Courses

Jennifer Smart, DPT, PRC is the headliner for our 12th Annual Interdisciplinary Integration Symposium. This symposium topic came together as a result of the extraordinary work she has been doing with those managing Parkinson’s Disease in her community, and the engaging discussions she has had with Ron over the past couple years. Jen is a clinician at heart, but also one who is current with the research and medical advancements that have been made for those experiencing extrapyramidal symptoms.

Her growing interest in Parkinson’s Disease began around 2015 when her best friend was diagnosed. This was the year she completed the PRC credentialing program, and shortly after neurologist, Dr. Jay Alberts, published research showing how, when a person with PD rides on the back of a tandem that is being pedaled at a cadence of 80-90 RPM, a variety of their PD symptoms decrease. After dissecting the research, Jen bought a tandem bike, and her and her friend rode for over an hour 3 times a week at the specified cadence. Others with PD heard what they were doing, and she ended up getting several tandem bikes and set them up on stationary trainers at a local gym, where she coordinated having members of the local cycling community ride on the front to set the cadence while people with PD rode on the back. “Park’n Ride” was officially started as a non-profit in January 2015.

Based on the success of this cycling program, Jen has become a regional expert on Parkinson’s Disease, where individuals have moved to her small coastal town of Oriental, North Carolina after their diagnosis. She became certified in LSVT BIG, Parkinson’s Wellness and Recovery (PWR!) and Rock Steady Boxing, which are all evidence-based, Parkinson’s-specific programs. Jen has attended the Parkinson’s World Congress and has even volunteered for a week with Becky Farley, PT, PhD who developed LSVT BIG and PWR. In 2017, Jen received a grant from the National Parkinson’s Foundation to organize and run a two-day event, called the Parkinson’s Exercise Program (PEP) Retreat, which was designed to help both patients and medical providers better understand how to use exercise as an evidence-based treatment for PD.

In her own words, “What I have taken away from all of this training, from working extensively with this population, and from the currently exploding literature regarding the benefits of specific exercise programs for PD, is that, perhaps unknowingly, the components that make each of these treatment techniques so effective, are the components that are based on the science of PRI. People with PD, just like all of us, need to be able to rhythmically alternate, but their disease, or somewhere along their journey towards developing this disease, this ability to rhythmically alternate was compromised so they needed to develop involuntary tics, muscle spasms, tremors, restless legs, dystonia and/or postural changes to help them to get to the other side, to help them to alternate. This is now the message that I am trying to get across in both the prevention and treatment of Parkinson’s, and so many other, syndromes or diseases.”

Ron had the opportunity to spend a couple days with Jen in her hometown a few months ago, and had this to say about his experience, “Jennifer is probably one of the most, if not the most respected, individuals in this community. Everyone who lives there knows how much she cares about humanity in general, and how much she dedicates herself to each individual specific needs and limitations. Her compassion, her wealth of knowledge on Parkinson’s Disease, her multi-level of experience, and her successful outcomes are immediately recognized by anyone who observes her classes, talks to her patients or witnesses the respect wherever she goes in this community. I am humbled by all of this and my admiration for her selflessness is unsurpassed.”

Read more about Jen’s upcoming presentations at our 12th Annual Interdisciplinary Integration below:

An Overview of the Science of Movement Disorders as They Relate to Sensory Input and Autonomic-Driven Postural Compensations
This presentation will review various types of movement disorders, examining their association with each other and with other non-motor symptoms, which may appear independently or as prodromal symptoms for various movement disorder syndromes, such as Parkinson’s disease. Current theories as to the causes of movement disorders will be explored, including evidence supporting basal ganglia oscillatory dysfunction, how and why this dysfunction may occur and techniques that are being employed to influence it, including pharmacological, surgical (especially the use of deep brain and/or implanted spinal stimulation) and physical activity interventions. Emphasis will be placed on the evidence supporting how intrinsic oscillations are being altered by afferent stimulation.

