Physical Maneuvers Research Articles

A Pilot Survey of Patient Perspectives on an Artificial Intelligence-Generated Presenter in a Patient Information Video about Face-Down Positioning after Vitreoretinal Surgery

Introduction: Video education is a commonly used patient education tool. However, the impact of integrating artificial intelligence (AI) into video education remains unexplored. This study aimed to examine the acceptability of an AI-generated presenter in a patient information video about face-down positioning after vitreoretinal surgery. Method: We prospectively enrolled participants who were planned for vitreoretinal surgery in which postoperative face-down positioning was recommended at the Royal Adelaide Hospital between December 2022 and September 2023. Participants were preoperatively provided with an educational video presented by an AI-generated presenter, incorporated into a surveyredcap. A pre- and post-video questionnaire was administered electronically. Results: There were 15 participants included in the study. In the pre-video questionnaire, most participants rated their awareness of special equipment for positioning as “not aware” (33%) and “slightly aware” (33%). The median pre-video six-item Spielberger State-Trait Anxiety Inventory Score was 12 (interquartile range 12–15). In the post-video questionnaire, most participants rated the video’s quality as “excellent” (73%) and would recommend it to others (73%). The majority of participants strongly agreed that they understood the AI presenter (60%), felt at ease with the presenter (60%), and trusted the presenter (60%). Four participants (22%) disagreed with the statement: “I was aware the presenter was computer generated.” Conclusions: Video-based education may provide information that patients find useful, particularly for physical maneuvers such as face-down positioning. The use of an AI-generated presenter was well-received by the majority of patients. Further research regarding the use of AI to develop educational video content is warranted.

Effects of Acute Hypocapnia on Postural Standing Balance Measured by Sharpened Romberg Testing (SRT) in Healthy Subjects.

The sharpened Romberg test (SRT) is a physical maneuver that has been used to identify ataxia in individuals in resource-limited settings. Previous research has suggested that performance on balance testing may be affected by hypocapnia. In this study, we sought to determine whether acute hyperventilation-induced hypocapnia affects performance on the SRT at 501 meters above sea level. We recruited 22 healthy subjects. Each subject performed a baseline SRT. Subjects were then asked to hyperventilate to the point of hypocapnia, confirmed by measurement with a capnometer. Subjects were then asked to re-perform SRT. The primary endpoint was time to loss of balance, measured as time-to-stepout. Time-to-stepout (TTS) on SRT at baseline had a mean ± standard deviation of 101 ± 117 s. In the hypocapnic condition, TTS was reduced to 48 ± 68 s. TTS normalized to 121 ± 132 s after recovery to normal capnic levels. Time-to-stepout was found to be significantly shorter in the hypocapnic measurement compared to the baseline measurement (P = .0128). Statistical analysis was conducted using one-tailed, paired sample T-tests using a P-value of < .05. Our study found a statistically and clinically significant reduction in performance on a balance test (SRT) when exposed to acute hyperventilation-induced hypocapnia compared to a eucapnic control. Our results suggest that acute hypocapnia may contribute to neurological dysfunction independently of hypobaric hypoxia.

Non-Pharmacological Treatment of Autonomic Dysfunction in Parkinson's Disease and Other Synucleinopathies.

Symptoms of autonomic dysfunction are prevalent and can be very debilitating, reducing the quality of life in patients with Parkinson's disease (PD) and other synucleinopathies such as dementia with Lewy bodies and multiple system atrophy. Non-pharmacological therapies are key to effective management and are frequently used alone in patients with mild autonomic symptoms, or in combination with pharmacological therapies in patients with moderate and severe symptoms. This article focuses on non-pharmacological approaches. Our objective was to review the non-drug and non-surgical approaches to treating autonomic symptoms in patients with PD and other synucleinopathies, focusing on cardiovascular, gastrointestinal, and genitourinary autonomic dysfunction. Evidence supporting the effectiveness of non-pharmacological treatment for the management of neurogenic orthostatic hypotension, supine hypertension, constipation, and bladder and sexual dysfunction is available. High-quality prospective trials are scarce, yet some non-pharmacological interventions (e.g., physical counter maneuvers) can be evaluated relatively quickly on an individual basis and often seem effective. The emerging variety of clinical presentations advocates for a stepwise, individualized, and non-pharmacological approach for the management of autonomic symptoms. Often, the first step is to reduce or discontinue drugs that cause or aggravate autonomic symptoms followed by lifestyle measures. While non-pharmacological and non-surgical treatments are available and, in many cases, effective to improve symptoms of autonomic dysfunction in PD and other synucleinopathies, they are often overlooked. Large randomized trials testing and comparing non-pharmacological approaches are warranted.

