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Cardiovascular and pulmonary (CVP) impairments of body structures and functions that occur during infancy and childhood can, in the short term, be life threatening. In these cases, medical and physical therapy intervention is focused primarily on acute-care issues.

However, the long-term effects of CVP conditions can alter the physical, social, and cognitive growth of a child, resulting in multifaceted restrictions on activities and participation. Physical therapists treating children with CVP conditions must not only focus on the evaluation and intervention of short-term CVP systems–related impairments, but also carefully consider issues related to long-term compliance to therapeutic interventions, prevention of secondary impairments, and the effects of impairments and interventions on the maturing child’s changing social, cognitive, and behavioral development, and eventual role in society.

In the past decade, the emergence of improved diagnostic procedures and interventions for CVP conditions has improved care and quality of life for these children and their families. Unfortunately, these improvements have been counterbalanced by increasingly sedentary lifestyles, lack of physical activity and fitness in children, and the impact of obesity-related childhood chronic health conditions. The role of physical therapists in providing care for children with CVP conditions is shifting. Physical therapists are uniquely prepared to improve and increase opportunities for physical activity for all children, including those with CVP and neuromuscular conditions.

The overall objective of this chapter is to provide the entry-level physical therapy practitioner with the necessary foundational knowledge to develop effective evaluation, examination, and intervention for children with CVP conditions. In this chapter, a detailed overview is provided of the development and maturation of the CVP systems’ structure and function, and the impact of common pediatric CVP conditions on the growth and development of children framed within the context of the International Classification of Functioning, Disability and Health (World Health Organization, 2001). Clinical guidelines to assist the reader in determining appropriate examination and intervention for children with CVP conditions and related impairments are presented. Physical fitness and the emerging issues concerning health promotion and wellness programs for all children are also addressed. The final focus of the chapter is the physical therapist’s role in reducing disability related to long-term CVP effects of childhood obesity and physical inactivity.

Structure and Function

Overview of Cardiovascular and Pulmonary Function

The discussion of CVP function is organized according to “systems theory,” with the systems’ components subdivided into three categories: individual (or organismic), environment, and task. Individual or organismic components of the CVP systems include characteristics such as the ability to generate muscle force of inspiration, diameter of the blood vessels, range of motion (ROM) of the thorax, or airway responsiveness. Environmental system components for CVP function include gravity, air quality, temperature, humidity, and oxygen content of the available air. Primary tasks of the CVP systems are ventilation, circulation, and respiration, which exchange, deliver, ...

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