posture kk.pptx

Dr. Kaushik K Patel
MPT, PhD Scholar
Assistant professor
SPB Physiotherapy college

 Posture is the attitude assumed by body
either with support during muscular
inactivity, or by means of co-ordinated action
of many muscles working to maintain
stability or to from an essential basis which is
being adapted constantly to the movement
which is superimposed upon it

POSTURE
ACTIVE POSTURE INACTIVE
POSTURE
1. Static posture
2. Dynamic posture

 Attitude adopted for resting or
sleeping
 Minimum muscular activity.
 Posture which make minimal
demand upon muscle
responsible to maintain body
function i.e. respiration and
circulation.

 Used for training general relaxation fulfill
these conditions by allowing freedom of
respiratory movement and least possible
work for the heart muscle

 Def: integrated action of many muscle is
required to maintain active posture, which
may be static or dynamic
 Static posture: a constant pattern of posture
is maintained by interaction of group of
muscles which work more or less statically to
stabilise the joints and in opposition to gravity
or other forces
 Erect posture they preserve state of
equilibrium

 Dynamic posture:
 This type of posture is required to form an
efficient basis for the movement
 Pattern of posture is constantly modified and
adjusted to meet the changing circumstances
which arise as the result of the movement

 Muscles:
 Intensity and distribution of the muscle work which
is required for the both static and dynamic posture
varies considerably with the pattern of the posture,
and the physical characteristics of the individual
who assume it.

 The groups of muscles most frequently
employed to maintain the erect position are
working to counteract the effect of gravity
 They are consequently known as the
antigravity muscle and their action with regard
to joints is usually that of extension
 Antigravity muscle:
 Multi pennate or fan shaped muscle
 Constituting red fibers.

 Postural reflex: a reflex is ,
by definition , an efferent
response to an afferent
stimulus
 The efferent response in this
instance is a motor one, the
anti gravity muscles being
principal effector organs

 Afferent stimuli arise from Variety of
sources:
1. The muscles
2. The eyes
3. The ears
4. Joint structure
 The muscles: neuromuscular and
musculotendenious spindle with in muscles
record changing tension. Increased tension
causes stimulation and result in reflex
contraction of muscle

 Visual sensation records in the position of the
body with regard to its surrounding
 Form receptor for righting reaction

 Stimulation of vestibular receptor
due to movement of fluid
contained in semicircular canal of
internal ear
 Give knowledge of movement and
its direction in which it take place

 Joint structure: weight bearing position
causes approximation of bone-stimulate
receptors –elicits reflex reaction to maintain
posture
 Skin sensation especially that of sole of feet,
when body is in standing position

 Impulses from all these
receptors are conveyed and
coordinated in central nervous
center
 Cerebral cortex
 Cerebellum
 Red nucleus
 Vestibular nucleus

 Both static and dynamic posture are built up
by the integration of many reflexes which
together make up the postural reflex

 Posture is said to be good when it fulfils the
purpose for which it used with maximum
efficiency and minimum effort
 Precise pattern of good posture for individual
 Erect posture: perfect balance of one segment
upon other
 Esthetically pleasing to eyes

 Dynamic posture involve constant
readjustment to maintain the efficiency of the
postural background throughout the progress of
the movement
 Much difficult to assess
 Alignment of different segment of body is
inclined or horizontal
 Effect of gravity on segment is altered and
muscle work required to maintain the
alignment is adjusted accordingly

 Essential mechanism should intact
 Stable psychological background
 Good hygienic condition
 Opportunity for plenty of natural free
movement.

 Emotion and mental attitude have a
profound effect upon the nervous system as
a whole, and this is reflected in the posture
of the individual.
 Joy, Happiness and confidence are
stimulating and are reflected by an alert
posture in which position of extension
predominate.
 Conversely unhappiness , conflict and feeling
of inferiority have just the opposite effect
and result in postures in which positions of
flexion are most evident.

 These connections between mental and physical
attitudes has always been recognized and used in
dancing and on the stage.
 It is certain that the mental attitude affect the
physical either temporarily or permanently.
 Can not physical attitude adopted consciously affect
the mental attitude.

 Good hygienic conditions, particularly with
regard to nutrition and sleep, are essential
for a healthy nervous system and for the
growth and development of bones and
muscles, which is ultimately reflected in
posture.
 The opportunities for performing plenty of
free movements also encourage development
of skeletal muscles.