Vasovagal Syncope: A Review of Current and Emerging Therapies for a Common Cardiology Condition

Vasovagal syncope (VVS), characterized by transient loss of consciousness, is among the most prevalent reasons for emergency visits worldwide. Although benign in nature, VVS can be accompanied by traumatic injury, leading to morbidity and decreased quality of life, especially in those with VVS recurrence. The management includes non-pharmacologic and pharmacologic therapies (if resistant), patient education and reassurance, salt and fluid intake increase, and physical counter-pressure maneuvers. Among medications, midodrine has shown promising results in reducing VVS recurrence and positive head-up tilt tests. Fluoxetine and atomoxetine also might be suitable candidates for VVS therapy. Permanent pacemakers, such as closed-loop stimulation, are under research and can be effective in cases unresponsive to medical treatment. In summary, while data are scarce regarding the definite treatment of VVS, there is a need for further research with novel, easy-to-use and cost-effective therapeutic methods to enhance quality of life and prevent traumatic injury.

A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies.

Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or stiffness of the neck, and difficulty walking due to loss of balance. Brachial plexus (BP) neuropathies arise due to compression to any distal branches arising from C5-T1, whereas cervical radiculopathy involves compression at the nerve root in the neck. Such conditions can present with variable degrees of musculoskeletal pain, weakness, sensory changes, and reflex changes. The pronounced convergence in symptomatic manifestation within these conditions can pose a formidable challenge to clinicians, particularly in primary care. Thus, the primary objective of this paper is to enhance clarity and distinction among these pathological conditions. This objective is pursued through comprehensive delineation of the dermatomal and myotomal distributions characteristic of each condition. Furthermore, a meticulous examination is undertaken to elucidate physical indicators and maneuvers that exhibit a notably high sensitivity in detecting these conditions. Accurate diagnosis and treatment of each nerve pathology is important as long-term spinal cord compression and its roots may result in permanent disability and severely impact one's quality of life. As such, this systematic review serves as a guide that aids clinicians in differentiating the aforementioned conditions based on anatomy, physical exam findings, and imaging studies. Furthermore, this study aims to outline common peripheral nerve neuropathies in the upper extremities and ways to mitigate these pathologies using the least to most invasive treatment modalities.

The efficacy of non-pharmacological and non-pacing therapies in preventing vasovagal syncope: Tilt training, physical counter pressure maneuvers, and yoga - A systematic review and meta-analysis

BackgroundVasovagal syncope (VVS) is a prevalent condition characterized by a sudden drop in blood pressure and heart rate, leading to a brief loss of consciousness and postural control. Recurrent episodes of VVS significantly impact the quality of life and are a common reason for emergency department visits. Non-pharmacological interventions, such as tilt training, physical counter pressure maneuvers, and yoga, have been proposed as potential treatments for VVS. However, their efficacy in preventing VVS remains uncertain. MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched up to March 2023 for randomized controlled trials comparing non-pharmacological interventions with control in preventing VVS recurrence. The primary outcome was the recurrence rate of VVS episodes. ResultsA total of 1130 participants from 18 studies were included in the meta-analysis. The overall mean effect size for non-pharmacological interventions versus control was 0.245 (95 % CI: 0.128–0.471, p-value <0.001). Subgroup analysis showed that yoga had the largest effect size (odds ratio 0.068, 95 % CI: 0.018–0.250), while tilt training had the lowest effect size (odds ratio 0.402, 95 % CI: 0.171–0.946) compared to control. Physical counter pressure maneuvers demonstrated an odds ratio of 0.294 (95 % CI: 0.165–0.524) compared to control. ConclusionNon-pharmacological interventions show promise in preventing recurrent VVS episodes. Yoga, physical counter pressure maneuvers, and tilt training can be considered as viable treatment options. Further research, including randomized studies comparing pharmacological and non-pharmacological approaches, is needed to evaluate the safety and efficacy of these interventions for VVS treatment.

Heart rate variability at rest and in response to stress: Comparative study between hemodialysis and peritoneal dialysis patients.

Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD). Autonomic nervous system (ANS) dysfunction contributes to this arrhythmogenic background. This study compared heart rate variability (HRV) indices between hemodialysis (HD) and peritoneal dialysis (PD) patients, both at rest and in response to mental and physical stimulation maneuvers. Thirty-four HD and 34 PD patients matched for age, sex, and dialysis vintage, and 17 age- and sex-matched controls were studied. ANS function was examined by linear and non-linear HRV indices. Heart rate was recorded continuously (Finometer-PRO) at rest and during ANS maneuvers (orthostatic, mental-arithmetic, sit-to-stand, handgrip exercise tests). At rest, no significant differences between HD and PD were observed in HRV (root mean square of successive differences [RMSSD]: HD = 57.1 ± 81.1 vs PD = 69.6 ± 113.4 ms; P = 0.792), except for detrended fluctuation analysis (DFA-α1) (HD = 0.87 ± 0.40 vs PD = 0.70 ± 0.20; P = 0.047). DFA-α1 was significantly lower in PD than controls (1.00 ± 0.33; P < 0.05). All HRV indices during the mental-arithmetic test (RMSSD: HD = 128.2 ± 346.0 vs PD = 87.5 ± 150.0 ms; P = 0.893) and the physical stress tests were similar between HD and PD. The standard deviation along the line-of-identity (SD2)/the standard deviation perpendicular to the line-of-identity (SD1) ratio during mental-arithmetic was marginally lower in HD and significantly lower in PD than controls (PD = 1.31 ± 0.47 vs controls = 1.79 ± 0.64; P < 0.05). Both dialysis groups presented similar patterns in HRV responses during orthostatic and handgrip exercise tests. After the sit-to-stand, RMSSD, SD1, SD2, and DFA-α2 were higher compared to rest only in HD (RMSSD = 57.1 ± 81.1 vs 126.7 ± 185.7 ms; P = 0.028), suggesting a greater difficulty of HD patients in recovering normal ANS function in response to physical stress. In conclusion, HRV indices at rest and after mental and physical stimulation did not differ between HD and PD; however, the ANS responses following the sit-to-stand test were more impaired in HD. These findings suggest that ANS dysfunction is not largely affected by dialysis modality, but small differences in normal ANS recovery may exist.

The Hoffmann parallax: a prospective study to determine the benefit of Hoffmann's sign.

Degenerative cervical myelopathy (DCM) is the most common cause of age-related spinal cord dysfunction worldwide. Despite the widespread use of provocative physical exam maneuvers in the workup of DCM, the clinical significance of Hoffmann's sign is controversial. The purpose of this study was to prospectively assess the diagnostic performance of Hoffmann's sign for DCM in a cohort of patients treated by a single spine surgeon. Patients were divided into two groups based on the presence of a Hoffmann sign on physical examination. Advanced imaging studies were independently reviewed by four raters for confirmation of a diagnosis of cervical cord compression. Prevalence, sensitivity, specificity, likelihood, and relative risk ratios for the Hoffmann sign were calculated, with subsequent Chi-square and receiver operator characteristic (ROC) analysis to further characterize correlative findings. Fifty-two patients were included - of whom, thirty-four (58.6%) patients presented with a Hoffmann sign, and eleven (21.1%) patients demonstrated cord compression on imaging. The Hoffmann sign demonstrated a sensitivity of 20% and a specificity of 35.7% (LR = 0.32; 0.16-1.16). Chi-square analysis revealed that imaging findings positive for cord compression were proportionally greater for patients lacking a Hoffmann sign than those with a confirmed Hoffmann sign (p =0.032) ROC analysis demonstrated that a negative Hoffmann sign performed moderately well in predicting cord compression (AUC.721; p =0.031). The Hoffmann sign is an unreliable marker for cervical cord compression, and the lack of a Hoffmann sign may be more predictive of cervical cord compression.

