Intended Learning Outcomes
Section 1 (Introduction and review of respiratory physiology)
Introduction to cardiopulmonary physiotherapy
- appreciate the various services provided by a cardiopulmonary physiotherapist
- identify clients that require cardiopulmonary physiotherapy
- understand the role of a cardiopulmonary physiotherapist in acute care, outpatient and community settings
Review of respiratory physiology: mechanics of breathing
- explain the physiology underpinning respiratory techniques commonly employed by a respiratory physiotherapist, such as cough, huff and breathing exercise
- appreciate the concepts of equal pressure point, airway and elastic resistance, pulmonary compliance, work of breathing, and the relationship between pleural pressure, alveolar expansion and ventilation
- use those concepts to assist with clinical decisions associated with positioning of patients and the selection of appropriate interventions that address issues relefant to a patient's respiratory mechanics
Review of respiratory physiology: ventilation and perfusion relationship
- explain the regional variation of ventilation and perfusion within the lungs
- identify factors that influence intrapulmonary shunting of blood
- provide reasoning for selection of an appropriate position to maximise lung volume and/or ventilation
- determine an appropriate strategy to maximise oxygenation through positioning
Oxygen therapy
- apply various oxygen delivery systems to a patient
- facilitate appropriate oxygen therapy to a patient
- advise a patient on the appropriate use of supplementary oxygen
- understand the risks of supplementary oxygen administration
Humidification and inhalation therapy
- make a clinical decision as to whether inhalation therapy (humidification or nebulisation) is indicated for a patient
- apply appropriate means to improve humidification of the airway
- teach a patient proper the use of a nebuliser
- instruct a patient on the appropriate use of various meter dosed inhalers
Section 2 (Physiotherapy assessment and cardiopulmonary physiotherapy intervention)
Understanding spirometry
- conduct an accurate spirometry test
- interpret the numerical and graphical spirometry data
- recognise the various spirometry patterns associated with restrictive and obstructive pulmonary disease
- appreciate the American Thoracic Society recommendations for presenting spirometry test data
- appropriately use spirometry data as an outcome measure to evaluate a physiotherapy intervention
Assessment of respiratory function
- conduct a patient interview and ask appropriate questions relating to a patient’s respiratory condition
- perform essential physical examination procedures in a patient with respiratory disease
- identify a patient’s problems from assessment findings in order of importance from the clinical evidence
- relate assessment findings to the pathophysiological presentation
- monitor appropriate measurable outcomes as indicators of progression of the patient’s respiratory condition
Data used to determine the level of respiratory function
- identify abnormal oxygenation and ventilation in a patient by interpreting a blood gas analysis profile and pulse oximetry
- interpret spirometric analysis of lung volume and airflow
- interpret normal and abnormal features of a chest radiograph
- measure an exhaled carbon monoxide level
- appreciate the role of thoracic ultrasound in monitoring breathing pattern and diaphragm thickness
Airway Clearance Techniques
- describe the concept of airway clearance
- select an airway clearance technique (ACT), underpinned by current best evidence, that is appropriate to the patient’s pathophysiological condition
- apply the appropriate airway clearance techniques covered in the lecture
- evaluate the effectiveness of an ACT with appropriate outcome measures
- make clinical decision regarding the needs of adjunctive therapy devices to assist airway clearance
Techniques to improve lung volume and ventilation
- identify indications for the need to employ techniques to improve a patient’s ventilation or lung volume
- perform techniques commonly used by physiotherapists to promote pulmonary ventilation
- based on the patient’s pathophysiological condition, make clinical decisions to select the appropriate technique for improvement of lung volume or ventilation
Role of Physiotherapy in Pre and post-surgical care
- identify risk factors that may contribute to post-surgical pulmonary complications
- appropriately provide pre- and post-surgical physiotherapy intervention
- deliver a pre-operative patient assessment and provide appropriate pre-operative advice and intervention for the patient
- conduct an appropriate post-operative assessment
- perform appropriate post-operative intervention followed by assessment of outcome
- consider discharge criteria for a patient
- formulate a comprehensive discharge plan for the patient prior to returning home
Section 3 (Management of COPD, pulmonary rehabilitation and paediatric care)
Management of patients with COPD
- describe the pathophysiology, diagnosis, signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD)
- explain mainstream medical management of COPD
- conduct an appropriate physiotherapy assessment using the ICF framework
- provide intervention and education for patients with COPD
- select appropriate outcome measures to determine effectiveness of the management program
- be aware of the risks of supplementary oxygen administration in patients with COPD
- identify global management guidelines for COPD
Management of patients with lung cancer
- describe the causes, risk factors and types of lung cancer
- interpret diagnostic reports of lung cancer
- outline the different stages of lung cancer
- understand the contemporary medical management of patients with lung cancer
- comprehend the role of physiotherapy in exercise management of patients with lung cancer
- appreciate the role of physiotherapy in pre and post-operative management of patients with lung cancer
- recognise the role of a physiotherapist in the prevention of lung cancer
Pulmonary rehabilitation and exercise prescription
- identify and prioritise each patient’s needs for pulmonary rehabilitation
- work with the patient to identify SMART goals during the various stages of pulmonary rehabilitation