 Activity that is enjoyable or performing by
children such as running, jumping and
climbing in which active extension movement
predominates and there by leads to
development of good posture.

 Inefficient posture
 Fails to serve the purpose for which it
was designed
 Unnecessary amount of muscular
effort is used to maintain it
 Ligament strain or cramping of
thoracic movement

 Aesthetically displeasing
 Clothes do not fit properly
 Unwelcome psychological reaction
 Doesn’t serve the function properly
 Reduces efficiency of movement

 Mental attitude
 Poor hygienic condition
 General debility
 Prolong Fatigue
 Localized pain
 Muscular weakness
 Occupational stress
 Faulty idea of good posture

 DEFINITION:
 Increased in the lumbosacral angle
 Increased lumbar lordosis
 Increased anterior pelvic tilt
 Hip flexion

 Lumbosacral angle:
 It is an angle that the superior border of the first
sacral vertebral body makes with horizontal line..
 It is approximately 30 degree.

 It is often seen with increased thoracic
kyphosis and foreward head, it is called
Kypholordosis posture.

 Mobility Impairment in Hip flexors (tightness)
 Iliopsoas
 TFL
 Rectus femoris
 Lumbar extensors – erector spine

 Stretched / weak muscles:
 Rectus abdominals
 Internal / externals oblique
 Transverse abdominis

 SYMPTOMES:
 Stress to anterior longitudinal ligaments
 Narrowing of posterior disk space
 Narrowing of intervertebral foramen
 This may compress the dura and blood
vessels of related nerve root or nerve itself
 Eg. Degenerative conditions

 CAUSES:
 Sustained faulty posture
 Pregnancy
 Obesity
 Weak abdominal muscles

 Also called as sway back.
 amount of pelvic tilting is variable
but there is a shifting of entire
pelvic segment anteriorly.
 Anterior shifting of pelvic segment
– hip extension – posterior shifting
of thoracic segment – increased
lordosis in lower lumbar spine –
increased kyphosis in thoracic
region – head foreward.

 Mobility impairment :
 Abdominal muscles
 Upper segment of rectus abdominals and obliques
 Internal intercostal
 Hip extensors
 Lower lumbar extensors

 Stretched and weak muscles
 Lower abdominal muscles (lower segments of the
rectus abdominis and obliques)
 Extensor muscles of the lower thoracic region
 Hip flexor muscles

 STMPTOMES:
 Stress to the
 Iliofemoral ligaments,
 The anterior longitudinal ligament of the lower lumbar
spine
 The posterior longitudinal ligament of the upper
lumbar and thoracic spine.

 With asymmetrical postures, there is also
stress to the iliotibial band on the side of the
elevated hip.
 Narrowing of the intervertebral foramen in
the lower lumbar spine that may compress
the blood vessels, dura, and nerve roots,
especially with arthritic conditions.
 Approximation of articular facets in the
lower lumbar spine.

 CAUSES:
 Relaxed posture in which the muscles are not
used to provide support.
 The person yields fully to the effects of gravity,
and only the passive structures at the end of
each joint range (e.g., ligaments, joint capsules,
bony approximation) provide stability.

 Attitudinal (the person feels comfortable
when slouching),
 Fatigue (seen when required to stand for
extended periods),
 Muscle weakness (the weakness may be the
cause or the effect of the posture).
 A poorly designed exercise program—one that
emphasizes thoracic flexion without
balancing strength with other appropriate
exercises and postural training—may
perpetuate these

 Characterized by a
 Decreased lumbosacral angle,
 Decreased lumbar lordosis,
 Hip extension, and
 Posterior tilting of the pelvis.

 Mobility Impairment:
 The trunk flexor (rectus abdominis, intercostals)
and
 Hip extensor muscles
 Stretched and weak muscles
 Lumbar extensor and
 Possibly hip flexor muscles

 SYMPTOMES:
 Lack of the normal physiological lumbar curve,
which reduces the shock-absorbing effect of the
lumbar region and predisposes the person to
injury
 Stress to the posterior longitudinal ligament
 Increase of the posterior disk space, which
allows the nucleus pulposus to imbibe extra
fluid and, under certain circumstances, may
protrude posteriorly when the person attempts
extension

 CAUSES:
 Continued slouching or flexing in sitting or
standing postures;
 Overemphasis on flexion exercises in general
exercise programs

 DEFINITION :
 Increased thoracic curve,
 Protracted scapulae (round shoulders), and
 Forward (protracted) head.