HEMODIALYSIS EFFECTS ON AUTONOMIC FUNCTION: RESULTS OF LINEAR AND NON-LINEAR ANALYSIS OF HEART-RATE-VARIABILITY AT REST AND IN RESPONSE TO PHYSICAL AND MENTAL STRESS TESTS

Objective: Cardiac arrhythmias are the most common cause of death in hemodialysis. Autonomic dysfunction plays a central role in this arrhythmogenic background. Previous studies on hemodialysis-related changes in heart-rate-variability(HRV) give contradictory results. This study investigated HRV indices both at rest and in response to physical and mental stimulation maneuvers at multiple time-points around and during the hemodialysis procedure. Design and method: Autonomic function was assessed by linear and non-linear HRV indices at pre-dialysis, during-dialysis(3 equal time-periods), post-dialysis, and on the non-dialysis day in 36 hemodialysis patients. Continuous measurement of beat-by-beat heart-rate was recorded with Finometer-PRO(The Netherlands) at rest and after orthostatic, sit-to-stand, handgrip and mental-arithmetic test. Results: The RMSSD, SD1, and SD2 indices significantly increased during dialysis(early-HD, mid-HD, late-HD periods) compared with the pre-dialysis levels(p&lt;0.05) and returned to baseline post-dialysis(RMSSD: 54.39±83.73 vs 137.98±109.53* vs 119.85±97.34* vs 144.47±88.74* vs 85.82±121.43msec, *p&lt;0.05 vs pre-dialysis and post-dialysis). No differences were detected in the above indices between the pre-dialysis and non-dialysis day. However, post-dialysis, the HRV responses to orthostatic and sit-to-stand tests were more exaggerated than in the pre-dialysis measurements (p&lt;0.05). The HRV responses both at resting and physical tests in the non-dialysis day were similar to the pre-dialysis levels. HRV indices in mental-arithmetic test during hemodialysis were much higher than at the non-dialysis day(RMSSD: 77.05 (180.41) vs 19.75 (105.47)msec; p = 0.031) were detected. Conclusions: Hemodialysis causes marked changes in autonomic function. Resting HRV indices return to baseline post-dialysis, but HRV responses to physical stress remain exaggerated and return to baseline on the non-dialysis day. Detecting patients with significant autonomic dysfunction may help towards reduction of arrhythmia risk through individualized approaches.

TREATMENT OF ARTERIAL HYPOTENSION

Treatment of arterial hypotension is a complex problem that requires correction of the hemodynamic parameters of the patient and, if possible, an impact on the cause of a decrease in blood pressure. It is necessary to pay attention to the correction of factors aggravating the course of hypotension. It is also important to use non-drug methods of correction of low blood pressure, such as wearing compression underwear, increasing fluid and salt intake, the use of physical maneuvers and exercises. Pharmacological therapy of hypotension includes the use of a number of drugs with different mechanisms of action, such as midodrine, fludcortisone, droxidopa, norepinephrine membrane transporter inhibitors. Special attention is paid to the treatment of orthostatic hypotension, postprandial hypotension.

PO-05-235 MANAGEMENT OF REFLEX VASOVAGAL SYNCOPE (VVS) WITH A PROTOCOL INCORPORATING “TADASANA” YOGA MANEUVER

VVS is a common clinical problem with no satisfactory standard treatment.Yoga is being used to treat VVS and effectiveness of Tadasana has been shown in a case-control pilot study To assess efficacy of a protocol incorporating "Tadasana"- A yoga maneuver in achieving freedom from clinical symptoms and quality of life in patients with VVS Patients with at least 2 episodes of syncope/Near syncope suggestive of VVS in the last 3 months and having positive Tilt test were included All patients were treated with a systematic protocol of reassurance, instructions on maintaining adequate hydration, syncope avoidance, physical maneuvers and systematic teaching of "Tadasana " maneuver of Yoga(Fig 1 A).This yoga maneuver was instructed to be repeated for 8 – 12 cycles while consciously breathing in a relaxed manner, undertaken once a day. Fludrocortisone and Midodrine were initiated if symptoms persisted. Pacemaker was implanted as per guidelines. Patients were regularly followed up by telephone for symptom assessment , and confirming adherence to treatment protocol. Syncope functional status questionnaires (QOL, Fear score and syncope dysfunctional status- SDS) were administered at time of inclusion in study and at 1 year of follow up There were 175 patients ( 116 M & 59 F, Mean age 50 ± 20 years), Patients excluded from analysis were 18. (death-1/lack of adherence-7 / voluntary withdrawal from study-10. Comorbidities were HTN - 65, DM- 33, Hypothyroid - 5, CAD- 7, All had structurally normal hearts (Mean LVEF=62 ± 5%.). Fludrocortisone was used in 7 patients (4%) and midodrine in 1(0.6%). 2 patients needed permanant pacemeker implantation.At a mean follow up of 22 ± 14 months, there was decrement in mean- Total events: 4.77 ± 7 to 0.26±1.5,P <0.001 Syncope: 2± 2 to 0.07 ± 0.04P <0.001, Near syncope:2.8 ± 7 to 0.2 ± 1.4 P <0.001 (Figure 1 B). At 1 year favourable improvent were seen in QOL (25±13 to1±6,P <0.001 ), Fear score (53 ±24 to 38 ±17P <0.001, ) and SDS (39±15 to11 ± 10, P <0.001). A protocol incorporating yoga manuver "Tadasana" is effective in achieving reduction in syncopal and near sycopal episodes and leading to an improvement in quality of life in patients with VVS.

