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AMERICAN BOARD OF PHYSICAL

THERAPY RESIDENCY AND


FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology
June 2017

Board of Physical T
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American Physical Therapy Association


1111 North Fairfax Street  Alexandria, VA 22314-1488
resfel@apta.org  703/706-3152  www.abptrfe.org
AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

Preamble
The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), a board-appointed
group of the American Physical Therapy Association (APTA), has created the following Description of Residency
Practice (DRP) to reduced unwarranted curriculum variability; provide residents minimum consistency in learning
experiences for that area of practice; and streamline the accreditation process for reporting.

This DRP is the product of collaborative work by ABPTRFE and the APTA Physical Therapy Outcomes Registry
staff, and is based on feedback received from members of the American Board of Physical Therapist Specialties
(ABPTS) and directors of residency programs. Feedback was analyzed and incorporated into the DRP as
ABPTRFE refined the document.

While all programs are required to meet the comprehensive curriculum and program requirements as outlined
within the ABPTRFE Quality Standards for Clinical Physical Therapist Residency and Fellowship Programs, the
purpose of the DRP is to: (1) establish a consistent curriculum expectation for residency programs within the
same specialty area, and (2) provide consistency in program reporting for accreditation processes. The DRP
allows flexibility for programs to incorporate additional learning experiences unique to the program’s environment
that are beyond the minimum standard expectations.

The DRP for each residency area will undergo revalidation at least once every 10 years. The process for revalidation
will be a collaborative process with ABPTS, for specialty areas recognized by ABPTS, and will occur as part of the
revalidation of that specialty area by ABPTS.

Neurology Description of Residency Practice (2017) 2


AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

I. Type of Program −− Pain, including neurogenic and nonneurogenic


nn Movement sciences in populations with and without
Neurology is a clinical area of practice.
neurologic conditions, including the following:
−− Biomechanics and kinesiology of movement

II. Learning Domain Expectations systems


−− Kinematic and kinetic analysis of functional
A residency program must have a curriculum inclusive
movements, postural control, and gait
of the learning domains identified within that area’s
−− Pathokinesiology of functional movement, such
current validated analysis of practice.
as gait, posture, and reaching
The following information is extracted directly from chapter −− Theories and principles of motor control

2 of the Neurologic Description of Specialty Practice.1 −− Theories and principles of skill acquisition and

motor learning
A. Knowledge Areas of Neurologic Practice −− Theories and principles of motor development

−− Interrelationship among social, cognitive, and


Foundation Sciences movement systems
nn Human anatomy and physiology in health and
−− Effects of movement dysfunctions on multiple
neurologic populations, including:
body systems, including immediate and long-term
−− Musculoskeletal system

−− Cardiovascular and pulmonary systems Behavioral Sciences


−− Integumentary system nn Psychology and neuropsychology, including

−− Exercise physiology knowledge of:


−− Electrophysiology −− Cognitive processes (attention, memory, and

nn Neuroanatomy and neurophysiology, including


executive dysfunction)
knowledge of central, peripheral, and autonomic −− Cognitive, language, and learning disorders

nervous systems in populations with and without −− Affective and behavioral disorders

neurologic conditions: −− Expected emotional and behavioral responses,

−− Anatomical organization and functional and individualized coping strategies to illness


specialization and recovery
−− Age-related changes across the life span, −− Influence of motivational factors and adherence

including developmental neuroanatomy strategies to facilitate behavioral change on


−− Neural growth and plasticity, such as cortical illness and recovery
remodeling, activity-dependent changes −− Impact of cultural and social systems on illness

−− Neurotransmission and neurotransmitters and recovery


−− Perception and sensory systems nn Psychiatry including knowledge of:

−− Motor systems −− Common psychiatric symptoms, syndromes,

−− Neural control of locomotion, such as central


and classifications
pattern generators −− Effect of psychiatric disease and treatment on