 FOREWARD HEAD :
 increased flexion of the lower cervical and the
upper thoracic regions,
 Increased extension of the upper cervical
vertebra, and extension of the occiput on C1.
 Temporomandibular joint dysfunction with
retrusion of the mandible.

 MOBILITY IMPAIRMENT:
 Mobility impairment in the muscles of the
anterior thorax (Intercostal muscles),
 Muscles of the upper extremity originating on the
thorax (pectoralis major and minor, Latissimus
dorsi, serratus anterior).

 Muscles of the cervical spine and head that
attached to the scapula and upper thorax
(levator scapulae, sternocleidomastoid, scalene,
Upper trapezius)
 Muscles of the suboccipital region (rectus capitis
posterior major and minor, obliquus capitis
Inferior and superior).

 Stretched and weak muscles:
 Lower cervical and upper thoracic erector spinae
and scapular retractor muscles (rhomboids,
middle trapezius),
 Anterior throat muscles (suprahyoid and
infrahyoid muscles), and
 Capital flexors (rectus capitis anterior and
lateralis, superior oblique longus colli, longus
capitis).

 Stress to the anterior longitudinal ligament in
the upper cervical spine and posterior
longitudinal ligament in the lower cervical
and thoracic spine
 Fatigue of the thoracic erector spinae and
scapular retractor muscles.
 Irritation of facet joints in the upper cervical
spine.

 Narrowing of the intervertebral foramina in
the upper cervical region, which may
impinge on the blood vessels and nerve
roots, especially if there are degenerative
changes.
 Impingement on the neurovascular bundle
from anterior scalene or pectoralis minor
muscle tightness.

 Strain on the neurovascular structures of the
thoracic outlet from scapular protraction.
 Impingement of the cervical plexus from
levator scapulae muscle tightness
 Impingement on the greater occipital nerves
from a tight or tense upper trapezius muscle,
leading to tension headaches.
 Lower cervical disk lesions from the faulty
flexed posture

 The effects of gravity,
 Slouching, and
 Poor ergonomic alignment in the work or home
environment.
 Occupational or functional postures requiring leaning
forward or tipping
 Faulty sitting posture
 Relaxed Posture

 DEFINITION:
 Decrease in the thoracic curve,
 Depressed scapulae,
 Depressed clavicles, and
 Decreased cervical lordosis with increased
flexion of the occiput on atlas.

 It is associated with an
exaggerated military
posture but is not a
common postural deviation.
 There may be
temporomandibular joint
dysfunction with
protraction of the
mandible.

 MUSCLE IMPAIRMENT:
 Anterior neck muscles,
 Thoracic erector spinae and
 Scapular retractors, and potentially restricted
scapular movement, which decreases the
freedom of shoulder elevation

 STRETCHED / WEAK MUSCLES:
 Scapular protractor and
 Intercostal muscles of the anterior thorax

 SYMPTOMES:
 Fatigue of muscles required to maintain the
posture
 Compression of the neurovascular bundle in
the thoracic outlet between the clavicle and
ribs
 Temporomandibular joint pain and occlusive
changes.
 Decrease in the shock-absorbing function of
the kypholordotic curvature, which may
predispose the neck to injury.

 Scoliosis usually involves the thoracic and
lumbar regions.
 Typically, in right-handed individuals, there is
a mild right thoracic, left lumbar S-curve, or
a mild left thracolumbar C-curve.
 There may be asymmetry in the hips, pelvis,
and lower extremities.

 Irreversible lateral curvature with fixed
rotation of the vertebrae.
 Rotation of the vertebral bodies is toward
the convexity of the curve.
 In the thoracic spine, the ribs rotate with the
vertebrae so there is prominence of the ribs
posteriorly on the side of the spinal
convexity and prominence anteriorly on the
side of the concavity.

 posterior rib hump is detected on forward bending
in structural scoliosis

 Reversible and can be changed with forward
or side bending and with positional changes
such as lying supine.
 Realignment of the pelvis by correction of a
leg-length discrepancy with muscle
contractions.
 It is also called functional or postural
scoliosis.

