cannot rule out a possible placebo effect in studies that looked at usual prenatal care (no treatment) versus active participation in exercise programs. The studies examining postpartum LBP and/or PGP showed high methodological quality. However, only one study demonstrated statistically and clinically significant positive and long-lasting effects. The treatment program studied focused on exercises for motor control and stability of the pelvic girdle. Good methodological quality of a study is important so the results can be relied upon. The quality of the interventions studied is another important aspect to consider when evaluating the results of an effect study. Many questions are then to be raised. How to exercise with PGP? Is stabilizing exercises the answer? Are there any exercises and movements women with PGP should avoid? Why did the study by Stuge and co-workers show long-lasting effects of 11 individual treatments and exercising for 20 weeks? |
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| 10:30 - 11:00 |
Coffee |
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| 11:00 – 12:00 |
The effect of abdominal work in diastasis of rectus abdominis |
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Dr Gil Pascoal, Lecturer in Physiotherapy, Lisbon, Portugal |
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| Details coming soon! |
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| 12:00 – 13:30 |
Lunch |
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| 13:30 – 16:00 |
Concurrent workshops |
- Stabilizing exercises for PGP
- Pilates in women’s health
- PNF Chi
- Awareness of the PFM and pelvic girdle in pregnancy
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| 16:00 – 17:00 |
IOPTWH - the way forward |
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| 17:00 |
Close of conference |
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| Conference Site |
Centro de apoio social de Oeiras
(Social support center of Oeiras)
Rua Infanta D. Isabel
2780-064 Oeiras
Lisbon, Portugal |
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| In 1995 this social complex was created for army personnel and their families, especially devoted to care of the elderly, catering for their health, social and recreational needs. Within the complex is a hospital, apartments for the elderly and a facility for 180 participants, where we shall be holding our conference |
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| Suggested Accommodations |
Hotel Riviera – Carcavelos
Rua Bartolomeu Dias - Junqueiro, 2775-551 Carcavelos
The Hotel Riviera is situated in a privileged area very close to Carcavelos Beach - considered to be the best of the various beaches in the area - and centrally located in relation both to Lisbon city and other places of great historic interest such as Cascais and Sintra.
A prestigious hotel, whose opening marks a new era of modern tourism, built in a privileged area, close to the magnificent Carcavelos Beach, on the Estoril Coast, 5 km from Cascais and 20 km from Lisbon.
Prices per room, per night, including breakfast
The Hotel Riviera is a short taxi drive (approximately 45 minutes walk) from the conference venue.
Inatel Oeiras
Alto da Barra – Est. Marginal, 2780-267 Oeiras
- The hotel comprises 138 apartments, each with a bathroom, central heating, telephone, television and parking for one car.
- Two bars with panoramic views and esplanade
- Restaurant with panoramic views
- Seminar and conference rooms
- Private carpark
- Swimming pool
.Prices per room, per night, including breakfast
- Tourist rooms €46 For one or two people
Rooms can accommodate up to four people, at an additional cost of €12 per person per night.
- Superior rooms €56 For one or two people
Rooms can accommodate up to four people, at an additional cost of €12 per person per night.
The Inatel is approximately 10 minutes walk from the conference venue.
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| Area Attractions |
- Interested attendees can find further information about our venue at these tourism websites:
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| Conference Registration |
All attendees must register via the website.
Rates increases go in effect after July 14th, 2009
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