Universitat Internacional de Catalunya - Barcelona

Physiotherapy Applied to Circulatory, Cardiac and Respiratory Dysfunctions

• code 08584
• course 3
• term Semester 2
• type OB
• credits 5

Module: Physiotherapy in clinical specialties

Matter: Physiotherapy applied to circulatory dysfunction, cardiac and respiratory

Main language of instruction: Spanish

Other languages of instruction: Catalan

Head instructor

Dra. Marta AMOR - mamor@uic.es

Office hours

Make an appointment by e-mail:

Mrs. Marta Amor

mamor@uic.es

Sra. Misericordia Fargas Buquera 

mfargas@uic.es

Mr. Juan Antonio Guzmán

jaguzman@uic.es

Mr.Eloi Arias

earias@csc.uic.es

Mr. Raul Carrion

rcarrion@uic.es

Respiratory Techniques Seminar:

The cardio-respiratory physiotherapy includes a set of physical techniques that sometimes act as a complement to medical treatment. These techniques help to improve breathing function, promote bronchial hygiene, reduce dyspnea and make retraining possible for patients with cardio-respiratory diseases. It is essential to know several of these techniques in order to adapt physiotherapy treatment to physiological changes in the body of these patients.

This course consists of a theoretical and practical seminar which where the student will learn the main treatment techniques in respiratory physiotherapy.

Oedema Treatment Seminar:

The Oedema is a common clinical sign in our daily practice, but it requires a specific analysis to know its origin.

The physical treatment of Oedema includes a set of techniques, interrelated to one another, through which we can improve the Oedema caused by the failure in the return circulation. 

Cardiac Rehabilitation Seminar:

Atherosclerosis is the leading cause of death in developed countries, responsible for about 20 million deaths per year worldwide, 3500 only in the Catalan territory. In adition, the progressive increase in life expectancy means a significant increase in morbidity of cardiovascular diseases.  

Since the Framingham Study 1979 associating physical activity with lower mortality in both men and women at any age, and also thanks to the meta-analysis of Taylor published in the American Journal of Medicine in 2004 which stated that there was a very significant increase in cardiovascular and total mortality decline, total cholesterol, triglycerides and systolic blood pressure, the implementation of training programs specifically designed for people who have suffered a cardiovascular death inside the family is a reality in treatment protocols (secondary prevention) and primary prevention.

Not specified, although it is advisable to have passed the Cardiorespiratory Assessment Seminar of the subject Specific Intervention Methods in Cardiorespiratory Physiotherapy, since treatment techniques in respiratory physiotherapy are closely related to examination /

  Respiratory Techniques Seminar:

• Know the practical foundations of different treatment techniques available to the physiotherapist for the management of patients with cardio-respiratory diseases.
• Acquire a complete education in physiotherapy to carry out comprehensive physiotherapy treatments of patients with cardio-respiratory diseases, which will make possible the achievement of the therapeutic goals formulated.
• Identify treatment priorities in each of the stages of the patient recovery.
• Offer the most appropriate therapeutic indications for respiratory therapy guided by patient assessment (mainly lung auscultation)
• Know how to identify potential complications during the evolution of the process.
• Know how to plan a program of effort retraining for the respiratory patient.
• Get a basic training of the most important aspects of infant respiratory physiotherapy treatment.
• Acquire basic knowledge about the inhaled and nebulized therapy.  

Oedema Treatment Seminar:  

• Know and differentiate the different types of oedemas.
• Know and understand the anatomy of the Lymphatic System well enough to perform the Manual Lymphatic Drainage adequately.
• Correct application of Manual Lymphatic Drainage, depending on the source and type of Oedema.
• Identification of possible complications all along the patient's treatment.
• Complex Descongestant Therapy Planning .
• Appropriate use of complementary therapies.
• Acquire the training necessary to differentiate the indications and counter-indications of the technique.

Cardiac Rehabilitation Seminar:

• Know the methodological basis of training.
• Provide students basic knowledge regarding the different physiological responses and adaptations of heart patient to acute and chronic exercise.
• Know the most effective strategies to promote initiation and maintenance of physical exercise on the heart patients.
• Know the methodological basis of the cardiac rehabilitation programs (RC).

• 01 - The ability to analysis and synthesis.
• 02 - The ability to organise and synthesize
• 06 - To have comprehensive problem-solving 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.
• 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.

