Posts Tagged gait

[ARTICLE] Combining transcranial direct-current stimulation with gait training in patients with neurological disorders: a systematic review – Full Text

Abstract

Background

Transcranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. However, its effectiveness has not been proven for many clinical applications.

Objective

The aim of this systematic review was to determine whether the effect of different strategies for gait training in patients with neurological disorders can be enhanced by the combined application of tDCS compared to sham stimulation. Additionally, we attempted to record and analyze tDCS parameters to optimize its efficacy.

Methods

A search in Pubmed, PEDro, and Cochrane databases was performed to find randomized clinical trials that combined tDCS with gait training. A chronological filter from 2010 to 2018 was applied and only studies with variables that quantified the gait function were included.

Results

A total of 274 studies were found, of which 25 met the inclusion criteria. Of them, 17 were rejected based on exclusion criteria. Finally, 8 trials were evaluated that included 91 subjects with stroke, 57 suffering from Parkinson’s disease, and 39 with spinal cord injury. Four of the eight assessed studies did not report improved outcomes for any of its variables compared to the placebo treatment.

Conclusions

There are no conclusive results that confirm that tDCS can enhance the effect of the different strategies for gait training. Further research for specific pathologies, with larger sample sizes and adequate follow-up periods, are required to optimize the existing protocols for applying tDCS.

Introduction

Difficulty to walk is a key feature of neurological disorders [1], so much so that recovering and/or maintaining the patient’s walking ability has become one of the main aims of all neurorehabilitation programs [2]. Additionally, the loss of this ability is one of the most significant factors negatively impacting on the social and professional reintegration of neurological patients [3].

Strategies for gait rehabilitation traditionally focus on improving the residual ability to walk and compensation strategies. Over the last years, a new therapeutic paradigm has been established based on promoting neuroplasticity and motor learning, which has led to the development of different therapies employing treadmills and partial body-weight support, as well as robotic-assisted gait training [4]. Nevertheless, these new paradigms have not demonstrated superior results when compared to traditional therapies [5,6,7], and therefore recent studies advise combining therapies to enhance their therapeutic effect via greater activation of neuroplastic mechanisms [8].

Transcranial direct-current stimulation (tDCS) is an intervention for brain neuromodulation consisting of applying constant weak electric currents on the patient’s scalp in order to stimulate specific brain areas. The application of the anode (positive electrode) to the primary motor cortex causes an increase in neuron excitability whereas stimulation with the cathode (negative electrode) causes it to decrease [9].

The effectiveness of tDCS has been proven for treating certain pathologies such as depression, addictions, fibromyalgia, or chronic pain [10]. Also, tDCS has shown to improve precision and motor learning [11] in healthy volunteers. Improvements in the functionality of upper limbs and fine motor skills of the hand with paresis have been observed in patients with stroke using tDCS, although the results were somewhat controversial [1213]. Similarly, a Cochrane review on the effectiveness of tDCS in treating Parkinson’s disease highlights the great potential of the technique to improve motor skills, but the significance level of the evidence was not enough to clearly recommend it [14]. In terms of gait rehabilitation, current studies are scarce and controversial [10].

Furthermore, tDCS is useful not only as a therapy by itself but also in combination with other rehabilitation strategies to increase their therapeutic potential; in these cases, the subjects’ basal activity and the need for combining the stimulation with the behavior to be enhanced have been highlighted. Several studies have combined tDCS with different modalities of therapeutic exercising, such as aerobic exercise to increase the hypoalgesic effect in patients with fibromyalgia [15] or muscle strengthening to increase functionality in patients suffering from knee osteoarthritis [16]. Along these lines, various studies have combined tDCS with gait training in patients with neurological disorders, obtaining rather disparate outcomes [17,18,19,20]. As a result, the main aim of this systematic review was to determine whether the application of tDCS can enhance the effectiveness of other treatment strategies for gait training. Additionally, as a secondary objective, we attempted to record and identify the optimal parameters of the applied current since they are key factors for its effectiveness. […]

 

Continue —>  Combining transcranial direct-current stimulation with gait training in patients with neurological disorders: a systematic review | Journal of NeuroEngineering and Rehabilitation | Full Text

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[WEB PAGE] Treatments for foot drop compared

 

Continue —> Treatments for foot drop compared | MS Trust

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[WEB SITE] Gait Rehabilitation Improvement Approach for Stroke Survivors Receives Research Funding

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RehabRobot

 

For stroke survivors whose ability to walk has been impaired by neurological damage, rehabilitation using robotics has proven to be an effective therapy to improve their gait. However, one of the major issues with this type of rehabilitation is that following training with a robotic device, motor improvements are not maintained in the patient’s daily life.

