TEDS group will be subjected to sessions of TEDS as follow : Digital electrical muscle stimulator (EV-906 Digital TENS/EMS made in TAIWAN) is applied to induce diaphragm contraction.

Device : Digital electrical muscle stimulator is applied to induce diaphragm contraction.

Non TEDS group will not be subjected to sessions of TEDS

baduanjin exercise, diaphragmatic breathing and upper and lower limb stretching exercises

baduanjin exercise is a type of traditional Chinese exercises that combines exercise and mindful breathing. Baduanjin also called eight section brocades Qigong, the combination of physical movement and intention in these exercises creates enjoyable experiences for both the body and the mind.

baduanjin exercise

diaphragmatic breathing and upper and lower limb stretching exercises

diaphragmatic breathing exercise is a breathing exercise which focuses on diaphragm muscle as it is the main respiratory muscle. While upper and lower stretching exercises focuses on flexibility and stretching of major muscle compartments of upper and lower limbs.

diaphragmatic breathing exercise and upper and lower limb stretching exercise

Participants will perform a combined program of pelvic floor muscle exercises and diaphragmatic breathing exercises. The exercises will be conducted according to the study protocol, with sessions scheduled regularly over the intervention period. Both physical and psychological outcomes will be assessed before and after the menstrual period.

Participants will perform both pelvic floor and diaphragmatic breathing exercises according to the study protocol. Assessments will focus on pain, quality of life, and psychological measures.

Pelvic Floor + Breathing Exercises

Participants will perform only diaphragmatic breathing exercises according to the study protocol. Assessments of pain, menstrual symptoms, quality of life, sleep quality, and psychological measures will be conducted before and after the menstrual period.

Participants will perform only diaphragmatic breathing exercises. Assessments will be conducted in the same manner.

Diaphragmatic Breathing Exercises

Only individuals who identify as female and have a uterus are eligible to participate.

20 children will receive traditional breathing exercise for 30 minutes 2 times per month for 3 months.

The child will lie on their back, place one hand on their belly and one on their chest, and use a balloon or doll to fill both belly and chest up like a balloon. Inhale deeply, let the hands on the belly rise, then exhale slowly, making the belly down. The exercise will last for 10 minutes.

Diaphragmatic breathing

Sit in a seated position with crossed legs or knees. Inhale slowly through the nose for three seconds, then exhale through pursed lips, similar to blowing out birthday candles.

Pursed lip breathing:

The study involves conducting Costal breathing exercises for children. The exercises involve placing hands on the apical region of the lung, turning the child's head, relaxing the shoulder and neck muscles, taking a deep breath, pushing the hand out, holding, and exhaling slowly. The hands provide pressure and resistance after initiation of inspiration, and the children rest for 2 minutes between exercises. The duration of the exercise varies between the control and study groups.

Costal breathing exercises

20 children who will receive traditional breathing exercise for 15 minutes and breathing exercises by incentive spirometer for 15 minutes 2 times per month for 3 months

The study group was instructed to use an incentive spirometer, which should be held upright, sealed around the mouthpiece, and taken slowly and deep breaths. They will be motivated to achieve a preset volume through visual feedback. The child will hold their breath for 2-3 seconds at full inspiration and, after each set of 10 breaths, cough to clear mucus from the lungs. The exercise duration is 15 minutes.

Incentive spirometer exercises

Rawan Muhammed Khairy, physical therapist

Eman Ebrahim El-hadidy, Professor

Manal Salah ELdeen Abdel Wahab, Professor

The Thoracic Squeeze Technique is a manual physiotherapy intervention aimed at improving lung function, airway clearance, and respiratory mechanics. It involves the application of gentle, rhythmic compression to the chest wall during the exhalation phase of breathing, followed by a release. This technique can be performed with the patient in a sitting, semi-reclined, or supine position, depending on their condition and comfort level.

The Thoracic Squeeze Technique is a manual therapy method used primarily in respiratory physiotherapy to improve lung expansion, enhance respiratory function, and facilitate secretion clearance in patients with respiratory conditions.

