Cardiopulmonary PT in red also covered in lab

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• Cardiopulmonary PT (in red also covered in lab)
• Patient History (what information do I need?)
• Systems review guess what systems---
• Tests and measures (collecting information)
• Body structures
• Anthropometrics chest wall
• Posture thoracic
• Movement abnormalities reduce mechanical
  efficiency
• (Can someone explain mechanical efficiency?)
• Cardiovascular Pulmonary
• Aerobic capacity / endurance
• Circulation (including perfusion)
• Ventilation Respiration

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• Evaluation / Prognosis (using information)
• Identify prioritize impairments (what's wrong?)
• Determine dysfunction toward which the
  intervention will be directed (reversible vs.
  irreversible) (systems thinking)
• Prognosis Outcomes (using information)
• Determine predicted level of improvement in
  function and amount of time needed to reach that
  level
• Determine prognosis with consideration of
  modifying factors
• Planning and sequencing patient interventions and
  progressing treatment based on outcomes
• Determining outcomes
• Collecting outcomes data
• Determining discharge criteria based on patient
  goals and patient status
• Differentiating between discharge,
  discontinuation, transfer of care, or re
  evaluation
• Modifying tests/measures interventions when
  necessary
• Recognizing the effectiveness of PT interventions

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Examine

Evaluate
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• Interventions (fixing problems)
• Non procedural Interventions
• Coordination of care
• Communication
• Documentation
• Patient/family/client instruction (education)
• Procedural Interventions
• Exercise
• Aerobic capacity / cardiovascular training
• Strengthening / muscular endurance
• Breathing (always helpful)
• Use of gait functional balance other modes
  of training as aerobic/cardiovascular/strength/
  endurance training
• Modification of environment (as if this is easy)

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• Airway clearance techniques
• Breathing strategies (coughing, huffing, pacing,
  PLB)
• Manual / mechanical techniques (percussion,
  vibration)
• Positioning
• Promoting health, wellness and prevention
• Standards of Care
• Recognizing implications of research
  (technological developments) on PT practice
• Utilizing proper body mechanics
• Positioning, draping stabilizing of patient

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• To review
• For terminology sake I mean the same by
• Work in the environment, functional activities,
  movement, goal directed tasks, doing stuff,
  meeting demands
• What allows us to engage in work in the
  environment?
• What allows us to sustain work in the
  environment?
• What measures are important for considering our
  ability to engage in and sustain work in the
  environment?
• How are these measures related? (anatomically,
  physiologically, and causally in an x, y manner)

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• Major Objective carried forward from
  EP/Physiology to this class.
• Describe the integrated and coordinated function
  of cardiovascular, pulmonary, neuromuscular and
  bioenergetic components of acute response and
  chronic adaptation to any physical activity
  explain the impact of a variety of environmental
  stressors and/or biological impairments and
  explain how exercise can modify risk as well as
  improve functional capacity.

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• Some slightly more specific objectives that are
  helpful
• Explain the consumption of oxygen as a downhill
  process and the role, as well as relationship,
  of the four required systems for energy
  production.
• Pulmonary function is based on two major systems
  of pressure guided movement air to lungs
  (ventilation) and gas exchange (external and
  internal respiration). Explain how ventilation
  supports respiration and how respiration supports
  ventilation.
• Explain how normal cardiac electrophysiology
  contributes to normal hemodynamics and how normal
  hemodynamics contributes to normal cardiac
  electrophysiology.
• Explain what determines the bioenergetic rate of
  energy production and whether a required rate is
  sustainable or not, how we can measure and/or
  estimate this rate and the functional
  significance.

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CNS Modulation of Force
Oxidative Phosp.
Glycolosis
CP
ATP Storage
In a fiber ATP Use ? Temporal ?
Between fibers ATP Use ? Spatial ?
Therefore Force a ATP Use
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Aerobic Capacity
How long an activity/task can be performed.
If below Anaerobic Threshold
Energy Cost of Activity / Mechanical Efficiency
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Force
gtgt Aerobic Capacity
1 Minutes
gtAerobic Capacity
20 Minutes
Aerobic Capacity
Time can Sustain
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Coordinated Focused
Muscular Activity
Work
Environment
Bioenergetic Process
O2
Glucose
H2O
Ventilation
CV System
Respiration
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• Work load Energy Demand Energy Cost
  Absolute Intensity
• What determines energy cost?
• How do we measure this absolute intensity?
• How can we estimate this absolute intensity?
• http//www.cdc.gov/nccdphp/dnpa/physical/measuring
  /met.htm
• What is the primary determinant of energy cost of
  walking along a flat surface?

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• What factors determine how someone will respond
  to a particular activity of a particular energy
  cost?
• What are the factors about the activity influence
  response?
• Upper extremity
• Lower extremity
• Position / posture during activity
• What factors about the person influence response?
  

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• Odds and ends
• What is the purpose of the examination?
• What is the purpose of the evaluation?
• What might some typical goals for the PT working
  with a patient with a cardiac and/or pulmonary
  disease be?