Gelsy Torres-Oviedo, assistant professor of bioengineering at the University of Pittsburgh Swanson School of Engineering, was awarded a $805,670 CAREER Award by the National Science Foundation to apply a novel approach to improve locomotor learning in stroke patients. She is the fifth Swanson School CAREER Award recipient in 2019, tying the school’s record from 2017.

“Our bodies adjust their movement to adapt to changes in the environment, but the very first thing that we need to do is sense that environment,” Torres-Oviedo, who directs the Sensorimotor Learning Laboratory at Pitt, explains in a media release.

“We then use this sensory information as input to our motor system, which drives our movement.”

The challenge with measuring sensation in people is that it is an internal variable; therefore, Torres-Oviedo’s group will use mathematical tools and perception experiments to estimate what individuals feel.

“We think that some stroke survivors have difficulty perceiving their asymmetric movement, and these proposed studies will help us characterize this deficit and indicate if split-belt walking – in which the legs move at different speeds – can correct it,” she says.

In the first part of this study, the lab will track how patients with brain lesions perceive asymmetries in their gait. They will then measure how their perception is adjusted once their movements are adapted in the split-belt environment.

In the second part of this study, the lab will use these data and a unique method to manipulate how people perceive their movement and create the illusion of error-free performance during split-belt walking, the release, from the University of Pittsburgh, continues.

They will use a human-in-the-loop (HITL) method, which is a closed-loop approach in which the behavioral output is feedback to tune the input to the motor system – in this case, the speed difference. This strategy creates an individualized outcome for each subject, which is a more effective method for training purposes.

“The idea is that if we understand how each patient adjusts their perceived movements, we can create the illusion of error-free performance where they think that they’re walking normally even though their movements are changing,” Torres-Oviedo explains.

“If they never perceive that they are doing something different, the hope is that changes in their movements can be carried over to the patient’s daily life.”

This research aims to enhance the generalization of movements from devices like treadmills and exoskeletons to daily activities.

“If Professor Torres-Oviedo and her group are successful in their work, it could have a profound effect on gait rehabilitation for stroke survivors,” notes Sanjeev G. Shroff, Distinguished Professor and the Gerald E. McGinnis Chair of Bioengineering.

Torres-Oviedo will also use this project as a way to increase the participation of students from underrepresented minorities (URM) in science and engineering. She will recruit, mentor, and prepare URM students from K-12 and college to pursue advanced education, with the ultimate goal of broadening the professional opportunities for this population, the release concludes.

[Source(s): University of Pittsburgh, EurekAlert]

 

via Gait Rehabilitation Improvement Approach for Stroke Survivors Receives Research Funding – Rehab Managment

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[Abstract] Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States

Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility.

Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States.

Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors.

Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion.

Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.

via Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States – Mary Stuart, Alexander W. Dromerick, Richard Macko, Francesco Benvenuti, Brock Beamer, John Sorkin, Sarah Chard, Michael Weinrich, 2019

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[Abstract] Design and Implementation of a Wearable Device for Motivating Patients With Upper and/or Lower Limb Disability Via Gaming and Home Rehabilitation

Abstract

Stroke survivors often suffer from a permanent or partial disability that restricts the movement of the hands, arms and/or legs. To help patients recover, rehabilitation should be at an earlier stage of the injury. Without motivation, it would be challenging for patients to successfully engage in the recovery process which can sometimes be painful of inconvenient. The application of wearable devices, games and Internet-of-Things (IoT) can create a motivating atmosphere to facilitate the rehabilitation process of patients while enabling remote monitoring of their health and progress. This paper presents the design and implementation of a rehabilitation system for aimed at helping stroke patients suffering from upper limb disability that exploits IoT by integrating gaming and wearable technology.

via Design and Implementation of a Wearable Device for Motivating Patients With Upper and/or Lower Limb Disability Via Gaming and Home Rehabilitation – IEEE Conference Publication

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[WEB PAGE] Ekso Bionics Unveils the EksoNR Neurorehabilitation Device

EksoNR, the latest exoskeleton from Ekso Bionics, features EksoView, a new touchscreen controller that allows therapists to intuitively adapt assistance to challenge patients using real-time feedback. (Photo courtesy of Ekso Bionics Holdings Inc)

EksoNR, the latest exoskeleton from Ekso Bionics, features EksoView, a new touchscreen controller that allows therapists to intuitively adapt assistance to challenge patients using real-time feedback. (Photo courtesy of Ekso Bionics Holdings Inc)

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The EksoNR is a next-generation EksoGT exoskeleton device developed by Ekso Bionics Holdings Inc to aid the neurorehabilitation of patients recovering from stroke and spinal cord injury, and to help them learn to walk again with a more natural gait.