 Mobility Impairment:
 In structures on the concave side of the curves.
• Stretched / Weak muscles : on the convex side of
the curves.
 If one hip is adducted, the adductor muscles
on that side have decreased flexibility and
the abductor muscles are stretched and
weak.
 The opposite occurs on the contralateral
extremity.

 With advanced structural scoliosis,
cardiopulmonary impairment may restrict
function

 SYMPTOMES:
 Muscle fatigue and ligamentous strain on the
side of the convexity
 Nerve root irritation on the side on the
concavity

 CAUSES: (STRUCTURAL)
 Neuromuscular diseases or disorders (e.g.,
cerebral Palsy, spinal cord injury, progressive
neurological or muscular diseases),
 Osteopathic disorders (e.G., Hemivertebra,
osteomalacia, rickets, fracture),
 Idiopathic disorders in which the cause is
unknown are common causes of structural
scoliosis.

 CAUSES (NON STRUCTURAL)
 Leg-length discrepancy (structural or functional),
 Muscle guarding or spasm from a painful stimuli in
the back or neck
 Habitual or asymmetrical postures

 Before developing a plan of care and
selecting interventions for management,
evaluate the findings from the examination of
the patient, including the history, review of
systems, and specific tests and measures, and
document the findings.

 Postural alignment (sitting and standing),
balance, and gait
 ROM, joint mobility, and flexibility
 Muscular strength and endurance for
repetitions and holding
 Ergonomic assessment if indicated
 Body mechanics
 Cardiopulmonary endurance/aerobic
capacity, breathing pattern

 ASSESSMENT includes,
 Anterior
 Posterior
 Lateral body’s alignment view.

 A systematic approach to postural analysis
involves viewing the body’s anatomical
alignment relative to a certain established
reference line.
 This reference (gravity) line serve to divide
the body into equal front and back halves
and to bisect it laterally.
 This line is called as plumb Line.

 HEAD AND NECK:
 PLUM LINE: It passes through the acromion
process.
 Common faults includes,
 Foreward head – head lies anterior to the plumb line
due to excessive cervical lordosis.

 Flattened lordotic cervical curve – plumb line lies
anterior to the vertebral bodies.
 It is due to – stretched posterior cervical ligaments
and extensor muscles.
 Excessive lordotic curve – plumb line lies posterior
to the vertebral bodies.
 Due to – vertebral bodies and joints compressed
posteriorly and anterior longitudinal ligament
stretched.

 SHOULDER:
 PLUMB LINE – it falls through the acromion process.
 Foreward shoulder – acromion process lies anterior
to the plumb line. And scapula abducted.
 Due to tight pectoralis major and minor, serratus
anterior and intercostal muscles.
 Excessive thoracic kyphosis and forward head.

 Lumbar lordosis : lumbar region is flat as the
subject raise arm overhead,
 It is due to – tightness of latissimus dorsi
muscle and thoraco lumbar fasciae.

 THORACIC VERTEBRAE:
 PLUMB LINE : line bisect the chest symmetrically.
 Kyphosis : increased posterior convexity of the
vertebrae.
 This may be due to - compression of inter vertebral
disk anteriorly. And stretched extensor , middle and
lower trapezius , posterior ligaments.

 Tightness of anterior longitudinal ligaments.
 PECTUS EXCAVATUM (FUNNEL CHEST) : depression
of anterior thorax and sternum.
 Tightness of upper abdominal, shoulder
adductors, pectoralis minor and intercostals.
 Stretched thoracic extensor , middle and lower
trapezius.
 Bony deformities of sternum and ribs.

 BARREL CHEST : increased overall
anteroposterior diameter of the chest.
 Due to - respiratory difficulties
 Stretched intercostals and anterior chest
muscles
 Tightness of scapular adductors muscles.

 PECTUS CARINATUM (PIGEON CHEST):
 Sternum projects anteriorly and downward.
 Due to – bony deformities of ribs and sternum.
 Stretched upper abdominal muscles.
 Tightness of upper intercostal muscles.

 LUMBAR VERTEBRAE:
 PLUMB LINE – fall midway between the
abdomen and back and slightly anterior to
the SI joint.
 COMMON FAULT INCLUDES,
 Lumbar Lordosis: hyper extension of lumbar
vertebrae.
 Anterior pelvic tilt , compressed vertebra
posteriorly.

