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S6- Neuro 2 > Week 5- SCI Treatment Considerations Part 2 > Flashcards

Week 5- SCI Treatment Considerations Part 2 Flashcards

1
Q

PART 1: PHYSICAL ACTIVITY

A

PART 1: PHYSICAL ACTIVITY

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2
Q

Physical Activity After SCI:

  • __ strength, endurance, mobility, sleep, self-image, blood lipid profiles
  • __ risk of premature mortality
  • __ anxiety, loneliness, depression, stress, heart disease, BP, respiratory illness, diabetes, obesity, and other medical complications
A
  • ↑
  • ↓
  • ↓
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3
Q

What are some methods we implement physical activity with SCI patients?

A
  • arm ergometry
  • FES UE or LE cycle
  • WC propulsion
  • adaptive rowing machines
  • adaptive biking
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4
Q

What are the (2) primary guidelines for SC physical activities?

A
  • Cardiovascular fitness and muscle strength

- Cardiometabolic health benefits

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5
Q

Cardiorespiratory Fitness and Muscle Strength:

  • ____ minutes mod-vigorous intensity aerobic exercise _x/week.
  • __ sets of strength exercises _x/week for each major functioning muscle group with mod-vigorous intensity.
A
  • 20 minutes mod-vig aerobic 2x/week

- 3 sets mod-vig strength exercises 2x/week

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6
Q

Cardiometabolic Health:

-___ minutes _x/week of mod-vigorous intensity aerobic exercise.

A

-30 minutes 3x/week

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7
Q

Be sure to take any of the following into consideration when looking at changes that can occur after an SCI:

  • Musculoskeletal = decreased _____________
  • Respiratory = decreased _____________
  • Cardiovascular = ________________
  • ANS = _____ regulation and impaired ___________
A
  • Musculoskeletal: decreased bone density
  • Respiratory: decreased pulmonary reserve
  • Cardiovascular: orthostatic hypotension
  • Autonomic nervous system: temperature regulation, impaired sweat glands
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8
Q

For anyone with an injury at ____ or above, we should be concerned of ANS dysfunction.

A

-T6

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9
Q
  • Do individuals with tetraplegia and high paraplegia experience blunted HR response to low activity and a low VO2 peak?
  • What may be warranted?
A
  • Yes

- Vascular support (TED stockings, abdominal binder) may be warranted

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10
Q

Contraindications to Exercise Testing and Training in SCI. (7)

A
  • Autonomic Dysreflexia
  • Severe or infected skin on weight bearing surfaces
  • Symptomatic hypotension
  • Urinary tract infection
  • Unstable fractures
  • Uncontrolled hot/humid environments
  • Insufficient ROM to perform exercises task
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11
Q

PART 2: MANUAL WHEELCHAIRS

A

PART 2: MANUAL WHEELCHAIRS

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12
Q

Picking out a WC….

  • What_________is used in fabricating the wheelchair frame.
  • What_______or design of the frame is chosen.
  • What________are included.
  • What________are available.
A
  • material
  • shape
  • components
  • adjustments
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13
Q

What is the primary goal of WC prescription?

A

-Finding the combination of parts that produces the LIGHTEST wheelchair.

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14
Q

Why do we want a lightweight WC?

A

-Less force needed for propulsion, less stress on shoulders.

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15
Q
  • What must a WC be made out of to be considered an Ultra-Lightweight Manual WC?
  • What are the wheelchairs called?
  • Why are titanium WCs more common than carbon fiber?
A
  • Titanium or carbon fiber (titanium more common, carbon fiber lighter)
  • K0005 (or K5)
  • Carbon fiber is more expensive, material is more difficult to shape, less impact resistance (doesn’t minimize vibration)
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16
Q

In regards to K5 WCs, what are the types of frames? (3)

A
  • Box frame
  • Cantilever frame
  • Folding frame
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17
Q
  • What is the difference between a box frame and cantilever frame?
  • What is the good things about folding frames?
A
  • Cantilever folds in half differently and tends to be easier to travel around.
  • Footrests are swing-away in folding frame.
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18
Q

What are the 3 main types of cushions?