Thoracic squeeze technique

The Manual Diaphragmatic Release Technique is a soft tissue manipulation technique used to improve the mobility, function, and efficiency of the diaphragm. It is commonly applied in physiotherapy, particularly in respiratory, musculoskeletal, and manual therapy practices, to address breathing dysfunctions, postural imbalances, and associated pain or discomfort.

Manual diaphragmatic release technique

Participants will perform moderate-intensity continuous cycling training with Pilates breathing exercise three times per week for six weeks.

Controlled lateral breathing technique focusing on rib cage expansion and core activation performed for 10-15 minutes. A 06 weeks protocol will be followed.

Pilates Breathing

Participants will perform moderate-intensity continuous cycling training combined with diaphragmatic breathing exercise three times per week for six weeks.

Slow deep breathing emphasizing diaphragmatic movement performed for 10-15 minutes.

A 06 weeks protocol will be followed.

Diaphragmatic Breathing

Participants will perform moderate-intensity continuous cycling training only, three times per week for six weeks.

Moderate-intensity continuous cycling training performed at 60-79% of maximum heart rate for 20-35 minutes, three sessions per week for six weeks.

Cycling Training (Moderate-intensity continuous training)

Sana Bashir, PhD*

Participants will perform moderate-intensity continuous treadmill training combined with pilates breathing exercises three times per week for six weeks.

Controlled lateral breathing technique focusing on rib cage expansion and core activation performed for 10-15 minutes, with low intensity, the perceived effort should be 3-4/10, with 3 days/week. A 06 weeks protocol will be followed.

Steps: Patient in neutral spine position and hands placed on rib cage and abdomen. Inhale deeply expanding the ribs laterally. Exhale drawing the navel inward to engage core muscles.

Participants will perform moderate-intensity continuous treadmill training combined with diaphragmatic breathing exercises three times per week for six weeks.

Slow deep breathing emphasizing diaphragmatic movement performed for 10-15 minutes, with low intensity, the perceived effort should be 3-4/10, with 3 days/week. A 06 weeks protocol will be followed.

Steps: Patient in supine or in seated position. Place one hand on chest and one below the ribs. Inhale slowly through the nose expanding the abdomen. Exhale through pursed lips, allowing the abdomen to fall inward and chest should remain still.

Participants will perform moderate-intensity continuous treadmill training only, three times per week for six weeks.

70% of maximum heart rate for 20-35 minutes, three sessions per week for six weeks.

Treadmill Training (Moderate-intensity continuous training)

Sana Bashir

Neonates with congenital diaphragmatic hernia in post-surgical period under mechanical ventilation during weaning of mechanical ventilation

While the patient is under respiratory assistance on the SERVO-I respirator, he will be included in the study and one esophageal transducer of 2,3 mm of diameter will be inserted through the mouth / nose in addition to NAVA's naso / Oro-Gastric tube( Edi Catheter, 6Fr, 49 cm, PHT free 5 pcs / pkg or Catheter Edi, 6Fr, 50 cm, PHT free 5 pcs / pkg). Measurements will be performed using the esophageal transducer under two conditions: 2 hours in conventional ventilation (pressure controlled), 2 hours in NAVA ventilation and then again 2 hours in conventional ventilation (PC) for a total duration of 6 hours.The parameters of conventional ventilation will be left free at the choice of the neonatologist and will be identical between the two periods of conventional ventilation. The initial NAVA level will be defined by the neonatologist using pre-visualization curves. All signals will be recorded via an amplification and acquisition system. Values will be averaged over 100 cycles.

Physiologic study measuring work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer

Participants in this group will receive supervised cervical stabilization exercise and diaphragmatic resistance training as home grogram.

6 weeks home exercise of diaphragmatic resistance training will be emphasized.

Diaphragmatic resistance training

Participants will finish 6 weeks supervised cervical stabilization exercise in person by physical therapist. Dissociated movement and movement control will be emphasized during cervical stabilization exercise.

Cervical stabilization exercise

Participants in this group will only receive supervised cervical stabilization exercise.

