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This is an ortho doc and he is saying the pt "is having nocturnally exacerbated tremors or "valythmic" type movements in the upper and lower extremities". End of word definitely sounds like "lythmic", it's just the first part I can't get. It's not rhythmic, too many syllables. Could possibly start with a "b", it's that type of "v" or "b" sound.
Thanks very much... :)