Afferentation Techniques and How to Clinically Incorporate Them into the Treatment of Movement Disorders
This presentation will be more clinically applicable, providing information about the current, evidence-based programs that are being used for people with Movement Disorders, examining their common effective elements regarding the movements involved in the activity, the dosage (time and intensity) of the activity, and the auditory, visual and tactile cues that are being used during the activity.  Emphasis will be placed on using specific afferentation techniques during these activities in order to alter the need to use pathological postural compensations, or movement disorders, to create a sense of stability and/or a method of mobility.  

A Review of Perspective and Progression Influences on Treatment and Management of Patients with Parkinson’s Disease
In this presentation, Jennifer Smart and Ron Hruska will discuss treatment and management of patients with Parkinson’s Disease and review several cases in which they have had the opportunity to collaborate together. Management discussion will include group exercise application, in addition to individual rehabilitation considerations.

Posted March 5, 2020 at 5:33PM
Categories: Courses

If there are three bones that have always had an impact on my course of study as related to respiration, airway, occlusion, oral function, head and neck position, speech, vocal cord dysfunction, tongue compensation, nasal flow, autonomics in general, auditory sense and the soft and hard palates, it is the temporal and occipital bones. Three very important nerves go through the most infamous foramen of mankind, the Internal Jugular Foramen (IJF). When the lumen or congruence of this foremen is challenged our bodies know it. Cranial mal-position and underlying associated predictable human torsional constraint increases the need for compensation and  work around this malpositioned set of paired bones, on an accompanying occiput bone that orients and houses the medulla and brain stem in off-centered state of un-rest. This positional state of unrest feeds neurologic information to our mid brain and associated cortices that are directly associated with my course of study, outlined above.   

Re-orientation of these two paired IJFs can have a major impact on ANS, SoNS and CNS function and behavior, secondary to the compression or lack of compression on these three nerves. The glossopharyngeal nerve innervates the stylopharyngeus muscles, the vagus nerve innervates the levator veli palatini, the salingopharyngeus, the palatoglossus, the palatopharyngeus, and the pharyngeal constrictor muscles, and the accessory nerve innervates the trapezius and the sternocleidomastoid muscles. I will not go over these three nerves sensory innervation, but these nerves are instrumental in how we physically, physiologically and psychologically behave and operate. Cranial mal-guidance provided by the calvaria, temporal and occiput bones and their associated torsional patterns of function can be resolved through PRI based sacral cranial repositioning and through PRI based thoracic cranial resolution, that incorporates cranial oscillatory alternation. Having the opportunity to outline and teach the reasoning behind these PRI techniques and considerations, offered by this unique course, through the involvement of the sinus cavities, the palatine bones, and the pharynx, is as fulfilling for me as any course I have ever written, designed or taught.

 

I would like to thank Amy Goddard PT, DPT, OCS, CSC, PRC and her staff, once again, for hosting another PRI course at her expansive and accommodating facility. Gail Kaiser PT, OCS, thank you for your willingness to participate in my demonstration autonomic orthotics. And Stephanie Irizarry Pt, CLT-LANA, PRC your presence is always welcomed because of your love for Pantone 269 C (purple), your predictable body performance through autonomic filtering, and your on-going smile. Jennifer Bullock PT, DPT, OCS, PRC your input, discussion and feedback was so invaluable. I honestly believe, this is ‘your course’ if there ever was one offered by PRI. I truly love everything you stand for and represent.  

    

Posted March 4, 2020 at 10:08PM

PRI nation, it’s good to be back!  

I returned this week from my first opportunity to visit the great state of Louisiana.  What a fantastic welcome this instructor received!  I had the pleasure of introducing nearly the entire class to the science of Pelvis Restoration thanks to the host and hostess Chris and Karlie McDougall at Renew Physical Therapy. Chris, Karlie and the whole team at Renew were kind and gracious, and provided King Cake, and other local delicacies…and I got the baby, so I’ll be back!  

The course involved great conversation and discussion about the theory, science and specifics of inhibiting, facilitating and integrating alternating function of a pelvis into our neuromechanical system. Thank you to PRC, Kyle Babin for your time and energy serving as the lab assistant during our many lab breakouts, you were excellent! This instructor enjoyed the discussion of how to implement PRI objective tests into a comprehensive triplanar picture of the position and tendency of a pelvis as part of the individual human system we assess. Many thanks to Payton Spell, Shaun Lopez, Jessica Lamothe, Lonnie Arroyo, David Giardina (even in the short time!) and more for your help with lab demonstrations and observation of objective tests and treatment techniques.