Under general anesthesia, a left neck incision exposes the left recurrent laryngeal nerve. Left level VI nodes are cleared, left inferior thyroid vein ligated. A single-port mediastinoscopy with CO2 is performed: the esophagus is mobilized to the inferior pulmonary vein while protecting the trachea, left main bronchus and thoracic duct; a marker gauze is placed. Right recurrent laryngeal nerve nodes are cleared. Five abdominal ports enable gastric mobilization with division of short gastric and left gastric vessels, preserving the right gastroepiploic vessels, and lymphadenectomy at splenic artery, both crura and cardia. The hiatus is opened and lower esophagus dissected to join the neck, then the cardia is transected. The specimen is pulled out cervically, a mediastinal drain left. Via a small upper midline laparotomy, a gastric tube is formed, pulled retrosternally, and anastomosed to the cervical esophagus. Jejunostomy and closure complete the operation.

inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) combined with laparoscopy

After positioning, right thoracoscopy: 4 ports; mobilize thoracic esophagus from inlet to hiatus, clearing mediastinal nodes including subcarinal and left RLN; transect at inlet. Then supine for laparoscopy: 5 ports; divide omentum, cut short gastric and left gastric vessels; open hiatus, pull specimen. Mini-laparotomy forms gastric tube. Left neck incision; protect left RLN; retrosternal pull-up of gastric tube; circular stapled anastomosis. Jejunostomy completes procedure.

Minimally invasive McKeown esophagectomy (MIME)

In this study, the game will be applied to the students in the game group by giving basic life support application training with escape room training method. Before the game process, the game scenario will be explained in detail to the students in the game group.

With randomization, students assigned to the escape room group will carry out the activity using a game prepared with a scenario designed by researchers and evaluated by experts in the field. During the activity, researchers will observe and assess the data using a skill form. The completion times for the activity will be recorded. The pre-test knowledge test, the post-test knowledge test, and the knowledge test taken one month later will be compared.

With randomization, students assigned to the escape room group will carry out the activity using a game prepared with a scenario designed by researchers and evaluated by experts in the field. During the activity, researchers will observe and assess the data using a skill form. The completion times for the activity will be recorded. The pre-test knowledge test, the post-test knowledge test, and the knowledge test taken one month later will be compared.

Experimental escape room group

With randomization, students assigned to the placebo (control) group in this group will perform the procedure using the standard BASIC LIFE SUPPORT (ADULT) SIMULATOR MANIKIN by the researchers. During the procedure, the researchers will observe and evaluate the data using a skills form. The pre-test knowledge test, the post-test knowledge test, and the knowledge test taken one month later will be compared.

plasebo control group

Students in the control group will be evaluated by practicing with a CPR simulator. With randomization, students assigned to the placebo (control) group in this group will perform the procedure using the standard BASIC LIFE SUPPORT (ADULT) SIMULATOR MANIKIN by the researchers. During the procedure, the researchers will observe and evaluate the data using a skills form. The pre-test knowledge test, the post-test knowledge test, and the knowledge test taken one month later will be compared.

Lumbar disc herniation surgecal treatment

Lumbar disc herniation surgery

Lumbar disc herniation treatment

Participants will receive diaphragmatic biofeedback combined with respiratory muscle training three times per day for 6 weeks

This intervention is novel because it integrates diaphragmatic biofeedback into a structured respiratory muscle training program specifically designed for patients with chronic kidney disease, a population in which respiratory dysfunction is prevalent yet under-addressed. By providing real-time feedback on diaphragmatic activity, the intervention aims to enhance motor learning, improve activation of the diaphragm, and optimize training efficiency beyond conventional breathing or respiratory muscle training approaches.

Diaphragmatic biofeedback combined with respiratory muscle training

Placebo intervention based on conscious breathing three times per day for 6 weeks

The placebo intervention will consist of concious guided breathing sessions based on the participant's subjective respiratory sensations, without the use of objective physiological feedback or diaphragm-specific biofeedback. Participants will be instructed to follow standardized breathing guidance focused on perceived comfort and awareness, matching the intervention group in session frequency and duration.

PLACEBO INTERVENTION

Participants in this experimental group will receive guided 4-7-8 breathing exercises before and during arteriovenous fistula cannulation in addition to routine hemodialysis care. The 4-7-8 breathing technique consists of inhaling through the nose for 4 seconds, holding the breath for 7 seconds, and exhaling slowly through the mouth for 8 seconds. The breathing exercises will be performed under researcher guidance according to a standardized protocol during each cannulation session.

