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Hiccups (Persistent)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Valsalva’s Maneuver: The patient can employ the Valsalva maneuver where the nose is pinched and the lips are sealed tightly. Then the patient bears down as if straining to induce a bowel movement for 10–15 seconds.
Contour of Pressure and Flow Waves in Arteries
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
The most obvious effects of the Valsalva maneuver are seen in the upper limb vessels and comprise a marked increase in diastolic fluctuations of pressure and flow and a marked increase in the relative amplitude of the brachial and radial pulses (see Figures 9.4 and 9.15). The radial pulse pressure is increased by 150 percent compared with the central aortic (46 percent under control conditions). The timing between successive pressure peaks in the brachial artery does not alter appreciably during the Valsalva maneuver, whereas the time interval between peaks in the femoral artery increases substantially (see Remington and Wood (1956)), and amplification of the pressure wave between the central aorta and femoral artery tends to decrease (Kroeker and Wood, 1956).
Practical guide to scanning the saphenous systems (GSV and SSV) and perforators
Published in Joseph A. Zygmunt, Venous Ultrasound, 2020
The Valsalva maneuver causes an increase of intra-abdominal pressure with the primary goal of testing the flow characteristics and valve functions in the central (proximal) vessels. This downward pressure is typically transmitted down and through non-functioning valves until it reaches the first competent valve. Once a competent valve is encountered, the pressure wave stops being transmitted distally. Steve Talbot has written, “a well performed Valsalva maneuver detects significant reflux in major veins until a competent valve is detected.…. Like descending venography, detection of reflux distal to competent valves may not be detected with these techniques” [55]. In this manner, if a CFV is competent (normal), the Valsalva maneuver will not adequately test the mid FV valves (or any distal valves) for competency. Unfortunately, this information is not universally understood by some performing venous ultrasound and is therefore stressed, so Valsalva is not used in distal venous segments. For this reason, many experts consider that a Valsalva maneuver is more appropriate to test valvular competence at the saphenofemoral junction only. A few others suggest that the Valsalva maneuver should only be used when there is no reflux noted with release of the distal compression maneuver [40].
Pelvic floor muscle activity during coughing and valsalva maneuver in continent women and women with stress urinary incontinence: a systematic review
Published in Physical Therapy Reviews, 2023
Renata Ferreira Lobo Martinez, Tatiana de Oliveira Sato, Jordana Barbosa da Silva, Vilena Barros de Figueiredo, Mariana Arias Avila, Patricia Driusso
Even though the Valsalva maneuver is not performed alone during daily life activities, executing this maneuver may help understand how PFM would behave in situations during which there is an increase in IAP, for example, when carrying a heavy object. As such, the definition of the Valsalva maneuver should be clear and consistent with the original definition (‘forceful expiration against closed nostrils and mouth in order to increase intrathoracic pressure that is transmitted through the open glottis to the oronasopharyngeal cavity, and thus opens eustachian tubes and inflates the middle ear’ [28]). Four out of the five studies that used the Valsalva maneuver defined the maneuver as ‘effort of forced expiration against the closed glottis’ [18–21], with subtle differences between them. Only one study [18] instructed participants to performed Valsalva maneuver ‘as if they were defecating’, which would impact how the PFM would be activated, given the differences between straining and Valsalva maneuver on PFM action [18].
Cough maneuver is superior to Valsalva maneuver for detecting mild-extent right-to-left shunt
Published in Scandinavian Cardiovascular Journal, 2020
Yun-Xia Zhang, Xiao-Yong Zhang, Qi Zhang
The current study found no difference between Valsalva maneuver and cough maneuver for detecting moderate or severe right-to-left shunt by cTTE. The hemodynamic effects of Valsalva maneuver are based on its mechanical and autonomic nervous effects [19], and the application of Valsalva maneuver during cTTE relies on the former. Right atrial pressure increases during the strain phase of Valsalva maneuver, resulting in a right-to-left shunt [5]. In addition, this is followed by a rapid drop in intrathoracic pressure as the strain is released, and the flow volume returning to the right atrium increases, potentially reopening a patent foramen ovale (PFO), resulting in detection of a right-to-left shunt [20]. In contrast, cough maneuver is associated with a short strain phase, and its hemodynamic effects are therefore based solely on its mechanical impact, with no autonomic nervous role. The changes in intrathoracic pressure are similar for Valsalva maneuver and cough maneuver, with an initial increase followed by a rapid fall when the strain phase is released. In the case of a moderate or severe right-to-left shunt, the PFO is large, resulting in no significant difference in detection rates between cough maneuver and Valsalva maneuver.
Cryotherapy reduces muscle hypertonia, but does not affect lower limb strength or gait kinematics post-stroke: a randomized controlled crossover study
Published in Topics in Stroke Rehabilitation, 2019
Carolina Carmona Alcantara, Julia Blanco, Lucilene Maria De Oliveira, Paula Fernanda Sávio Ribeiro, Esperanza Herrera, Theresa Helissa Nakagawa, Darcy S. Reisman, Stella Maris Michaelsen, Luccas Cavalcanti Garcia, Thiago Luiz Russo
The isometric evaluation was performed with the ankle in the neutral position.42 To test the dorsiflexor muscles, the subject was instructed to lift the tip of the foot and maintain maximum contraction for 10 s. For the plantarflexors, the subject was instructed to push the tip of the foot forward and to maintain a maximum contraction for 10 s. For the isokinetic evaluation, maximum contractions in the dorsiflexion and plantar ankle flexion movements at 30°/s were obtained in the concentric and eccentric modes.8,43 The ROM was set between 10° of dorsiflexion and 20° of plantar flexion. Before each test, the subjects performed three repetitions of the movements of dorsiflexion and plantar flexion, with submaximal resistance, in order to become familiar with the movement. Subsequently, the subjects performed five successive maximum contractions,44 during which verbal commands were given by the evaluator asking the subjects to push and pull the lever with the greatest possible force throughout the ROM. Cardiac parameters (blood pressure and heart rate) were monitored before, during and at the end of each evaluation. In addition, subjects were instructed and monitored to not perform a valsalva maneuver during the strength tests. All data were processed using Matlab software (The MathWorks, Natick, Massachusetts).