 

This group had an exceptional array of patterned movement strategies that made this an enjoyable cross-section overview of the greater population and a great venue for learning first hand. I did my part to eat Covington out of Gumbo and I very much appreciated being welcomed to enjoy an evening with the McDougall family for my very first Marti Gras parade. What an enjoyable spectacle!

Thank you again, my fine Louisiana friends, for an enjoyable learning experience in The Bayou, my best to each of you!

Posted February 26, 2020 at 5:29PM
Categories: Courses Clinicians Science

 PRI Integration for Pilates kicked off first course of 2020 at its home base at Pilates Central in Wilmette, IL with fantastic group of Pilates teachers, PT’s, massage therapists, a chiropractor and other fitness professionals. We started the day with introductions and then introduced PRI and Pilates principles. There so many commonalities with Postural Restoration and Pilates, especially that Joseph Pilates and Ron Hruska were both 50 years ahead of their time.

Sarah Petrich introduced the concepts of ZOA and the asymmetrical human body and soon we were all fully exhaling to inflate purple balloons. Day one morning ended with a mat and breathing lab.

I then introduced the supine reformer gait integration assessment test followed by lab so everyone had a chance to observe and experience the tests. Sarah got us all dancing the hula and salsa to illustrate triplanar motion.

Followed by a conversation in which I covered quadruped abdominal assessment and the sidelying stance tests which drive the programming labs. Speaking of driving, Sarah taught us all how to get in the left lane and make legal right turns while discussing lateralized gait. Attendees practiced hand and foot references to “layer “ on to the “choreography “.

So many wonderful attendees to mention: shout out to Chad Moreau, PRC and Whitney from Southern California for braving the Chicago winter; Wanda, who works with wounded warriors in Atlanta and Beth from Houston. Honored that Donna Olivero PT PRC was there to learn how to incorporate more Pilates into her chronic pain practice, especially because she completes the trio of Donna’s in the PRC class of 2012. Thank you to Stephanie (her 3rd PRI Pilates course!) Holly, Petra and Amanda from corepilates Chicago who have embraced PRI Pilates at their studio. Last but not least thank you to my wonderful instructors , Elizabeth, Charmaine, Deb, and Laura for their help in lab, for asking great questions and for help getting the studio back together for Monday morning Pilates.

“Thanks for hosting such a wonderful class! It gave me so much inspiration to continue down the PRI path and incorporate more Pilates into my practice”  -Karolyn

Posted February 24, 2020 at 10:29PM
Categories: Courses Techniques Science

Pasadena Physical Therapy was the location of last weekend's Cervical Revolution. Locatelli Rao, P.T. hosted this course and it is always a pleasure to share time and knowledge with "Loc" on this PRI journey. I first met Loc two years ago in L.A. when I taught Postural Respiration and the questions he was asking then and now are some of the best. What is really gratifying is when a student can take a complex subject, like Cervical Rev, and break it down into component parts to provide a simple, sequential and detailed description of the concepts of the course. This has been a goal in Cervical Revolution to have students take a course and "get" the primary concepts with motivation to go back into the course manual and absorb more completely the material. Application on Monday morning means just getting the most important concepts, start to practice examinations of the cervical spine/neck, know the basics of what they mean and then experiment and provide PRI techniques! Yes PRI courses make our brains hurt a little as most students will attest while their enthusiasm for more expands with their craniums! One of the most powerful PRI techniques and taught in this course is the Active Left Lateral Pterygoid in Protrusion. After testing a student in lab with bi-lateral positive findings, this technique with just a few breathes demonstrated how powerful inhibiting a Right TMCC can be with a left lateral pterygoid. Not only was the R TMCC inhibited, but so were the BC and AIC chains bilaterally.

