Universitat Internacional de Catalunya
Physiotherapy Applied to Circulatory, Cardiac and Respiratory Dysfunctions
Other languages of instruction: Catalan
Teaching staff
Schedule an appointment via email:
Respiratory Techniques Seminar:
Dr. Marta Amor
mamor@uic.es
Mr. Raúl Carrión
rcarrion@uic.es
Edema Treatment Seminar:
Dr. Carlos Zárate
czarate@uic.es
Mrs. Sonia Subías Blas
ssubias@uic.es
Cardiac Rehabilitation Seminar:
Dr. Monique Sartor
msartor@uic.es
Introduction
Respiratory Techniques Seminar:
Respiratory physiotherapy encompasses a set of physical techniques that act complementarily to medical treatment, allowing the improvement of ventilatory function, promoting bronchial hygiene, reducing dyspnea, and enabling the retraining of effort in patients with respiratory pathologies.
Edema Treatment Seminar:
Edema is a common clinical sign in our daily practice that requires specific analysis to understand its origin. The physical treatment of edema includes a set of interrelated techniques through which we can improve edema caused by insufficient return circulation.
Cardiac Rehabilitation Seminar:
Cardiac rehabilitation stands out as one of the cornerstones in the treatment of patients with heart diseases. This approach involves a multidisciplinary intervention, with exercise being the main focus. Therefore, it is important to acquire and deepen knowledge on how to prescribe exercise effectively and safely for these patients.
Pre-course requirements
Not specified, although it is advised to have passed the Cardiorespiratory Assessment Seminar from the subject Specific Intervention Methods in Cardiorespiratory Physiotherapy, since treatment techniques in respiratory physiotherapy are closely related to the examination.
Objectives
- To understand the practical foundations of the different treatment techniques available to physiotherapists in order to treat patients with cardiorespiratory diseases.
- To acquire a comprehensive education in physiotherapy and administer comprehensive physiotherapy treatment to patients with cardiorespiratory diseases, which will make it possible to achieve the therapeutic goals set.
- To identify treatment priorities in each stage of patient recovery.
- To offer the most appropriate therapeutic indications for respiratory therapy guided by patient assessment (mainly lung auscultation)
- To understand how to identify potential complications as the process evolves.
- To know how to plan a breathing re-education programme for patients with respiratory problems.
- To acquire basic training in the most important aspects of respiratory physiotherapy for infants.
- To acquire the basic knowledge about inhalation and nebulised therapies.
- To recognise and be able to differentiate between the different types of oedemas.
- To understand the anatomy of the Lymphatic System well enough to perform Manual Lymphatic Drainage correctly.
- To master manual lymphatic drainage depending on the source and type of oedema.
- To identify possible complications throughout a patient's treatment.
- To plan complex decongestant therapy.
- To use complementary therapies appropriately.
- To acquire the training necessary to differentiate between the indications and counter-indications of the technique.
- To understand the methodological basis for training.
- To provide students with basic knowledge of the different physiological responses and adaptations of patients with heart conditions to acute and chronic exercise.
- To understand the most effective strategies for promoting the take-up and maintenance of physical exercise in patients with heart conditions.
- To understand the methodological basis of cardiac rehabilitation programmes (RC).
Competences/Learning outcomes of the degree programme
- 01 - The ability to analysis and synthesis.
- 02 - The ability to organise and synthesize
- 06 - To have comprehensive problem-solving skills.
- 10 - Develop autonomous learning skills.
- 14 - Demonstrate initiative and an entrepreneurial spirit.
- 15 - Demonstrate a concern for quality.
- 21 - Knowledge of the physiological and structural changes that can occur after physiotherapeutic interventions.
- 28.1 - Capacity for oral and written communication in the native language.
- 28.3 - Show respect, appreciation and sensitivity towards the work of others.
- 30.1 - Teamwork skills.
- 37.1 - Use discretion, use available information appropriately and respect patient dignity and confidentiality
- 37.5 - knowledge of the profession's deontological ethics codes
- 38.1 - Respect for the rights of the patient and their family.
