A hand-held VG can be offered to most children as a low cost, easy to implement, portable, and effective method to reduce anxiety in the preoperative area and during induction of anesthesia. Distraction in a pleasurable and familiar activity provides anxiety relief, probably through cognitive and motor absorption.

An intraoperative infusion of dexmedetomidine combined with inhalation anesthetics provided satisfactory intraoperative conditions for T&A without adverse hemodynamic effects. Postoperative opioid requirements were significantly reduced, and the incidence and duration of severe emergence agitation was lower with fewer patients having desaturation episodes.

Although most studies indicated an improvement of at least one sexual variable in women with pelvic floor dysfunction, and one study demonstrated an improvement in SF in postpartum women selected independently of their continence status, the results need to be interpreted with caution. High-quality RCTs specifically designed to investigate the impact of PFMT on women's SF are required.

Purpose: The authors investigated the reliability of myotonometry-measured muscle tone in the thenar and perineal muscles. Methods: Participants were women aged 18-50 years who were asymptomatic for thumb and pelvic floor dysfunction (interrater study n ¼ 20; intrarater study n ¼ 43) or who were symptomatic for vulvodynia (interrater study n ¼ 14; intrarater study n ¼ 32). Mechanical properties (stiffness, frequency, decrement, relaxation time, and creep) of the muscles were measured using a myotonometer (MyotonPRO) while the muscles were in a relaxed state. Measures were performed twice by two assessors. Intra-and interrater reliability were determined using intra-class correlation coefficients (ICCs) and absolute reliability using the standard error of measurement and a minimum detectable change. Results: The primary property of interest, muscle stiffness, showed very good interrater (ICC 0.85-0.86) and intrarater (ICC 0.82-0.88) reliability in the thenar eminence. In the perineal muscles, reliability results ranged from good to very good for interrater (ICC 0.70-0.86) and intrarater (ICC 0.80-0.91) reliability for muscle stiffness. Absolute reliability was confirmed, with all measures showing minimal variance. Conclusions: Muscle stiffness of the smaller muscles of the body can be reliably measured using the MyotonPRO. The device could be used as a reference standard in the development of a digital palpation scale that would facilitate accurate diagnosis of muscle tone.Key Words: muscle; perineum; reproducibility of results; thumb. RÉ SUMÉObjectif : é tudier la fiabilité de la raideur musculaire mesuré e par myotonomé trie dans les muscles de l'é minence thé nar et du pé riné e. Mé thodologie : Les participantes é taient des femmes â gé es de 18 à 50 ans ne pré sentant aucun symptô me de dysfonctionnement du pouce ni du plancher pelvien (é tude interé valuateur n ¼ 20; é tude intra-é valuateur n ¼ 43) ou pré sentant des symptô mes de vulvodynie (é tude interé valuateur n ¼ 14; é tude intra-é valuateur n ¼ 32). Les proprié té s mé caniques (raideur, fré quence, dé cré ment, temps de relaxation et fluage) des muscles au repos ont é té mesuré es à l'aide d'un myotonomè tre (MyotonPRO). Les mesures ont é té prises deux fois par deux é valuateurs. La fiabilité intra-é valuateur et interé valuateur a é té dé terminé e à l'aide des coefficients de corré lation intraclasse (CCI) et la fiabilité absolue à l'aide de l'é cart type de mesure et du changement minimal dé tectable. Ré sultats : la proprié té d'inté rê t principal, la raideur musculaire, a montré une trè s bonne fiabilité interé valuateur (CCI 0,85-0,86) et intra-é valuateur (CCI 0,82-0,88) pour l'é minence thé nar. Concernant les muscles du pé riné e, les ré sultats de fiabilité variaient de bons à trè s bons pour la fiabilité interé valuateur (CCI 0,70-0,86) et intra-é valuateur (CCI 0,80-0,91) pour la raideur musculaire. La fiabilité absolue a é té confirmé e, toutes les mesures montrant une variabilité minimale. Conclusions : la raideur musculair...

Aim: Physiotherapists typically use digital palpation to determine residual tension in a muscle, referred to as muscle stiffness or tone. These assessments are subjective, and little is known about their accuracy or repeatability. Despite this, it is standard practice to base clinical treatment on these findings. The aim of this study was to assess physiotherapists' ability to assign a seven-point palpation scale to quantitative stiffness values generated by a novel device. Methods: Prospective observational study involving 125 musculoskeletal and pelvic floor physiotherapists. A novel device was developed that replicates the haptic feedback that clinicians assess as muscle stiffness. Measurements of displacement, force, and stiffness were recorded.Results: There was wide overlap between each scale category assigned to the stiffness values, from low stiffness at −3 (119 [106, 132] N/m) to moderate stiffness at 0 (462 [435,489] N/m); to high stiffness at +3 (897 [881,913] N/m). Consistency in applying the scale was poor, and the probability of a similar value of stiffness being assigned to the same scale category by different participants was low.Conclusions: While palpation is used globally by physiotherapists as a readily available and low-cost method of assessing muscle stiffness, these results indicate that it should be used with caution in diagnosing and defining patient care. Clinical assessment of muscle stiffness requires a validated and reliable palpation scale if this metric is to be used to diagnose pathology and develop treatment protocols. Training in this scale should then be recommended to improve reliability in patient assessment. K E Y W O R D S assessment, digital palpation, muscle stiffness, scale, tone