Revisiting pathophysiology of benign paroxysmal positional vertigo: a review

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. There are several possible underlying causes of BPPV, although the idiopathic form is the most common. BPPV is characterized by brief recurrent episodes of vertigo that are triggered by changes in head position. Although BPPV is a benign vestibular disorder, it can be a severe and disabling problem for some of patients. The pathophysiology of BPPV is still unclear. The pathophysiology for BPPV is complex and the underlying mechanism is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These otolith/debris are originally accumulated after detachment from the neuroepithelium of the utricular macula secondary to degeneration. BPPV can occur following other vestibular disorders. In the majority of cases, the triggering factors are unknown. Some patients of BPPV have a history of previous inner ear diseases such as Meniere’s disease or acute unilateral peripheral vestibulopathy. This clinical entity is well-defined in medical literature and usually effectively treated by certain physical maneuvers. However, the pathophysiology is still obscure and is being critically discussed in this article, which reviews the details pathological mechanism for BPPV. This review article will discuss that aging, trauma, migraine, Meniere’s disease, vestibular neuronitis, and vitamin-D deficiency are the most commonly investigated etiopathological factors resulting in BPPV.

A Case Study of Successful Application of the Principles of ME/CFS Care to an Individual with Long COVID

Persistent fatigue is one of the most common symptoms of post-COVID conditions, also termed long COVID. At the extreme end of the severity spectrum, some individuals with long COVID also meet the criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), raising the possibility that symptom management approaches for ME/CFS may benefit some long COVID patients. We describe the long-term outcomes of a 19-year-old male who developed profound impairment consistent with ME/CFS after a SARS-CoV-2 infection early in the pandemic. We evaluated and treated him using our clinic's approach to ME/CFS. This included a history and physical examination that ascertained joint hypermobility, pathological reflexes, physical therapy maneuvers to look for a range of motion restrictions in the limbs and spine, orthostatic testing, and screening laboratory studies. He was found to have profound postural tachycardia syndrome, several ranges of motion restrictions, and mast cell activation syndrome. He was treated according to our clinic's guidelines for managing ME/CFS, which included manual physical therapy maneuvers and both non-pharmacologic measures and medications directed at postural tachycardia syndrome and mast cell activation. He experienced significant improvement in his symptoms over 30 months. His case emphasizes how the application of the principles of treating ME/CFS has the potential to provide a direction for treating long COVID.

Abstract P5-07-14: A pilot study of novel approach of intraneural facilitation versus standard physical therapy for prevention of chemotherapy induced peripheral neuropathy