- 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.
- 48.1 - Knowledge of the internationally accepted norms and 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.
- 49.1 - Ability to develop a specific physiotherapy treatment plan through clinical thinking and problem-solving skills.
- 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.
- 50.10 - Ability to establish a scheduled plan to follow during treatment.
- 50.2 - Ability to design and apply therapeutic exercises specifically designed for cardiorespiratory, orthopedic, traumatologic, pediatric, rheumatologic, geriatric, neurologic, pulmonary, and sport-related diseases and injuries, as well as those for spine defects, urinary and fecal incontinence and pre/post-partum exercises.
- 50.8 - Ability to encourage the client and family to participate in the rehabilitation process.
- 51 - Ability to assess the outcomes of the physiotherapy treatment against the initial goals set and the established outcome criteria.
- 51.1 - Ability to design and set up activities related to disease prevention and health promotion.
- 51.2 - Ability to assess the patient's /client's progress.
- 51.3 - Ability to re-assess and modify treatment goals if necessary, and to adjust the intervention or treatment plan according to the new goals.
- 52.2 - Capacity to prepare a comfortable environment in which physiotherapy will be provided.
- 52.3 - Ability to keep the patient informed about the treatment by explaining the tests and techniques that are involved, the preparation they require, to ensure the patient's collaboration at all times.
- 53.1 - Ability to design and set up activities related to health promotion and disease prevention.
- 57 - Ability to keep up-to-date on knowledge, skills and attitudes related to professional competencies through continuous education.
- 61 - Ability to motivate others, through the capacity to generate a desire and enthusiasm for active participation in any kind of project or task.
Learning outcomes of the subject
After completing this subject, students will be able to:
Respiratory Techniques Seminar:- Understand how to correctly apply the main treatment techniques for cardio respiratory pathologies.
- Design a specific physiotherapy intervention plan, using problem-solving skills and clinical reasoning, according to criteria of adequacy, validity and efficiency.
- Identify the most appropriate treatment techniques based on a previous patient assessment and evaluate the evolution of the results.
- Adapt a beathing re-education plan for cardiac patients.
- Use the main respiratory physiotherapy treatment techniques for children.
- Identify the structural, physiological, functional and behavioural changes that occur as a result of using cardiorespiratory physiotherapy.
- Adapt respiratory physiotherapy treatment to children.
- Assimilate basic knowledge of inhalation and nebulised therapies.
- Give practical information to patients on their rehabilitation and prevention.
- Differentiate between the different types of oedema and apply the correct techniques according.
- Identify oedemas that can be treated by complex decongestive therapy.
- Properly use MLD and the various complementary techniques.
- Be aware of new developments in lymphatic pathology.
- Stimulate students’ interest in a specialised, comprehensive and forward-thinking outlook, not only by discussing cardiac rehabilitation programmes (PRC), but also what it means for the training and rehabilitation of chronic diseases.
Syllabus
Respiratory Techniques Seminar:
