In this photo we are using proprioceptive neuromuscular facilitation to encourage improved core muscle recruitment and strength. Having the patient use gross motor movements utilized in rolling on her weaker side will work her core muscles. It is ideal to give the bladder a lot of support by strengthening the diaphragm, multifidis, pelvic floor muscles, and lower abdominals (otherwise known as the canister muscles). ADEM is acute disseminated encephalomyelitis and is characterized by a brief widespread attack of inflammation in the brain and spinal cord that damages the myelin of nerves. Our patient is still trying to gain more strength since the onset of ADEM eight years ago. She came to us from India for intensive care for pelvic floor rehab due to residual urinary incontinence and pelvic floor dyssynergia/anismus with constipation. Her case is complex and she will be returning to us for another intensive later this year.