Abstract Background Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent side effect of commonly used chemotherapy (CT) regimens and often results in dose reduction or cessation of treatment which can adversely affect cancer outcomes. Treatment options for CIPN are limited and no standard approaches exist to prevent CIPN. A novel therapy, Intraneural Facilitation (INF) has been developed by physical therapists at our institution’s neuropathy treatment center as a preventative and treatment modality for CIPN. INF therapy involves physical maneuvers and systematic application of pressure to improve peripheral microvascular circulation to the endoneurial capillaries of the extremities. We conducted a randomized pilot study evaluating INF versus standard physical therapy (PT) maneuvers as a non-invasive treatment modality for preventing CIPN during participants’ ongoing chemotherapy. This study was supported by an intramural (GRASP) grant and registered on clinicaltrials.gov (NCT0327919). Methods Newly diagnosed patients with breast cancer stages I to III and CT naive gynecologic cancers without preexisting peripheral neuropathy planning to receive treatment with platinum-based compounds and/or taxanes were eligible for this study. Participants were randomized into two treatment groups. Group one received INF and group two received a standardized program of PT including muscle stretching and strengthening exercises. Each group received two (45-minute) treatments twice a week for six weeks under the supervision of trained physical therapists. Participants were evaluated at baseline, week 3, week 6, and 3 months after the date of initiation of chemotherapy. The use of neuropathy medications, CT dose reductions, and treatment discontinuation was compared between the two treatment groups. Vascular perfusion was also evaluated at the same intervals using ultrasound to measure volume flow and pulsatility of the popliteal and posterior tibial arteries. Participants completed a survey at the end of treatment evaluating the effectiveness and satisfaction of the intervention. Results 44 out of 104 patients screened met the eligibility criteria and were randomized to either of the two therapy modalities from July 2017 to June 2022. A total of 38 participants received the allocated intervention and were included in the analysis (n=20 in the INF arm and n=18 in the PT arm). CT dose reduction due to CIPN grade 2 or higher occurred in 6/18 (33%) and 4/20 (20%) participants who received standard PT and INF, respectively. 2/18 (11%) participants required discontinuation of CT prematurely due to CIPN in the standard PT arm when compared to 1/20 (5.0%) in the INF arm. Pharmacologic interventions were required to manage CIPN in 4/18 (22%) participants in the standard PT arm vs 2/20 (10%) in the INF arm at the end of CT. Participants reported more control over their health (95.2% INF arm vs. 83.3% PT arm) and decreased nerve discomfort (75% in the INF arm vs. 61.1% in the PT arm). Participants reported high levels of satisfaction overall at the end of each intervention (95% in the INF arm vs. 83% in the PT arm). Conclusion Our pilot study evaluated the feasibility and potential for INF therapy compared to standard PT for the prevention of CIPN during ongoing chemotherapy. Based on the patient satisfaction survey, the burden and satisfaction with the assigned therapy modality between the two arms were favorable overall. Our results showed that CT dose reduction and early cessation in addition to pharmacologic interventions for CIPN were numerically less prevalent in the INF arm compared to the standard PT arm; however, further studies are needed to validate these findings. Citation Format: Dani Ran Castillo, Won Jin Jeon, Carvy Floyd Luceno, Mark Bussell, Ron Coleman, Karla Pieters, Jamie Hankins, Annette Boggs, Lorena Garcia, Salem Dehom, Ellen D’Errico, Gayathri Nagaraj. A pilot study of novel approach of intraneural facilitation versus standard physical therapy for prevention of chemotherapy induced peripheral neuropathy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-14.

Friendzone réal. par Charles Van Tieghem

Reviewed by: Friendzone réal. par Charles Van Tieghem Maria G. Traub Tieghem, Charles Van, réal. Friendzone. Int. Mickaël Lumière, Manon Azem, Fadili Camara, Eva Danino. Nabi, 2021. From a vintage-style Volkswagen van descend three beautiful twenty-something women, calling to "Titi" to join them. A smiling, obliging young man steps out and follows along. The ladies are headed to a bachelorette party for Alex, one of the three. The camera pans people with glasses and bottles in their hands, frolicking from hotel rooftop to poolside, dancing, drinking, and splashing into the water. The hired, male entertainer performs hip undulations that pantomime sex before the bride-to-be, then removes (off-camera) his bathing brief. This first explicit gesture announces the general theme of the film: mating. Titi, who prefers the name Thibault, is propositioned by a nude male partygoer. It takes Thibault a few seconds to understand what is asked, before he refuses. This unsophisticated, softhearted young man rushes to save an attractive young woman stung by a jellyfish. Using his nursing skills to assist her, he gets to know Rose and begins to feel strongly attracted to her. Lighting and music accentuate the plot line, but Thibault gets in his own way. He is so eager to please, even verbally; he trips over everything he says. On another visit to Rose, a TV movie scene shows copulation in progress. Rose is nonchalant because Thibault is a friend, but his feelings make him uncomfortable. The film wants to be a romantic comedy but becomes tedious and predictable. His three friends decide to help him gain sex appeal. An unusual trio—independent banker Maud, a lesbian, Afro-French nurse Lulu, a co-worker, and newlywed, experienced Alexandra, come together to plan their friend Thibault's makeover. The three are all on-screen so much that it becomes their story about transforming a friend as much as Thibault's quest to win Rose. Rose is hardly present on screen. Their makeover includes physical exercise, African dancing, as well as conversation practice. When Thibault is given instructions for physical maneuvers to stimulate women during sex by lesbian Maud, the film clearly flirts with the pornographic. Lulu gets him to dance lessons and strategizes winning scenarios, while Alex coaches him on how to speak to a woman. Thibault tries out his newfound skills at a bar. He encounters Jennifer, a French version of Kim Kardashian. They begin a steamy, passionate affair, spending time together in empty, self-indulgent ways. Having had enough, Thibault confronts, rebukes, and breaks all relationships and all pretense. Fleeing to Rose, he humbly explains who he is and what his feelings are. This confessional scene is a film cliché, but it continues to please. The movie has feel-good tonality, but there is no real character development or growth. We do not have a substantial backstory to any of the characters; we do not know what Thibault's heart says to his head, likewise for Rose. The nudity and sex talk garner red flags for educators: check institutional policies! The film's language is peppered with contemporary French street talk as well as English. The takeaway message, "Be honest, be yourself," is conveyed after an odyssey in hedonism. [End Page 268] Maria G. Traub Neumann University (PA) Copyright © 2023 American Association of Teachers of French

