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.

Understand the theoretical basis of methods and techniques of intervention addressed to cardiovascular, pulmonary and integumentary systems;

Know, understand and know how to apply the basic procedures of the methods and techniques of intervention addressed;

 Select the appropriate methods and techniques for the intervention in specific health conditions and sustain these options on the best available evidence;

Acquire manual dexterity to perform correctly the specific intervention techniques addressed;

Record completely and accurately all data relating to the intervention in cardiovascular, respiratory and integumentary conditions.

Respiratory physiotherapy:

Objectives, indications, precautions, general principles, breathing pattern and phases of respiratory reeducation.

Techniques used: teaching, manual pressure, thoracic mobilization, diaphragm mobilization, strengthening of respiratory muscles, bronchial clearance techniques.

Therapeutic modalities and techniques for airway clearance: active breathing cycle technique; autogenic drainage; techniques for proximal, distal and peripheral upper and lower airway clearance: Retrograde rhinopharyngeal clearance, nasal cough, expiratory tracheal pompage, directed and provoked cough, forced expiration or huffing technique, total slow expiration, prolonged slow expiration, positive expiratory pressure ventilation (semi-closed lips, flutter, acapela, RC- Cornet), exercises at controlled inspiratory output, incentive inspirometry.

Mechanical therapeutic means for airway clearance: percussive intrapulmonary ventilation, Cough Assist, Vest Therapy; suctioning, humidification/fluidification of secretions.

Positioning to facilitate respiratory work.

Reeducation of breathing.

Invasive and non invasive mechanical ventilation (IMV and NIVV):

Objectives, principles, indications, principles, parameters to control, mandatory cycle, characteristics, interfaces, mask placement, side effects, complications.

Modalities of ventilatory support.

Volume controlled ventilation (VCV), Volume assisted/controlled ventilation (A/C VCV), Pressure controlled ventilation (PCV), Pressure assisted/controlled ventilation (A/C PCV), Pressure assisted ventilation (ASB).

Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BIPAP).

NIV in neuromuscular diseases, obstructive sleep apnea-hypopnea syndrome (OSAHOS), in obesity and obstructive and restrictive pulmonary diseases: effects, indications, contraindications.

Oxygen therapy (indications contraindications). Aspiration of secretions (indications, contraindications and practical use).

Respiratory physiotherapy in specific population groups.

Pulmonary rehabilitation:

Team, aims, benefits, indications and contraindications, components of the intervention programme, training sessions and education and psychosocial support session, and progression.

Segmental relaxation: objectives, indications and postures to adopt;

Global relaxation:

Objectives and indications.

Concept of Snoezelen progressive relaxation of Jacobson and physiological relaxation of Laura Mitchell.

Benefits of regular physical activity.

Difference between physical activity and physical exercise.

Acute and chronic metabolic adaptations to exercise.

Exercise prescription:

Objectives, conditioning, components and essential principles of cardiovascular conditioning;

Endurance training, strength, flexibility;

Aerobic exercise: calculating the target training zone and the advisable energy expenditure; calculating the advisable volume of strength training;

Components of an exercise session;

Classification of risk for exercise training;

Care to be taken with autonomous exercise;

Benefits of exercise training and recommendations for exercise prescription in special groups – Acute coronary syndrome and revascularisation, chronic coronary syndrome, heart transplantation, valvular surgery, heart failure, diabetes, hypertension, obesity, peripheral arterial disease (PAD) and chronic obstructive pulmonary disease (COPD).

Cardiac rehabilitation:

Primary versus secondary prevention; objectives; benefits; progression; components of the intervention programme and training session.

Stages of cardiac rehabilitation (inpatient, outpatient, maintenance):

Indications and contraindications; risk stratification; general recommendations and exercise prescription in the various phases; clinical safety criteria; intervention in special groups.

 
Pressure ulcers:

Preventive action of the physiotherapist; risk assessment; skin care; early intervention; reduction of mechanical load; use and selection of support products with anti-scald property or with possibility of alternating positioning; teaching the user / caregivers.

NAO

Principal Bibliography:

DeTurk W & Cahalin L P. Cardiovascular and Pulmonary Physical Therapy: An Evidence-based Approach. McGraw-Hill Professional, 2004.

European Association of Cardiovascular Prevention and Rehabilitation. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: Key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J (2010) 31 (16): 1967-1974. DOI: https://doi.org/10.1093/eurheartj/ehq236
European Society of Cardiology. European Guidelines on cardiovascular disease prevention in clinical practice. European Journal of Preventive Cardiology, 2016; 37,2315–2381.

Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M; ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021 Jan 1;42(1):17-96. doi: 10.1093/eurheartj/ehaa605. Erratum in: Eur Heart J. 2021 Feb 1;42(5):548-549. PMID: 32860412.

Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C,
Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P,
Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler AO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2020 Mar 30:2047487320913379. doi:
10.1177/2047487320913379. Epub ahead of print. PMID: 32223332.

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, 10th edition, 2018.

Secondary Bibliography:

Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor. RS. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol 2016;67(1):1–12
European Society of Cardiology. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial
Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal, 2017; 00: 1–60. https://doi.org/10.1093/eurheartj/ehx391

Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine 2020;54:1451-1462.

Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor. RS. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol 2016;67(1):1–12

American Thoracic Society. (2002). ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 166 , 518 624

Australian and New Zealand Burn Association (ANZBA). Burn Survivor Rehabilitation: Principles and Guidelines for the Allied Health Professional: Allied Health Forum…, 2008.

British Burn Association. Standards of Physiotherapy and Occupational Therapy Practice in the management of burn injured adults and children, 2005.

Burns, K E Stevenson, J Laird, M Adhikari N K Li, Y Lu, C Friedrich, J O 2022 Non invasive ventilation versus invasive weaning in critically ill adults a systematic review and meta analysis Thorax, 77(8): 752-761
Chang, A B Fortescue R Grimwood K Alexopoulou E Bell, L Boyd J Kantar A 2021 European Respiratory Society
guidelines for the management of children and adolescents with bronchiectasis European respiratory journal 58 2

Chatwin M, Toussaint M, Gonçalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, et al. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med [Internet]. 2018;136 (November 2017):98–110. Available from: https://doi.org/10.1016/j.rmed.2018.01.012.

Dowman L, Hill CJ, May A, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2021 Feb 1;2(2):CD006322.

Fidalgo ASF, Farinatti P, Borges JP, de Paula T, Monteiro W. Institutional Guidelines for Resistance Exercise Training in Cardiovascular Disease: A Systematic Review. Sports Med. 2019 Mar;49(3):463-475. doi:
10.1007/s40279-019-01059-z. PMID: 30701461.

Grupo de Interesse em Fisioterapia Cardiorrespiratoria Associação Portuguesa de Fisioterapeutas 2021 Perfil de competências do fisioterapeuta especialista em cardiorrespiratória

Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64 (SUPPL. 1).
Holland AE, Cox NS, Houchen Wolloff L, Rochester CL, Garvey C, ZuWallack R, et al. Defining Modern

Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2021
May;18(5):e12 e29.

Hough A. Physiotherapy in Respiratory Care: an evidence-based approach to respiratory and cardiac management. Nelson Thornes Ltd (Cheltenham); 3rd Revised edition, 2001.

Laveneziana , P., Albuquerque, A., Aliverti , A., Babb , T., Barreiro, E., Dres , M., … & Verges , S. (2019). ERS
statement on respiratory muscle testing at rest and during exercise European Respiratory Journal 53 (6)
McDermott MM. Exercise Rehabilitation for Peripheral Artery Disease: A REVIEW. J Cardiopulm Rehabil Prev. 2018 Mar;38(2):63-69. doi: 10.1097/HCR.0000000000000343. Erratum in: J Cardiopulm Rehabil Prev. 2018 Sep;38(5):347. PMID: 29465495; PMCID: PMC5831500.

McIlwaine , M., Bradley, J., Elborn , J. S., & Moran, F. (2017). Personalising airway clearance in chronic lung
disease. European Respiratory Review 26 (143)

Postiaux G. Kinésithérapie Respiratoire de l’Enfant. Editors De Boeck & Larcier s.a., 2e édition. Bruxelles, 2000; Postiaux G. Kinésitherapie e bruits respiratoires – Nouveau paradigme. Editores De Boeck Superior, s.a. Belgique 2016

Reid WD; Chung F; Hill K. Cardiopulmonary physical therapy: management and case studies. 2nd ed. Slack Incorporated, 2014;
Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, et al.; ATS/ERS Task Force on Policy
in Pulmonary Rehabilitation. An Official American Thoracic Society/European Respiratory Society Policy
Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care
Med. 2015 Dec 1;192(11):1373 86.

Royal Dutch Society for Physical Therapy. Chronic obstructive pulmonary disease – Practice guidelines. Dutch Journal of Physical Therapy, 2008; Suppl.118(4):1-64

Royal Dutch Society for Physical Therapy. KNGF Guideline – Cardiac rehabilitation. Dutch Journal of Physical Therapy, 2011; 121(4): s1-48.

Schmidt, G A Girard, T D Kress, J P Morris, P E Ouellette, D R Alhazzani W Truwit J D (2017). Official executive summary of an American Thoracic Society/American College of Chest Physicians clinical practice guideline liberation from mechanical ventilation in critically ill adults American journal of respiratory and critical care medicine 195(1): 115-119

Sociedade Portuguesa de Cardiologia. Manual de Reabilitação cardíaca. 1ª edição, 2013.