Posts Tagged motor skills

[Abstract+References] Motion-Based Serious Games for Hand Assistive Rehabilitation

Abstract

Cerebral Palsy, trauma, and strokes are common causes for the loss of hand movements and the decrease in muscle strength for both children and adults. Improving fine motor skills usually involves the synchronization of wrists and fingers by performing appropriate tasks and activities. This demo introduces a novel patient-centered framework for the gamification of hand therapies in order to facilitate and encourage the rehabilitation process. This framework consists of an adaptive therapy-driven 3D environment augmented with our motion-based natural user interface. An intelligent game generator is developed, which translates the patient’s gestures into navigational movements with therapy-driven goals, while adapting the level of difficulty based on the patient profile and real-time performance. A comprehensive evaluation and clinical-based assessments were conducted in a local children disability center, and highlights of the results are presented.

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[Abstract+References] The Effectiveness of Developing Motor Skills Through Motion-Based Video Gaming: A Review

Background. Technology growth affords innovative teaching techniques as video gaming within education has increased in popularity. Motion-based video gaming (MBVG) is a type of gaming that requires the individual playing the game to be physically interactive. Thus, whatever movements the individual playing the game does is picked up by motion sensors and is mimicked via the on-screen character. MBVG provides constant feedback to learners and has been found to help motivate students, replace sedentary with active gaming, and can facilitate social interactions with peers.

Aim. This literature review reveals the current knowledge regarding the potential educational benefits of MBVG, particularly in physical education and sport pedagogy settings. Developments of video gaming in education as well as recent research regarding MBVG and its potential impact on physical skill development within educational environments are discussed.

Conclusion. MBVG may be beneficial with novices in teaching basic sport concepts or with individuals with special needs who might otherwise not be able to participate in the full authentic version of the sport. However, empirical evidence is lacking which supports the effective use of MBVG in accurately teaching authentic sport-specific motor skills.

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 via The Effectiveness of Developing Motor Skills Through Motion-Based Video Gaming: A ReviewSimulation & Gaming – Seth E. Jenny, David P. Schary, Kristy M. Noble, Shelley D. Hamill, 2017

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[Abstract] Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study

 

Abstract

Objective

To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient’s unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training.

Design

Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks.

Setting

Rehabilitation university hospital.

Participants

Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo).

Interventions

Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment.

Main Outcome Measures

Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log.

Results

Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05).

Conclusions

EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis.

Source: Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study – Archives of Physical Medicine and Rehabilitation

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[Conference paper] Assistance System for Rehabilitation and Valuation of Motor Skills – Abstract+References

Abstract

This article proposes a non-invasive system to stimulate the rehabilitation of motor skills, both of the upper limbs and lower limbs. The system contemplates two ambiances for human-computer interaction, depending on the type of motor deficiency that the patient possesses, i.e., for patients with chronic injuries, an augmented reality environment is considered, while virtual reality environments are used in people with minor injuries. In the cases mentioned, the interface allows visualizing both the routine of movements performed by the patient and the actual movement executed by him.

This information is relevant for the purpose of

  • (i) stimulating the patient during the execution of rehabilitation, and
  • (ii) evaluation of the movements made so that the therapist can diagnose the progress of the patient’s rehabilitation process.

The visual environment developed for this type of rehabilitation provides a systematic application in which the user first analyzes and generates the necessary movements in order to complete the defined task.

The results show the efficiency of the system generated by the human-computer interaction oriented to the development of motor skills.

References

Source: Assistance System for Rehabilitation and Valuation of Motor Skills | SpringerLink

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[Abstract] Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study  

Abstract

Objective

To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient’s unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training.

Design

Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks.

Setting

Rehabilitation university hospital.

Participants

Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo).

Interventions

Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment.

Main Outcome Measures

Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log.

Results

Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05).

Conclusions

EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis.