−− Neural control of balance and postural control


cognition, learning, and function
−− Aphysiologic presentation, such as conversion
−− Regulation and modulation of reflexes
disorder
−− Regulation and modulation of autonomic function

1
Neurologic Physical Therapy Description of Specialty Practice. 3rd ed. Alexandria, VA: American Physical Therapy Association; 2016. Reproduced with permission. © 2016
American Physical Therapy Association. All rights reserved.
Neurology Description of Residency Practice (2017) 3
AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

nn Teaching and learning theory Clinical Reasoning and Critical Inquiry


−− Principles of teaching and learning nn Application of decision-making algorithms and

−− Development and implementation of


models to clinical practice
educational planning process nn Integration of the International Classification of

Functioning, Disability, and Health (ICF) framework to


Clinical Sciences inform clinical decisions and prioritize plan of care
(Signs and symptoms, management, and epidemiology nn Clinical research methodology appraisal
of injuries and diseases) nn Critical evaluation of test psychometrics and
nn Pathology, including congenital and acquired application of principles of measurement in
pathology/pathophysiology of: clinical practice
−− Neuromuscular system nn Judicious evaluation of components and merit of
−− Musculoskeletal system published evidence
−− Cardiovascular and pulmonary systems
B. Professional Competencies of
−− Physiologic response to trauma and stress
Neurologic Physical Therapists
−− Impact of neurologic conditions on other

body systems Communication


nn Epidemiology, including knowledge of: nn Employs effective communication strategies in

−− Incidence and prevalence


individuals with neurologic conditions, including
verbal, nonverbal, and assistive technologies
−− Prognostic indicators
nn Empowers individuals in the management of their
−− Risk factors relevant to health status across
own health
the lifespan
nn Facilitates collaborative team management and
−− Natural history, morbidity, and mortality
transitions of care for individuals with neurologic
nn Medical management, including knowledge of:
conditions
−− Imaging, such as MRI, f-MRI, CT Scans, and
nn Addresses cultural or social issues that affect the
PET scans plan of care
−− Clinical diagnostic procedures, such as EMG,

NCV, and evoked potential exam Education


−− Laboratory tests, including normal and nn Performs a needs assessment, including

abnormal findings determining the educational needs and unique


−− Surgical and nonsurgical interventions characteristics of the learners and group of learners
performed for neurologic conditions nn Develops educational objectives based on the

−− Assessment, monitoring, and activity learning needs of individuals and their families,
modifications related to medical procedures significant others, and caregivers; colleagues; and/
nn Pharmacology, including knowledge of:
or the public with consideration of learning domains
and level of expected outcomes for learners and
−− Pharmacokinetics and pharmacodynamics
groups of learners
−− Abnormal drug reactions, interactions, and
nn Develops and customizes appropriate teaching
adverse dosage effects
strategies and methods based on learning
−− Effects on the body systems, including
objectives and identified learning style preferences
common short- and long-term effects of individuals and their families, significant others,
and caregivers

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AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

nn Implements an educational plan that includes Prevention, Wellness, and Health Promotion
explanation, demonstration, practice, and effective nn Develops and implements programs to promote
use of feedback as appropriate health and fitness at the individual and societal level
nn Accurately and objectively assesses learning nn Promotes health and quality of life for individuals
outcomes of teaching strategies and modifies with and without neurologic conditions
strategies based on outcomes nn Establishes screening programs for neurologic
nn Educates physical therapy students and colleagues problems and uses screening programs to identify
to enhance knowledge and skills in neurologic at-risk populations
physical therapy
nn Educates health care professionals outside of Social Responsibility and Advocacy
nn Seeks unique solutions to challenging problems
physical therapy and outside agencies about
neurologic physical therapy for the individual patient or client, such as access
to health services, equipment, and community
nn Educates community groups in primary, secondary,
resources
and tertiary prevention
nn Advocates for neurologically impaired individuals

