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Cui J, Hao Z, Tian H, Yang Y, Wang J, Lin X. The effects of Tai Chi on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude. Front Aging Neurosci 2024; 16:1330063. [PMID: 38650868 PMCID: PMC11033441 DOI: 10.3389/fnagi.2024.1330063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Tai Chi has proved to be an effective therapy for balance performance and cognition. However, non-consistency exists in the results of the effect of Tai Chi training on standing balance control in older adults. This study aimed to use traditional and non-traditional methods to investigate the effect of Tai Chi on standing balance in older adults. Methods Thirty-six Tai Chi practitioners (TC group) and thirty-six older adults with no Tai Chi practice (control group) were recruited in this study. A Nintendo Wii Balance Board was used to record the center of pressure (COP) during standing balance over 20 s in the condition of eyes closed with three repetitions. The wavelet analysis, multiscale entropy, recurrence quantification analysis, and traditional methods were used to evaluate the standing balance control in the anterior-posterior (AP) and mediolateral (ML) directions. Results (1) Greater sway mean velocity in the AP direction and sway Path length were found in the TC group compared with the control group; (2) lower Very-low frequency band (0.10-0.39 Hz) and higher Moderate frequency band (1.56-6.25 Hz) in the AP and ML directions were found in the TC group compared with the control group; (3) greater complexity index (CI) and lower determinism (DET) in the AP and ML directions were observed in the TC group compared with control group; (4) greater path length linked with smaller Very-low frequency band in the AP and ML directions and higher Moderate frequency band in the AP direction in both groups; (5) greater path length linked with lower DET and higher CI in the AP direction only in the TC group. Conclusion Long-term Tai Chi practice improved sensory reweighting (more reliance on the proprioception system and less reliance on the vestibular system) and complexity of standing balance control in older adults. In addition, greater sway velocity may be as an exploratory role in standing balance control of TC older adults, which correlated with greater complexity, but no such significant relationship in the control group. Therefore, the effects of Tai Chi practice on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude.
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Affiliation(s)
- Jianhua Cui
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, China
| | - Zengming Hao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haibo Tian
- School of Teacher Education, Shaoxing University, Shaoxing, China
| | - Yi Yang
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, China
| | - Jian Wang
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, China
- Center for Psychological Sciences, Zhejiang University, Hangzhou, China
| | - Xiaomei Lin
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, China
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Moreira GM, Scrok ND, Loureiro APC, Manffra EF. Strategies Adopted by Stroke Patients to Maintain Balance in Dynamic Tasks in a Video Game. J Mot Behav 2023; 55:384-393. [PMID: 37245864 DOI: 10.1080/00222895.2023.2216150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
Postural instability affects motor tasks after a stroke. We investigated the strategies used to maintain balance during quiet standing posture and dynamic tasks in a video game. Sixteen stroke volunteers (12 males, 56 ± 9 years, post-stroke time 35 ± 10 months) and sixteen matched healthy volunteers had their biomechanical data collected to obtain the variables: center of mass, base of support, margin of stability, and weight symmetry. Healthy individuals and stroke patients showed similar dynamic stability. However, they adopted different motor strategies to achieve this: healthy individuals increased their base of support as they progressed to more challenging tasks, and stroke volunteers maintained the same base. The margin of stability of stroke volunteers was correlated with the MiniBEST scale.
