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Chapter Objectives

Upon completion of this chapter, the learner should be able to:

  1. Gather appropriate information through history and chart review.

  2. Identify risk for cardiovascular/pulmonary disease and complications in patients with neuromuscular disorders.

  3. Select appropriate cardiovascular/pulmonary tests and measures for given patient characteristics.

  4. Describe the test procedure for cardiovascular/pulmonary tests and measures described in the chapter.

  5. Evaluate cardiovascular/pulmonary examination data to determine prioritized problems to be addressed.

Introduction

Mrs. Norma is an 89 year-old grandmother who is 4 weeks statuspost stroke. In addition to her poststroke motor and sensory deficits you note throughout her right side, it is obvious she has limited cardiovascular and pulmonary reserves. Your initial observations of the patient include shortness of breath (SOB) that occurs with any activity and feelings of faintness every time she attempts to stand up. This chapter explores some of the tests and measures of cardiovascular/pulmonary function including oxygenation, ventilation, and functional endurance.

Physical therapists are responsible for screening and examination of four major body systems: musculoskeletal, neuromuscular, integumentary, and cardiovascular/pulmonary (APTA, 2014). The cardiovascular/pulmonary system may be negatively affected in neuromuscular disorders often as a secondary impairment related to decreased activity level. However, rehabilitation therapists often overlook examination of the cardiovascular/pulmonary system (Scherer, 2011; Village, 2011; Frese, 2002). Frese (2002) reported 38% of physical therapists did not measure heart rate (HR) and 43% did not measure blood pressure (BP) in their initial examination of new patients. Scherer (2011) reported that 65.8% of acute care patients who received gait training did not have their vital signs monitored and clients who had abnormal vital signs still received gait training, indicating results may not be used to inform clinical decision making.

Proper operation of the cardiovascular/pulmonary system is crucial to movement and functional activity because of the system’s role in oxygen (O2) delivery, extraction of O2 from the blood by the body tissues, and utilization (Frownfelter, 2006). If the body is unable to effectively deliver O2 to the working tissues, aerobic capacity, the maximum amount of O2 that can be absorbed by the blood (as a measure of fitness), will be impaired. The decreased aerobic capacity will limit the patient’s function and restrict progress in the rehabilitation program. Additionally, chronic diseases of the cardiovascular/pulmonary system not only affect the patient’s well-being but may result in alteration of the treatment plan by the therapist. Therefore, therapists need to be proficient in selecting and performing the appropriate tests and measures to effectively examine this system. This will facilitate evaluation of how impairments of the system affect mobility, functional capacity, and health and guide development of a customized plan of care that takes into consideration the patient’s cardiovascular/pulmonary status.

Cardiovascular/pulmonary system review should include, at a minimum, measuring HR, BP, respiratory rate (RR), and edema. Based on this screening, a more thorough cardiovascular/pulmonary ...

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