PRI Cervical Revolution Course - Skip George

PRI Cervical Revolution - Skip George
Follow up recommendations included Standing Cervical Cranial Repositioning with a Supine Active Sacro-Spheno Flexion which were demonstrated in lab with other students all producing immediate neutrality.  A manual technique was provided on another student in lab called the Frontal Occipital Hold who was also bilaterally positive in testing. After this technique, he was neutral upon testing. That was astounding to all, especially this instructor! This course is really about autonomics and reflexive oscillatory function of a neck that has to be free to turn. Cervical Revolution is so fun to teach because of the power in it's application just like all the courses in PRI. Big Shout Out to Chad Moreau, D.C., CCSP, PRC for being our lab assistant again. Your support and presence always brings a positive force to the room. Thanks again Loc for you support, questions, restates, hosting and always expanding your knowledge. 

 

Posted February 18, 2020 at 5:28PM

Dominant cortical behavior and function as related to human bias and behavior has always been a strong interest, and passion of mine. In 2007 I wrote and compiled a course entitled ‘Impingement and Instability’ to begin a journey with those who have interest in the gifts of contact and oscillation. Four tabs were selected based on their importance in corporeal-sense, hemispheric influence, and biased lateralized behavior. Interaction of calcaneus, femur, hip/pelvis, and scapula anatomy through our extrapyramidal system is critical for reflexes, forward locomotor motion, complex dominant driven function and postural control. This has always been an ‘extrapyramidal’ based course. However, after thirteen years of presentation, I feel the Institute is at a great place to incorporate the significance of pressure, pronation, and push as it relates to these sites of interactive referenced modulated motor activity.

 

The extent of our creativity and capriciousness depends on both our soul and the soles we use to develop behavioral patterns associated with confidence built off of integrating contralateral, hemispheric and bio-tensegrity input. I was so excited this last weekend to discuss how we are regulated by self-regulating pressure of the scapula to capitalize on our ability to perform with things that push, propel and please us. The ground developed, directed and designed our anatomical behavior, while the earth’s gravity gave us the security to defend, offend and create without loss of life. This updated course has not really taken on a new course of direction, but definitely will take those, who attend, into dimensions never before looked at or addressed in the manner they are now presented and applied, with evidence that was not considered when addressing the reasoning for symptomology related to feet and hand haptics.

   

The re-assurance from the wonderful feedback I received after this course, re-assured me that the PRI nation is ready for the importance of variable femoral and scapula instability, and associated counterpart contralateral stability, as related to the metric embracement of calcaneal and pelvis impingement that directs and orchestrates the possible disharmony and dysfunction associated with pre-patterned forward locomotor movement. Thank you One on One Physical Therapy for hosting another PRI course. You all were so gracious with your time, support and assistance. Karen Warren PT, MPT, OCS, ATC the coffee was great from both cups, even when you lifted the left hand with the cup in it and your body’s mass moved to the right, (LAIC, RBC coffee). Dan Houglum MSPT, ATC/L, PRC, Jennifer Smart DPT,PRC and Michael DuBois DPT, OCS, TDN, CS USPHS/HIS provided so much insight and instructional feedback, thank you.

Posted February 12, 2020 at 2:44PM
Categories: Courses Clinicians Science

This is absolutely one of most gratifying courses I get to give twice a year. I truly could engage into this type of instructional endeavor every week. So much fun. And so gratifying to read the comments after each course and how much it meant to both the attendee that has taken a number of PRI courses prior to attending and those that are starting out on the PRI journey.

Ron Hruska, PRI Non-Manual Technique Workshop

For a quick review, I am given techniques that were selected by these attendees; and then I summarize who the techniques were designed for at the time I initially clinically used them and applied them to. Obviously this reasoning of application is limited and incomplete, but it gives those in the room opportunity to learn what I was thinking at the time each selected technique was clinically designed. This explanation allows me the opportunity to engage on how each technique is presently viewed by me and incorporated into my integrative mind set and practice, because of the many years of application and outcome assessment. Some of these techniques I have been using over 30 years. Clinical concepts as they relate to things that the clinician should consider, be mindful of, and cautiously move through for optimal outcome and patient acceptance, appreciation and apprehensive containment, are outlined whenever possible. Much of this discussion is generated by real time through class participation and input. This is the most interactive PRI course available, because of the availability of the founder’s mindset and the time spent on each step and the integrative mindful purpose of each individual step.