1. Ventilatory reeducation techniques.
1.1 Respiratory control for proper diaphragmatic use.
1.2 Abdomino-diaphragmatic Directed Ventilation.
1.3 Costal Directed Ventilation.
1.4 Pursed-lip Ventilation.
1.5 ICDE: Controlled Inspiratory Debit Exercise.
1.6 Facilitating postures for ventilation.
1.7 Postural changes for pleural effusion.
1.8 Chest mobilizations.
1.9 Protection of the surgical wound.
2. Bronchial hygiene techniques.
2.1 Gravitational techniques: Postural Drainage.
2.2 Shock waves: Percussion and Vibration.
2.3 Techniques for modifying expiratory flow:
2.3.1 Low flow: ELTGOL and AD.
2.3.2 High flow: Cough, TEF, AFE.
3. Instrumental techniques.
3.1 Inspiratory instrumental techniques.
3.1.1 Incentive Spirometry.
3.1.2 Resisted Spirometry.
3.2 Expiratory instrumental techniques:
3.2.1 Continuous positive pressure: Pep-mask, Thera-pep.
3.2.2 Discontinuous positive pressure: Flutter, Acapela.
3.3 Cough assistance: In/exsufflator.
3.4 Nebulization.
5. Safety measures
5.1 Incremental stress test.
5.2 Electrocardiogram monitoring during the test.
5.3 Basic cardiopulmonary resuscitation principles.
Edema Treatment Seminar:
1. Introduction.
2. Lymphatic System.
2.1 Components of the Lymphatic System.
2.2 Physiology of the Lymphatic System.
2.3 Anatomy of the Lymphatic System.
2.3.1 Upper Limb Anatomy.
2.3.2 Lower Limb Anatomy.
3. Edema.
3.1 Edema Classification.
3.1.1 Venous Edema.
3.1.2 Lymphatic Edema or Lymphedema.
3.1.2.1 Primary Lymphedema.
3.1.2.2 Secondary Lymphedema.
3.1.3 Lipedema.
3.1.4 Lipolymphedema.
4. MLD (Manual Lymphatic Drainage).
4.1 Definition.
4.2 Lymph node drainage.
4.3 "Call" maneuver.
4.4 "Reabsorption" maneuver.
4.5 Derivation or Substitution Paths.
4.6 Physiological and Therapeutic Effects.
4.7 Indications.
4.8 Contraindications.
4.8.1 Absolute.
4.8.2 Relative.
5. Complementary Techniques.
5.1 Pressotherapy.
5.2 Multilayer Bandaging.
5.3 Compression Garments.
5.4 Kinesiotherapy.
6. Surgical Techniques.
7. Prevention and General Recommendations.
Cardiac Rehabilitation Seminar
1. Anatomy and Physiology of the Heart.
1.1 Coronary Anatomy
1.2 Systemic and Pulmonary Circulation
2. Cardiovascular Diseases
2.1 Cardiovascular Diseases: Definition
2.2 Risk Factors
2.3 Most Prevalent Cardiac Pathologies
2.4 Primary Prevention
2.5 Cardiovascular Health
3. Cardiac Rehabilitation (CR)
3.1 Historical Evolution of CR
3.2 Concept of CR
3.3 Configuration of a Cardiac Rehabilitation Program (CRP)
3.4 Human Resources and Material Resources
3.5 Phases I-IV: Specifics of each phase.
4. Physiological Basis of Exercise.
4.1 Physiological response of different systems to exercise (cardiac, muscular, respiratory).
4.2 Basic principles of metabolic pathways
4.3 Complementary Cardiology Assessment: Ergometry, Incremental Exercise Test with gas analysis, ECG.
5. Planning an exercise program for a cardiac patient
5.1 Risk level stratification.
5.2 Determinants of an Exercise Program (Intensity, Duration, Frequency, and Mode).
5.3 Principles of aerobic exercise prescription in cardiac patients.
5.4 Principles of strength exercise prescription in cardiac patients.
5.5 Principles of respiratory muscle training prescription in cardiac patients.
5.6 Training session (Warm-up, Aerobic Exercise Period, Recovery Period, Strength Exercise Period, and Respiratory Muscle Training Period).
Teaching and learning activities
In person
This subject will be carried out in small groups.
After a theoretical explanation and a practical demonstration by the teacher, students will be able to put into practice the cardiorespiratory physiotherapy treatment techniques learned during this subject.
Students will have to solve some practical problems/cases during the seminar. Student participation through interventions during the subject will be highly valued.
| TRAINING ACTIVITY | METHODOLOGY | COMPETENCES | ECTS CREDITS |
| independent study | cooperative learning | 37.5 43 48.1 53.1 | 2 |
| theoretical and practical seminars | cooperative learning case method problem-solving exercises | 06 21 28.1 28.3 30.1 38.1 43 48.2 49 49.1 50 50.1 50.2 50.8 51 51.1 51.2 51.3 61 | 2 |
| autonomous learning activities | learning contract | 01 02 14 15 37.1 37.5 48.1 50.10 53.2 57 | 1 |
Evaluation systems and criteria
In person
The evaluation of this subject is mainly based on the execution of practical procedures based on real tasks and problem-solving through the presentation of clinical cases.