Correlation of Carpal Tunnel Syndrome 6 Score and Physical Exam Maneuvers With Electrodiagnostic Test Severity in Carpal Tunnel Syndrome: A Blinded Prospective Cohort Study

Although carpal tunnel syndrome (CTS) can be diagnosed clinically with the Carpal Tunnel Syndrome 6 (CTS-6) evaluation tool, the relationship between disease severity and CTS-6 score has not been elucidated. The purpose of our study was to determine the correlation of the CTS-6 score and other physical examination maneuvers with the carpal tunnel severity grade by electrodiagnostic testing (EDT). We hypothesized that the CTS-6 score, Durkan test, and Semmes Weinstein Monofilament Testing (SWMT) positively correlate with EDT severity. We prospectively enrolled 105 consecutive patients who presented to the office with suspected CTS, excluding those with previous surgery, previous EDT from an outside facility, or concomitant neuropathy. Four fellowship-trained hand surgeons obtained the CTS-6 score, time to obtain a positive Durkan compression test, and SWMT of the thumb, index, and middle fingers. All patients were sent for EDT. Hand surgeons were blinded to the results of the EDT, and the electrodiagnosticians were blinded to the clinical data. We used the Bland criteria (0-6) to grade CTS severity on EDT. This grade was compared with the CTS-6 score, Durkan time, and SWMT results. Using Spearman correlation coefficients, we found a weakly positive correlation between a higher CTS-6 score and a higher severity grade on EDT. The mean CTS-6 score based on EDT grading were the following: (1) 14.8 (grade 0), (2) 16.0 (grade 1), (3) 14.8 (grade 2), (4) 16.7 (grade 3), (5) 18.7 (grade 4), (6) 18.3 (grade 5), and (7) 22.4 (grade 6). We also found a statistically significant association between the SWMT and a higher CTS-6 score as well as a higher severity grade on EDT. Durkan compression test did not appear to correlate with the EDT grade. The CTS-6 and SWMT show a positive correlation with EDT severity in CTS on the basis of the Bland criteria. The time to a positive Durkan test did not show any correlation. Diagnostic II.

Effectiveness of Leg Raise and Leg Fold Maneuver to Prevent Syncope During Extraction of Teeth: A Pilot Study.

Objectives The primary objective of this study is to evaluate the effectiveness of leg raise and leg fold maneuvers to prevent syncope during extraction procedures. Methods This study included 30 patients with a previous history of syncope and dental anxiety. Patients were randomly divided into two groups consisting of 15 patients each. Group I (test group) patients were educated about a few physical maneuvers, and instructions were given preoperatively about when to perform them. Group II (control group) underwent extraction conventionally. The blood pressure, saturation, pulse rate, and clinical signs and symptoms of the patients were assessed preoperatively, intraoperatively, and postoperatively. Informed consent was obtained from all the patients. Results There is a significant difference between the control and study groups in terms of the occurrence of syncope and patient comfort. This indicates that the leg raise and leg fold maneuvers reducethe occurrence of syncope during extraction. No participant in the test group experienced syncope post-treatment, while five subjects (33.3%)experienced syncope in the control group. Conclusion Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope.Leg raise and leg fold maneuversimproved the hemodynamics of the patients.