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Affiliation(s)
- Gabrielly Marques Moreira
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, Curitiba, Brazil
| | - Nicoly Dominique Scrok
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, Curitiba, Brazil
| | - Ana Paula Cunha Loureiro
- Pontifícia Universidade Católica do Paraná, Department of Physical Therapy, School of Medicine and Life Sciences, Rua Imaculada Conceição, Curitiba, Brazil
| | - Elisangela Ferretti Manffra
- Pontifícia Universidade Católica do Paraná, Health Technology Graduate Program, Rua Imaculada Conceição, Curitiba, Brazil
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Igawa T, Ishii K, Urata R, Suzuki A, Ui H, Ideura K, Isogai N, Sasao Y, Funao H. Association between the Horizontal Gaze Ability and Physical Characteristics of Patients with Dropped Head Syndrome. Medicina (B Aires) 2022; 58:medicina58040465. [PMID: 35454304 PMCID: PMC9032265 DOI: 10.3390/medicina58040465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Patients with dropped head syndrome exhibit weakness of the cervical paraspinal muscles. However, the relationship between horizontal gaze disorder and physical function remains unclear. This study aimed to examine and clarify this relationship. Materials and Methods: Ninety-six patients with dropped head syndrome were included. We measured the McGregor’s Slope and investigated physical characteristics, including cervical muscle strength, back muscle strength, and walking ability. Factor analysis was used to classify the characteristics of physical function, and a linear multiple regression analysis was used to evaluate independent variables explaining the variance in the McGregor’s Slope. The physical functions of DHS patients were classified into three categories by factor analysis: limb and trunk muscle strength, walking ability, and neck muscle strength. Results: The average value of the McGregor’s Slope was 22.2 ± 24.0 degrees. As a result of multiple regression analysis, walking speed (β = −0.46) and apex (β = −0.30) were extracted as significant factors influencing the McGregor’s Slope. Conclusions: Horizontal gaze disorders are not associated with cervical muscle strength but with the walking ability and the alignment type of dropped head syndrome.
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Affiliation(s)
- Tatsuya Igawa
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Ohtawara 323-8501, Japan
- Correspondence: (T.I.); (K.I.); Tel.: +81-476-35-5600 (T.I. & K.I.)
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Correspondence: (T.I.); (K.I.); Tel.: +81-476-35-5600 (T.I. & K.I.)
| | - Ryunosuke Urata
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Akifumi Suzuki
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Hideto Ui
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Kentaro Ideura
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
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Yoshimoto K, Shinya M. Use of the Azure Kinect to measure foot clearance during obstacle crossing: A validation study. PLoS One 2022; 17:e0265215. [PMID: 35275979 PMCID: PMC8916621 DOI: 10.1371/journal.pone.0265215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
Obstacle crossing is typical adaptive locomotion known to be related to the risk of falls. Previous conventional studies have used elaborate and costly optical motion capture systems, which not only represent a considerable expense but also require participants to visit a laboratory. To overcome these shortcomings, we aimed to develop a practical and inexpensive solution for measuring obstacle-crossing behavior by using the Microsoft Azure Kinect, one of the most promising markerless motion capture systems. We validated the Azure Kinect as a tool to measure foot clearance and compared its performance to that of an optical motion capture system (Qualisys). We also determined the effect of the Kinect sensor placement on measurement performance. Sixteen healthy young men crossed obstacles of different heights (50, 150, and 250 mm). Kinect sensors were placed in front of and beside the obstacle as well as diagonally between those positions. As indices of measurement quality, we counted the number of measurement failures and calculated the systematic and random errors between the foot clearance measured by the Kinect and Qualisys. We also calculated the Pearson correlation coefficients between the Kinect and Qualisys measurements. The number of measurement failures and the systematic and random error were minimized when the Kinect was placed diagonally in front of the obstacle on the same side as the trail limb. The high correlation coefficient (r > 0.890) observed between the Kinect and Qualisys measurements suggest that the Azure Kinect has excellent potential for measuring foot clearance during obstacle-crossing tasks.
