Universitat Internacional de Catalunya
Specific Methods of Intervention in Cardiorespiratory and Vascular Physiotherapy
Other languages of instruction: Catalan
Teaching staff
Theoretical Block:
María Antonia Ramon, PhD
maramon@uic.es
Practical Block:
Marta Amor, PhD
mamor@uic.es
Mr. Raúl Carrión
rcarrion@uic.es
Introduction
The cardio-respiratory physical therapy is a discipline that uses physical techniques, based on knowledge of respiratory pathophysiology, in order to prevent, cure or stabilize disorders affecting thoraco-pulmonary system.
The course is divided into two blocks, a theoretical one and a practical one. The theoretical block is dedicated to the various theoretical aspects of cardio-respiratory physiotherapy. The practical block consists of a cardio-respiratory evaluation seminar.
Theoretical block: Cardio-respiratory Physiotherapy
This block is intended to facilitate the student to acquire the knowledge necessary to face the physical therapy of major cardio-respiratory diseases.
It is therefore essential the knowledge of anatomy, biomechanics and physiology of the respiratory system, that will make possible to understand how certain diseases may disrupt the normal functioning of this system. The most important aspects will also be addressed for a complete evaluation (clinical, physical and functional) of cardio-respiratory patients and will teach the student to interpret the results from these evaluations. The physiological properties of the main techniques of respiratory physiotherapy will be examined. The student will be introduced into effort retraining of the patient. Finally, the major cardio-respiratory diseases suitable to physiotherapy treatment will be reviewed. This block is closely related to the cardio-respiratory evaluation seminar and "physiotherapy matter applied to respiratory dysfunction".
Practical Block: Cardio-respiratory evaluation Seminar
The practical part of the course is intended to train students in the evaluation of patients with cardio-respiratory disease. Students will study and work on practical aspects of topographic anatomy of the chest, physical examination in respiratory therapy (with special emphasis on lung auscultation) and functional evaluation of cardiorespiratory patient.. The acquisition of this knowledge will guide the diagnosis in physiotherapy and thereby define the objectives of our treatment. This block is closely related to the theoretical part of the course and with the subject of physical therapy for respiratory dysfunctions, in which the main techniques of respiratory physiotherapy will be reviewed in a practical way.
Pre-course requirements
Not specified
Objectives
- Knowing the anatomy, biomechanics and the most important physical properties of the respiratory system; all of it is necessary to perform a good intervention in cardio-respiratory physiotherapy.
- Knowing the consequences that can produce physiological and structural changes caused by various respiratory diseases in the proper functioning of the respiratory system.
- Knowing the basic self-defense mechanisms that the respiratory system has.
- Acquire a complete training to carry out a comprehensive evaluation of patients with cardio-respiratory disease, which will enable the formulation of therapeutic goals.
- Knowing how to interpret the results of the main tests of cardiorespiratory functional evaluation.
- Knowing the characteristics and clinical symptoms of major cardio-respiratory diseases.
- Knowing the theoretical basis and physiological properties on which the main respiratory physiotherapy techniques, both manual and instrumental, are based.
- Knowing the scientific evidence supporting or otherwise disapproving the use of certain techniques for physiotherapy treatment of diseases of the cardio-respiratory system. Get a basic training of the most important aspects of infant respiratory physiotherapy.
Competences/Learning outcomes of the degree programme
- 01 - The ability to analysis and synthesis.
- 02 - The ability to organise and synthesize
- 05 - The ability to manage information.
- 09 - Demonstrate critical thinking skills.
- 10 - Develop autonomous learning skills.
- 15 - Demonstrate a concern for quality.
- 17 - The ability to work responsibly and autonomously, so as to handle job-related activities without the need for strict supervision.
- 29.1 - Demonstrate a committment to ongoing learning and self-improvement.
- 30.1 - Teamwork skills.
- 43 - Knowledge of physiotherapeutic procedures based on techniques and methods specific to physiotherapy interventions applied to the various disorders of all systems and medical and surgical specialisations, as well as health promotion and disease prevention.
- 48 - Ability to establish a physiotherapeutic diagnosis according to international norms and using internationally validated assessment tools.
- 48.2 - Ability to assess the patient's/client's needs in order to give priority to the ones that could compromise the rehabilitation process.