Characterizing the Blood Pressure Response to Physical Counterpressure Manoeuvres Using Surface Electromyography in Adults With Long Covid

Orthostatic intolerance (OI) is common in Long Covid. Physical counterpressure manoeuvres (PCM) may improve OI in other disorders. We characterised the blood pressure-rising effect of PCM using surface electromyography (sEMG) and investigated its association with fatigue in adults with Long Covid. Participants performed an active stand with beat-to-beat hemodynamic monitoring and sEMG of both thighs, including PCM at 3-minutes post-stand. Multivariable linear regression investigated the association between change in systolic blood pressure (SBP) and change in normalised root mean square (RMS) of sEMG amplitude, controlling for confounders including the Chalder Fatigue Scale (CFQ). In 90 participants (mean age 46), mean SBP rise with PCM was 13.7 (SD 9.0) mmHg. In regression, SBP change was significantly, directly associated with change in RMS sEMG ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\beta =0.25$ </tex-math></inline-formula> , 95% CI 0.07–0.43, P = 0.007); however, CFQ was not significant. PCM measured by sEMG augmented SBP without the influence of fatigue.

The Effectiveness of Physical Maneuvers in the Conversion of Supra-Ventricular Tachycardia on the Example of the Valsalva’s Maneuver

The Valsalva maneuver (VM) is one of the physical maneuvers used by medical personnel. In emergency medicine, it is known primarily for its use as a non-pharmacological method of restoring sinus rhythm possible to perform in almost every patient, and side effects are noticed incidentally. A distinction is made between the classic and the modified Valsalva tests. Multiple studies confirm its use and effectiveness in cases of supraventricular tachycardia episodes in hemodynamically stable patients. The VM allows to determine heart failure by showing abnormal rise of blood pressure as a response to the Valsalva test and thus suggests impaired ventricular function. This maneuver lowers the preload and thus the enddiastolic volume, thereby enhancing some murmurs and weakening others. As a result of phase IV of VM, clinically significant bradycardia occurs, which is used for, at least temporary, termination of supraventricular tachycardia. Based on the available literature, the effectiveness of the modified Valsalva sample was almost twice as high as that of the classical method. However, both methods are effective in the conversion of supra-ventricular tachycardia. Its implementation is relatively simple and possible to perform for almost any patient, provided that he cooperates. As majority of patients using the services of sanatoriums are people burdened with numerous diseases, including cardiovascular diseases, some of them may present with supraventricular tachycardia. Hence, it is important to know simple, safe and non-pharmacological methods of stopping it, the most common of which is the Valsalva maneuver.

Brandt-Daroff Exercise versus Standard Technique on Symptoms Experienced by Patients with Benign Paroxysmal Positional Vertigo in a tertiary Care hospital: A Comparative Study

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. It’s considered to be the most common cause of vertigo among the elderly, since 30% of the people reported to have suffered from it at least once in their lifetime.Several studies have indicated that physical therapy, including rehabilitative exercises and physical maneuvers, is an effective treatment for BPPV. Therefore, the objectives of the study was designed to compare Brandt-Daroff exercise versus standardized technique on symptoms experienced by patients with Benign paroxysmal positional vertigo (BPPV) in a selected hospital of Bangalore, India. MATERIALS AND METHODS: The post-test only group design was adopted for this study. The setting was ENT OPD of St. John’s Medical College Hospital. A sample of 20 BPPV patients in each Group 1 and Group 2 were taken using purposive sampling technique. A dizziness handicap inventory scale, a visual analogue scale and a checklist was used to assess the symptoms of patients with BPPV. RESULTS: Median score of dizziness in group 1 was 37 and in group 2 was 16, the obtained Mann Whitney value was 13, which is statistically significant at p&lt;0.001. Likewise, median score for nausea in group 1 was 3 and in group 2 was 0, the obtained Mann Whitney value was 108.5 which is statistically significant at p&lt;0.0001. Further, finding depicts that there was no statistically significant difference of vomiting between group 1 and group 2. CONCLUSIONS: there was a substantial difference in the degree of nausea and dizziness between groups 1 and 2. Group 1 had higher median scores for nausea and dizziness when compared to group 2. However, the frequency of vomiting did not differ substantially between the two groups.