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Carson RG, Hayward KS. Using mechanistic knowledge to appraise contemporary approaches to the rehabilitation of upper limb function following stroke. J Physiol 2024. [PMID: 39129269 DOI: 10.1113/jp285559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
It is a paradox of neurological rehabilitation that, in an era in which preclinical models have produced significant advances in our mechanistic understanding of neural plasticity, there is inadequate support for many therapies recommended for use in clinical practice. When the goal is to estimate the probability that a specific form of therapy will have a positive clinical effect, the integration of mechanistic knowledge (concerning 'the structure or way of working of the parts in a natural system') may improve the quality of inference. This is illustrated by analysis of three contemporary approaches to the rehabilitation of lateralized dysfunction affecting people living with stroke: constraint-induced movement therapy; mental practice; and mirror therapy. Damage to 'cross-road' regions of the structural (white matter) brain connectome generates deficits that span multiple domains (motor, language, attention and verbal/spatial memory). The structural integrity of these regions determines not only the initial functional status, but also the response to therapy. As structural disconnection constrains the recovery of functional capability, 'disconnectome' modelling provides a basis for personalized prognosis and precision rehabilitation. It is now feasible to refer a lesion delineated using a standard clinical scan to a (dis)connectivity atlas derived from the brains of other stroke survivors. As the individual disconnection pattern thus obtained suggests the functional domains most likely be compromised, a therapeutic regimen can be tailored accordingly. Stroke is a complex disorder that burdens individuals with distinct constellations of brain damage. Mechanistic knowledge is indispensable when seeking to ameliorate the behavioural impairments to which such damage gives rise.
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Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland
- School of Psychology, Queen's University Belfast, Belfast, UK
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn S Hayward
- Departments of Physiotherapy, University of Melbourne, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- The Florey, University of Melbourne, Melbourne, Australia
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Boccuni L, Marinelli L, Trompetto C, Pascual-Leone A, Tormos Muñoz JM. Time to reconcile research findings and clinical practice on upper limb neurorehabilitation. Front Neurol 2022; 13:939748. [PMID: 35928130 PMCID: PMC9343948 DOI: 10.3389/fneur.2022.939748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The problemIn the field of upper limb neurorehabilitation, the translation from research findings to clinical practice remains troublesome. Patients are not receiving treatments based on the best available evidence. There are certainly multiple reasons to account for this issue, including the power of habit over innovation, subjective beliefs over objective results. We need to take a step forward, by looking at most important results from randomized controlled trials, and then identify key active ingredients that determined the success of interventions. On the other hand, we need to recognize those specific categories of patients having the greatest benefit from each intervention, and why. The aim is to reach the ability to design a neurorehabilitation program based on motor learning principles with established clinical efficacy and tailored for specific patient's needs.Proposed solutionsThe objective of the present manuscript is to facilitate the translation of research findings to clinical practice. Starting from a literature review of selected neurorehabilitation approaches, for each intervention the following elements were highlighted: definition of active ingredients; identification of underlying motor learning principles and neural mechanisms of recovery; inferences from research findings; and recommendations for clinical practice. Furthermore, we included a dedicated chapter on the importance of a comprehensive assessment (objective impairments and patient's perspective) to design personalized and effective neurorehabilitation interventions.ConclusionsIt's time to reconcile research findings with clinical practice. Evidence from literature is consistently showing that neurological patients improve upper limb function, when core strategies based on motor learning principles are applied. To this end, practical take-home messages in the concluding section are provided, focusing on the importance of graded task practice, high number of repetitions, interventions tailored to patient's goals and expectations, solutions to increase and distribute therapy beyond the formal patient-therapist session, and how to integrate different interventions to maximize upper limb motor outcomes. We hope that this manuscript will serve as starting point to fill the gap between theory and practice in upper limb neurorehabilitation, and as a practical tool to leverage the positive impact of clinicians on patients' recovery.
