Special Tests of the Cardiopulmonary, Vascular, and Gastrointestinal Systems

Dennis G. O’Connell, PT, PhD, CSCS, FACSM is a founding member of Hardin-Simmons University Department of Physical Therapy. He serves as a professor and the Shelton-Lacewell Endowed Chair. He is an adjunct professor at the Rocky Mountain University of Health Professions in Provo, Utah. Dr. O’Connell received his Bachelor of Science in Physical Education from Manhattan College, his Master of Arts and PhD in Exercise Physiology from Kent State University and the University of Toledo, respectively. He obtained a second Bachelor of Science degree in Physical Therapy from The University of Texas Health Science Center at San Antonio. Dr. O’Connell has 30 years of experience as an exercise physiologist and 15 years as a physical therapist. His clinical experience has centered on patients with cardiac, pulmonary, and musculoskeletal disorders, and ergonomic issues. In addition to providing pro bono services on-campus, he and his wife, Janelle, created HSU PT Ministries and have served with their students in Guatemala, Mexico, and Abilene, TX. Janelle K. O’Connell, PT, PhD, DPT, ATC, LAT is a founding member of Hardin-Simmons University Department of Physical Therapy where she currently serves as professor and department head. Dr. O’Connell received her Bachelor of Science in Education from Central Michigan University, her Master of Arts in Exercise Physiology from Kent State University, and her PhD in Health Promotion from the University of Toledo. She has earned an entry-level MPT and a DPT from Hardin-Simmons University. Dr. O’Connell has 14 years of experience as a physical therapist and has been an athletic trainer for 31 years. As an athletic trainer, Dr. O’Connell has worked in high school and collegiate sports and in athletic training education. She is a Certified Exercise Expert for Aging Adults and enjoys working with the elderly. Martha R. Hinman, PT, EdD, CEEAA is a professor in the Hardin-Simmons University Department of Physical Therapy and an adjunct professor at the University of Alabama at Birmingham and the University of Indianapolis. Dr. Hinman received her Bachelor of Science in Physical Therapy and her Master of Health Education from the Medical College of Georgia and earned her EdD in Allied Health Education and Administration at the University of Houston. Dr. Hinman's 34 years of experience as a physical therapist have focused in the areas of wound care, orthopedics, and geriatric wellness. She is a Certified Exercise Expert for Aging Adults and has expertise in the assessment of fall and fracture risk in the elderly. Dr. Hinman has been involved in physical therapy education for 30 years and has served as an educational consultant and accreditation reviewer for numerous physical therapy programs across the United States.

Dedication Acknowledgments About the Authors Preface Foreword by Donald K. Shaw, PT, PhD, FAACVPR Introduction Section One: Examination of the Cardiovascular System Cardiovascular Disease Risk Factors Heart Rate—Resting (Adults) Heart Rate—Resting (Infants-Adolescents) Pulses Blood Pressure Measurement Pulse Pressure Rate-Pressure Product or Double Product Acute Chest Pain—Cardiac Origin Angina Pain Rating Scale Other Sources of Chest Pain Cardiac Inspection and Palpation Auscultation Jugular Venous Distension Section Two: Examination of the Pulmonary System Respiratory History Inspection of the Thorax Pulmonary Anatomy Respiratory Rate Respiratory Rhythm Respiratory Depth and Symmetry of Movement Thoracic Depth, Width, and Diameter Thoracic Excursion Measurement via Circumference Palpation of Tactile Fremitus Percussion Diaphragmatic Excursion Auscultation Technique and Normal Sounds Auscultation of Transmitted Voice Sounds Oxygen Saturation Chest Disorders Dyspnea With Activities of Daily Living Dyspnea at Rest Dyspnea During Activity Section Three: Examination of the Abdomen Inspection Auscultation of the Abdominal Vasculature Percussion of the Abdomen Light Palpation of the Abdomen Deep Palpation of the Abdomen Deep Palpation of the Abdomen—Bimanual Technique for the Liver Deep Palpation of the Abdomen—Bimanual Technique for the Spleen Deep Palpation of the Abdomen—Bimanual Technique for the Kidneys Deep Palpation of the Aorta BlumbergÆs Sign (Rebound Tenderness) MurphyÆs Sign Iliopsoas Muscle Test for Appendicitis Obturator Muscle Test for Appendicitis Assessment of Diastasis Recti (Done) Section Four: Examination of the Peripheral Vascular System Peripheral Vascular History: Differential Diagnosis for Arterial and Venous Diseases Assessing the Integumentary System for Skin Cancer Skin Turgor Skin Temperature Figure-of-Eight Methods for Measuring Limb Edema Volumetric Measures of Limb Edema (Water Displacement Method) Girth Measurements and Estimated Limb Segment Volume Capillary Refill Time Test (CRTT) Elevation Pallor Stoop Test Treadmill Time to Claudication Active Pedal Plantarflexion (APP) Intermittent Claudication Test AllenÆs Test for Hand Circulation Vertebral Artery Test Roos Test for Thoracic Outlet Syndrome (TOS) Ankle-Brachial Index (ABI) HomansÆ Test WellÆs Clinical Prediction Rule for Deep Vein Thrombosis WellÆs Clinical Prediction Rule for Pulmonary Embolism Clinical Prediction Rule for Upper Extremity Deep Vein Thrombosis Cuff Test for Venous Insufficiency/Occlusion Venous Percussion, Tap, or Cough Test Venous Filling Time Pitting Edema Kaposi Stemmer Sign (Edema vs Lymphedema) Auscultation of Carotid Artery Section Five: Submaximal Exercise Evaluation Concepts of Submaximal Testing Oxygen Consumption and METs Metabolic Equivalents (METs) Measuring Exercise Heart Rate Predicting VO2max From Submaximal Heart Rate Data Max METs Normative Data Risk Stratification for Exercise Testing or Prescription General Exercise Test Procedural Information Bruce Treadmill Protocol Exercise Test or Exercise Session Termination Prediction of VO2max via Nonexercise Survey Duke Activity Status Index Two-Minute Walk Test Six-Minute Walk Test Six-Minute Walk Test on Treadmill for Younger Adults Timed One-Mile Walk Seated Step Test (SST) Tecumseh Step Test YMCA Step Test Astrand-Rhyming Cycle Ergometer Test YMCA Cycle Ergometer Test Single-Stage Treadmill Test Naughton Treadmill Protocol Wheelchair Test The Talk Test (Indirect Assessment of Anaerobic Threshold) Calculating Target Heart Rates Appendices Appendix A: Maximal Aerobic Power Appendix B: Monark Cycle Ergometer Calibration Appendix C: Treadmill Calibration Appendix D: HR-MET Chart Altug Book Appendix E: YMCA HR-VO2max Chart Appendix F: Astrand-Rhyming Nomogram Index