Source: Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] Virtual reality intervention shows promise to repair mobility and motor skills in impaired limb

A combination of traditional physical therapy and technology may improve the motor skills and mobility of an impaired hand by having its partner, more mobile hand lead by example through virtual reality training, new Tel Aviv University research suggests.

“Patients suffering from hemiparesis — the weakness or paralysis of one of two paired limbs — undergo physical therapy, but this therapy is challenging, exhausting, and usually has a fairly limited effect,” said lead investigator Prof. Roy Mukamel of TAU’s School of Psychological Sciences and Sagol School of Neuroscience, who conducted the research with his student Ori Ossmy. “Our results suggest that training with a healthy hand through a virtual reality intervention provides a promising way to repair mobility and motor skills in an impaired limb.” The research was published in Cell Reports.

Does the left hand know what the right hand is doing?

53 healthy participants completed baseline tests to assess the motor skills of their hands, then strapped on virtual reality headsets that showed simulated versions of their hands. The virtual reality technology, however, presented the participants with a “mirror image” of their hands — when they moved their real right hand, their virtual left hand would move.

In the first experiment, participants completed a series of finger movements with their right hands, while the screen showed their “virtual” left hands moving instead. In the next, participants placed motorized gloves on their left hands, which moved their fingers to match the motions of their right hands. Again, the headsets presented the virtual left hands moving instead of their right hands.

The research team found that when subjects practiced finger movements with their right hands while watching their left hands on 3D virtual reality headsets, they could use their left hands more efficiently after the exercise. But the most notable improvements occurred when the virtual reality screen showed the left hand moving while in reality the motorized glove moved the hand.

Tricking the brain

“We effectively tricked the brain,” said Prof. Mukamel.

“Technologically, these experiments were a big challenge,” Prof. Mukamel continued. “We manipulated what people saw and combined it with the passive, mechanical movement of the hand to show that our left hand can learn even when it is not moving under voluntary control.”

The researchers are optimistic that this research could be applied to patients in physical therapy programs who have lost the strength or control of one hand. “We need to show a way to obtain high-performance gains relative to other, more traditional types of therapies,” said Prof. Mukamel. “If we can train one hand without voluntarily moving it and still show significant improvements in the motor skills of that hand, we’ve achieved the ideal.”

The researchers are currently examining the applicability of their novel VR training scheme to stroke patients.

Source: American Friends of Tel Aviv University

Source: Virtual reality intervention shows promise to repair mobility and motor skills in impaired limb

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[ARTICLE] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Full Text

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions.

Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices.

A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover.

On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Neurologic rehabilitation has been testing a motor learning theory for the past quarter century that may be wearing thin in terms of leading to more robust evidence-based practices. The theory has become a mantra for the field that goes like this. Repetitive practice of increasingly challenging task-related activities assisted by a therapist in an adequate dose will lead to gains in motor skills, mostly restricted to what was trained, via mechanisms of activity-dependent induction of molecular, cellular, synaptic, and structural plasticity within spared neural ensembles and networks.

This theory has led to a range of evidence-based therapies, as well as to caricatures of the mantra (eg, a therapist says to patient, “Do those plasticity reps!”). A mantra can become too automatic, no longer apt to be reexamined as a testable theory. A recent Cochrane review of upper extremity stroke rehabilitation found “adequately powered, high-quality randomized clinical trials (RCTs) that confirmed the benefit of constraint-induced therapy paradigms, mental practice, mirror therapy, virtual reality paradigms, and a high dose of repetitive task practice.”1 The review also found positive RCT evidence for other practice protocols. However, they concluded, no one strategy was clearly better than another to improve functional use of the arm and hand. The ICARE trial2 for the upper extremity after stroke found that both a state-of-the-art Accelerated Skill Acquisition Program (motor learning plus motivational and psychological support strategy) compared to motor learning-based occupational therapy for 30 hours over 10 weeks led to a 70% increase in speed on the Wolf Motor Function Test, but so did usual care that averaged only 11 hours of formal but uncharacterized therapy. In this well-designed RCT, the investigators found no apparent effect of either the dose or content of therapy. Did dose and content really differ enough to reveal more than equivalence, or is the motor-learning mantra in need of repair?