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Affiliation(s)
- Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- *Correspondence: Leonardo Boccuni
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Clinical Neurophysiology, Genova, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Alvaro Pascual-Leone
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology and Harvard Medical School, Boston, MA, United States
| | - José María Tormos Muñoz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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Using motor imagery practice for improving motor performance - A review. Brain Cogn 2021; 150:105705. [PMID: 33652364 DOI: 10.1016/j.bandc.2021.105705] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
Motor imagery practice is a current trend, but there is a need for a systematic integration of neuroscientific advances in the field. In this review, we describe the technique of motor imagery practice and its neural representation, considering different fields of application. The current practice of individualized motor imagery practice schemes often lacks systematization and is mostly based on experience. We review literature related to motor imagery practice in order to identify relevant modulators of practice effects like previous experience in motor training and motor imagery practice, the type of motor task to be trained, and strategies to increase sensory feedback during physical practice. Relevant discrepancies are identified between neuroscientific findings and practical consideration of these findings. To bridge these gaps, more effort should be directed at analyzing the brain network activities related to practically relevant motor imagery practice interventions.
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Szynkiewicz SH, Kamarunas E, Drulia T, Nobriga CV, Griffin L, O'Donoghue CR. A Randomized Controlled Trial Comparing Physical and Mental Lingual Exercise for Healthy Older Adults. Dysphagia 2020; 36:474-482. [PMID: 32770381 DOI: 10.1007/s00455-020-10164-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/25/2020] [Indexed: 11/25/2022]
Abstract
Mental practice using motor imagery (MP-MI) has been shown to improve motor outcomes of upper and lower extremities especially when combined with physical exercise. Here, we studied community-dwelling, healthy older adults to determine the effects of including an MP-MI component with lingual strengthening exercise. In this pilot study, twenty-nine typically aging participants were assigned to an intervention group: physical lingual exercise (n = 7), physical and MP-MI lingual exercise (n = 8), MPMI lingual exercise (n = 7), or a control group (placebo exercise) (n = 7). All participants completed the assigned exercise regimen with three sessions per day, three days a week, for 6 consecutive weeks. Maximum isometric pressure (MIP) and regular effort saliva swallowing (RESS) pressure were collected at baseline and weeks 2, 4, and 6. A post hoc Bonferroni corrected treatment effect from baseline to week 6 was shown for only participants in the MP-MI/Physical exercise group for MIP (p = 0.003 MPMI/ Physical group; p = 0.11 Control group; p = 0.32 Physical only group; p = 0.14 MP-MI only group) and RESS (p = 0.009 MP-MI/Physical group; p = 0.14 Control group; p = 0.10 Physical only group; p = 0.04 MP-MI only group). Findings also indicate spontaneous carryover of significantly increased swallowing pressure when mental and physical exercise are combined. In conclusion, the potential effect of including an MPMI lingual exercise component in preventative and rehabilitative frameworks with older persons to possibly enhance functional swallowing improvement is promising and should be investigated.
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Affiliation(s)
- Sarah H Szynkiewicz
- College of Science and Mathematics, Communication Sciences and Disorders, University of South Florida, Sarasota-Manate, 8350 N. Tamiami Trail, Sarasota, FL, 34243, USA. .,School of Health Professions, Communication Sciences and Disorders, Samford University, 800 Lakeshore Drive, Birmingham, AL, 35229, USA.
| | - Erin Kamarunas
- College of Health and Behavioral Studies, Communication Sciences and Disorders, James Madison University, MSC 4304, 235 Martin Luther King Jr. Way, Harrisonburg, VA, 22807, USA
| | - Teresa Drulia
- Harris College of Nursing and Health Sciences, Davies School of Communication Sciences and Disorders, Texas Christian University, TCU Box 297450, Fort Worth, TX, 76109, USA
| | - Christina V Nobriga
- School of Allied Health Professions, Communication Sciences and Disorders, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Lindsay Griffin
- College of Health and Behavioral Studies, Communication Sciences and Disorders, James Madison University, MSC 4304, 235 Martin Luther King Jr. Way, Harrisonburg, VA, 22807, USA.,School of Communications, Communication Sciences and Disorders, Emerson College, 120 Boylston Street, Boston, MA, 02116, USA
| | - Cynthia R O'Donoghue
- College of Health and Behavioral Studies, Communication Sciences and Disorders, James Madison University, MSC 4304, 235 Martin Luther King Jr. Way, Harrisonburg, VA, 22807, USA
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Szynkiewicz SH, Nobriga CV, Cheung A, Khoury L, Piven M, Quibin K. Mental Practice Using Motor Imagery in Dysphagia Rehabilitation: A Survey of Practicing Speech-Language Pathologists. Semin Speech Lang 2020; 41:349-364. [PMID: 32375193 DOI: 10.1055/s-0040-1709204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mental practice (MP) using motor imagery is recognized as an effective clinical tool in rehabilitative medicine for improving motor performance. Preliminary data using MP in dysphagia rehabilitation are promising, though nothing is known about the current landscape among speech-language pathologists (SLPs) relating to MP implementation. This nationwide study surveys practicing SLPs about knowledge and practice patterns of using MP to gain a better understanding of the current knowledge, as well as perceived benefits and challenges in using MP. Descriptive data are reported and open-ended questions analyzed for emerging themes using inductive coding. Over half of the participants were familiar or somewhat familiar with motor imagery in the context of dysphagia rehabilitation, though only 16% of those SLPs reported using MP with a patient. Nearly 75% of respondents expressed interest in learning more about MP. Emerging themes include factors SLPs perceive to limit patient engagement, evidence-based practice concerns, and therapeutic environmental factors. More research on MP and access to training for clinicians is needed in the area of dysphagia rehabilitation to address acknowledged interest in MP.