- 49 - Ability to design a physiotherapy treatment plan.
- 50 - Ability to execute, direct and coordinate a physiotherapy treatment plan while attending to the client's individual needs and using therapeutic tools specific to the physiotherapy profession.
- 50.1 - Ability to establish and implement physical therapy in treatments provided by all other medical and surgical specialties whenever it is deemed necessary.
- 53 - Capacity to participate within the areas of health promotion and disease prevention.
- 55 - Capacity to incorporate scientific research and an evidence-based practice within the professional culture.
Learning outcomes of the subject
Students:
- Understand physiotherapy procedures based on specific methods and techniques applicable in the pathology related to the specialty of medicine and surgery in Neurology.
- Know how to apply the diagnostic process in physical therapy, establishing a hierarchy of the patient's needs.
- Design physiotherapy intervention plans incorporating scientific research and evidence-based practice.
- Maintain an attitude of motivation and improvement in the learning proces.
- Have the necessary skills for teamwork and oral/written communication.
Syllabus
Theoretical Block: Cardio-respiratory Physiotherapy
1. Physical Properties of the Respiratory System (RS)
1.1. Compliance
1.2. Elasticity
1.3. Resistance
1.4. Time Constant
1.5. Respiratory Work
1.6. Muscular Force
1.7. Resistance and Fatigue of Respiratory Musculature
1.8. Equal Pressure Point (EPP)
1.9. Röhrer Equation
1.10. Volume, Ventilation, and Pulmonary Perfusion
1.11. Diaphragmatic Excursion
2. Defense Mechanisms of the RS
2.1. Physical Barriers of the Upper Airway
2.2. Mucociliary System of the Lower Airway
2.3. Reflex Mechanical Systems
2.4. Immune System
3. Evaluation in Respiratory Physiotherapy (FR)
3.1. Clinical Evaluation
3.2. Physical Examination
3.3. Auscultation
3.4. Functional Respiratory Evaluation
3.5. Effort Capacity Evaluation
4. FR Techniques (Physiological Properties and Indications/Contraindications)
4.1. Respiratory Rehabilitation Techniques
4.1.1. Correct Use of the Diaphragm
4.1.2. Directed Ventilations
4.1.3. Ventilation with Pursed Lips
4.1.4. Exercise with Controlled Inspiratory Flow (EDIC)
4.2. Bronchospasm Reduction Techniques
4.2.1. Fractionated Ventilations
4.2.2. Stepped Ventilations
4.3. Bronchial Hygiene Techniques
4.3.1. Gravitational Techniques: Postural Drainage
4.3.2. Shock Waves
4.3.2.1. Percussion
4.3.2.2. Vibration
4.3.3. Airflow Modification
4.3.3.1. Low Flow: ELTGOL, DA
4.3.3.2. High Flow: Cough, TEF, AFE
4.4. Instrumental Techniques
4.4.1. Incentive Spirometer
4.4.2. Positive Expiratory Pressure
4.4.3. Assisted Cough (in-exsufflator)
5. Retraining of Respiratory and Cardiac Patient Effort
5.1. Limiting Factors of Effort Capacity
5.2. Indications for Effort Retraining
5.3. Effort Capacity Evaluation
5.3.1. Maximum Tests
5.3.2. Sub-maximum Tests
5.3.3. Muscle Strength Tests
5.3.4. Quality of Life Test
5.4. Training Modalities
5.4.1. Constant Load Training
5.4.2. Interval Load Training
5.4.3. Muscle Strength Training (extremities and respiratory muscles)
5.5. Training Variables
5.5.1. Intensity
5.5.2. Duration
5.5.3. Frequency
5.5.4. Modality
5.6. Parts of a Retraining Session
5.7. Retraining of Respiratory Patients
5.8. Retraining of Cardiac Patients
6. Main Pathologies
6.1. COPD
6.2. Asthma
6.3. Pneumonia
6.4. Bronchiectasis
6.5. Cystic Fibrosis
6.6. Atelectasis
6.7. Pneumothorax
6.8. Pleural Effusion