Consultation with policy- and lawmaking bodies


nn Synthesizes information from a wide variety of sources nn Promotes advanced neurologic practice at the
when providing consultative services to colleagues local, regional, national, and/or international levels
nn Effectively contributes to multidisciplinary team nn Represents neurologic physical therapy to other
decision-making to maximize patient and client professionals and professional organizations
outcomes
nn Renders specialist opinion about patients and
Leadership
nn Models and facilitates ethical principles in decision-
clients with neurological dysfunction to other health
professionals and external organizations making and interpersonal interactions
nn Pursues opportunities to mentor others and seeks
nn Provides peer and utilization review
mentors to expand own knowledge, skills and abilities
Evidence-Based Practice nn Resolves conflicts or challenging situations using
nn Evaluates the efficacy and effectiveness of new and multiple strategies
established examination tools, interventions, and nn Models and facilitates the translation of evidence
technologies into clinical practice
nn Critically appraises peer-reviewed evidence and nn Facilitates the use of evidence to shape system
judiciously translates evidence into practice policies and procedural change
nn Participates in conducting and disseminating

clinical research following ethical guidelines Professional Development


nn Practices active reflection and self-evaluation
nn Participates in collecting and interpreting patient

and client outcomes data, such as programmatic nn Models and facilitates a continued pursuit of additional

assessment and advanced knowledge, skills, and competencies


nn Synthesizes information from a variety of sources, nn Maintains current knowledge of regional, national,

such as clinical practice guidelines, to develop and international developments that impact
evidence-based clinical practice neurologic physical therapist practice

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AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

C. Psychomotor Skills of Neurologic nn Performs test and measures, including:


Physical Therapists in the Patient/Client −− Aerobic capacity/endurance
Management Model −− Assistive Technology, including orthotic,
prosthetic, protective and supportive
Patient and Client Examination devices, and including indications, use,
1. History effectiveness, and safety
nn Performs an interview that is patient- or client- −− Balance during static, dynamic, and
centered and that includes information relevant functional activities with or without the
to health restoration, promotion, and prevention use of devices or equipment
nn Integrates knowledge of disease with • Static posture, structure, and
history taking, such as medical, surgical, alignment
pharmacological history • Impairment-based measures to
delineate body function and structure
2. Systems Review • Functional performance measures,
nn Prioritizes relevant screening procedures based including measures used for
on identified health condition, previous tests and classification, prognosis, and to
interventions, patient history, and observation examine activities and participation
nn Recognizes signs and symptoms that require −− Circulation abnormalities, auscultation,
urgent referral to physician or emergency and activity tolerance
medical care −− Community, social, and civic life
integration and reintegration
3. Examination Procedures −− Cranial nerve integrity
nn Prioritizes important tests and measures −− Disease-specific scales for classification
based on history and systems review and prognosis
nn Prioritizes test selection based on scientific −− Environmental factors (domestic,
merit and clinical utility educational, work, community, social,
nn Incorporates risk-benefit analysis, such as and civic life)
physiologic cost to the patient or client, in −− Ergonomics and return-to-work
selection of tests and measures assessments
nn Selects measures that help assess the patient
−− Gait and locomotion, ambulatory and
or client across the ICF domains of body nonambulatory mobility (biomechanical,
function and structures, activity limitations, kinematic, kinetic, temporal-spatial
and participation restrictions characteristics)
• Analysis of safety, strategy, with and
nn Performs measures such that data
without devices and equipment,
are accurate and precise, considering
in various terrains, and in different
communication, cognition, affect, and
environments
learning styles of the patient or client
• Observational analysis
4. Tests and Measures • Functional performance measures of
nn Performs tests and measures, using self-
ambulation and wheelchair mobility
report, quantitative, and functional performance used for classification, prognosis, and
tools, with standardized, valid, reliable, and to examine activities and participation
population-appropriate methodologies −− Integumentary integrity
−− Joint integrity and mobility

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AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

