PTAS 2470 - Cardiopulmonary Rehabilitation

Credit Hours: 2.00

Outcome 1: Upon completion of this course, the student will be able to describe the anatomy, physiology and pathology of the cardiopulmonary system as it relates to physical therapy.

Objectives: The student will be able to:

1. Describe the anatomical and physiological aspects of the respiratory system
2. Describe the anatomical and physiological aspects of the cardiac system
3. Describe diagnostic techniques for respiratory and cardiac pathologies

Outcome 2: Upon completion of this course, the student will be able to describe the clinical manifestations of pulmonary disease as it relates to physical therapy.

Objectives: The student will be able to:

1. Describe common causes of obstructive and restrictive lung disease
2. Discuss impairments found in patients with obstructive and restrictive pulmonary conditions
3. Describe the role of physical therapy in the management of obstructive and restrictive pulmonary conditions
4. Describe precautions in treatment of obstructive and restrictive pulmonary conditions

Outcome 3: Upon completion of this course, the student will be able to describe the clinical manifestations of cardiac disease as it relates to physical therapy.

Objectives: The student will be able to:

1. Describe common causes of cardiac disease
2. Discuss impairments seen in patients with congestive heart failure, myocardial infarction, angina pectoris, and sudden death
3. Describe the role of physical therapy in the management of patients with cardiac disease
4. Describe precautions in the treatment of patients with cardiac disease

Outcome 4: Upon completion of this course, the student will be able to describe tests and measures commonly used in the evaluation of the patient with cardiopulmonary disease.

Objectives: The student will be able to:

1. Discuss procedures utilized by the physical therapist in evaluation of physical therapy plan of care for pulmonary and cardiac patients
2. Describe tests commonly used by physicians in the management of cardiopulmonary patients
3. Describe the role of the PTA in applying select interventions for the pulmonary and cardiac patient recognizing when interventions may be outside the PTA scope of practice
4. Describe expected and adverse responses in the pulmonary and cardiac patients recognizing the need to report responses to the supervising PT

Outcome 5: Upon completion of this course, the student will be able to demonstrate competency in select physical therapy techniques used in the evaluation and treatment of the cardiopulmonary patient appropriate to the role of the PTA.

Objectives: The student will be able to:

1. Describe and demonstrate various treatment techniques such as: diaphragmatic breathing, coughing, vibration, thoracoabdominal movement
2. Demonstrate accurate hand placement, positioning, and technique for postural drainage and vibration
3. Describe goals, indications, and basic principles for breathing exercises, chest mobilization exercises, and postural drainage
4. Identify precautions and contraindications for postural drainage
5. Describe characteristics of cough and sputum
6. Describe the relationship between supplemental oxygen, breathing patterns, and functional activities

Outcome 6: Upon completion of this course, the student will be able to describe aerobic exercise, cardiac rehabilitation and fitness programming for the healthy and impaired population.

Objectives: The student will be able to:

1. Define fitness, endurance, conditioning, adaptation, cardiac output, VO2 MAX, MET
2. Identify the physiologic changes to aerobic exercise
3. Discuss in general stress-testing and fitness testing
4. Identify the appropriate guidelines for determining the intensity, duration and frequency of an exercise program
5. Calculate a target training heart rate
6. Discuss overload principle in endurance training
7. Identify components of an exercise program
8. Compare and contrast high-level and low-level exercise program
9. Describe the three phases of cardiac rehabilitation
10. Describe activities that are utilized in each phase
11. Apply the principles of aerobic conditioning to rehabilitation programs for myocardial infarction or coronary artery by-pass patient
12. Identify the characteristics of each phase of cardiac rehabilitation
13. Identify and describe the role and function of PTA in cardiac rehabilitation
14. Demonstrate vital sign management in the plan of care for the cardiopulmonary patient

1. Review of Respiratory Structure and Function
   1. Specific Topics Covered
      1. thorax and ribs
      2. muscles of respiration
      3. movements of thorax in respiration
      4. movement of air
      5. anatomy and function of respiratory tracts
         1. upper respiratory tract
         2. lower respiratory tract - tracheobronchial tree
      6. lungs
         1. anatomy
         2. volume and capacities
      7. evaluation in chest PT performed by PT
         1. purpose
         2. general appearance
         3. breathing pattern
         4. chest mobility
         5. posture and chest deformities
         6. palpation
         7. percussion
         8. auscultation
         9. cough and sputum
      8. PTA role in evaluation process
2. Management of Pulmonary Conditions
   1. Specific topics covered:
      1. obstructive lung disease
         1. define
         2. terminology
         3. characteristics - clinical picture
         4. clinical problems
      2. specific obstructive pulmonary conditions and clinical picture
         1. chronic bronchitis
         2. emphysema
         3. asthma
      3. general treatment goals and plan of care
         1. chronic bronchitis and emphysema
         2. asthma
      4. restrictive or non-obstructive lung disorders
         1. define
         2. causes
         3. clinical problems
      5. specific restrictive pulmonary conditions
         1. post-thoracotomy
         2. pneumonia
      6. general treatment goals and plan of care
         1. post-thoracotomy
         2. pneumonia
      7. precautions
      8. role of PTA in treatment
3. Treatment Techniques in Cardiopulmonary PT
   1. Specific topics covered:
      1. breathing exercises
         1. indications
         2. goals
         3. principles for teaching
         4. precautions
         5. specific breathing patterns
            1. diaphragmatic breathing
            2. lung expansion - inspiratory breathing
            3. segmented breathing
            4. glossopharyngeal
            5. pursed-lip breathing
      2. exercises for chest mobilization
      3. coughing
         1. cough mechanism
         2. factors that affect mechanism
         3. teaching and facilitatory cough
         4. precautions
      4. postural drainage
         1. goals and rationale
         2. contraindications
         3. techniques
            1. huffing
            2. coughing
            3. percussion
      5. postural drainage positions
         1. general treatment considerations
         2. positions and rationale
         3. hand placement
         4. percussion
         5. treatment duration
      6. functional activities
      7. role of PTA
4. Review of Cardiovascular System and Principles of Coronary Heart Disease
   1. Specific topics covered:
      1. review of anatomy and physiology of cardiovascular system
      2. basic principles of the electrocardiogram
      3. cardiovascular disorders - clinical pictures
         1. arteriosclerosis
         2. coronary artery disease
         3. myocardial infarction
         4. hypertension
         5. valvular disease
5. Principles of Aerobic Exercise
   1. Specific topics covered:
      1. terminology
         1. fitness
         2. endurance
         3. VO₂ MAX
         4. conditioning
         5. adaptation
      2. physiological responses to aerobic exercise
         1. cardiovascular
         2. respiratory
         3. circulatory
      3. stress testing and fitness testing
      4. determinants of an exercise program
         1. intensity
         2. duration
         3. frequency
      5. exercise program
         1. warm-up
         2. aerobic exercise
         3. cool-down
      6. physiologic changes with training
6. Application of Aerobic Exercise Principles to a Conditioning Program for Coronary Artery Conditions
   1. Specific topics covered:
      1. three phases of cardiac rehabilitation
         1. Phase 1 acute myocardial infarction hospital admission to discharge
         2. Phase II after discharge from hospital
         3. Phase III active reconditioning program
      2. role and function of PTA in cardiac rehabilitation