 Stretched anterior longitudinal ligament and
lower abdominal muscles
 Tightness of posterior longitudinal ligament ,
lower back extensor and hip flexors.
 Sway back – flattening of lumbar vertebra
 Pelvis displaced foreward
 Due to - thoracic kyphosis and posterior pelvic
tilt.

 Flat back – flattening of the lumbar vertebra
 Due to – posterior pelvic tilt
 Hamstring tightness and weak hip flexors

 PELVIS AND HIP:
 PLUMB LINE : line falls slightly anterior to the SI
joint and posterior to the hip joint through GT.
 Common faults includes,
 Anterior pelvic tilt – ASIS lie anterior to the pubic
symphysis.
 Due to – increased lumbar lordosis and thoracic
kyphosis.

 Posterior pelvic tilt.: symphysis pubis lies
anterior to the ASIS.
 Due to – sway back with thoracic kyphosis.

 KNEE – line passes slight anterior to the midline of
knee.
 Genu Recurvatum – hyper extension of the knee.
 Plumb line lies foreward to the joint axis.
 Tightness of quadriceps, gastrocnemius and soleus.
 Stretched popliteus and hamstrings
 Compression force anteriorly.

 Flexed knee:
 Plumb line falls posterior to the joint axis
 Due to – tightness of hamstring muscles
 Stretched quadriceps and tightness
gastrocnemius
 Posterior compression force.

 ANKLE:
 PLUMB LINE : Line lies slightly anterior to the
lateral malleolus, aligned with tuberosity of
5th metatarsal.
 Foreward posture – line is posterior to the
body
 Body weight is carried on metatarsal heads of
the feet.
 Due to – posterior muscles stretched and
tightness of dorsal muscles.

 HEAD AND NECK:
 PLUMB LINE – bisect the head through the
external occipital protuberance.
 Head tilt
 Head rotated.

 SHOULDER AND SCAPULA:
 PLUMB LINE – falls midway between shoulders
 Dropped shoulder – hand dominancy, lateral trunk
muscles are short and hip is high, tight rhomboid
and latissimus dorsi.
 Elevated shoulder. – tight upper trapezius and
levator scapulae., weak or elongated lower
trapezius and because of scoliosis of thoracic
vertebrae.

 Adducted Scapula: scapula are too close to
the midline of thoracic vertebra
 Due to short rhomboid and stretched
pectoralis.
 Abducted scapula : scapula moved away from
the midline.
 Due to tightness of serratus anterior and
elongated rhomboid and middle trapezius.

 Winging of scapula:
 Medial border of the scapula lift off ribs
 Due to – weakness of serratus anterior muscle

 TRUNK:
 PLUMB LINE: line bisects the spinous process
of the thoracic and lumbar vertebra.
 Lateral deviation (Scoliosis): spinous process
of the vertebrae are lateral to the midline of
the trunk.

 Trunk muscles are shorted on one side
 Stretched on opposite side.
 Structural changes in ribs and vertebra
 Leg length discrepancy.

 PELVIS AND HIP
 PLUMB LINE: line bisect the gluteal cleft and
PSIS.
 Lateral pelvis tilt
 Pelvic rotation
 Abducted hip

 KNEE:
 PLUMB LINE – equidistance between the
knees.
 Genu Varum
 Genu Valgum

 ANKLE AND FOOT
 PLUMB LINE – equidistance from both
malleoli.
 Feiss line – line drawn from the medial
malleolus to the first metatarsal bone and
the tuberosity of navicular bone lies on the
line.
 Common fault includes,
 Pes planus (pronated) – low medial longitudinal
arch
 Pes Cavus (supinated) – high medial longitudinal
arch.

 HEAD AND NECK – line bisect the head at the
midline.
 Common fault includes,
 Lateral tilt
 Rotation
 Mandibular asymmetry – upper and lower teeth
are not aligned. (tightness of mastication
muscles)

 SHOULDER - line bisect the sternum and
xiphoid process.
 Common deviation includes,
 Dropped and elevated shoulder
 Clavicle asymmetry – due to trauma.

 ELBOW: - Line bisect the limbs and form an
angle of 5 to 15 laterally at the elbow with
the elbow extension.
 Cubitus valgus – forearm deviated laterally from
the arm. Due to stretched ulnar collateral
ligaments
 Cubitus varus – forearm deviated medially from
the arm. Due to stretches radial collateral
ligaments.