After completing the course the student will be able to:

Respiratory Techniques Seminar:

• Know the correct way to use the main techniques of treatment for pathologies affecting the cardio-respiratory system.
• Be able to design the 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. Know how to evaluate the evolution of the results.
• Know how to adapt a retraining plan to the respiratory patient.
• Know and use the main techniques of respiratory physiotherapy treatment for children. Identify structural, physiological, functional and behavioral changes that occur as a result of the use of the cardio-respiratory physiotherapy.    
• Know how to adapt the treatment of respiratory physiotherapy to children.
• Understand basic knowledge of nebulized and inhaled therapy.
• Have the necessary skills to give practical information to patients on their rehabilitation/prevention  

Oedema Treatment Seminar:  

• Know and differentiate the different types of Oedema, and the correct application of the techniques according to it.
• Identify those oedemas that can be treated by complex decongestive therapy.
• Properly use MLD and the different complementary techniques.
• Be aware of the new developments in lymphatic pathology.  

Cardiac Rehabilitation Seminar:

• Stimulate student interest in a framework of specialized, comprehensive and a forward looking outlook not only by making reference to cardiac rehabilitation programs (PRC), but also for what it means in the training and rehabilitation of chronic diseases.

Respiratory Techniques Seminar:

1. Breathing re-education techniques .

1.1 Breathing control by correct use of diaphragm.
1.2 Guided Abdominal-diaphragmatic breathing.
1.3 Guided Costal breathing.
1.4 Pursed-lip breathing
1.5 EDIC: Exercise à Debit Inspiratoire Controlè
1.6 Postures that Facilitate Breathing
1.7 Postural Changes for pleural effusion.
1.8 Movements of the ribcage
1.9 Protection of the surgical wound

2. Bronchial hygiene techniques

2.1. Gravitational techniques: Postural drainage.
2.2. Shockwaves: Percussion and Vibration.
2.3. Expiratory flow modification:  
- LOW FLOW:
2.3.1. ELTGOL
2.3.2. Prolonged Slow Expiration
- HIGH FLOW:
2.3.3. Forced Expiration Technique
2.3.4. Increased Expiratory Flow
2.3.5. Cough.

3. Respiratory Physiotherapy Children techniques

3.1 ELPR (Prolongued Slow Expiration)
3.2 Glosso-pulsion retrograde
3.3 Désobstruction Rhinopharyngée Rétrograde
3.4 Provoked coughing

4. Instrumental techniques

4.1 Inspiratory Instrumental Techniques: incentive spirometer
4.2 Expiratory Instrumental Techniques:

4.2.1 Continuous Positive Airway Pressure: Pep-mask, Thera-pep

4.2.2 Discontinuous Positive pressure: Flutter, Acapela

4.3 In / exsuflator (cough assist)

5. Oxygen Therapy

5.1 Indications
5.2 Sources of oxygen: Compressed gas, concentrators and liquid oxygen
5.3 Management Systems: nasal cannula, masks, saving systems
5.4 Effort oxygen therapy  

6. Inhaled therapy

6.1 Nature
6.2 Indications
6.3 Inhalation Systems
6.4 Use procedures 

Edema Treatment Seminar:

1. Introduction

2. Lymphatic system

2.1. Lymphatic System Components

2.2. Lymphatic System Physiology

2.3. Anatomy of the Lymphatic System

2.3.1. Upper extremity anatomy

2.3.2. Lower extremity anatomy

3. Oedema

3.1. Oedema Ranking

3.1.1. Venous Oedema

3.1.2. Lymphedema

3.1.2.1. Primary lymphedema

3.1.2.2. Secondary lymphedema

3.1.3. Lipedema

3.1.4. Lipo-lymphedema

4. Manual lymphatic drainage

4.1. Definition

4.2. Lymph Node Drainage

4.3. Manœuvres d'appel

4.4. Manœuvres résorption

4.5. Bypass or Replacement

4.6. Physiological and Therapeutic Effects

4.7. Indications

4.8. Counter-indications

4.8.1. Absolutes

4.8.2. Relative

5. Complementary techniques

5.1. Pressure therapy

5.2. Multilayer bandaging

5.3. Containment or compression garments

5.4. Kinesiotherapy

6. Surgical techniques

7. Prevention and General Recommendations

Cardiac Rehabilitation Seminar:  

1. Cardiac rehabilitation (CR)Historical evolution of the CR

• CR concept
• Configuration of a Cardiac Rehabilitation Program (CRP)
• Human resources and material resources

