Knowing your patients are in capable hands can make all the difference. Greg Adams PT, MS, CCS graduated from Thomas Jefferson University in Philadelphia in 1992. Since his graduation he has been very involved in care for patients with cardiopulmonary disorders. Greg has worked with patients who have undergone transplants, lung volume reductions, valve replacements, and bypasses. His specialized experience includes 2 years on a ventilator rehab unit and numerous years on Intensive Care Units.

He has worked in multiple teaching hospitals, including Temple University Hospital, Albert Einstein Hospital (Philadelphia), and his present position at the University of Maryland Medical Center.

Greg has furthered his knowledge and skills by obtaining additional training and certifications, for example:

• Advanced Cardiac Life Support (ACLS) certification since 1993.
   
• Exercise Specialist certification in cardiopulmonary rehab from the American College in Sports Medicine (ACSM) since 1995.
   
• Board-certified physical therapy clinical specialist in Cardiovascular and Pulmonary physical therapy from the American Board of Physical Therapy Specialties (ABPTS) of the American Physical Therapy Association (APTA).

There are about 120,000 licensed Physical Therapists in the US and about 4,100 board-certified Physical Therapists in various specialties.

As of 2003, there are a total of 82 Cardiovascular and Pulmonary Clinical Specialists in the US. There are 3 Cardiovascular and Pulmonary Clinical Specialists in Maryland. Two (including Greg) work at University of MD; one works for NIH.

In one survey of employers by the APTA they found that:

• More than half of the of respondents to their survey believed board certified clinical specialists had better clinical outcomes.
   
• Almost half of the total respondents agreed that certified specialists routinely manage patients with more complex patient conditions than other physical therapists.
   
• About half of homecare employers that responded agreed that certified specialists manage patients more efficiently than other physical therapists.
   
• 37% of the employers that responded believed that there is a difference in the number of patients referred from other health care professionals directly to certified specialists versus other physical therapists.

The American Board of Physical Therapy Specialties (ABPTS) of the American Physical Therapy Association (APTA) awards certificates to physical therapists meeting approved requirements. To obtain board certification, candidates must submit evidence of required clinical practice in a specialty area, perform research, and successfully complete a rigorous written examination, which demonstrates specialized knowledge and advanced clinical proficiency in a specialty area of physical therapy practice.

Greg has been teaching at cardiopulmonary conferences nationwide for 3 years and for physical and occupational therapy programs.

What type of specialized Cardiovascular and Pulmonary
Home Health Evaluations/ Treatments may include with Greg:

1. Close monitoring of vitals and auscultation
   Functional exercise training with higher risk patient populations
   For Example: CHF:
   Monitor for drop in SBp with exercise
   Monitor for drop in pulse with exercise
   Auscultate lungs pre/post activity
   
   Hypotensive:
   Orthostatic vitals
   Adams Maneuver (Baroreceptor Activation)
   Abdominal binder
   Leg wraps, as appropriate
   Warm-ups
   Deep Breathing (increased negative thoracic pressure)
    
2. Airway Clearance Techniques:
   Chest PT, suctioning, huff cough, and teaching in use of clearance devices
   (Acapella, Flutter valve, TheraPEP). Follow-up on use of The Vest for patients with Cystic Fibrosis.
    
3. Dyspnea Management
   Pulmonary patients:
   Chest Wall Mobilization
   Inspiratory Muscle Training
   Monitor SpO2, RR
   6 minute walk
    
4. Treatment of chest wall pain
   Chest Wall Mobilization
    
5. Intermittent claudication
   Grade III/IV on PVD scale
    
6. Heart/Lung Transplants
   Prolonged warm-up
   Monitor for signs of infection/rejection
    
7. Patient Education:
   Peak flow meter follow-up and monitoring
   Incentive spirometer
   Self monitoring: Pulse, Borg Scale

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