A
  • Air
  • Gel
  • Hybrid
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19
Q

Air Cushion:

  • _________ level of protection for skin
  • Comes in low-, mid-, high-grade
  • ______ maintenance, can pop.
  • More disruptive to ___________.
A
  • highest
  • high maintenance
  • posture
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20
Q

Gel Cushion:

  • ____ protective of skin, but still highly superior to typical foam cushions
  • _____ maintenance
A
  • less protective of skin

- less maintenance

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21
Q

Hybrid Cushion:

  • Combination air or gel and _______.
  • Offers additional stability over ________ thighs.
  • Good option for patients who need air but struggle with postural implications.
A
  • foam

- posterior thighs

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22
Q
  • If you patient has skin breakdown or a history, which cushion will they use?
  • What are the biggest cons to this?
A
  • Air Cushion

- Often pop, low stability in regards to support

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23
Q

Which cushion is better for postural support?

A

-Gel Cushion

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24
Q

Which cushion offers stability over the posterior thighs?

A

Hybrid Cushion

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25
Q

What are the 3 types of back rests?

A
  • Low Back
  • Mid Back
  • High Back
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26
Q

Low Back:

  • _______ supportive.
  • Allows for _____ upper trunk movement.
  • Least likely to get in way of _________.
A
  • least supportive
  • full
  • propulsion
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27
Q

Mid Back:

  • Extends to just below ___________ of scapula.
  • May get in way of ________ movements.
A
  • inferior angle

- scapular

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28
Q

High Back:

  • ______ supportive.
  • Restrictive to scapular movement and certain _________ movements.
A
  • most supportive

- shoulder

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29
Q
  • Each height option for backrests also come with different options for _______.
  • What are the 2 options?
A
  • DEPTH

- Lateral and Deep

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30
Q
  • _______ depth has minimal lateral support to trunk and allows for more freedom of trunk movements.
  • ______ offers much more lateral support but is more restrictive?
A
  • Lateral

- Deep

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31
Q

What is one way we can offset instability provided from someone who is using air roho cushion?

A

-Lateral support to help with postural sway.

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32
Q

What are the 3 types of armrests?

A
  • None
  • Swing-away
  • Flip-back
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33
Q

Armrests (None):

  • For more _________ wheelchair users.
  • Offers more freedom of movement, but lose benefits of armrest (stability, ___________ surface).
A
  • advanced

- push up surface

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34
Q

Armrests (Swing-away):

  • Easiest to operate, do not need _______/______.
  • Unable to attach trough or table if needed.
A

-wrist/hand

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35
Q

Armrests (Flip-back):

  • Need adequate ______ and ______ use.
  • More versatile - Able to attach trough or table.
A

-hand and finger

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36
Q

What are the 2 types of Footrests?

A
  • Rigid

- Swing-away

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37
Q

Footrests (Rigid):

  • _____ maintenance.
  • Extra thing to maneuver feet around during transfers.
A

-Less maintenance

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38
Q

Footrests (Swing-away):

  • Ideal for individuals participating in ____ trials.
  • Need adequate ______ and _______ function to operate.
A
  • gait trials

- hand and wrist

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39
Q

What are the 3 considerations when looking at wheels?

A
  • Rubber
  • Air
  • Push-Rims
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40
Q
  • ________ wheels are the lighter option and provide for a smoother ride but have more maintenance and can pop.
  • -_________ wheels are the heavier option but have way less maintenance.
  • _________ allow for easier propulsion and can build up to compensate for weaker grip. They also make the chair wider and can make it difficult to negotiate tight spaces.
A
  • Air
  • Rubber
  • Push-Rims
41
Q

Casters:

  • ______ casters are more lightweight.
  • ______ casters are beneficial when frequently negotiating outdoors/rough terrain.
A
  • Small

- Large

42
Q

What does deciding on WC parts come down to?

A

-Patient capabilities, patient limitations, and patient preferences.

43
Q

PART 3: POWER WHEELCHAIRS

A

PART 3: POWER WHEELCHAIRS

44
Q

What are the 3 primary drive systems?

A
  • Rear-wheel
  • Mid-wheel
  • Front-wheel
45
Q
  • The primary consideration with power wheelchairs is the _________ which includes 360-degree turning circumference and turning radius.
  • What is 360-degree turning circumference?
  • What is turning radius?
A
  • Maneuverability (360-degree turning circumference and turning radius)
  • Room needed to complete a full 360.
  • How tight the are able to turn.
46
Q

Rear-Wheel Drive:

  • ________ 360-degree circumference and turning radius.
  • ________ chair.