Respiratory Techniques Seminar (40%):
- Continuous evaluation (30%): resolution of clinical cases
- Theoretical-practical exam (70%): formulation of objectives, treatment, and execution of respiratory physiotherapy techniques based on a clinical case
It is established as a requirement to pass with a minimum grade of 5.0 in the theoretical-practical exam to pass the seminar.
Edema Treatment Seminar (30%):
- Theoretical block (50%): multiple-choice exam
- Practical block (50%): practical/oral exam (35%) + practical clinical case (15%)
It is established as a requirement to pass with a minimum grade of 5.0 in each of the blocks to pass the seminar.
Cardiac Rehabilitation Seminar (30%):
- Ongoing assessment (40%): resolution of quizzes in class.
- Theoretical-practical exam (60%): formulation of objectives and treatment of the cardiac patient based on a clinical case.
It is established as a requirement to pass with a minimum grade of 5.0 in the theoretical-practical exam to pass the seminar.
Terms and Conditions for Passing the Subject
To pass the subject, it is necessary to pass independently each of the seminars that make it up, setting the passing grade at 5.0 or higher. If a seminar is failed in the first call, the student must attend the second call for the entire content of the failed seminar, keeping the grade of the seminars passed. If the student does not pass the seminar on the second call, even if they have passed other seminars, they will fail the subject entirely and must repeat it in the next academic year.
The grading system will be used in accordance with 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 mention of "honors" may be awarded to students who have obtained a grade equal to or higher than 9.0. The number of honors granted cannot exceed 5% of the students enrolled in a subject in the corresponding academic year unless the number of enrolled students is less than 20, in which case only one honor may be granted.
Attendance regulations:
Attendance at the three seminars that make up the subject is mandatory. The student must attend at least 70% of the sessions of each seminar to be evaluated.
Subjects in the Physiotherapy Degree that have theoretical-practical contents 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 direct and continuous supervision by the subject's faculty. Therefore, attendance at seminars is considered fundamental and necessary to ensure the acquisition of these competencies. Based on the above, absences can only occur exceptionally and must be motivated by major causes, and, in any case, if they exceed 30% of the training load, the student will be required to re-enroll in that subject in the following academic year, without the possibility of taking the exam in the second call. The consequences of not complying with this regulation can be negative and directly related to the enrollment process (overlaps and/or academic incompatibilities) and the corresponding temporal forecast for the completion of the degree studies.
Bibliography and resources
Seminar on Respiratory Techniques:
Postiaux, G. Respiratory Physiotherapy in Children. McGraw-Hill, 2000.
West J. Pulmonary Pathophysiology. Panamerican Medical Publishing, 2004.
Güell R. Respiratory Rehabilitation. M & M Communications,1999.
Pryor JA. Physiotherapy for Respiratory & Cardiac Problems. Churchill Livingstone,1998.
Delplanque D, Antonello M. Respiratory Physiotherapy and Resuscitation. Masson, 1996.
Smith, M. Ball, V. Cardiovascular and Respiratory Rehabilitation. Harcourt, 2000.
Cash JE. Kinesiotherapy for Thoracic, Cardiac, and Vascular Disorders. Panamericana.
Vandevenne A. Respiratory Rehabilitation of Chronic Obstructive Pulmonary Diseases. Masson.
Pneumokinesitherapie. Barthe, J. Doin Publishing.
Databases of Scientific Publications: PubMed, ISI Web of Knowledge, etc.
Seminar on Edema Treatment:
Wittlinger H., Wittlinger D., Wittlinger A., Wittlinger M. Manual Drainage according to Dr. Vodder's Method. Panamerican Medical Publishing, 2012.
Leduc A. Leduc O. D.L.M. Theory and Practice. Masson, 2003.