 HIP
 Lateral rotation
 Medial rotation

 KNEE:
 External tibial torsion – normally distal end of tibia
is rotated laterally from the proximal end.
 Excess of 25 degree rotation is lateral tibial torsion
(toeing out)
 Internal tibial torsion – feet face foreward and
inward.

 ANKLE AND FOOT
 Hallux valgus – lateral deviation of 1st toe at MTP
joint.
 Claw toes – hyperextension of MTP and flexion of the
proximal IP joints.
 Hammer toes – hyper extension of MTP and distal IP
joint and flexion of Proximal IP joints.

 Find out the cause of abnormal posture by
thorough assessment of the subject.
 Posture which results from unsatisfactory
mental attitude and poor hygienic
conditions, corrected by alteration in
habitual mental attitudes by improving
hygienic condition.

 The measure taken by PT to combat poor
posture and to train efficient good posture
depends upon the cause
 Success of treatment depends upon ability to
gain cooperation of patient
 Posture which is result of poor mental attitude
and poor hygienic condition can be remedied
by permanent change in mental attitude and
improvement of hygienic condition

 Postural defect- structural
changes- muscle and
ligament adopt its length
according to habitual
posture- limitation of normal
ROM

 Relaxation
 Mobility exercise
 Repeated presentation of satisfactory postural
pattern helps in improvement of posture
 During instruction…
cheerful atmosphere
spirit of enjoyment
judicious praise
helps in re establishment of satisfactory postural
pattern

 Generalized debility and fatigue is cause- pt
should be first treated with relaxation
 Relaxation helps in
1. Reliving tension
2. Assist in remembering satisfactory
alignment of the body

 Localised pain treated with appropriate means
 Muscular weakness treated with strengthening
exercise to improve muscle power
 Localised tension can be removed by relaxation
method
 Faulty idea of good posture can be cured by
giving pt the idea of correct posture and by
teaching him how to assume it habitual by
repeated voluntary effort

 Atmosphere
 Individual instruction
 Group instruction

 General relaxation
 Local relaxation
 contract and “ letting go”
General relaxation
 Crook lying ,supine lying
 Prone lying

 Crook lying
shoulder to
supporting surface
and expiration
 Forehead prone
raising and
lowering
 Sitting shoulder
retraction

 Normal mobility is essential
 Abnormal mobility – additional muscle force
to control it- contribute to poor posture
 General mobility exercise
 Rhythmic free exercise in full ROM

 Emphasis on Extension except shoulder and
lumber spine
 Stiffness of joint lead to increase mobility of
adjacent segment
 Stiff shoulder flexion compensated by lumber
hyperextension
 Hanging position- helps in maintaining
alignment

 Strengthening exercise to
weaker muscle
 Kyphosis: Upper back
extensor and retractor

 No ideal method
 PT should have faith in the method she
adopted
 Explain the importance of good posture
 Feedback: mirror, photographs

 Videotapes helps in training of dynamic
posture: lifting
 Provide sufficient repetition and precision…
till new pattern of posture become habitual
and no longer require voluntary control

 Head upward thrust of vertex in erect
position
 Crook lying: body lengthening
 Standing: head stretching upwards

 Voluntary control of pelvic tilt teaches the
patient to recognize any deviation from the
normal, trains him to be able to adjust and
correct it
 Crook lying: AP movement of pelvis
 Contraction of hip extensor and abdominals
followed by hallowing of lumber spine.

 Low wing sitting or standing: pelvis tilting
 Movement felt by putting hands on ASIS

 Painless, mobile and strong feet form a stable
base on which weight of body is balanced and
supported
 Exercise of arches should be practiced
 Sitting : pressing toes to floor
 Standing: standing on medial border, lateral
border of foot

 Complete pattern of good posture build up
gradually and progressively from complete
relaxation
 A state of balanced tension and much co-
operation (efforts) is required first, but the
effort and tension are progressively reduced
by repetition

 With sufficient repetition and precision, the
new and satisfactory pattern of posture
becomes habitual
 Therefore no longer requires voluntary
control, as it is maintained by a conditional
reflex (part of postural reflex)

posture kk.pptx

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