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Affiliation(s)
- Sarah H Szynkiewicz
- College of Science and Mathematics, University of South Florida, Sarasota-Manatee, Sarasota, Florida
| | - Christina V Nobriga
- Communication Sciences and Disorders, Loma Linda University, Loma Linda, California
| | - Ashley Cheung
- Communication Sciences and Disorders, Loma Linda University, Loma Linda, California
| | - Lauren Khoury
- College of Science and Mathematics, University of South Florida, Sarasota-Manatee, Florida
| | - Morgan Piven
- College of Science and Mathematics, University of South Florida, Sarasota-Manatee, Florida
| | - Kassandra Quibin
- Communication Sciences and Disorders, Loma Linda University, Loma Linda, California
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Pichiorri F, Mattia D. Brain-computer interfaces in neurologic rehabilitation practice. HANDBOOK OF CLINICAL NEUROLOGY 2020; 168:101-116. [PMID: 32164846 DOI: 10.1016/b978-0-444-63934-9.00009-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The brain-computer interfaces (BCIs) for neurologic rehabilitation are based on the assumption that by retraining the brain to specific activities, an ultimate improvement of function can be expected. In this chapter, we review the present status, key determinants, and future directions of the clinical use of BCI in neurorehabilitation. The recent advancements in noninvasive BCIs as a therapeutic tool to promote functional motor recovery by inducing neuroplasticity are described, focusing on stroke as it represents the major cause of long-term motor disability. The relevance of recent findings on BCI use in spinal cord injury beyond the control of neuroprosthetic devices to restore motor function is briefly discussed. In a dedicated section, we examine the potential role of BCI technology in the domain of cognitive function recovery by instantiating BCIs in the long history of neurofeedback and some emerging BCI paradigms to address cognitive rehabilitation are highlighted. Despite the knowledge acquired over the last decade and the growing number of studies providing evidence for clinical efficacy of BCI in motor rehabilitation, an exhaustive deployment of this technology in clinical practice is still on its way. The pipeline to translate BCI to clinical practice in neurorehabilitation is the subject of this chapter.
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Affiliation(s)
- Floriana Pichiorri
- Neuroelectrical Imaging and Brain Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Donatella Mattia
- Neuroelectrical Imaging and Brain Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy.
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Szynkiewicz SH, Nobriga CV, O'Donoghue CR, Becerra BJ, LaForge G. Motor Imagery Practice and Increased Tongue Strength: A Case Series Feasibility Report. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1676-1684. [PMID: 31112668 DOI: 10.1044/2019_jslhr-s-18-0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of the study was to determine the effects of a 6-week progressive resistance tongue exercise protocol in mental practice form on tongue strength. Investigation begins in typically aging adults, a population susceptible to reduced tongue strength and dysphagia secondary to age-related changes in the swallowing mechanism. It was hypothesized that typically aging adults who perform a 6-week progressive resistance tongue exercise protocol in mental practice form would increase tongue strength. Method A prospective, case series intervention study was used. Six healthy women aged 53-78 years completed a 6-week mental practice tongue resistance exercise program utilizing motor imagery to imagine completion of tongue exercises. The main outcome was mean isometric maximum tongue pressures (tongue strength), which were collected at baseline and Weeks 2, 4, and 6 using the Iowa Oral Performance Instrument ( IOPI Medical, 2013 ). Results By Week 6 of the study, all participants had significantly increased their tongue strength compared to baseline. Conclusions The findings indicate that mental practice using motor imagery for tongue exercise may improve tongue strength in healthy individuals at risk for dysphagia and may thus represent a promising direction warranting further investigation in typically aging individuals and patients with dysphagia and decreased tongue strength.