−− Mental functions nn Links examination findings, personal modifiers,


• Consciousness and environmental factors, with the individual’s and
• Orientation caregiver’s expressed goal(s)
• Attention nn Integrates examination findings obtained by other
• Cognition health care professionals
• Dual-task nn Develops sound clinical judgments based on data
−− Motor functions of peripheral and central collected from the examination
nervous system
• Motor control measures to assess Diagnosis
and classify movement control nn Differentially diagnoses emergent versus
and performance nonemergent neurologic signs and symptoms
• Dexterity and coordination nn Differentially diagnoses body function, body
• Task and motion analysis considering structures, and functional performance findings
kinematic, kinetic, behavioral, and consistent or inconsistent with health condition,
environmental factors and if amenable to intervention
−− Muscle performance, including strength,
nn Confers with other professionals regarding
power, and endurance
examination needs that are beyond the scope of
−− Pain assessment (multidimensional,
physical therapy and refers as appropriate
pain scales)
−− Perception of sensory input, including Prognosis
vertical orientation, body schema, depth nn Analyzes barriers, such as resources and
perception, neglect, and motion sensitivity psychosocial barriers, that limit the individual
−− Quality of life measures, including disease in achieving optimal outcomes based on
and nondisease specific measures neurologic condition
−− Range of motion, including muscle
nn Predicts potential for recovery and time to achieve
extensibility and flexibility
optimal level of improvement across the ICF domains
−− Reflex integrity, including normal and
nn Collaborates with individuals and their families,
pathological
significant others, and caregivers in setting goals
−− Self-care and domestic life
nn Develops a plan of care that prioritizes interventions
−− Self-efficacy scales
−− Sensory integrity of peripheral and related to the recovery process, patient and client
central systems goals, and resources
−− Specialized sensory and motor tests (Dix nn Develops a plan of care that prioritizes interventions

Hallpike maneuver, positional testing) related to all levels of prevention, health, and wellness
−− Ventilation and respiration, including
pulmonary function, auscultation, and Intervention
cough assessment 1. Clinical Decision-Making and Prioritization of
Interventions
Evaluation nn Selects and, if needed, modifies interventions

nn Skillfully interprets observed movement and based on potential short-term impact


function, particularly when objective measures are and secondary prevention benefits with
not available or cannot be applied consideration of the individual’s body function
nn Differentiates examination findings across and structure, activity limitations, and
ICF domains that require remediation versus participation restrictions
compensatory strategies
Neurology Description of Residency Practice (2017) 7
AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

nn Selects and, if needed, modifies interventions Therapeutic Exercise


based on physiological or behavioral changes nn Designs and implements a customized

across the lifespan exercise program related to activity limitations


nn Prioritizes optimal interventions based on type nn Prescribes an exercise program with

and severity of impairments in body function appropriate timing, intensity, and dosage to
and structures, activity limitations, and maximize outcomes
participation restrictions nn Analyzes the relationship between exercise

nn Analyzes risk versus benefit when selecting biomechanics and the intended functional
interventions outcome at the task level
nn Negotiates interventions with the patient or client nn Effectively addresses multi-system

and family, significant others, and caregivers impairments when designing and
nn Modifies or continues intervention based implementing an exercise program
on ongoing evaluation nn Adapts aerobic conditioning programs for

patients and clients with neurologic dysfunction


2. Coordination, Communication, Documentation nn Skillfully designs and implements customized
nn Adapts communication to meet the diverse
balance training programs based on body
needs of the patient or client and family, structure/function, activity limitations and
significant others, and caregivers, such participation restrictions
as cultural, age-specific, educational, and
nn Skillfully designs and implements gait and
cognitive needs
locomotion training strategies customized to
nn Adapts communication to meet the health
body structure/function, activity limitations
literacy needs of the patient or client and and participation restrictions
family, significant others, and caregivers
nn Integrates physiological findings and
nn Asks questions which help to determine an
behavioral response(s), including pain
in-depth understanding of the patient’s or behaviors in the modification and progression
client’s problems of therapeutic exercise programs
nn Coordinates patient and client management