Mid-Wheel Drive:

  • Most maneuverable, excellent _______ chairs.
  • Fair maneuverability over ________ surfaces.

Front-Wheel Drive:

  • _________ turning radius than mid-wheel, but excellent at navigating tight corners.
  • Helpful with negotiating ______ terrain.
A
  • largest
  • fastest
  • indoor
  • outdoor
  • larger
  • rough
47
Q

-Which power chair is the most stable on slopes? Why?

A

-Mid-wheel drive, because they are the only ones that have front and rear casters.

48
Q

Power wheelchairs are for _______ spinal cord injuries and will always have high-back due to loss of trunk control.

A

-higher

49
Q

What are some other power wheelchair considerations? (6)

A
  • Head Array
  • Sip and Puff
  • Low-resistance joystick (Tongue control)
  • Chin control
  • Football post joystick
  • Standard joystick
50
Q

What are the 2 main ways to navigate a power wheelchair with arms or hands?

A
  • Standard joystick

- Football post joystick

51
Q

What is the good thing about chin control and drawback of tongue control?

A

Chin control allows ability to talk and drink while tongue control does not.

52
Q
  • At what levels do we use sip and puff, tongue control, and chin control?
  • At what level can we usually transition to using joystick control?
A
  • C4/C5

- C6

53
Q

What is the last option for our highest injuries that have minimal to no movement below the neck?

A

-Head array

54
Q 
General WC Considerations:
\_\_\_-\_\_\_
   -power WC
   -head array, chin, tongue, or sip and puff controls
   -portable respiratory may be attached

____

  • Can use a manual chair with propulsion aids, but will likely need PWC for distance and energy conservation
  • Sip and puff, chin, tongue or football post controls

____
-Manual wheelchair with friction surface hand rims
Should progress to independent on smooth surfaces

____
-Manual wheelchair with friction surface hand rims but increased propulsion ability

____
-Manual wheelchair with standard hand rims

A
  • C1-C4
  • C5
  • C6
  • C7
  • C8
55
Q

At what level do we consider full time use of manual wheelchair only?

A

C6 and down

56
Q

PART 4: MODALITIES

A

PART 4: MODALITIES

57
Q

What is Functional Electrical Stimulation (FES)?

A

-The use of electrical stimulation of the peripheral nervous system to contract muscles during functional activities.

58
Q

What are the 2 main uses of FES?

A
  • Independent Application

- FES Dependent Application

59
Q

Independent Application:

  • Use of FES for a finite time period to minimize impairments and to encourage motor _________ in context of function.
  • What is the expectation of independent application of FES?
A
  • relearning

- Patient will be weaned off of FES.

60
Q

FES Dependent Application:

  • This enables the patient to perform functional activities that wouldn’t otherwise be possible.
  • “___________”
A

-“Neuroprosthesis”

61
Q

What are the (4) indications for FES?

A
  • UMN injury
  • Absent/diminished motor function (focal/diffuse)
  • Demonstrates active contraction when e-stim provided over motor point of muscle belly
  • Able to tolerate stimulus provided by FES
62
Q

RT300 FES Bike Indications/Uses:

  • Relaxation of muscle _________.
  • Prevention or reduction of _____ ______.
  • Increasing local ______ ___________.
  • Maintaining or increasing _________.
  • Improve muscle ________ with intact innervation..
A
  • spasms
  • disuse atrophy
  • blood circulation
  • ROM
  • endurance
63
Q

RT300 FES Bike Considerations:

  • Risk of raising _______ expectations.
  • Difficult to predict outcome.
  • Insufficient evidence for _______ and ______ of treatment.
A
  • unrealistic expectations

- duration and dosage

64
Q

What are the contraindications for FES? (9)

A
  • Lower motor neuron pathology
  • Cardiac pacemaker
  • Pregnancy
  • Unhealed fracture in area
  • Skin breakdown in area
  • Internal stimulator near area (ex: Phrenic nerve/bladder stimulator)
  • DVT in area
  • Malignancy in area of treatment
  • Uncontrolled autonomic dysreflexia
65
Q

What are the relative contraindications for FES? (5)

A
  • Absent sensory
  • Severe spasticity
  • Heterotopic ossificans
  • Severe osteoporosis
  • Chronic pain syndrome
66
Q

PART 5: WALKING

A

PART 5: WALKING

67
Q

What is the Lokomat?

A

-Robotic assisted BW treadmill system.

