Movement Therapy III

Physiological and pathophysiological fundamentals of the cardiovascular and respiratory systems. Main differences between adults and children. Assessment of cardiorespiratory fitness, including exercise testing and field tests. Components and basic principles of exercise prescription.

The teaching methodologies include: content exposition; analysis and discussion of concepts and demonstration/example of techniques with simulated practice among students. Case study discussion.

The main goal is: To master the theoretical, practical, and applied foundations of methods and intervention techniques in physiotherapy for the cardiovascular, pulmonary, and integumentary systems.

General Objective

To master the theoretical, practical, and applied foundations of physiotherapeutic intervention methods and techniques within the cardiovascular, pulmonary, and integumentary systems.

Specific Objectives

• To understand the theoretical foundations underlying specific treatment methods and techniques for the cardiovascular, pulmonary, and integumentary systems.
• To select and apply appropriate interventions for each case, based on the best available evidence.
• To perform specific interventions accurately and competently.
• To record data in a complete and precise manner.

Skills to Develop

• Critical thinking in the selection of interventions and clinical decision-making.
• Effective communication with patients.
• Manual dexterity for the execution of intervention techniques and methodologies.

Importance of Evidence-Based Practice and Patient-Centered Care

Highlighting the importance of evidence-based practice and patient-centered care in selecting specific interventions for cardiovascular and respiratory conditions is essential to ensure high-quality, individualized physiotherapeutic management.

Benefits of Regular Physical Activity

• Health advantages and impact on physical and psychological well-being.

Distinction Between Physical Activity and Exercise

• Definitions and conceptual differences.

Acute and Chronic Cardiac, Respiratory, and Metabolic Adaptations to Exercise

• Short-term and long-term body responses at cardiac, respiratory, and metabolic levels.

Exercise Prescription

• Essential components and principles of cardiovascular conditioning and strength training.
• Aerobic exercise: calculation of target training zone; key elements of an exercise session.
• Cardiovascular risk Stratification for training; essential precautions for unsupervised exercise.

Cardiac Rehabilitation

• Primary vs. secondary prevention; goals, benefits, progression, and intervention components.
• Phases of cardiac rehabilitation (inpatient, outpatient, maintenance).
• Indications and contraindications for exercise in cardiovascular pathologies; risk stratification; recommendations and prescription across rehabilitation phases; clinical safety criteria.
• Exercise prescription for special populations: acute and chronic coronary syndrome, revascularization, heart transplant, valve surgery, heart failure, hypertension, diabetes, obesity, and peripheral arterial disease.

 Respiratory Physiotherapy

• Definition, respiratory physiotherapist’s skill set, aim, indications, precautions, principles of general respiratory physiology, breathing patterns (children and adults) and phases of respiratory re-education.
• Techniques: education, chest mobilization, thoracic mobility, reeducation of diaphragmatic movement, respiratory muscle strengthening, bronchial clearance techniques (with or without devices), and exercise prescription.
• Therapeutic modalities and airway clearance techniques: active breathing cycle technique; autogenic drainage; techniques for upper and lower, proximal, distal, and peripheral airway clearance (children and adults): retrograde rhinopharyngeal clearance, nasal cough, expiratory tracheal pumping, directed and induced cough, forced expiration or huffing, total slow expiration, prolonged slow expiration, positive expiratory pressure ventilation (pursed lips, flutter, acapella, RC-Cornet), controlled inspiratory flow exercises, incentive spirometry.
• Instrumental secretion removal techniques: mechanical in-exsufflator, chest oscillation (Vest), intra-pulmonary percussion (IPV); suction, secretion humidification/fluidification.
• Positioning to facilitate respiratory work.
• Effort re-education.

Invasive and Noninvasive Mechanical Ventilation (IMV and NIMV):

• Objectives, principles, indications, principles, parameters to monitor, mandatory cycle, characteristics, interfaces, mask placement, side effects, complications.
• Ventilatory support modes.
• Volume Controlled Ventilation (VCV), Assisted/Controlled Volume Ventilation (A/C VCV), Pressure Controlled Ventilation (PCV), Assisted/Controlled Pressure Ventilation (A/C PCV), Assisted Pressure Ventilation (ASB).
• Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BIPAP).
• NIMV in neuromuscular diseases, obstructive sleep apnea syndrome (OSAHS), obesity, and obstructive/restrictive lung diseases: effects, indications, contraindications.
• Oxygen therapy (indications, contraindications). Suctioning (indications, contraindications, practical use).

Respiratory Physiotherapy in Specific Populations:

• Neuromuscular diseases; spinal trauma and disorders of the rib cage and spinal column.
• Main characteristics of these conditions
• Assessment and intervention specificities
• Soft skills vs. hard skills

Respiratory Rehabilitation:

• Portuguese vs. international standards, team, goals, benefits, indications and contraindications, intervention program components, training session and education/psychosocial support session, and progression.

Physiological Relaxation Techniques:

• Codman’s segmental relaxation; Snoezelen concept; Jacobsen’s progressive relaxation and Laura Mitchell’s physiological relaxation.

Physiotherapist’s Intervention in Diabetic Foot

• Role of the physiotherapist in pressure ulcer prevention: assessment, prevention, selection and use of anti-decubitus products, positioning, and education for users and caregivers.

NAO