PRI Non-Manual Techniques Workshop

Additional considerations that I offer, enhances the existential experience and reasoning. This dialogue not only focuses on the technique’s interdimensional outcome, but allows the room of attendees to watch, listen and experience these relationships first hand. This is what I absolutely enjoy the most. To listen to the feedback the attendee gives, describes and relates to after the processed feedforward sense is felt, cortically incorporated and functionally measured, is so humbling and consistently rewarding for both the avatar on stage, i.e. the person who is performing the technique he or she selected, and the engaged viewers. 

PRI Non-Manual Techniques Workshop

Each of the 13 techniques that were dissected in this manner, offered positional, selection, reference, referent, and respiratory considerations for neuro-cognitive repeatable results. Quite honestly, the time preparing for these two days and its unique material, after Jen gave me each separate techniques that were requested by this particular course’s attendees, was as enjoyable as the actual class time. This time spent on outlining key concepts, application, steps, integrative sense, and desired outcomes, acknowledges my historical perspective and strengthens this Institute’s future application of such needed integrated and desired processing. I look forward to any and all of the future Non-Manual days ahead of me, and hope you will consider the possibilities you personally will experience, if you accept this invitation to participate with me. Thank you!

PRI Non-Manual Techniques Workshop

PRI Non-Manual Techniques Workshop

PRI Non-Manual Techniqeus Workshop

Posted February 6, 2020 at 9:54PM
Categories: Courses Techniques Science

“This course was mind blowing!”
“This was my third of the basic PRI courses. This really helped to bring all the information together.”
 “Before working on shoulders, I now know I need to retrain the diaphragm and restore rib position.”

Attendees came from far and wide to the most recent Postural Respiration course, held at Body Dynamics in Falls Church, VA.  Nicholas Clark, PhD, PT, hails from London, where he recently stumbled across the science of PRI on YouTube.  “After trying a couple of the PRI exercises, my arm numbness, that I had been dealing with for many months, resolved.” That experience convinced him he needed to learn more.   

Half of the attendees were brand new to PRI, their eyes opened to a new and different perspective on human movement and behavior.  The clinicians at Body Dynamics (Lisa Clarkson, PT; Jennifer Gamboa, PT; Deborah Gilpin, PT, ATC; Gwynn Hegyi, LMT; Kathryn Sparks, LMT; Ashley Templer, PT; and Jorge Villalobos, PT) hosted Myokinematics a year ago, and they were ready to deepen their PRI knowledge.  Many Myokinematics concepts were presented and reviewed, most importantly the left anterior interior chain of muscles’ influence on pelvic-femoral dynamics and a person’s ability to shift their center of mass fully and effectively to the left.  Once the body’s foundation was established, we moved up to the thorax and assessed its ability to function in three dimensions.  

Discussion began with our body’s normal, typical asymmetries which create lateralization to the right.  Countering this lateralized state begins with establishing a zone of apposition of the left hemi-diaphragm, which allows us to deflate a left chest wall, giving us a sense of weight on the left, and inflate a right chest wall to enable rotation of the thorax.  When people engage in occupations and sports that require repetitive movements (think lawyers, dentists, musicians, runners, and baseball players -- the list goes on), the ZOA becomes compromised, leading to the postural maladies that we clinicians witness every day:  hyperinflation, forward head posture, concave chests, scoliosis, winging scapulas, and thoracic flat backs.

Ample time was spent in lab to experience PRI’s non-manual and manual techniques.  Attendees learned concepts such as sensing rib expansion, biasing air flow patterns, sensing reference centers to re-direct the nervous system to new strategies of movement and perception of stability, and guiding a patient through a logical progression, from supine 90-90 positions to upright, rotational performance called gait.

Our labs were enhanced by our attendee-models:  Grace Ball, Pilates trainer; Scott Birch, PT; Nicholas; Bethany Middleton, PTA; and Keith Zrinyi, DC.  Thank you to all of you!

It was awesome to have Sarah Ratti, PT, PRC, in attendance, who brought her colleagues from Bon Secours in Richmond.  Tom Van Ornum, PT, also introduced his colleagues from M.O.S.T. to the science of PRI.  A huge thank you goes out to Karen Soiles, PT, PRC.  Karen is highly experienced and knowledgeable in the science of PRI, and she provided helpful guidance, clarity, and context throughout the weekend.  