Katılımcılar, rutin hemodiyaliz bakımına ek olarak, arteriyovenöz fistül kanülasyonu öncesinde ve sırasında rehberli 4-7-8 nefes egzersizi yapacaklardır. Bu teknik, 4 saniye boyunca burundan nefes almak, 7 saniye boyunca nefesini tutmak ve 8 saniye boyunca ağızdan yavaşça nefes vermekten oluşur. Egzersiz, her kanülasyon seansı sırasında standart bir protokole göre araştırmacıların rehberliğinde uygulanacaktır.

Guided 4-7-8 Breathing Exercise

Participants in this experimental group will receive guided diaphragmatic breathing exercises before and during arteriovenous fistula cannulation in addition to routine hemodialysis care. The intervention involves slow and deep breathing with diaphragmatic expansion, emphasizing abdominal movement rather than chest movement. The breathing exercises will be performed under researcher guidance according to a standardized protocol during each cannulation session.

Participants will perform guided diaphragmatic breathing exercises before and during arteriovenous fistula cannulation in addition to routine hemodialysis care. The intervention involves slow and deep breathing with diaphragmatic expansion, emphasizing abdominal movement rather than chest movement. The breathing exercises will be administered under researcher guidance according to a standardized protocol during each cannulation session.

Guided Diaphragmatic Breathing Exercise

Participants in this control group will receive routine nursing care during arteriovenous fistula cannulation according to standard clinical practice. No breathing exercise or additional intervention will be applied.

Participants in this group will receive routine nursing care during arteriovenous fistula cannulation according to standard clinical practice. No breathing exercise or additional intervention will be applied.

routine care

The percutaneous technique uses endoscopic scopes through the maternal skin and uterus to perform the surgery. A variation of the percutaneous technique is the mini-laparotomy technique, which uses an endoscopic scope through an incision on the abdomen, smaller than a laparotomy ("mini-laparotomy"), and smaller endoscopic scopes through the maternal skin and uterus to perform the surgery.

The percutaneous approach uses endoscopes through a closed maternal abdomen and closed uterus to perform the spina bifida correction.

In Utero Endoscopic Correction of Myelomeningocele IDE - Percutaneous Technique

The laparotomy/uterine exteriorization technique consists of performing a laparotomy (incision into the abdominal cavity), exteriorizing the uterus, and using endoscopic scopes through the uterus to perform the correction.

The laparotomy/uterine exteriorization technique uses endoscopes through an open abdomen and closed, exteriorized uterus to perform the spina bifida correction.

장치 : 디지털 전기 근육 자극기를 사용하여 횡격막 수축을 유도합니다.

팔단진 운동, 횡격막 호흡 운동 및 상하지 스트레칭 운동

골반저근 + 호흡 운동, 횡격막 호흡 운동

인센티브 스피로미터 운동, 횡격막 호흡, 입술을 모아 호흡, 늑골 호흡 운동

흉부 압박 기술, 수동 횡격막 릴리스 기술

자전거 훈련(중강도 지속 훈련), 필라테스 호흡법, 횡격막 호흡법

러닝머신 운동(중강도 지속 운동), 필라테스 호흡법, 횡격막 호흡법

식도 및 횡격막 압력-시간 곱을 통해 추정할 수 있는 호흡 작업을 측정하는 생리학적 연구

횡격막 저항 훈련, 경추 안정화 운동

팽창식 비디오 보조 종격동경하 경횡격막 식도절제술(IVMTE)과 복강경을 결합한 최소 침습 맥키온 식도절제술(MIME)

실험적 방탈출 그룹, 플라세보 대조 그룹

요추 디스크 탈출증 치료, 요추 디스크 탈출증 수술

횡격막 바이오피드백과 호흡근 훈련을 병행한 위약 개입

4-7-8 호흡법 유도, 횡격막 호흡법 유도, 일상 관리

자궁 내 내시경을 이용한 척수수막탈출증 교정술(IDE) - 경피적 기법, 자궁 내 내시경을 이용한 척수수막탈출증 교정술(IDE) - 개복술/자궁 외측화 기법