Among the EksoNR’s new features and enhancements is EksoView, a new touchscreen controller that allows therapists to intuitively adapt assistance to challenge patients using real-time feedback and perform outcome measures during use.

Held in the palm of a therapists’ hand, EksoView provides visualization of various exercises beyond gait training, such as balancing, squatting from sit-to-stand positioning, lifting one leg, or standing in place, to actively engage patients and enhance the use of these beneficial features.

Another feature is the optimized SmartAssist software, developed to enable EksoNR to have a smoother and more natural gait path when transitioning between steps.

SmartAssist also gives gait symmetry and posture feedback and allows therapists to track patient progress with the upgraded EksoPulse, a cloud-based analytics solution. EksoPulse now uses rehabilitation data to generate insightful metrics and graphs for therapists and administrators to monitor patient progress and outcomes, Ekso Bionics notes in a media release.

“Ekso Bionics is committed to developing the latest exoskeleton advances for rehabilitation. We continue to innovate to ensure physical therapists have access to the latest tools to deliver better patient outcomes and superior care in neurorehabilitation,” says Jack Peurach, chief executive officer and president of Ekso Bionics, in the release.

“EksoNR is a full neurorehabilitation tool that is effective, intuitive, and differentiating. There is an increasing demand for adoption, as our technology sets rehabilitation centers apart,” he adds.

EksoNR is cleared by the US Federal Drug Administration for stroke and spinal cord injury rehabilitation. The device is also CE-marked and available in Europe.

Ekso Bionics will begin taking orders for EksoNR immediately. Existing customers will have the option to upgrade, the release continues.

[Source: Ekso Bionics]

 

via Ekso Bionics Unveils the EksoNR Neurorehabilitation Device – Rehab Managment

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[WEB PAGE] How a robotic cane could improve walking stability – Video


 

By adding electronics and computation technology to a simple cane that has been around since ancient times, a team of researchers at Columbia Engineering have transformed it into a 21st century robotic device that can provide light-touch assistance in walking to the aged and others with impaired mobility.

A team led by Sunil Agrawal, professor of mechanical engineering and of rehabilitation and regenerative medicine at Columbia Engineering, has demonstrated, for the first time, the benefit of using an autonomous robot that “walks” alongside a person to provide light-touch support, much as one might lightly touch a companion’s arm or sleeve to maintain balance while walking. Their study is published today in the IEEE Robotics and Automation Letters.

“Often, elderly people benefit from light hand-holding for support,” explained Agrawal, who is also a member of Columbia University’s Data Science Institute. “We have developed a robotic cane attached to a mobile robot that automatically tracks a walking person and moves alongside,” he continued. “The subjects walk on a mat instrumented with sensors while the mat records step length and walking rhythm, essentially the space and time parameters of walking, so that we can analyze a person’s gait and the effects of light touch on it.”

robotic cane

The light-touch robotic cane, called CANINE, acts as a cane-like mobile assistant. The device improves the individual’s proprioception, or self-awareness in space, during walking, which in turn improves stability and balance.

 

Related: Challenges of building haptic feedback for surgical robots

“This is a novel approach to providing assistance and feedback for individuals as they navigate their environment,” said Joel Stein, Simon Baruch Professor of Physical Medicine and Rehabilitation and chair of the department of rehabilitation and regenerative medicine at Columbia University Irving Medical Center, who co-authored the study with Agrawal. “This strategy has potential applications for a variety of conditions, especially individuals with gait disorders.”

To test this new device, the team fitted 12 healthy young people with virtual reality glasses that created a visual environment that shakes around the user – both side-to-side and forward-backward – to unbalance their walking gait. The subjects each walked 10 laps on the instrumented mat, both with and without the robotic cane, in conditions that tested walking with these visual perturbations. In all virtual environments, having the light-touch support of the robotic cane caused all subjects to narrow their strides. The narrower strides, which represent a decrease in the base of support and a smaller oscillation of the center of mass, indicate an increase in gait stability due to the light-touch contact.