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Affiliation(s)
- Sarah H Szynkiewicz
- College of Science and Mathematics, University of South Florida Sarasota-Manatee
| | - Christina V Nobriga
- Department of Communication Sciences and Disorders, Loma Linda University, CA
| | - Cynthia R O'Donoghue
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | | | - Garret LaForge
- College of Science and Mathematics, University of South Florida Sarasota-Manatee
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Faturi FM, Lopes Santos G, Ocamoto GN, Russo TL. Structural muscular adaptations in upper limb after stroke: a systematic review. Top Stroke Rehabil 2018; 26:73-79. [PMID: 30222075 DOI: 10.1080/10749357.2018.1517511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability in the adult population, impairing upper limb (UL) movements affecting activities of daily living. Muscle weakness has been associated to disabilities in this population, but much attention is given to central nervous system alterations and less to skeletal muscles. OBJECTIVE The objective of this review is to carry out a systematic literature review to identify structural muscle alterations in the UL of poststroke individuals. METHOD The search was performed in December, 2017. MEDLINE, PubMed, SCOPUS, CINAHL, and Science Direct were used as electronic databases. There was no restriction regarding language and publication dates. Studies conducted on poststroke subjects and results on UL skeletal muscle alterations identified by imaging tests were included. RESULTS Seven studies were included. The sample size and the variables varied among the studies. All the studies compared the paretic UL with the nonparetic UL and one of the studies also compared healthy subjects. Ultrasonography was the most used measurement tool to assess muscle adaptation. CONCLUSIONS This review demonstrated little evidence with poor to fair quality on the structural muscle adaptations in the poststroke subjects, showing muscle atrophy, a higher stiffness, and amount of fibrous and fat tissue without alterations in lean tissue of distal muscles of the paretic UL compared to the nonparetic limb. However, the nonparetic side also presented alterations, which makes it an inappropriate comparison. Thus, well-designed studies addressing this issue are required.
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Affiliation(s)
- Fernanda Maria Faturi
- a Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , SP , Brazil
| | - Gabriela Lopes Santos
- a Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , SP , Brazil
| | - Gabriela Nagai Ocamoto
- a Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , SP , Brazil
| | - Thiago Luiz Russo
- a Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy , Federal University of São Carlos (UFSCar) , São Carlos , SP , Brazil
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Bondoc S, Booth J, Budde G, Caruso K, DeSousa M, Earl B, Hammerton K, Humphreys J. Mirror Therapy and Task-Oriented Training for People With a Paretic Upper Extremity. Am J Occup Ther 2018; 72:7202205080p1-7202205080p8. [PMID: 29426386 DOI: 10.5014/ajot.2018.025064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke. METHOD This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home. RESULTS All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment. CONCLUSION Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis.
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Affiliation(s)
- Salvador Bondoc
- Salvador Bondoc, OTD, OTR/L, FAOTA, is Professor and Chair of Occupational Therapy, School of Health Sciences, Quinnipiac University, Hamden, CT;
| | - Julie Booth
- Julie Booth, DPT, PCS, is Clinical Associate Professor of Physical Therapy, School of Health Sciences, Quinnipiac University, Hamden, CT
| | - Grace Budde
- Grace Budde, MOT, OTR/L, is Occupational Therapist, Professional Hand Therapy, Merrick, NY
| | - Katelyn Caruso
- Katelyn Caruso, MOT, OTR/L, is Occupational Therapist, Excel Orthopaedic Specialists, Woburn, MA
| | - Michelle DeSousa
- Michelle DeSousa, DPT, is Physical Therapist, Lawrence + Memorial Hospital, New London, CT
| | - Brittany Earl
- Brittany Earl, MOT, OTR/L, is Occupational Therapist, CareOne at Wall, Wall Township, NJ
| | - Kaitlynn Hammerton
- Kaitlynn Hammerton, DPT, is Physical Therapist, Burke Rehabilitation Hospital, White Plains, NY
| | - Jill Humphreys
- Jill Humphreys, DPT, is Physical Therapist, The Center at Lowry, Denver, CO
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Motor Imagery Training After Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Neurol Phys Ther 2017; 41:205-214. [DOI: 10.1097/npt.0000000000000200] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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