2. The training load

• Parameters defining the training load

- Volume

- Intensity

- Density

3. General principles of physical training

• Theories on adaptation in physical exercise

General Adaptation Syndrome

Schultz-Arnodt Rule

Principle of overcompensation

•  Biological principles of adaptation

Principles to initiate adaptation

Principles to ensure adaptation

Principles for specific adaptation

4. Heart patients’ phenomena of response and adaptation to exercise

• Response and muscle adaptation to exercise

Response and adaptation of muscle fiber

Response and adaptation of motor units

• Adaptation of the energy systems

Adaptation of the aerobic system

Adaptation and lactic anaerobic system

• Cardiovascular Response and adaptation to exercise of heart patients

FC

Heart Flow

Systolic Execution Volume

Pharmacological conditioning

5. Methodological basis for strength training in cardiac patient

• Strength Training Systems

Concentric method

Eccentric method

Isometric method

•  Strength-resistance training

6. Methodological basis for resistance training in cardiac patient

• Physiological adaptations related to training of energy systems

VO2MÀX

Anaerobic verge

Aerobic system training

Training zones

Anaerobic system training

Training zones

7. Heart patient training program planning

• Training Planning

Interpretation of the PE and HC

Risk level Stratification

Diagnosis of the current level

Training plan

Training Control

•  Planning structures

The session

The microcicle

The macrocicle

This course will be carried out 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 treatment techniques that make up the course.
Students will have to solve some practical problems/cases during the seminar.
 Student participation through interventions during the course will be highly valued.

Respiratory Techniques Seminar:  

Attendance to the seminar is mandatory. The student must attend at least 80% of the sessions in order to be evaluated.

The evaluation of this course is mainly based on the practical implementation of procedures based on real tasks and problem solving by presenting clinical cases.

• Continuous evaluation (30%): 4 clinical cases in group 
• Practical exam (70%): planning objectives, treatment and execution of respiratory physiotherapy techniques from a clinical case  

 Oedema Treatment Seminar:  

The evaluation of this course will consist of two parts:

Theoretical block (50%):

- Multiple-choice exam

Practical block (50%)

- Practical/oral exam (35%)

- Practical Case (15%)

Cardiac Rehabilitation Seminar:  

The evaluation system and criteria in this seminar will consist of a theoretical exam (70% of total grade) and a practical part (30%) that will consist of submission of exercises, clinical cases and participation on forums.

It is mandatory to submit all the assignments in order to get the 30% of the practice.

The grading system is in accordance with the regualtions in force. Presently, according to RD 1.125/2003 of September 5:

0 to 4.9: Fail/F (Suspenso in Spanish)
5.0 to 6.9: Pass/C (Aprobado in Spanish).
7.0 to 8.9: B (Notable in Spanish)
A (Sobresaliente in Spanish) 9.0 to 10

The mention of "Honors" can be granted to students whose grade has been equal or higher than 9.0. Their number may not exceed 5% of students enrolled in a subject in the corresponding academic year, unless the number of students is less that 20, in which case it may be granted only to one student. 

Attendance Regulations

The subjects in the Physiotherapy Degree present theoretical and practical content in which the main objective is the acquisition and development of procedures and technical skills that are directly related to the professional practice These classes are structed in small groups where there is direct and continuous supervision of the teacher. Therefore, attendance to seminars is considered essential and necessary to ensure the acquisition of these skills. Based on what has been presented above, absences will only be excused to those who have missed class due to major causes and even under these circumstances, if they miss more than 20% of the training work, students will have to retake the subject in the next academic year, without the possibility of a resit.The consequences derived from non-compliance with this regulation can have very negative effects directly related to the registration process (overlapping and / or academic incompatibilities), as well as the corresponding expectations in the completion of the Degree.

Seminario Técnicas Respiratorias:

Bibliografía Recomendada (disponible en Biblioteca Campus Sant Cugat):

• Postiaux, G. Fisioterapia Respiratoria en el niño Ed McGraw-Hill, 2000.

• 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.

• Bases de dades de publicacions científiques: PubMed, ISI Web of Knowledge, etc.