68
Q

Is Lokomat training appropriate for complete or incomplete injuries?

A

-Both

69
Q

What are the benefits of lokomat training in complete injuries?

A

-Upright benefits with standing

70
Q

What are the benefits of lokomat training in incomplete injuries?

A
  • Individually adjustable gait pattern and guidance
  • Real-time biofeedback
  • Neuroplasticity, CPGs
71
Q

What are the main considerations with Lokomat training? (4)

A
  • Realistic expectations/goals
  • Hemodynamic stability
  • Skin integrity
  • Autonomic Dysreflexia
72
Q

Lokomat Contraindications:

  • Fixed LE __________.
  • Considerably reduced _____ ________ (osteopenia or osteoporosis).
  • Bone _________.
  • Non-consolidate fractures, unstable spinal column, severe OP.
  • Significant _________ disease/compromise.
  • __________ concerns (uncooperative, aggressive behavior, agitation).
  • ___________
  • > _____lbs, >__ft __in
A
  • contractures
  • bone density
  • bone instability
  • cardiac
  • behavioral
  • > 300lbs, >6ft 1in
73
Q

What is a ReWalk?

A

-Exoskeleton device that enables the device user to sit, stand, walk, turn, and has the ability to climb/descend stairs.

74
Q

Are ReWalk users able to independently operate the systems?

A

-Yes

75
Q

Prerequisites for ReWalk Trials:

  • Hands and shoulders can support ______/_______.
  • Healthy ______ _______.
  • No unhealed _________.
  • Adequate __________ tolerance.
  • No ______,_______,_______ comorbidities of concern.
  • Height is between ___-___cm (5′ 3″ – 6′ 2″)
  • Weight does not exceed ____ kg (220 lbs)
A
  • crutches/walker
  • bone density
  • fractures
  • standing tolerance
  • cardiac, respiratory, autonomic
  • 160-190cm
  • 100kg
76
Q

What is BWSTT?

A

-Bodyweight Supported Treadmill Training

77
Q

Is this used for incomplete or complete injuries?

A

-Incomplete (ASIA B, C, or D)

78
Q

BWSTT:

  • BWSTT promotes spinal cord _______/_______ of spinal locomotor pools.
  • Variable levels of loading.
  • During early training, what do therapists help with?
  • _____ frequency (__x/week).
  • _____ duration (___-___ minutes).
  • Typically __-__ weeks.
A
  • learning/activation
  • foot placement
  • high frequency (4x/week)
  • moderate duration (20-30 minutes)
  • 8-12 weeks
79
Q

What does progression with BWSTT look like in 4 steps?

A
  • Decreased BWS
  • Increased speed
  • Eliminate manual assistance
  • Progression to over ground locomotor training for community ambulation
80
Q

What are some types of orthotics? (4)

A
  • HKAFO (Hip-Knee-Ankle-Foot Orthosis)
  • RGO (Reciprocating Gait Orthosis)
  • KAFO (Knee-Ankle-Foot Orthosis)
  • AFO (Ankle-Foot-Orthosis)
81
Q

What 2 orthotics are mainly only used for SCIs?

A
  • HKAFO

- KAFO

82
Q

What is the difference between a RGO and HKAFO?

A
  • RGO consists of L and R HKAFO connected to a central pelvis section that has a reciprocating mechanism that acts as a pivot joint and spring loaded hip hinge.
  • Causes momentum from reciprocating mechanism.
83
Q

What are the 2 considerations with orthotics?

A
  • Ambulation goals

- Weight of orthosis

84
Q

Home Modification Considerations:

  • Ramps
    • 1ft length/ __in hieght
  • Doorframe Widths and Doors
    • Width of WC seat +__in
    • Easier to _____ door
  • Door and Appliance Handles
    • Consideration of patient’s hand function
  • Hallway Considerations
    • More width required to allow turn in/out
    • PWC: Consider _______ ______
A
  • Ramps
    • 1ft length/ 1in hieght
  • Doorframe Widths and Doors
    • Width of WC seat + 6in
    • Easier to PUSH door
  • Door and Appliance Handles
    • Consideration of patient’s hand function
  • Hallway Considerations
    • More width required to allow turn in/out
    • PWC: Consider drive type
85
Q 
Home Modification Considerations:
-Surface considerations
   -\_\_\_\_\_\_\_ vs \_\_\_\_\_\_\_\_
   -Thresholds 
Bathroom modifications
   -Bathrooms tend to be VERY narrow/small
   -\_\_\_\_\_/\_\_\_\_\_ height
   -Tub shower vs. shower stall
   -\_\_\_\_ \_\_\_\_ are a must 
Kitchen modifications
   -Countertop type, height
   -Appliance type, location
A