Walking trials after stroke and spinal cord injury,38 such as robot-assisted stepping and body weight-supported treadmill training (BWSTT), were conceived as adhering to the task-oriented practice mantra. But they too have not improved outcomes more than conventional over-ground physical therapy. Indeed, the absolute gains in primary outcomes for moderate to severely impaired hemiplegic participants after BWSTT and other therapies have been in the range of only 0.12 to 0.22 m/s for fastest walking speed and 50 to 75 m for 6-minute walking distance after 12 to 36 training sessions over 4 to 12 weeks.3,9 These 15% to 25% increases are just as disappointing when comparing gains in those who start out at a speed of <0.4 m/s compared to >0.4 to 0.8 m/s.3

Has mantra-oriented training reached an unanticipated plateau due to inherent limitations? Clearly, if not enough residual sensorimotor neural substrate is available for training-induced adaptation or for behavioral compensation, more training may only fail. Perhaps, however, investigators need to reconsider the theoretical basis for the mantra, that is, whether they have been offering all of the necessary components of task-related practice, such as enough progressively difficult practice goals, the best context and environment for training, the behavioral training that motivates compliance and carryover of practice beyond the sessions of formal training, and blending in other physical activities such as strengthening and fitness exercise that also augment practice-related neural plasticity? These questions point to new directions for research….

Continue —> A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Mar 01, 2017

Figure 1. Components of a Rehabilitation-Internet-of-Things: wireless chargers for sensors (1), ankle accelerometers with gyroscopes (2) and Android phone (3) to monitor walking and cycling, and a force sensor (4) in line with a stretch band (5) to monitor resistance exercises.

 

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[Abstract] Cognitive motor interference on upper extremity motor performance in a robot-assisted planar reaching task among patients with stroke

Abstract

Objective

To explore motor performance on two different cognitive tasks during robotic rehabilitation in which motor performance was longitudinally assessed.

Design

Prospective study

Setting

Rehabilitation hospital

Participants

Patients with chronic stroke and upper extremity impairment (N=22)

Intervention

A total of 640 repetitions of robot-assisted planar reaching, five times a week for 4 weeks

Main Outcome Measures

Longitudinal robotic evaluations regarding motor performance included smoothness, mean velocity, path error, and reach error by the type of cognitive task. Dual-task effects (DTE) of motor performance were computed in order to analyze the effect of the cognitive task on dual-task interference.

Results

Cognitive task type influenced smoothness (p = 0.006), the DTE of smoothness (p = 0.002), and the DTE of reach error (p = 0.052). Robotic rehabilitation improved smoothness (p = 0.007) and reach error (p = 0.078), while stroke severity affected smoothness (p = 0.01), reach error (p < 0.001), and path error (p = 0.01). Robotic rehabilitation or severity did not affect the DTE of motor performance.

Conclusions

The present results provide evidence for the effect of cognitive-motor interference on upper extremity performance among participants with stroke using a robotic-guided rehabilitation system.

Source: Cognitive motor interference on upper extremity motor performance in a robot-assisted planar reaching task among patients with stroke – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Motor Learning in Stroke – Full Text

Background and Objective: Stroke rehabilitation assumes motor learning contributes to motor recovery, yet motor learning in stroke has received little systematic investigation. Here we aimed to illustrate that despite matching levels of performance on a task, a trained patient should not be considered equal to an untrained patient with less impairment. Methods: We examined motor learning in healthy control participants and groups of stroke survivors with mild-to-moderate or moderate-to-severe motor impairment. Participants performed a series of isometric contractions of the elbow flexors to navigate an on-screen cursor to different targets, and trained to perform this task over a 4-day period. The speed-accuracy trade-off function (SAF) was assessed for each group, controlling for differences in self-selected movement speeds between individuals. Results: The initial SAF for each group was proportional to their impairment. All groups were able to improve their performance through skill acquisition. Interestingly, training led the moderate-to-severe group to match the untrained (baseline) performance of the mild-to-moderate group, while the trained mild-to-moderate group matched the untrained (baseline) performance of the controls. Critically, this did not make the two groups equivalent; they differed in their capacity to improve beyond this matched performance level. Specifically, the trained groups had reached a plateau, while the untrained groups had not. Conclusions: Despite matching levels of performance on a task, a trained patient is not equal to an untrained patient with less impairment. This has important implications for decisions both on the focus of rehabilitation efforts for chronic stroke, as well as for returning to work and other activities.