Seminario Tratamiento del Edema: 

• Wittlinger H., Wittlinger D., Wittlinger A., Wittlinger M. Drenaje Manual según el Método del Dr. Vodder. Ed. Medica Panamericana, 2012
• Leduc A. Leduc O. D.L.M. Teoría y Practica.  Ed Masson, 2003
• Francesc Viñas. La Linfa y  su drenaje, 2000
• Serra Escorihuela. Tratamiento  braquiedema en el cancer de mama, 2002
• Ferrandez J-C  S. Theys , J-Y Bouchet. Reeducación de los edemas de los miembros inferiores. Ed Masson, 2002
• Ferrandez J-C Theys,S. Actualizaciones del DLM en el Linfedema secundario a cáncer de mama. De la anatomía al gesto pasando por la fisiopatología, 2003

Seminario Rehabilitación Cardíaca:

Bases Teóricas del entrenamiento

• Bompa, T.: Theory and methodology of training. Kendall-Hunt. Iowa. 1990.

• García Manso, J.M.; Navarro, M.; i Ruiz, J.A.: Bases teóricas del entrenamiento deportivo. Principios y apliaciones. Gymnos. Madrid. 1996.
• García Manso, J.M.; Navarro, M.; i Ruiz, J.A.: Planificación del entrenamiento deportivo. Gymnos. Madrid. 1996.
• García Manso, J.M.; Navarro, M.; i Ruiz, J.A.: Pruebas para la valoración de la capacidad motriz en el deporte. Evaluación de la condición física. Gymnos. Madrid. 1996.
• García Manso, J.M.: La fuerza. Gymnos. Madrid. 1999.
• Matveiev, L: El proceso del entrenamiento deportivo. Stadium. Buenos Aires. 1982.
• Navarro, F.: La resistencia. Gymnos. Madrid. 1998.
• Platonov, V.N.: El entrenamiento deportivo. Teoría y metodología. Paidotribo. Barcelona. 1988.
• Platonov, V.N.: La adaptación en el deporte. Paidotribo. Barcelona. 1991.
• Verjoshanski, I.V.: Entrenamiento deportivo. Planificación y programación. Martinez Roca. Barcelona. 1990.
• Volkov, M.V.: Los procesos de recuperación en el deporte. Stadium. Buenos Aires. 1984.
• Zintl, F.: Entrenamiento de la resistencia. Martinez Roca. Barcelona 1991.

Fisiología del ejercicio

• Barbany, J.R.: Fisiología del esfuerzo. Barcelona. Generalitat de Catalunya. Institut Nacional d’Educació Física de Catalunya. 1ª edició, 1986.
• López Chicharro, J.L.; Fernández Vaquero, A.: Fisiología del ejercicio. Madrid. Editorial Médica Panamericana, 2008.
• López Chicharro, J.L.; López Mojares, L. M.: Fisiología clínica del ejercicio. Madrid. Editorial Médica Panamericana, 2008.
• McArdle, W.D.; katch, F.I.; i Katch, V.L.: Fundamentos de fisiología del ejercicio. Madrid. McGraw-Hill/Interamericana de España, 2004.

Rehabilitación cardiaca

• AMERICAN COLLEGE OF SPORTS MEDICINE, (2010).: Manual de consulta para el control y la prescripción de ejercicio. Barcelona. Paidotribo.
• AMERICAN COLLEGE OF SPORTS MEDICINE, (1990): The recommended quantity and quality of exercise for developing and maintaining cardiorespiatory and muscular fitness in henny adults. (Position Stand of the American College of Sport Medicine). Medicine and Science Exercise. 22:265 271.
• Fardy, S.P.; Franklin, B.A.; Porcaro, P.J.; Verril, E.D.: Training Techniques in Cardiac Rehabilitation. Human Kinetics Monograph nº3 1998.
• The Heart and Exercice. A Practical Guide for the Clinica.: Raudal J. Thomas, M.D., M. S. IGAKU - SHOIN Medical Publishers, Inc. 1996.
• Fitness Movilidad. Fuerza. Resistencia. Teoría y prácticas.: W. Scheider et al. Ediciones Scriba, S.A. Barcelona. 1993.
• El Corazón.: Manual Hurst. Alexander SCHLANT. FUSTER. O'ROURKE. Robert ROBERTS. Edmund H. SONNENBLICK. McGraw-Hill. INTERAMERICANA. 2000.
• Desarrollo y admininstración de programas de rehabilitación cardíaca.: Dr. LINDAK HALL. Ed. Paidotribo. 1997.
• Evaluación y Prescripción del Ejercicio.: Vivian H Heyward, Ph. D. Ed.Paidotribo. 1997.

E: exam date | R: revision date | 1: first session | 2: second session:

• E1 26/05/2020 08:00h
• E2 23/06/2020 13:00h