-Surface considerations
-Hardwood vs carpet
-Thresholds
Bathroom modifications
-Bathrooms tend to be VERY narrow/small
-Toilet/sink height
-Tub shower vs. shower stall
-Grab bars are a must
Kitchen modifications
-Countertop type, height
-Appliance type, location

86
Q
  • ___% of SCI employed after 1 year.

- ___% of SCI employed after 20 years.

A
  • 12%

- 33%

87
Q

PART 6: OUTCOME MEASURES

A

PART 6: OUTCOME MEASURES

88
Q

What are the main outcome measures? (9)

A
  • Multidimensional Pain Inventory – SCI Version(MPI-SCI)
  • Satisfaction With Life Scale
  • Reintegration to Normal Living Index (RNL)
  • Penn Spasm Frequency Index
  • Capabilities of UE Functioning Instrument
  • Spinal Cord Independence Measure (SCIM)
  • Wheelchair Skills Test
  • Walking Index for SCI II (WISCI-II)
  • SCI Functional Ambulation Inventory (SCI-FAI)
89
Q

MPI-SCI:

  • The MPI-SCI puts emphasis on subjective ______ and impact of ____ on patient’s lives.
  • What are the 3 sections?
  • How long does it take to complete?
  • Final score = ____ score
  • High correlation with __________
  • Moderate correlation with ___________ and ____________.
A
  • distress and impact of pain
  • Pain impact, Response by Significant Others, General Activities
  • 20 minutes
  • final score = mean score
  • High correlation with Brief Pain Inventory (BPI)
  • Mod correlation with Beck Depression Inventory (BDI) and Functional Independence Measure (FIM)
90
Q

Satisfaction with Life Scale:

  • Assesses satisfaction with patient’s life as a whole.
  • Quick easy ____-_______.
  • Excellent validity with other scales assessing well-being and recommended to complement other scales.
  • Scoring is from __-__ with higher scores being ______ satisfaction.
A
  • self-report

- 5-35, higher

91
Q

Reintegration to Normal Living Index (RNL):

-11 item (1-10) scale looking at patient’s ability to do what?

A

-How patient is able to move around house/community for “Reintegration to Normal Living”.

92
Q

Penn Spasm Frequency Index:

  • Self-report measure that assesses what?
  • Best to use alongside __________.
  • Grades from 0-4 with 0 being _______.
A
  • Patient’s perception of spasticity frequency and severity following SCI.
  • Modified Ashworth Scale (MAS)
  • no spasm
93
Q

Capabilities of UE Functioning Instrument:

  • Measures UE Functional limitations in individuals with _________.
  • 32 item questionnaire with what 7 domains?
A
  • tetraplegia

- Unilateral (L and R) items, bilateral items, reaching, pulling/pushing, wrist function, hand and finger function

94
Q

What are the (4) more commonly used outcome measures in SCI patients?

A
  • Spinal Cord Independence Measure (SCIM)
  • Wheelchair Skills Test
  • Walking Index for SCI II (WISCI-II)
  • SCI Functional Ambulation Inventory (SCI-FAI)
95
Q

Spinal Cord Independence Measure (SCIM):

-Score from 0-100 in what 3 domains?

A
  • Self-care (6 items, 0-20)
  • Respiration and sphincter management (4 items, 0-40)
  • Mobility (9 items, 0-40)
96
Q

Wheelchair Skills Test:

  • Comprehensive, objective WC mobility assessment.
  • _______ or ______ versions.
  • > ___% = advanced WC skills
A
  • manual or power versions

- >60% = advanced WC skills

97
Q

Walking Index for SCI II (WISCI-II):

  • Rank orders ability to walk ___m after SCI from most to least severe impairment.
  • What are some considerations?
A
  • 10m

- Amount of assistance, AD, braces

98
Q

SCI Functional Ambulation Inventory (SCI-FAI):

  • Observational _____ assessment.
  • What are the3 subscales?
A
  • gait assessment

- Gait parameters (20pts), Assistive device (14pts), Temporal distance (5pts)

S6- Neuro 2 (18 decks)

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