6.9. Bronchiolitis
6.10. Chest Wall Disorders
6.11. Neuromuscular Pathologies
6.12. Thoracic and Abdominal Surgery
Theoretical Block: Cardio-respiratory Physiotherapy
1. Physical Properties of the Respiratory System (RS)
1.1. Compliance
1.2. Elasticity
1.3. Resistance
1.4. Time Constant
1.5. Respiratory Work
1.6. Muscular Force
1.7. Resistance and Fatigue of Respiratory Musculature
1.8. Equal Pressure Point (EPP)
1.9. Röhrer Equation
1.10. Volume, Ventilation, and Pulmonary Perfusion
1.11. Diaphragmatic Excursion
2. Defense Mechanisms of the RS
2.1. Physical Barriers of the Upper Airway
2.2. Mucociliary System of the Lower Airway
2.3. Reflex Mechanical Systems
2.4. Immune System
3. Evaluation in Respiratory Physiotherapy (FR)
3.1. Clinical Evaluation
3.2. Physical Examination
3.3. Auscultation
3.4. Functional Respiratory Evaluation
3.5. Effort Capacity Evaluation
4. FR Techniques (Physiological Properties and Indications/Contraindications)
4.1. Respiratory Rehabilitation Techniques
4.1.1. Correct Use of the Diaphragm
4.1.2. Directed Ventilations
4.1.3. Ventilation with Pursed Lips
4.1.4. Exercise with Controlled Inspiratory Flow (EDIC)
4.2. Bronchospasm Reduction Techniques
4.2.1. Fractionated Ventilations
4.2.2. Stepped Ventilations
4.3. Bronchial Hygiene Techniques
4.3.1. Gravitational Techniques: Postural Drainage
4.3.2. Shock Waves
4.3.2.1. Percussion
4.3.2.2. Vibration
4.3.3. Airflow Modification
4.3.3.1. Low Flow: ELTGOL, DA
4.3.3.2. High Flow: Cough, TEF, AFE
4.4. Instrumental Techniques
4.4.1. Incentive Spirometer
4.4.2. Positive Expiratory Pressure
4.4.3. Assisted Cough (in-exsufflator)
5. Retraining of Respiratory and Cardiac Patient Effort
5.1. Limiting Factors of Effort Capacity
5.2. Indications for Effort Retraining
5.3. Effort Capacity Evaluation
5.3.1. Maximum Tests
5.3.2. Sub-maximum Tests
5.3.3. Muscle Strength Tests
5.3.4. Quality of Life Test
5.4. Training Modalities
5.4.1. Constant Load Training
5.4.2. Interval Load Training
5.4.3. Muscle Strength Training (extremities and respiratory muscles)
5.5. Training Variables
5.5.1. Intensity
5.5.2. Duration
5.5.3. Frequency
5.5.4. Modality
5.6. Parts of a Retraining Session
5.7. Retraining of Respiratory Patients
5.8. Retraining of Cardiac Patients
6. Main Pathologies
6.1. COPD
6.2. Asthma
6.3. Pneumonia
6.4. Bronchiectasis
6.5. Cystic Fibrosis
6.6. Atelectasis
6.7. Pneumothorax
6.8. Pleural Effusion
6.9. Bronchiolitis
6.10. Chest Wall Disorders
6.11. Neuromuscular Pathologies
6.12. Thoracic and Abdominal Surgery
Practical Block: Cardio-respiratory Evaluation Seminar
1. Topographic Anatomy of the Chest
1.1. Reference Lines
1.2. Thoracic Regions
1.3. Airway
1.4. Chest Cavity
1.5. Pulmonary Topography
1.5.1. Projections of Pulmonary Parenchyma in the Chest
1.5.2. Lobes and Fissures
1.5.3. Bronchial Tree and Pulmonary Segments
1.5.4. Pleura
1.6. Respiratory Musculature
1.7. Cardiac Topography
2. Physical Examination
2.1. Inspection
2.2. Respiratory Rate
2.3. Heart Rate
2.4. Oxygen Saturation
2.5. Blood Pressure
2.6. Chest Perimeter
2.7. PIM and PEM
2.8. Measurement and Monitoring of Peak Flow
2.9. Evaluation of Cough Effectiveness (Peak Cough Flow)
2.10. Auscultation
3. Evaluation of Functional Effort Capacity
3.1. Laboratory Test
3.2. Field Tests
3.2.1. Incremental Shuttle Test
3.2.2. Stair Climb Test
3.2.3. 6-Minute Walk Test
3.2.4. Glittre Test
3.2.5. Sit-to-Stand Test
Teaching and learning activities
In person
Theoretical block:
This block will be done with the whole group.
