Vestibular rehabilitation in older people with vestibular dysfunction
Abstract Introduction and objective: Dizziness and imbalance are common symptoms in the elderly and have a great impact on their quality of life. Method: Narrative review. Results: Main factors that condition instability in the elderly and the impact of falls are reviewed, as well as the most profitable tests in diagnosis. Finally, the need to perform a multidisciplinary approach was discussed, highlighting the importance of vestibular rehabilitation in the treatment of these disorders. Conclusions: Instability in the elderly is multifactorial and not only due to physiological reasons. Hence the need to identify precipitating factors, treat them if possible and carry out a multidisciplinary approach that minimizes the morbidity and mortality associated with this process and improve their quality of life. Vestibular rehabilitation can significantly ameliorate balance in the elderly with instability which would lead to a significant reduction in falls.
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Baloh RW, Jacobson KM, Socotch TM. The effect of aging on visual-vestibuloocular responses. Exp Brain Res. 1993; 95:509-16.
Basta D, Rossi-Izquierdo M, Soto-Varela A, Greters ME, Bittar RS, Steinhagen-Thiessen E,et al. Efficacy of a vibrotactile neurofeedback training in stance and gait conditions for the treatment of balance deficits: a double-blind, placebo-controlled multicenter study. Otol Neurotol. 2011;32:1492-9. doi: 10.1097/MAO.0b013e31823827ec
Bracchi E, Rizzo S, Longari F, Bernardini M, Bizzotti C, Frenguelli A. Balance disorders in the elderly. Acta Otorhinolaryngol Ital. 2002; 22: 263-7.
Bronstein A, Lempert T. Dizziness, imbalance and falls in the elderly. En: Bronstein A, Lempert T, editores. Dizziness. A practical approach to diagnosis and management 2a Edición. Cambridge (United Kingdom): Cambridge University Press; 2017.p. 147-66.
Brosel S, Strupp M. The Vestibular System and Ageing. Subcell Biochem. 2019;91:195-225. doi: 10.1007/978-981-13-3681-2_8.
Cabrero-García J, Muñoz-Mendoza CL, Cabañero-Martínez MJ, González-Llopís L, Ramos-Pichardo JD, Reig-Ferrer A. Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud. Aten Primaria. 2012;44:540-8. doi: 10.1016/j.aprim.2012.02.007.
Cuevas-Trisan R. Balance Problems and Fall Risks in the Elderly. Clin Geriatr Med. 2019 ;35:173-183.
Eibling D. Balance Disorders in Older Adults. Clin Geriatr Med. 2018;34:175-181. doi: 10.1016/j.cger.2018.01.002.
Faraldo García A. Paciente con presbivértigo y riesgo de caídas. En Rosssi- Izquierdo M, Soto Varela A, Santos Pérez S, editores. Rehabilitación vestibular [ Internet]. Santiago de Compostela: Sociedad Gallega de Otorrinolaringología; 2016 [acceso 8 de junio de 2018].p. 195- 202. Disponible en: http://www.sgorl.org/images/Ponencias/Ponencia_SGORL_Rehabilitación_Vestibular_.pdf.
Gabriel Trinidad Ruíz. Ejercicios de rehabilitiación domiciliaria. . En Rosssi- Izquierdo M, Soto Varela A, Santos Pérez S, editores. Rehabilitación vestibular [ Internet]. Santiago de Compostela: Sociedad Gallega de Otorrinolaringología;2016 [acceso 8 de junio de 2018].p. 169- 177. Disponible en: http://www.sgorl.org/images/Ponencias/Ponencia_SGORL_Rehabilitación_Vestibular_.pdf.
Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther. 2016 Apr;40(2):124-55. doi: 10.1097/NPT.0000000000000120.
Ishiyama G. Imbalance and vertigo: the aging human vestibular periphery. Semin Neurol. 2009; 29: 491-9. doi: 10.1055/s-0029-1241039.
Jahn K. The Aging Vestibular System: Dizziness and Imbalance in the Elderly. Adv Otorhinolaryngol. 2019; 82:143-149. doi: 10.1159/000490283.
Jeka JJ, Allison LK, Kiemel T. The dynamics of visual reweighting in healthy and fall-prone older adults. J Mot Behav. 2010;42:197-208. doi: 10.1080/00222895.2010.481693.