Stroke is a leading cause of adult disability, leaving 30% to 66% of patients with lasting motor impairment.1,2 It has long been proposed that motor recovery following stroke is a form of relearning3,4 and that there is considerable overlap between the brain regions involved in both processes.57 However, while acquiring skill at a task may allow a patient to perform at the same level as an individual with lesser impairment, this does not necessarily make them equal. For example, well-recovered stroke patients can match the performance of healthy controls on a motor task, but differences exist in the neural networks that underlie performance for each group.8 Furthermore, matched performance does not necessarily imply that both groups have the same ability to continue improving given the opportunity for practice. These differences can complicate judgments regarding patients’ capacity to return to work and other activities,9 and which rehabilitation activities they should focus on. In this article, we propose that acquiring skill through motor training raises a similar issue—a patient who has trained on a task may “appear better,” masking categorical differences in his or her abilities. Consider two hypothetical patients—Patient A, who has mild motor impairment, and Patient B, who is more severely impaired. Patient A performs better in a movement task than Patient B. Patient B then trains at the task, reaching the same performance level as Patient A. If Patient B is now equal to Patient A, he or she should have a similar capacity for further improvement with training. If this is not the case (eg, if Patient B has reached a performance plateau beyond which further training has a limited effect), then a categorical difference remains between these patients despite their matching task performance.

In comparison to healthy individuals, stroke patients select slower voluntary movement speeds when performing movement tasks.10 As speed and accuracy are inherently linked,11 a confound arises when comparing the accuracy of movements performed at different speeds. This limitation makes it difficult to interpret previous results, such as cases where patients improve their accuracy yet decrease their speed.12 In such cases, it is impossible to determine whether a patient improved his or her ability to perform the task (through skill acquisition) or whether he or she simply changed the aspect of performance on which they focused (eg, sacrificed speed for accuracy while remaining at the same overall level of ability). The only way to disambiguate these alternatives is to first derive the speed-accuracy trade-off function (SAF13) for a given task; participants are required to complete the task in a fixed time, allowing accuracy to be measured without the confounding effects of differences in speed. Once derived, skill represents a shift in the SAF.1315

Here we introduce a serial voluntary isometric elbow force task, a modified version of the serial voluntary isometric pinch task (SVIPT). This task is based on an established laboratory-based model of motor learning in which participants learn to control a cursor by producing isometric forces.1319 In the task used in the present study, participants controlled a cursor by exerting forces with their elbow flexor muscles, allowing comparisons of performance across participants with greater ranges of impairment than would be possible with the standard (hand controlled) SVIPT paradigm. To control for differences in movement speeds across groups, performance was assessed by comparing the speed-accuracy trade-off pre and post training, using measures of task-level performance (ie, binary success/failure to complete all specified aspects of the task)1318 and trial-level measures of endpoint error and variability.20 We predicted that the severity of a participant’s motor impairment would limit his or her ability to perform the task and that training may allow him or her to achieve a similar level of performance as an individual with lesser impairment. However, we hypothesized that despite their matching performance, there would be a categorical difference between these individuals; the previously untrained participant with lesser impairment would be able to make large, rapid improvements through training, while the trained participant would not.