There will be master exhibitions with audiovisual tools, videos and the theoretical content will be combined with real case studies.
Students will have to write articles or other documents in order to complete their training and continue with the professor's lectures.
Students will solve during the theoretical block various activities related to the contents of the subject.
Practical block:
This block will be held in small groups.
Thanks to a theoretical explanation and a practical demonstration by the teacher, students will be able to put into practice the cardiorespiratory physiotherapy techniques that make up the block.
Student participation will be highly valued.
| TRAINING ACTIVITY | METHODOLOGY | COMPETENCES | ECTS CREDITS |
|---|---|---|---|
| lectures | oral presentation / master class case method | 01 02 05 30.1 43 48 48.2 | 1.2 |
| theoretical and practical workshops | cooperative learning oral presentation / master class problem-solving exercises | 09 10 49 50 50.1 | 0.8 |
| self-learning activities | apprenticeship contract | 15 17 29.1 53 | 1 |
| student's independant work-study | 43 55 | 2 |
Evaluation systems and criteria
In person
Theoretical Block (60%):
- Written tests (40%). It is essential to pass this part to pass the theoretical block.
- Individual or group assignments (20%)
Practical Block (40%):
- Practical test (25%)
- Theoretical test (15%)
To pass the subject, it is necessary to independently pass each of the two blocks that make it up, setting the passing grade at 5 or higher. If one of the blocks is failed in the first attempt, the student must retake the entire content of the failed block in the second attempt, saving the grade of the passed block. If the student does not pass both blocks of the subject in the second attempt, even if one of the blocks has been passed, they will fail the entire subject and will have to repeat both blocks in the next academic year.
The grading system will be used according to current legislation. Currently, according to RD 1.125/2003 of September 5:
- 0-4.9 Fail.
- 5.0-6.9 Pass.
- 7.0-8.9 Notable.
- 9.0-10 Excellent.
The "Honors" mention may be awarded to students who obtain a qualification equal to or higher than 9.0. Its number cannot exceed 5% of the students enrolled in the subject in the corresponding academic year, unless the number of enrolled students is less than 20, in which case only one honors mention may be granted.
Attendance Policy:
Attendance at the practical block is mandatory. The student must attend at least 70% of the sessions to be evaluated.
Subjects in the Degree in Physiotherapy that have theoretical-practical content have as their main objective the acquisition and development of procedures and technical skills directly related to the practical exercise of the profession. This is the reason that determines the structure of these classes, in small groups with the direct and continuous supervision of the subject teacher. Therefore, attendance at the seminars is considered fundamental and necessary to ensure the acquisition of these competencies.
Based on the above, absences can only occur exceptionally, motivated by major causes, and, in any case, if they exceed 30% of the training load, they will require the student to re-enroll in that subject in the next academic year, with no possibility of taking the exam in the second attempt.
The consequences of not complying with this regulation can have very negative effects directly related to the enrollment process (overlaps and/or academic incompatibilities) and with the corresponding temporal forecast for the completion of the Degree studies.
Bibliography and resources
Recommended Bibliography (available at the Sant Cugat Campus Library):
Postiaux, G. Fisioterapia Respiratoria en el niño Ed McGraw-Hill, 2000.
West J. Fisiopatoligía Pulmonar. Ed Médica Panamericana, 2004.
Güell R. Rehabilitación Respiratoria. Ed M & M Communications,1999.
Pryor JA. Physiotherapy for Respiratory & Cardiac Problems. Ed Churchill Livingstone,1998.
Delplanque D, Antonello M. Fisioterapia y reanimación Respiratoria. Ed Masson, 1996.
Smith, M. Ball, V. Rehabilitación Cardiovascular y Respiratoria. Ed. Harcourt, 2000.
Cash JE. Kinesioterapia para trastornos torácicos, cardíacos y vasculares. Ed Panamericana.
Vandevenne A. Reéducation Respiratoire des bronchopneumopaties chroniques obstructives. Ed Masson.
Pneumokinesitherapie.Barthe, J. Ed Doin.
Resources:
1. Slides from theoretical classes
2. Clinical cases
3. Lung sounds in MP3 format