“The next phase in our research will be to test this device on elderly individuals and those with balance and gait deficits to study how the robotic cane can improve their gait,” said Agrawal, who directs the Robotics and Rehabilitation (ROAR) Laboratory. “In addition, we will conduct new experiments with healthy individuals, where we will perturb their head-neck motion in addition to their vision to simulate vestibular deficits in people.”


The Robot Report has launched the Healthcare Robotics Engineering Forum (Dec. 9-10 in Santa Clara, Calif.). The conference and expo focuses on improving the design, development and manufacture of next-generation healthcare robots. Learn more about the Healthcare Robotics Engineering Forum.


While mobility impairments affect 4% of people aged 18 to 49, this number rises to 35% of those aged 75 to 80 years, diminishing self-sufficiency, independence, and quality of life. By 2050, it is estimated that there will be only five young people for every old person, as compared with seven or eight today.

“We will need other avenues of support for an aging population,” Agrawal noted. “This is one technology that has the potential to fill the gap in care fairly inexpensively.”

Editor’s Note: This article was republished from the Columbia University School of Engineering and Applied Science.

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[ARTICLE] Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke – Full Text

Abstract

Background

Gait is usually assessed by clinical tests, which may have poor accuracy and be biased, or instrumented systems, which potentially solve these limitations at the cost of being time-consuming and expensive. The different versions of the Microsoft Kinect have enabled human motion tracking without using wearable sensors at a low-cost and with acceptable reliability. This study aims: First, to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging; Second, to determine its concurrent validity with standardized clinical tests in individuals with stroke; Third, to quantify its inter and intra-rater reliability, standard error of measurement, minimal detectable change; And, finally, to investigate its ability to identify fall risk after stroke.

Methods

The most widely used spatiotemporal and kinematic gait parameters of 82 individuals post-stroke and 355 healthy subjects were estimated with the Kinect v2-based system. In addition, participants with stroke were assessed with the Dynamic Gait Index, the 1-min Walking Test, and the 10-m Walking Test.

Results

The system successfully characterized the performance of both groups. Significant concurrent validity with correlations of variable strength was detected between all clinical tests and gait measures. Excellent inter and intra-rater reliability was evidenced for almost all measures. Minimal detectable change was variable, with poorer results for kinematic parameters. Almost all gait parameters proved to identify fall risk.

Conclusions

Results suggest that although its limited sensitivity to kinematic parameters, the Kinect v2-based gait analysis could be used as a low-cost alternative to laboratory-grade systems to complement gait assessment in clinical settings.

Background

The physiological basis of cerebrovascular accidents make gait deficits a common sequelae after stroke [1]. More than 60% of stroke survivors are unable to walk independently after the injury [2] and, even after rehabilitation, more than half of the cases still present gait-related deficits [3]. Most prevailing deficits after stroke include reduced speed [4] and increased gait inter-limb asymmetry [5]. These gait impairments can be aggravated in the elderly, due to the natural musculoskeletal and cognitive decline with age [67], where the incidence of stroke is higher [8]. Importance of these deficits relies on their great impact on independence [9], quality of life [10], and fall risk [11]. Consequently, their adequate assessment is necessary for a proper diagnosis and to plan, if required, customized interventions to each individual’s condition and evaluate the effectiveness of these interventions.

Assessment of gait is commonly performed in the clinical setting using standardized scales and tests that evaluate different aspects of human locomotion and, in some cases, compare the results of the person being tested with those obtained by a matched healthy sample [12]. Although these tools are easy to administer and, in general, not time-consuming, they can present lack of specificity and, more importantly, may have poor accuracy and be biased by subjective evaluations [13]. Over the years, different technological solutions have been proposed to overcome these limitations. Accurate estimation of spatiotemporal parameters has been enabled by instrumented walkways [14] and force plates [15], generally, from ground reaction forces during walking. Estimation of kinematic parameters, however, require the position of several joints to be tracked during the test, which has been indirectly facilitated by different technological solutions that estimate the position of some sensors that are attached to specific body parts [16,17,18]. Among them, optical motion tracking has become the most common alternative for accurate investigation of kinematic gait parameters [19]. Although instrumented systems allow for accurate spatiotemporal and kinematic analysis, their high cost and large size have restricted their use to research laboratories and large clinical centers with high economic resources [20].