Figure 1. Experimental setup and procedure. (A) Participants sat with their (affected) arm supported by a robotic exoskeleton. A force transducer measured contractions of their elbow flexors. (B) On screen display. Contracting the elbow flexors moved the cursor (white circle) to the right, while relaxing moved the cursor to the home position (grey square). A “go” indicator (used in training trials) indicated to participants that they could begin a trial when ready (illustrated here as a green circle). Each trial involved navigating the cursor through the sequence Home-1–Home-2–Home-3–Home-4–Home-5. Target positions and sequence order remained fixed throughout the study. (C) Procedure. Participants first completed a pretraining skill assessment, performing the task at trial durations set by an auditory metronome (indicated by tempos presented in beats per minute—see main text for further detail). One “run” of the task involved completing 10 trials at each tempo in a pseudorandom order. This procedure was repeated to generate 2 runs of data (ie, a total of 20 trials for each tempo). Participants later trained to perform the task over consecutive days, aiming to complete the sequence as quickly and as accurately as possible. Finally, on a separate day, participants completed a posttraining skill assessment.

Continue —> Motor Learning in Stroke – Oct 27, 2016

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[WEB SITE] Despite Weakness, Stroke Patients Can Learn New Tasks Through Rehab Training – Rehab Managment

Even though rehab training doesn’t change the neurological deficits resulting from a stroke, it can help patients learn new motor skills and achieve more independence in their daily lives, a recent study suggests.

Pablo Celnik, MD, director of the Department of Physical Medicine and Rehabilitation at Johns Hopkins, explains the finding more specifically, in a study published in Neurorehabilitation and Neural Repair.

“What we found is that physical rehab is not going to change the weakness caused by damaged brain cells in chronic patients, but it is going to change how well they can perform certain tasks, which can have a huge impact on a patient’s daily life,” Celnik says in a media release from Johns Hopkins Medicine.

The study included 10 chronic stroke patients with Fugi-Meyer Assessment (FMA) scores of >50 out of 66, categorized as having “mild to moderate” functional deficits; 10 patients with FMA scores of <50 out of 66, categorized as having “moderate to severe” impairment.; and 10 able-bodied participants who served as a control group.

All of the study participants were trained to control a simple video game using a using a robotic piece of equipment that held their dominant arm at 90 degrees from their bodies. This eliminated gravity as a burden for those whose arms were weakened by their strokes. The subjects were then taught to use the muscles around their elbow to move a cursor across a screen into small target windows, the release explains.

The participants were then asked to move the cursor through the windows in time with a metronome and completed nine blocks of 10 trials at various speeds—24, 30, 38, 45, 60, 80, 100, 110, and 120 beats per minute.

Next, the participants attended 30-minute training sessions for 4 consecutive days, during which time they were asked to complete five blocks of 30 trials, all at their own pace, and were encouraged to improve their speed and accuracy in each consecutive block. Following the training sessions, the participants’ skill levels were tested again in another skill assessment.

Results showed that while each group’s skill level improved by the end of the training, those with greater motor impairment still demonstrated less skill in both the pre- and post-training assessments. All participants reached a plateau in their improvement around experimental days 3 and 4.

However, the study showed that there was considerable overlap between the post-training performance of the stroke patients and the pre-training performance of groups with less impairment, the release continues.

“When you look at the data, the post-training mild-to-moderate group is indistinguishable from the pre-training control group. And the same was true for post-training scores of those in the moderate-to-severe group and the mild-to-moderate group,” says Robert Hardwick, PhD, postdoctoral fellow in the Department of Neurology at the Johns Hopkins University School of Medicine, in the release.

“This is good news for patients because it means that even when there is little likelihood of further neurological recovery, it means I can still teach them new tasks through training,” Celnik states in the release.

“What is important is to not create false expectations of neurological recovery, while at the same time being hopeful that patients can learn within the boundaries of their neurological deficit to improve their lives.”

[Source(s): Johns Hopkins Medicine, Science Daily]

Source: Despite Weakness, Stroke Patients Can Learn New Tasks Through Rehab Training – Rehab Managment

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