across care settings, disciplines, and Functional training in self-care and in domestic,
community and funding resources education, work, community, social, and civic life
nn Analyzes the interaction between multiple body
3. Patient and Client Instruction system impairments, activity limitations, and
nn Educates patient or client and family, participation restrictions, and the environment
significant others, and caregivers on nn Determines which problems related to chronic
diagnosis, prognosis, treatment, responsibility, disability are amenable to training
and self-management within the plan of care
nn Selects and implements training that enhances
nn Provides instruction aimed at risk reduction,
the ability to participate in domestic, education,
prevention, and health promotion work, community, social, and civic activities
nn Provides instruction using advances in
nn Makes recommendations for environmental
technology, such as web-based resources modifications in domestic, education, work,
community, social, and civic environments
4. Procedural Interventions
to optimize functional independence and
Performs skilled and effective procedural
participation
interventions, including:

Neurology Description of Residency Practice (2017) 8


AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

nn Performs task-specific training, considering nn Prescribes or recommends assistive


appropriate timing, intensity, and dosage technology that optimizes activity and
to maximize outcomes, such as early participation, such as environmental control
mobilization and locomotor training units and powered mobility
nn Provides customized assistance, cues, and nn Prescribes devices and equipment,
feedback to facilitate skill acquisition considering the financial implications for the
nn Interprets observed movements and function individual and society
during intervention and adjusts intervention nn Selects or recommends appropriate orthotics
accordingly, including the interrelationship for use in a neurologic population, including
between body segments and movement phases electro-orthotics
nn Anticipates and addresses the impact of faulty
biomechanics on short- and long-term health Airway clearance techniques
nn Skillfully adapts airway clearance techniques for
nn Adapts training techniques and environment
the unique needs of the neurologic population
to maximize safety, prevent injury, and address
nn Applies a variety of interventions, such as
risk reduction, such as falls prevention
seating and functional activities, to maximize
nn Judiciously applies available or emerging
pulmonary function for complex patients
technologies that promote skill training and
and clients
acquisition, such as virtual reality, robotics,
nn Integrates knowledge of the interrelationship
and assistive technology
between pulmonary status, and swallowing
ƒƒ Interprets motion analysis findings and
function and vocalization
applies to interventions
nn Designs and modifies interventions

Manual therapy techniques considering the impact of mechanical


nn Integrates manual therapy into the ventilation on the patient’s or client’s function
management of patients and clients with
neurologic conditions, such as joint and soft Integumentary repair and protective techniques
tissue mobilization nn Prevents and manages integumentary

impairment through the use of equipment,


Prescription, application, and, as appropriate, such as pressure mapping, seating systems,
fabrication of devices and equipment, including and cushion and orthotic prescriptions
assistive, adaptive, orthotic, protective, nn Prevents and manages integumentary
supportive, or prosthetic impairment through education, exercise,
nn Skillfully prescribes and adapts devices positioning, and mobility and activity prescription
and equipment for the complex patient in
collaboration with the patient or client and Electrotherapeutic modalities
family, significant others, and caregivers nn Integrates motor learning and motor

nn Predicts the impact of devices and equipment on control concepts into the application of
the biomechanics and efficiency of movement electrotherapeutic modalities, such as
nn Analyzes the impact of the devices and
biofeedback and NMES
equipment across a wide range of functional nn Applies electrotherapeutic modalities with

activities and participation in social and knowledge of plasticity, neurologic pathology,