Judge JO, King MB, Whipple R, Clive J, Wolfson LI. Dynamic balance in older persons: effects of reduced visual and proprioceptive input. J Gerontol A Biol Sci Med Sci. 1995;50:M263-70.
Kearney FC, Harwood RH, Gladman JR, Lincoln N, Masud T. The relationship between executive function and falls and gait abnormalities in older adults: a systematic review. Dement Geriatr Cogn Disord. 2013;36:20-35.
Krager R. Assessment of vestibular function in elderly patients. Curr Opin Otolaryngol Head Neck Surg. 2018;26:302-306. doi: 10.1097/MOO.0000000000000476.
Lin CC, Barker JW, Sparto PJ, Furman JM, Huppert TJ. Functional near-infrared spectroscopy (fNIRS) brain imaging of multi-sensory integration during computerized dynamic posturography in middle-aged and older adults. Exp Brain Res. 2017;235:1247-1256. doi: 10.1007/s00221-017-4893-8.
Lord SR, McLean D, Stathers G. Physiological factors associated with injurious falls in older people living in the community. Gerontology. 1992;38:338-46.
Manchester D, Woollacott M, Zederbauer-Hylton N, Marin O.Visual, vestibular and somatosensory contributions to balance control in the older adult. J Gerontol. 1989;44:M118-27.
McMurdo ME, Gaskell A. Dark adaptation and falls in the elderly.Gerontology. 1991;37(4):221-4.
Osoba MY, Rao AK, Agrawal SK, Lalwani AK. Balance and gait in the elderly: A contemporary review. Laryngoscope Investig Otolaryngol. 2019;4:143-153. doi: 10.1002/lio2.252. eCollection 2019 Feb.
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148-57. doi: 10.1111/j.1532-5415.2010.03234.x.
Panzer VP, Bandinelli S, Hallett M. Biomechanical assessment of quiet standing and changes associated with aging. Arch Phys Med Rehabil. 1995;76:151-7.
Patel M, Magnusson M, Kristinsdottir E, Fransson PA The contribution of mechanoreceptive sensation on stability and adaptation in the young and elderly. Eur J Appl Physiol. 2009;105:167-73. doi: 10.1007/s00421-008-0886-4.
Peterka RJ, Black FO, Schoenhoff MB. Age-related changes in human vestibulo-ocular reflexes: sinusoidal rotation and caloric tests. J Vestib Res. 1990-1991;1(1):49-59.
Pyykkö I, Jäntti P, Aalto H. Postural control in elderly subjects. Age Ageing. 1990;19:215-21.
Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance?. Clin Rehabil. 2000; 14:402-6.
Robbins S, Waked E, McClaran J. Proprioception and stability: foot position awareness as a function of age and footwear. Age Ageing. 1995;24:67-72.
Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, Del-Río-Valeiras M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, et al. Prognostic factors that modify outcomes of vestibular rehabilitation in elderly patients with falls. Aging Clin Exp Res. 2019 Apr 11. doi: 10.1007/s40520-019-01185-8. [Epub ahead of print].
Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, Del-Río-Valeiras M, Faraldo-García A, Vaamonde-Sánchez-Andrade I,et al. Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls-a randomized clinical trial. Aging Clin Exp Res. 2018 ;30:1353-1361.
Rossi-Izquierdo M, Santos-Pérez S, Rubio-Rodríguez JP, Lirola-Delgado A, Zubizarreta-Gutiérrez A, San Román-Rodríguez E, et al. What is the optimal number of treatment sessions of vestibular rehabilitation? Eur Arch Otorhinolaryngol. 2014;271:275-80.
Rossi-Izquierdo M, Santos-Pérez S, Soto-Varela A. What is the most effective vestibular rehabilitation technique in patients with unilateral peripheral vestibular disorders? Eur Arch Otorhinolaryngol. 2011;268:1569-74. doi: 10.1007/s00405-011-1532-z.
Sharpe JA, Sylvester TO. Effect of aging on horizontal smooth pursuit. Invest Ophthalmol Vis Sci. 1978;17:465-8.
Shaw FE, Bond J, Richardson DA, Dawson P, Steen IN, McKeith IG, et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ. 2003;326:73.
Shen DC, Wu SL, Shi YZ, Wang S, Zhang YM, Wang CX. The correlation between white matter hyperintensity and balance disorder and fall risk: An observational, prospective cohort study. Chronic Dis Transl Med. 2016;15:173-180. doi: 10.1016/j.cdtm.2016.11.008.
Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(24):1750-1758. doi: 10.1136/bjsports-2016-096547. Epub 2016 Oct 4.
Shumway-Cook A, Woollacott M, Kerns KA, Baldwin M. The effects of two types of cognitive tasks on postural stability in older adults with and without a history of falls. J Gerontol A Biol Sci Med Sci. 1997;52:M232-40.
Soto-Varela A, Faraldo-García A, Del-Río-Valeiras M, Rossi-Izquierdo M, Vaamonde-Sánchez-Andrade I, Gayoso-Diz P, et al. Adherence of older people with instability in vestibular rehabilitation programmes: prediction criteria. J Laryngol Otol. 2017;131:232-238.
Soto-Varela A, Faraldo-García A, Rossi-Izquierdo M, Lirola-Delgado A, Vaamonde-Sánchez-Andrade I, del-Río-Valeiras M, et al. Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx. 2015; 42:8-14. doi: 10.1016/j.anl.2014.06.005.
Soto-Varela A, Rossi-Izquierdo M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, Gayoso-Diz P, Del-Río-Valeiras M et al. Balance Disorders in the Elderly: Does Instability Increase Over Time? Ann Otol Rhinol Laryngol. 2016; 125(7):550-8.
Spooner JW, Sakala SM, Baloh RW. Effect of aging on eye tracking. Arch Neurol. 1980 ;37:575-6.
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12(5):290-5.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701-7.
Verghese J, Ayers E, Barzilai N, Bennett DA, Buchman AS, Holtzer R, et al. Motoric cognitive risk syndrome: Multicenter incidence study. Neurology. 2014;83:2278-84. doi: 10.1212/WNL.0000000000001084.
Whitney SL, Marchetti GF. Physical therapy management of the older person with vestibular rehabilitation. In Herdman SJ, Clendaniel RA, editores. Vestibular rehabilitation. 4ªEdición. Philadelphia: F.A. Davis Company;2014;p.480-503.
Xie Y, Anson ER, Simonsick EM, Studenski SA, Agrawal Y. Compensatory Saccades Are Associated With Physical Performance in Older Adults: Data From the Baltimore Longitudinal Study of Aging. Otol Neurotol. 2017;38:373-378. doi: 10.1097/MAO.0000000000001301.
Zwergal A, Linn J, Xiong G, Brandt T, Strupp M, Jahn K. Aging of human supraspinal locomotor and postural control in fMRI. Neurobiol Aging. 2012;33:1073-84. doi: 10.1016/j.neurobiolaging.2010.09.022.
Basta D, Rossi-Izquierdo M, Soto-Varela A, Greters ME, Bittar RS, Steinhagen-Thiessen E,et al. Efficacy of a vibrotactile neurofeedback training in stance and gait conditions for the treatment of balance deficits: a double-blind, placebo-controlled multicenter study. Otol Neurotol. 2011;32:1492-9. doi: 10.1097/MAO.0b013e31823827ec
Bracchi E, Rizzo S, Longari F, Bernardini M, Bizzotti C, Frenguelli A. Balance disorders in the elderly. Acta Otorhinolaryngol Ital. 2002; 22: 263-7.
Bronstein A, Lempert T. Dizziness, imbalance and falls in the elderly. En: Bronstein A, Lempert T, editores. Dizziness. A practical approach to diagnosis and management 2a Edición. Cambridge (United Kingdom): Cambridge University Press; 2017.p. 147-66.
Brosel S, Strupp M. The Vestibular System and Ageing. Subcell Biochem. 2019;91:195-225. doi: 10.1007/978-981-13-3681-2_8.
Cabrero-García J, Muñoz-Mendoza CL, Cabañero-Martínez MJ, González-Llopís L, Ramos-Pichardo JD, Reig-Ferrer A. Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud. Aten Primaria. 2012;44:540-8. doi: 10.1016/j.aprim.2012.02.007.
Cuevas-Trisan R. Balance Problems and Fall Risks in the Elderly. Clin Geriatr Med. 2019 ;35:173-183.
Eibling D. Balance Disorders in Older Adults. Clin Geriatr Med. 2018;34:175-181. doi: 10.1016/j.cger.2018.01.002.