- prescribe an appropriate individual exercise program based on patient assessment
- work collaboratively with other members of the pulmonary rehabilitation team
Physiotherapy management of paediatric patients
- identify the anatomical differences in the adult and neonatal respiratory system
- consider an appropriate position to maximise lung volume or ventilation in an neonate
- recognise the role of physiotherapy at different stages of common paediatric respiratory conditions
- identify the indications for physiotherapy in children with spinal muscular atrophy (SMA)
- assess the need for and provide, appropriate pre and post operative interventions, in children undergoing orthopaedic and cardiac surgery
Prescribing breathing devices in respiratory care
- understand the working mechanisms of different breathing devices
- recognise indications for use of a breathing device in the appropriate patient
- provide clear instructions to patients on the use of a breathing device
- provide prescription of an appropriate program to a patient who may benefit from the use of a breathing device
Section 4 (Cardiac rehabilitation)
Contemporary concepts of cardiac rehabilitation
- communicate the evolvement of cardiac rehabilitation to clients and relevant stake holders
- explain to the client the concept of cardiac rehabilitation
- select appropriate candidates for a cardiac rehabilitation program
- refer clients to an appropriate cardiac rehabilitation service
- participate in the planning and/or organisation of a cardiac rehabilitation program
- apply appropriate indicators to evaluate the quality of a cardiac rehabilitation program
- collaborate with other professions in the various domains of a cardiac rehabilitation program
Role of physiotherapy in phase I cardiac rehabilitation
- explain the role of physiotherapy in management for patients with cardiac conditions that require hospitalisation
- retrieve relevant information from the patient’s hospital notes
- assess the cardiac and haemodynamic status of the patient
- identify and prioritise the patient’s problems
- formulate a safe and appropriate intervention plan for a patient after acute myocardial infarction
- assess and provide appropriate intervention for patients with acute coronary syndrome
- assess and provide appropriate intervention for patients requiring cardiac surgery
- formulate appropriate physiotherapy discharge criteria for a patient admitted for cardiac management
- design a realistic discharge plan for a patient admitted for cardiac management
Phase II cardiac rehabilitation -Assessment and goal setting
- assess the individual needs of participants recruited to a cardiac rehabilitation program
- develop a comprehensive plan of care for participants in a cardiac rehabilitation program
- work collaboratively with other members of the cardiac rehabilitation team in assessment and goal-setting for participants undertaking a Phase II cardiac rehabilitation program
Role of physiotherapy in exercise prescription for Phase II cardiac rehabilitation
- apply the principle of exercise prescription to participants in a cardiac rehabilitation program
- prescribe an appropriate exercise training program for a patient undergoing Phase II cardiac rehabilitation
- modify the exercise protocol based on the patient’s responses to exercise training
- document the mode of exercise and patient response following each exercise session
- prescribe an individualised home exercise program for a patient based on patient responses to supervised exercise
- evaluate the effectiveness of an exercise program
Management of patients with chronic heart failure
- explain the difference between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction
- recognise the symptoms of heart failure
- explain to a patient with heart failure the benefits of physiotherapy
- prescribe an individualised exercise program for a patient with heart failure
- work with the cardiac rehabilitation team to deliver a comprehensive rehabilitation program for a patient with heart failure
- evaluate the effectiveness of an exercise program for a patient with heart failure
Section 5 (Physiotherapy in ICU care)
Introduction to ICU care
- understand the organisation and management of an ICU
- describe the general management of the critically ill in the ICU
- explain the need for early mobilisation in ICU patients
- work together with the ICU team in proning an intubated patient
- work collaboratively with other members in the ICU team
Monitoring in the ICU
- describe the commonly used outcome measures that reflect the oxygenation status of an ICU patient
- describe and interpret capnogram data
- describe and interpret the data which provide the haemodynamic profile of a patient
- interpret the data elicited by various neurological assessment tools
- explain and perform a Physical Function ICU Test and ICU mobility test
Principle of mechanical ventilation
- define the types of respiratory failure
- explain the indications for mechanical ventilation
- describe common modes of mechanical ventilation
- understand the concept of lung recruitment
- appreciate the role of physiotherapist during weaning from mechanical ventilation
The manual hyperinflation technique
- describe the process of manual hyperinflation
- select appropriate patients who will benefit from manual hyperinflation
- describe and explain the clinical application of non-invasive ventilation
Ventilator hyperinflation
- describe the process of ventilator hyperinflation
- understand various protocols of VHI reported in the literature
- describe and apply appropriate selection criteria for patients to undergo ventilator hyperinflation
Role of physiotherapy in ICU care
- describe the role of a physiotherapist in ICU
- provide an appropriate assessment for physiotherapy procedure in ICU
- recognise factors that inhibit patient mobilisation in ICU
- apply appropriate outcome measures to determine effectiveness of physiotherapy care delivered in an ICU environment
Physiotherapy documentation
Physiotherapy documentation
- understand the need to document every physiotherapy assessment, intervention and outcome
- document a patient’s consent to physiotherapy assessment and interventio
- document a patient’s past medical history, social history, subjective, and objective assessment findings
- document an intervention plan for the patient