environmental contexts and recovery patterns

Neurology Description of Residency Practice (2017) 9


AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

Outcomes Assessment If a residency program is unable to provide each


nn Selects appropriate outcome measures, such as resident with an opportunity to engage in patient
sensitive and responsive, across the ICF domains, care activities within these populations, the program
based on patient or client acuity, diagnosis, must provide additional learning opportunities (eg,
prognosis, and practice setting observation, didactic, journal club, research) related to
nn Adjusts the plan of care within and across episodes patient care within these populations for the minimum
based on interpretation of outcome measure results required hours noted above.
nn Analyzes and interprets patient and client outcomes
The minimum required patient populations for
to modify own future practice and perform
neurologic residency programs are:
programmatic assessments
Age:
III. Practice Settings ƒ Adults (22-59 years of age)
The clinical curriculum of all accredited residency ƒ Geriatrics (60 years of age to end of life)
programs must include a variety of practice settings, as
noted below. A resident should experience a minimum Sex:
of 5% of their time in each setting, as required by ƒƒ Female
the ABPTRFE Quality Standards for Clinical Physical ƒƒ Male
Therapist Residency and Fellowship Programs.
V. Primary Health Conditions
If a residency program is unable to provide each The clinical curriculum of all accredited residency
participant with an opportunity to engage in patient programs must include a variety of primary health
care activities within these settings, the program conditions associated with the program’s area of
must provide additional learning opportunities (eg, practice (see below list).
observation, didactic, journal club, research) related
to patient care within these settings for the minimum If a residency program is unable to provide each
required hours noted above. resident with an opportunity to engage in patient care
activities within the majority of these populations, the
The minimum required practice settings for neurologic program must provide additional learning opportunities
residency programs are: (eg, observation, didactic, journal club, research) related
ƒƒ Acute care facility to patient care within these conditions.
ƒƒ Inpatient rehabilitation facility or Skilled nursing facility
ƒƒ Outpatient facility The following template must be used when logging
resident–patient encounters as part of the residency
IV. Patient Populations curriculum. Patients evaluated, treated, or managed
The clinical curriculum of all accredited residency by the resident as part of the resident’s education
programs must include a variety of patient populations, throughout the course of the residency program should
specific to sex and age group as listed below, for a be included within the template. The patient’s primary
minimum of 5% of the program hours required by health condition is only counted during the first patient
the ABPTRFE Quality Standards for Clinical Physical encounter. Patient encounters beyond the initial
Therapist Residency and Fellowship Programs. visit should not be included in the frequency
count.

Neurology Description of Residency Practice (2017) 10


AMERICAN BOARD OF PHYSICAL THERAPY
RESIDENCY AND FELLOWSHIP EDUCATION
Description of Residency Practice
Neurology

Name of Resident:
Primary Health Conditions Number of Patients Evaluated, Treated,
Neurology or Manage by the Resident as Part of the
Program’s Curriculum
PULMONARY SYSTEM
Anoxia (eg, near drowning, drug induced)
NERVOUS SYSTEM
Acquired brain injury (eg, closed head injury, Brain injury,
Traumatic brain injury)
Central nervous system infections (eg, viral infections of the
CNS - meningitis, encephalitis)
Central nervous system neoplasms (eg, glioma, lymphoma,
meningioma, craniopharyngioma, pituitary tumor)
Cerebellar disorders (eg, degenerative cerebellar disorder,
cerebellar stroke)
Cerebral palsy
Cerebrovascular accident (eg, hemorrhagic, embolic/
thrombotic, anteriorvenous malformation, brainstem stroke,
basal ganglia stroke, thalamic stroke)
Concussion (post-concussion syndrome)
Dementia (eg, vascular, dementia with Lewy Body, mixed,
frontotemporal, Huntington disease, Wernicke-Korsakoff
Syndrome, Creutzfeldt-Jakob Disease, Alzheimer’s disease)
Multiple sclerosis
Normal pressure hydrocephalus
Other neuromuscular disorders (eg, Huntington disease,
Myasthenia gravis)
Parkinson’s disease/parkinsonism syndromes
Peripheral neuropathy (metabolic disease/idiopathic)
Polyneuropathy (eg, acute inflammatory demyelinating
polyneuropathy- Guillain-Barre Syndrome/chronic
inflammatory demyelinating polyneuropathy)
Spinal cord injury
Vestibular disorders (eg, peripheral, central, vestibular
pathology associated with disease process, acoustic neuroma)
OTHER

Neurology Description of Residency Practice (2017) 11

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