Posted January 31, 2020 at 10:31PM
Categories: Clinicians Courses Science

Kelsie Giles, PTA, and her team at Elite Physical Therapy (Michael Brown, PT, Kara Patterson, PTA, Luke Rowan, PT, and Matthew Thomas, PT), hosted Postural Respiration, the first-ever PRI course held in Mississippi!
Attendees grasped key concepts, including what is the ZOA, how do we establish it on the left, how does it change pathological patterned air flow, and what areas of the thorax need to expand to achieve alternating, reciprocal movement when we move?  How does hyperinflation restrict our movement from side to side?  How does blowing up a balloon change pelvic orientation, rib mechanics, and scapular position?  How does the right lower trap and tricep help us feel the ground under our left foot?  Why would Jimmy Kimmel benefit from a PRI program?


The course cites multiple research articles and includes numerous photos of typical humans with typical jobs and hobbies to illustrate how patterned breathing, from patterned position, stemming from the natural, normal asymmetries within us all, feed patterns of muscle over-activity. These patterns become entrained in our nervous system and underlie and explain the onset of neuro-musculoskeletal pathologies. Thank you to our models, Kelsie and Michael for helping the class better understand the superior T4 syndrome – what it looks like and how to address it.  Our other models, Kaitlyn Keyser, TP, Kara, Herb Reinhard, ATC, Luke, and Nathan Yost, ATC, were game to take on some challenging non-manual techniques.  There were lots of good questions to clarify concepts, most notably from Micheal Brown and Donna Rush, PT.  Jason Reeves, PT – your oratory skills were much appreciated as we guided our models through non-manual techniques.


Thank you to the entire group for a wonderful weekend.  Your southern hospitality was a treat for this Marylander!

Posted January 24, 2020 at 5:28PM

The New Year for PRI was kicked off with the first Cervical Revolution course hosted by Advance Physical Therapy January 18-19th. This host site is a Postural Restoration Center with some of the most experienced and professional clinicians I have ever met. Their experience and  knowledge of PRI, Schroth Method for Scoliosis, pediatrics and working with dental professionals for occlusal reference is truly interdisciplinary and artful in approach.

Cervical Revolution has  had a lot of "evolution" this past year with a refined, step-by-step description of atlas on occipital bone position that is clear cut and more easy to understand in the Right vs. Left TMCC. This weekend students learned to appreciate and understand what seems to be at first the challenging subtleties of atlas on occipital function. Visualizing how "A" on "O" drives the sphenoid and how the sphenoid positions temporal bones and ultimately the jaw for a tri-planer picture of how the neck, cranium and TMJ complex affects the entire postural system seems daunting to everyone at first. In this course, autonomics is a prime focus as the neck is the neurologic appendage that drives the rest of the body.


This high level PRI group of practitioners was engaged from the first minute on Saturday to the last minute on Sunday actively asking questions, contributing to the professional dialogue and just working really hard to take in the detailed insights of an advanced PRI course. And then, be enthusiastic about how to apply the basic concepts of this course on Monday morning. This weekend there was a strong emphasis on the basics with a straight forward path to application of course principles.

This was a dream course for any faculty member with this kind of energy and participation from students. What made this course rewarding for me was the staff at Advance Physical Therapy. It was such a comfort to be with physical therapists and PRC's Lisa Mangino, Jean Masse, Joe Belding, Susan Henning, Josh Olinick from STEPS for Recovery, Sangini Rane and of course Jennifer Smart in attendance. Jennifer Smart will be presenting at the next Interdisciplinary Symposium in April and her presentation is not to be missed! In addition, this group of veteran PRC's offered clinical discussion and were all lab assistants in one way or another to lighten the load for the entire class and elevate everyone's experience. Shout out to Angela Ellis, DDS who works with Advance Physical Therapy. She is a dentist and was a first time attendee to a PRI course and she could not have been more delightful and engaged! Thank you again Advance Physical Therapy for hosting Cervical Revolution and supporting PRI.

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