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Affiliation(s)
- Kohei Yoshimoto
- Graduate School of Humanities and Social Science, Hiroshima University, Higashi-Hiroshima, Japan
| | - Masahiro Shinya
- Graduate School of Humanities and Social Science, Hiroshima University, Higashi-Hiroshima, Japan
- * E-mail:
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Meyer A, Hrdlicka HC, Cutler E, Hellstrand J, Meise E, Rudolf K, Grevelding P, Nankin M. Preliminary Evaluation of a Novel Body-Weight Supported Postural Perturbation Module for Gait and Balance Rehabilitation after Stroke. JMIR Rehabil Assist Technol 2022; 9:e31504. [PMID: 35080495 PMCID: PMC8924779 DOI: 10.2196/31504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/30/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. Objective This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. Methods This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. Results The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95% (SD 43.78%) and that for the BWSS control sample (n=15) was 53.29% (SD 24.13%). These values were greater than those for the standard of care group (n=30; mean 28.31%, SD 17.25%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). Conclusions Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. Trial Registration ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161
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Affiliation(s)
- Amanda Meyer
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Henry Charles Hrdlicka
- Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Erica Cutler
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Jill Hellstrand
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Emily Meise
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Kaitlyn Rudolf
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Pete Grevelding
- Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Matthew Nankin
- Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, US
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Dynamic alignment changes during level walking in patients with dropped head syndrome: analyses using a three-dimensional motion analysis system. Sci Rep 2021; 11:18254. [PMID: 34521880 PMCID: PMC8440518 DOI: 10.1038/s41598-021-97329-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
In patients with dropped head syndrome (DHS), cervical malalignment is one of the risk factors for impaired horizontal gaze and restrictions to ambulation. The characteristics of gait in patients with DHS have not been clarified biomechanically from the viewpoint of dynamic alignment and lower limb kinematics. This study aimed to clarify kinematic and kinetic differences during level walking in patients with DHS compared to the healthy elderly. Twelve patients with DHS and healthy elderly individuals performed level walking at a self-selected speed. Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. Statistical analysis was performed to compare these data between the two groups, respectively. Compared with the healthy elderly, stride length and peak hip-joint extension angle in patients with DHS were significantly shorter and smaller. The thorax was also significantly tilted backwards. Peak ankle-joint plantar-flexion moment was significantly smaller despite larger dorsiflexion angle compared with the healthy elderly. The walking of DHS patients demonstrated kinematic and kinetic characteristics of the lower limb joints and alignment of the thorax and pelvis corresponding to their short stride and walking speed.
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Huang SJ, Yu XM, Wang K, Wang LJ, Wu XB, Wu X, Niu WX. Short-Step Adjustment and Proximal Compensatory Strategies Adopted by Stroke Survivors With Knee Extensor Spasticity for Obstacle Crossing. Front Bioeng Biotechnol 2020; 8:939. [PMID: 32850762 PMCID: PMC7424008 DOI: 10.3389/fbioe.2020.00939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022] Open
Abstract
Stroke survivors adopt cautious or compensatory strategies for safe and successful obstacle crossing. Although knee extensor spasticity is a common independent secondary sensorimotor disorder post-stroke, few studies have examined the step adjustment and compensatory strategies used by stroke survivors with knee extensor spasticity during obstacle crossing. This study aimed to compare the differences in the kinematics and kinetics during obstacle crossing between stroke survivors with and without knee extensor spasticity, and to identify knee extensor spasticity-related differences in step adjustment and compensatory strategies. Twenty stroke subjects were divided into a spasticity group [n = 11, modified Ashworth scale (MAS) ≥ 1] and a non-spasticity group (n = 9, MAS = 0), based on the MAS score of the knee extensor. Subjects were instructed to walk at a self-selected speed on a 10-m walkway and step over a 15 cm obstacle. A ten-camera 3D motion analysis system and two force plates were used to collect the kinematic and kinetic data. During the pre-obstacle phase, stroke survivors with knee extensor spasticity adopted a short-step strategy to approach the obstacle, while the subjects without spasticity used long-step strategy. During the affected limb swing phase, the spasticity group exhibited increased values that were significantly higher than those seen in the non-spasticity group for the following measurements: pelvic lateral tilt angle, trunk lateral tilt angle, medio-lateral distance between the ankle and ipsilateral hip joint, hip work contributions, the inclination angles between center of mass and center of pressure in anterior–posterior and medio-lateral directions. These results indicate that the combined movement of the pelvic, trunk lateral tilt, and hip abduction is an important compensatory strategy for successful obstacle crossing, but it sacrifices some balance in the sideways direction. During the post-obstacle phase, short-step and increase step width strategy were adopted to reestablish the walking pattern and balance control. These results reveal the step adjustment and compensatory strategies for obstacle crossing and also provide insight into the design of rehabilitation interventions for fall prevention in stroke survivors with knee extensor spasticity.
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Affiliation(s)
- Shang-Jun Huang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopaedic Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Ming Yu
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kuan Wang
- Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, China
| | - Le-Jun Wang
- Sport and Health Research Center, Physical Education Department, Tongji University, Shanghai, China
| | - Xu-Bo Wu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xie Wu
- Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Wen-Xin Niu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopaedic Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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