Faraldo García A. Paciente con presbivértigo y riesgo de caídas. En Rosssi- Izquierdo M, Soto Varela A, Santos Pérez S, editores. Rehabilitación vestibular [ Internet]. Santiago de Compostela: Sociedad Gallega de Otorrinolaringología; 2016 [acceso 8 de junio de 2018].p. 195- 202. Disponible en: http://www.sgorl.org/images/Ponencias/Ponencia_SGORL_Rehabilitación_Vestibular_.pdf.
Gabriel Trinidad Ruíz. Ejercicios de rehabilitiación domiciliaria. . En Rosssi- Izquierdo M, Soto Varela A, Santos Pérez S, editores. Rehabilitación vestibular [ Internet]. Santiago de Compostela: Sociedad Gallega de Otorrinolaringología;2016 [acceso 8 de junio de 2018].p. 169- 177. Disponible en: http://www.sgorl.org/images/Ponencias/Ponencia_SGORL_Rehabilitación_Vestibular_.pdf.
Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther. 2016 Apr;40(2):124-55. doi: 10.1097/NPT.0000000000000120.
Ishiyama G. Imbalance and vertigo: the aging human vestibular periphery. Semin Neurol. 2009; 29: 491-9. doi: 10.1055/s-0029-1241039.
Jahn K. The Aging Vestibular System: Dizziness and Imbalance in the Elderly. Adv Otorhinolaryngol. 2019; 82:143-149. doi: 10.1159/000490283.
Jeka JJ, Allison LK, Kiemel T. The dynamics of visual reweighting in healthy and fall-prone older adults. J Mot Behav. 2010;42:197-208. doi: 10.1080/00222895.2010.481693.
Judge JO, King MB, Whipple R, Clive J, Wolfson LI. Dynamic balance in older persons: effects of reduced visual and proprioceptive input. J Gerontol A Biol Sci Med Sci. 1995;50:M263-70.
Kearney FC, Harwood RH, Gladman JR, Lincoln N, Masud T. The relationship between executive function and falls and gait abnormalities in older adults: a systematic review. Dement Geriatr Cogn Disord. 2013;36:20-35.
Krager R. Assessment of vestibular function in elderly patients. Curr Opin Otolaryngol Head Neck Surg. 2018;26:302-306. doi: 10.1097/MOO.0000000000000476.
Lin CC, Barker JW, Sparto PJ, Furman JM, Huppert TJ. Functional near-infrared spectroscopy (fNIRS) brain imaging of multi-sensory integration during computerized dynamic posturography in middle-aged and older adults. Exp Brain Res. 2017;235:1247-1256. doi: 10.1007/s00221-017-4893-8.
Lord SR, McLean D, Stathers G. Physiological factors associated with injurious falls in older people living in the community. Gerontology. 1992;38:338-46.
Manchester D, Woollacott M, Zederbauer-Hylton N, Marin O.Visual, vestibular and somatosensory contributions to balance control in the older adult. J Gerontol. 1989;44:M118-27.
McMurdo ME, Gaskell A. Dark adaptation and falls in the elderly.Gerontology. 1991;37(4):221-4.
Osoba MY, Rao AK, Agrawal SK, Lalwani AK. Balance and gait in the elderly: A contemporary review. Laryngoscope Investig Otolaryngol. 2019;4:143-153. doi: 10.1002/lio2.252. eCollection 2019 Feb.
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148-57. doi: 10.1111/j.1532-5415.2010.03234.x.
Panzer VP, Bandinelli S, Hallett M. Biomechanical assessment of quiet standing and changes associated with aging. Arch Phys Med Rehabil. 1995;76:151-7.
Patel M, Magnusson M, Kristinsdottir E, Fransson PA The contribution of mechanoreceptive sensation on stability and adaptation in the young and elderly. Eur J Appl Physiol. 2009;105:167-73. doi: 10.1007/s00421-008-0886-4.
Peterka RJ, Black FO, Schoenhoff MB. Age-related changes in human vestibulo-ocular reflexes: sinusoidal rotation and caloric tests. J Vestib Res. 1990-1991;1(1):49-59.
Pyykkö I, Jäntti P, Aalto H. Postural control in elderly subjects. Age Ageing. 1990;19:215-21.
Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance?. Clin Rehabil. 2000; 14:402-6.
Robbins S, Waked E, McClaran J. Proprioception and stability: foot position awareness as a function of age and footwear. Age Ageing. 1995;24:67-72.
Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, Del-Río-Valeiras M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, et al. Prognostic factors that modify outcomes of vestibular rehabilitation in elderly patients with falls. Aging Clin Exp Res. 2019 Apr 11. doi: 10.1007/s40520-019-01185-8. [Epub ahead of print].
Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, Del-Río-Valeiras M, Faraldo-García A, Vaamonde-Sánchez-Andrade I,et al. Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls-a randomized clinical trial. Aging Clin Exp Res. 2018 ;30:1353-1361.
Rossi-Izquierdo M, Santos-Pérez S, Rubio-Rodríguez JP, Lirola-Delgado A, Zubizarreta-Gutiérrez A, San Román-Rodríguez E, et al. What is the optimal number of treatment sessions of vestibular rehabilitation? Eur Arch Otorhinolaryngol. 2014;271:275-80.
Rossi-Izquierdo M, Santos-Pérez S, Soto-Varela A. What is the most effective vestibular rehabilitation technique in patients with unilateral peripheral vestibular disorders? Eur Arch Otorhinolaryngol. 2011;268:1569-74. doi: 10.1007/s00405-011-1532-z.
Sharpe JA, Sylvester TO. Effect of aging on horizontal smooth pursuit. Invest Ophthalmol Vis Sci. 1978;17:465-8.
Shaw FE, Bond J, Richardson DA, Dawson P, Steen IN, McKeith IG, et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ. 2003;326:73.
Shen DC, Wu SL, Shi YZ, Wang S, Zhang YM, Wang CX. The correlation between white matter hyperintensity and balance disorder and fall risk: An observational, prospective cohort study. Chronic Dis Transl Med. 2016;15:173-180. doi: 10.1016/j.cdtm.2016.11.008.
Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(24):1750-1758. doi: 10.1136/bjsports-2016-096547. Epub 2016 Oct 4.
Shumway-Cook A, Woollacott M, Kerns KA, Baldwin M. The effects of two types of cognitive tasks on postural stability in older adults with and without a history of falls. J Gerontol A Biol Sci Med Sci. 1997;52:M232-40.
Soto-Varela A, Faraldo-García A, Del-Río-Valeiras M, Rossi-Izquierdo M, Vaamonde-Sánchez-Andrade I, Gayoso-Diz P, et al. Adherence of older people with instability in vestibular rehabilitation programmes: prediction criteria. J Laryngol Otol. 2017;131:232-238.
Soto-Varela A, Faraldo-García A, Rossi-Izquierdo M, Lirola-Delgado A, Vaamonde-Sánchez-Andrade I, del-Río-Valeiras M, et al. Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx. 2015; 42:8-14. doi: 10.1016/j.anl.2014.06.005.
Soto-Varela A, Rossi-Izquierdo M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, Gayoso-Diz P, Del-Río-Valeiras M et al. Balance Disorders in the Elderly: Does Instability Increase Over Time? Ann Otol Rhinol Laryngol. 2016; 125(7):550-8.
Spooner JW, Sakala SM, Baloh RW. Effect of aging on eye tracking. Arch Neurol. 1980 ;37:575-6.
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12(5):290-5.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701-7.
Verghese J, Ayers E, Barzilai N, Bennett DA, Buchman AS, Holtzer R, et al. Motoric cognitive risk syndrome: Multicenter incidence study. Neurology. 2014;83:2278-84. doi: 10.1212/WNL.0000000000001084.
Whitney SL, Marchetti GF. Physical therapy management of the older person with vestibular rehabilitation. In Herdman SJ, Clendaniel RA, editores. Vestibular rehabilitation. 4ªEdición. Philadelphia: F.A. Davis Company;2014;p.480-503.
Xie Y, Anson ER, Simonsick EM, Studenski SA, Agrawal Y. Compensatory Saccades Are Associated With Physical Performance in Older Adults: Data From the Baltimore Longitudinal Study of Aging. Otol Neurotol. 2017;38:373-378. doi: 10.1097/MAO.0000000000001301.
Zwergal A, Linn J, Xiong G, Brandt T, Strupp M, Jahn K. Aging of human supraspinal locomotor and postural control in fMRI. Neurobiol Aging. 2012;33:1073-84. doi: 10.1016/j.neurobiolaging.2010.09.022.
Franco-Gutiérrez, V., & Perez-Vázquez, P. (2019). Vestibular rehabilitation in older people with vestibular dysfunction. Revista ORL, 11(1), 67–78. https://doi.org/10.14201/orl.20953
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