Francesc Viñas. Lymph and its Drainage, 2000.
Serra Escorihuela. Treatment of arm edema in breast cancer, 2002.
Ferrandez J-C S. Theys, J-Y Bouchet. Rehabilitation of lower limb edemas. Masson, 2002.
Ferrandez J-C Theys, S. Updates on DLM in secondary lymphedema due to breast cancer. From anatomy to gesture through pathophysiology, 2003.
Cardiac Rehabilitation Seminar:
Boron. Fisiología médica 2017. Elsevier, 3ª Ed, 2017.
Rhoades, R.A. y Bell, D.R. Fisiología médica. Fundamentos de medicina clínica. 4ª edición, Wolters Kluwer, Lippincott Williams & Wilkins, 2012.
Guyton y Hall. Tratado de Fisiología Médica, Elsevier, 13 ª edición, 2016.
Gilles R Dagenais, et al. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study, The Lancet, Volume 395, Issue 10226, 2020, Pages 785-794 - https://doi.org/10.1016/S0140-6736(19)32007-0.
https://www.msdmanuals.com/es-es/professional/trastornos cardiovasculares/miocardiopat%C3%ADas/miocardiopat%C3%ADa-dilatada
Otto CM, Nishimura RA, Bonow RO, et al: 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 143(5):e35–e71, 2021. doi: 10.1161/CIR.0000000000000932
Weir HK, Anderson RN, Coleman King SM, et al. Heart disease and cancer deaths—trends and projections in the United States, 1969–2020. Prev Chronic Dis. 2016;13:E157. S1-2.
Johnson NB, Hayes LD, Brown K, et al. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005–2013. MMWR Suppl. 2014;63:3–27. S1-3.
Xu J, Murphy SL, Greenland P, Knoll MD, Stamler J, et al. Major risk factors as antecedents
of fatal and nonfatal coronary heart disease events. JAMA. 2003;290:891–7. S1-5.
Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586–613. S1-6.
Turco JV, Inal-Veith A, Fuster V. Cardiovascular health promotion: an issue that can no longer wait. J Am Coll Cardiol. 2018;72:908–13. S1-7.
Younus A, Aneni EC, Spatz ES, et al. A systematic review of the prevalence and outcomes of ideal cardiovascular health in US and non-US populations. Mayo Clin Proc. 2016;91:649–70.
Redfern J, Gallagher R, O’Neil A, Grace SL, Bauman A, Jennings G, Brieger D and Briffa T (2022) Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future. Front. Cardiovasc. Med. 9:842567. doi: 10.3389/fcvm.2022.842567.
The ESC Handbook of Preventive Cardiology. Edited by Catriona Jennings, Ian Graham and Stephan Gielen. Oxford University Press, United Kingdom; 2016: 240. ISBN: 978-0-19-967403-9. DOI: http://dx.doi.org/10.1016/j.rec.2016.09.003.
DibbenG, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800.pub4.
Dominique Hansen et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2022 Feb 19;29(1):230-245. doi: 10.1093/eurjpc/zwab007.
William J. Kraemer, Steven J. Fleck, Michael R. Deschenes. Fisiologia del Ejercicio. Teoria y Aplicación Práctica. 3Edición. Wolters-Kluwer. 2016.
Evaluation period
- E1 02/04/2024 G5 08:00h
- E1 02/04/2024 I2 11:00h
- E1 02/04/2024 G6 08:00h
- E1 02/04/2024 I3 11:00h
- E1 02/04/2024 I1 11:00h
- E1 04/04/2024 I1 11:00h
- E1 04/04/2024 I3 11:00h
- E1 04/04/2024 G5 08:00h
- E1 04/04/2024 I2 11:00h
- E1 04/04/2024 G6 08:00h
- E1 07/05/2024 G5 08:15h
- E1 09/05/2024 G5 08:15h
- E1 21/05/2024 G6 08:00h
- E1 23/05/2024 G6 08:00h
- E2 02/07/2024 A08 12:00h
- E2 02/07/2024 G2 12:00h