Cardiovascular Health: Assessment and Intervention Among Patients with Physical and/or Cognitive Disabilities

Cardiovascular Health:

Assessment and Intervention Among Patients with Physical and/or Cognitive Disabilities

Jessica Skeeter, SPT

UNC PT Outreach – 2015

¡Hola!

Welcome to my Capstone site! This Capstone has been developed in conjunction with the UNC PT Outreach Service Learning trip to Guatemala during April 2015. In addition to providing physical therapy students with a means for enhancing their cultural competence, UNC PT Outreach strives to meet the needs of underserved populations through collaborative educational and clinical efforts.¹ From April 21^st – 29^th, I will travel with four other PT students and five UNC faculty members to Antigua, Guatemala. We will have the opportunity to immerse ourselves in Guatemalan culture while interacting with Guatemalan physical therapists and treating children and adults with physical and cognitive disabilities. During this trip, UNC students and faculty members will be providing educational presentations on a variety of topics to the therapists at Las Obras Sociales del Santo Hermano Pedro (Las Obras) and to community members during three health fairs that have been organized as a part of the Outreach trip.

Las Obras Sociales del Santo Hermano Pedro is a private hospital facility funded primarily through generous donations and supported in part by the Guatemalan government.² Approximately 300 employees provide healthcare to over 230 adults and children with physical and cognitive disabilities.² After discussing the current needs for the 2015 service-learning trip with UNC faculty members who had previously participated in the outreach efforts, I decided to develop a Capstone presentation that could be delivered to the physical therapists and physical therapy students at Las Obras. Additional conversations with faculty regarding current PT service delivery and patient characteristics at Las Obras influenced me to investigate cardiovascular health. Accordingly, I designed my Capstone project around the following purposes: (1) to provide education to physical therapists at Las Obras regarding the importance of aerobic exercise for promoting cardiovascular health among patients with disabilities, and (2) to offer strategies for assessment and intervention related to cardiovascular health that could be easily integrated into a patient’s plan of care at Las Obras.

To prepare my Capstone, I performed a thorough review of the current literature and developed an Evidence Table exploring the benefits of exercise for patients with a variety of disabilities. A reference list of the articles used in the table can be accessed HERE. Please note that this evidence table does not provide an exhaustive list of research studies supporting aerobic activity, as the examination of all articles related to individuals with disabilities was out of the scope of this project. The conclusions drawn from studies examined formed the basis of my presentation materials. Additionally, I considered the assessment tools and outcome measures used in these studies to determine which would be most appropriate for the physical therapists at Las Obras to learn and apply in practice. Accordingly, I determined that the 6-minute walk test (6MWT) for ambulatory patients and the 6-minute push test (6MPT) for patients who propel themselves in a wheelchair would be feasible to use at Las Obras, as they are relatively easy to administer, allow therapists to track changes over time, and provide a submaximal evaluation of a patient’s endurance.^3-11 Moreover, studies have reported the validity and responsiveness of these measures among patients with disabilities.^3-11 Furthermore, I determined that physical therapists would need to monitor heart rate (HR), blood pressure (BP), and rate of perceived exertion (RPE) in order to assess each patient’s response to activity and to ensure patient safety throughout a physical therapy session.

In order to deliver an effective and useful presentation, I utilized resources from the DPT Capstone site, including “Teaching and Learning in Physical Therapy: From Classroom to Clinic” by Margaret Plack and Maryanne Driscoll; a YouTube Video titled “Life After Death by PowerPoint 2012” by Don McMillan; and the “Handbook of Teaching and Learning for Physical Therapists” by Gail Jensen and Elizabeth Mostrom.^12-14 Additionally, I completed a Health Literacy Assessment to ensure that my materials were culturally sensitive and the appropriate reading level for my audience. Based on the resources I accessed, the health literacy assessment, and feedback from my Capstone advisor, Lisa Johnston, I edited my presentation materials accordingly.

Utilizing feedback and guidance from my Capstone advisor and my Capstone committee members, I developed a PowerPoint presentation entitled “Cardiovascular Health: Assessment and Intervention Among Patients with Physical and/or Cognitive Disabilities.” (English/Spanish) All presentation materials have been translated to Spanish and the verbal presentation of my PowerPoint will take place with the assistance of a translator. In conjunction with the presentation, I developed a hands-on lab experience focusing on utilizing the assessments and outcome measures I will discuss in my PowerPoint. Additionally, I have created multiple resources that will guide lab the activities and supplement my presentation. These resources, which I hope the therapists at Las Obras will utilize and refer to in future practice, include the following materials:

• Rate of Perceived Exertion Chart: This modified, pocket-sized Borg scale has been laminated for easy reference during patient activities. (English/Spanish)
• “Decision Tree for Safe Participation in Exercise” Handout: Can be used to make judgments regarding a patient’s appropriateness for exercise at baseline, during activity, and after activity. Appropriate and abnormal HR and BP values were included on the 2^nd page of the document. A quick calculation of target heart rate is also explained. (English/Spanish)
• “Cardiovascular Health Lab Activities” Handout: Provides detailed description of HR and BP assessment, and how to administer both the 6-Minute Walk Test and the 6-Minute Push Test. (English/Spanish)

In order to obtain feedback from the audience members who attend my presentation, a Presentation Evaluation Form will be provided. The form will address the organization of my presentation, the quality of its content, its relevance to clinical practice, and the clarity/usefulness of the practice session and handout materials. At the request of my Capstone advisor, this form will invite feedback regarding my presentation as well as other presentations given by UNC students and faculty during our time at Las Obras. Additionally, if possible, therapists will be observed throughout the days following my presentation to determine if there is evidence of learning and whether presented materials were utilized in practice. Feedback and observations relevant to my presentation will be shared following the conclusion of the service-learning trip.

I would like to express my sincerest gratitude to Lisa Johnston, my Capstone advisor, who has offered invaluable feedback, guidance, and encouragement since I began developing my Capstone in December 2014. Furthermore, I would like to thank my Capstone committee members, Sadye Paez Errickson, PT, MPH, PhD and Sean Lowers, PT, DPT, CCS, for their commitment of time and effort for assessing and assisting me with this Capstone project.  I owe a substantial debt of gratitude to my dear classmate, Sarah van der Horst, for translating all of my presentation materials into Spanish – you are awesome, Sarah! Finally, last but definitely not least, I offer my deepest appreciation to my friends and family members who have supported and reassured me throughout this entire process.

Thank you all so very much! Without your contributions, this project would not have been possible!

References:

1. Department of Allied Health Sciences: Physical Therapy. UNC PT Outreach 2012.  Available at:  http://www.med.unc.edu/ahs/physical/news/unc-pt-outreach-2012.  Accessed April 15, 2015.
2. Edwards N, Errickson S. Introduction to Health and Disability in Guatemala. [PowerPoint]. Chapel Hill, NC: UNC Doctorate of Physical Therapy Program; 2013.
3. Mossberg KA, Fortini E. Responsiveness and validity of the six-minute walk test in individuals with traumatic brain injury. Phys Ther. 2012;92(5):726-733.
4. Fulk GD, Echternach JL, Nof L, O’Sullivan S. Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke. Physiother Theory Pract. 2008;24(3):195-204.
5. Nsenga Leunkeu A, Shephard RJ, Ahmaidi S. Six-minute walk test in children with cerebral palsy gross motor function classification system level I and II: reproducibility, validity, and training effects. Arch Phys Med Rehabil. 2012;93(12):2333-2339.
6. Elmahgoub SS, Van de Velde A, Peersman W, Cambier D, Calders P. Reproducibility, validity and predictors of six-minute walk test in overweight and obese adolescents with intellectual disability. Disabil Rehabil. 2012;34(10):846-51.
7. Hassan J, van der Net J, Helders PJ, Prakken BJ, Takken T. Six-minute walk test in children with chronic conditions. Br J Sports Med. 2010;44(4):270-274.
8. Patrick C, Sami E, Dirk C. Physical and Metabolic Fitness of Children and Adolescents with Intellectual Disability – How to Rehabilitate? IN: Tan U, ed. Latest Findings in Intellectual and Developmental Disabilities Research. Rijeka, Croatia: Intech, 2012. Available at: http://cdn.intechopen.com/pdfs-wm/28161.pdf. Accessed February 24, 2015.
9. Nasuti G, Stuart-Hill L, Temple VA. The Six-Minute Walk Test for adults with intellectual disabilities: a study of validity and reliability. J Intellect Dev Disabil. 2013;38(1):31-38.
10. Cowan RE, Callahan MK, Nash MS. The 6-min push test is reliable and predicts low fitness in spinal cord injury. Med Sci Sports Exerc. 2012;44(10):1993-2000.
11. Verschuren, Ketelaar, De Groot, Vila, Takken. Reproducibility of two functional field exercise tests for children with cerebral palsy who self propel a manual wheelchair. Dev Med Child Neuro 2013;55(2):185-190.
12. Plack M, Driscoll M. Teaching and Learning in Physical Therapy: From Classroom to Clinic. Thorofare, NJ: SLACK, Inc; 2011.
13. McMillan D. Life After Death by PowerPoint [Video]. YouTube. Available at: https://www.youtube.com/watch?v=MjcO2ExtHso. Published September 12, 2012. Accessed March 5, 2015.
14. Mostrom E. Patient Education and Health Literacy. IN: Jensen GM, Mostrom E, eds. Teaching and Learning for Physical Therapists. 3^rd St. Louis, MO: Elsevier; 2013: 200-216.