In the last years, the Microsoft Kinect (Microsoft, Redmond, WA), a portable off-the-shelf infrared camera originally intended for entertainment, has enabled human motion tracking without using wearable sensors at a very low-cost. Reliability studies have shown comparable performance of the Kinect to laboratory-grade gait analysis systems, for both the first [2122] and the second version of the device [23], known as the Kinect v2, which features improved depth accuracy and number of joints tracked [24]. Characteristics of the Kinect v2 have motivated their use for assessing spatiotemporal [25,26,27] and kinematic parameters of gait [2628] with promising results in healthy individuals, even on treadmills [2829]. Its reliability in stroke population, however, remains almost unexplored. Little evidence suggests that data retrieved from the Kinect v2 can be used to differentiate healthy subjects from individuals with stroke [30] and to complement clinical assessment [31]. Despite of the existing data supporting the reliability of the Kinect v2 to assess spatiotemporal and kinematic gait parameters, the unavailability of the software, the limited investigation in individuals with stroke, and the unknown psychometric properties of Kinect-based tests in this population could compromise the clinical relevance of these results.

The objective of this study was fourfold. First, to compare a cohort of individuals with stroke with respect to a group of healthy controls to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging. Second, to determine the concurrent validity of the system with standardized clinical tests in individuals with stroke. Third, to quantify its reliability as defined by the inter and intra-rater reliability, the standard error of measurement, and the minimal detectable change. And, finally, to investigate the ability of the system to identify risk of falls after stroke.

[…]

 

Continue —>  Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

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[WEB SITE] Achieve Dramatic Foot-Drop Relief with X-Strap Systems

X-Strap Systems offers unique proven products for foot drop relief. Products provide full-time comfort, normal ankle joint mobility, and normal gait. Products include the Dorsi-Strap, Dorsi-Strap PRO, and Dorsi-Lite Foot Splint.

Each foot drop product is easy on and off, ultra-low profile, lightweight, durable, washable, and latex free. No Rx needed. No fitting requirements. 30-day refund warranty. Shipped worldwide within 24 hours.

Dorsi-Lite can be used with or without shoes, during day or night, and in dry or wet conditions. No oversized shoes are needed. Treats plantar fasciitis, Achilles tendonitis, heel spurs and shin splints.

Dorsi-Strap is available in Standard and heavy-duty PRO models. Nothing is placed into the shoe or under the foot, so no oversize shoes are needed. The units offer quick adjustment and can be easily transferred or removed from the shoe. Available in White, Black, or Tan/Brown to match a wide array of shoe colors.

Guaranteed results!

via Achieve Dramatic Foot-Drop Relief with X-Strap Systems | Lower Extremity Review Magazine

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[Abstract] Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight–Supported Gait After Stroke

Introduction. Physiological responses are rarely considered during walking after stroke and if considered, only during a short period (3-6 minutes). The aims of this study were to examine physiological responses during 30-minute robot-assisted and body weight–supported treadmill and overground walking and compare intensities with exercise guidelines.

Methods. A total of 14 ambulatory stroke survivors (age: 61 ± 9 years; time after stroke: 2.8 ± 2.8 months) participated in 3 separate randomized walking trials. Patients walked overground, on a treadmill, and in the Lokomat (60% robotic guidance) for 30 minutes at matched speeds (2.0 ± 0.5 km/h) and matched levels of body weight support (BWS; 41% ± 16%). Breath-by-breath gas analysis, heart rate, and perceived exertion were assessed continuously.

Results. Net oxygen consumption, net carbon dioxide production, net heart rate, and net minute ventilation were about half as high during robot-assisted gait as during body weight–supported treadmill and overground walking (P < .05). Net minute ventilation, net breathing frequency, and net perceived exertion significantly increased between 6 and 30 minutes (respectively, 1.8 L/min, 2 breaths/min, and 3.8 units). During Lokomat walking, exercise intensity was significantly below exercise recommendations; during body weight–supported overground and treadmill walking, minimum thresholds were reached (except for percentage of heart rate reserve during treadmill walking).

Conclusion. In ambulatory stroke survivors, the oxygen and cardiorespiratory demand during robot-assisted gait at constant workload are considerably lower than during overground and treadmill walking at matched speeds and levels of body weight support. Future studies should examine how robotic devices can be Future studies should examine how robotic devices can be exploited to induce aerobic exercise.

 

via Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight–Supported Gait After Stroke – Nina Lefeber, Emma De Keersmaecker, Stieven Henderix, Marc Michielsen, Eric Kerckhofs, Eva Swinnen, 2018

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