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Introduction to LAMP

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This presentation provides an initial overview to to LAMP Words for life and the LAMP therapy approach. LAMP stands for language acquisition through motor planning.

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Introduction to LAMP

  1. 1. What is LAMPTM? An introduction to Language Acquisition through Motor Planning, an AAC approach Merryn Gibson Speech Pathologist – Liberator merryn@liberator.net.au
  2. 2. Learning outcomes • Identify the five key components of the LAMP approach • Understand the role of readiness to learn and joint engagement in language intervention • Identify the importance of learning language through a consistent and unique motor plan paired with an auditory signal and natural consequence • Examine the growing body of evidence for the LAMP approach and its individual principles • Discuss strategies for supporting language development for those who express themselves using a speech-generating device
  3. 3. AUGMENTATIVE and Alternative Supports speech and language development Multi-modal
  4. 4. What is LAMP? Language Acquisition through Motor Planning A therapeutic approach based on neurological and motor learning principles, designed to give individuals who are nonverbal or have limited verbal abilities a method of independently and spontaneously expressing themselves through the use of a speech-generating device. (LAMP Words for Life = a vocabulary option)
  5. 5. History of LAMP LAMP was developed out of clinical practices of John Halloran (MS, CCC-SLP), Cindy Halloran (OTR/L) and Mia Emerson (MS, CCC-SLP). They found that: • Giving access to core words on a SGD PLUS • Teaching words in sensory-rich activities PLUS • Accessing each word with a consistent, unique motor pattern provided a means for developing independent communication. 2009 – Center for AAC & Autism established www.aacandautism.com
  6. 6. Guiding principles • Goal of LAMP is development of language skills • No cognitive prerequisites, because intervention can begin at cause & effect level and systematically build upon stages of natural language development • Addresses core deficits affecting language delay in individuals with autism, & follows motor learning and sensory integration theories • Strives to improve language & communication by imitating neurological processes associated with typical speech development
  7. 7. Who is LAMP suitable for? • non-verbal or limited verbal skills • individuals on the autism spectrum • no cognitive prerequisites • anyone!
  8. 8. There are no specific prerequisite skills for successful use of AAC Speech Pathology Australia: “Candidacy for AAC is based on a person’s unmet communication needs across all communicative contexts and not upon his or her skills or capacities” Speech Pathology Australia (2012). Augmentative and Alternative Communication Clinical Guideline. Melbourne: Speech Pathology Australia.
  9. 9. From the LAMP manual… • “The myth that a child needs to have cognitive prerequisites or move through a hierarchy of steps prior to using high-tech systems has been discredited repeatedly (Adamson et al, 1992, Stuart et al, 2008, Beukelman & Mirenda, 2005).” • “Motor skills are developed by shaping the motor movement to better accomplish the desired goal. A reach or isolated index finger does not have to be achieved in a non-related task prior to using a communication device. These motor skills can be targeted while working on the goal of communication.”
  10. 10. Desired outcome: S.N.U.G. Spontaneous Novel Utterance Generation … allows a person to say anything he or she wants at any time … is based on access to the individual words, word combinations, and commonly used phrases of our language Another approach = pre-stored sentences … faster communication, initially … limits what can be communicated Katya Hill: https://www.asha.org/public/speech/disorders/CommunicationDecisions/
  11. 11. Key Components of LAMP Language Connections Auditory Signals Consistent and Unique Motor Patterns Joint Engagement Readiness to Learn Natural Consequences https://www.aacandautism.com/lamp/components
  12. 12. Language Connections Auditory Signals Consistent and Unique Motor Patterns Joint Engagement Readiness to Learn Natural Consequences
  13. 13. Readiness to Learn • Client ready to get OPTIMAL BENEFIT from the learning experience • Assuring CORRECT AROUSAL LEVEL • Matching difficulty level of ACTIVITY with SKILL LEVEL of CLIENT • Adjust TASK &/or ENVIRONMENT to suit Schmidt, Richard A. and Wrisberg, Craig A. (2008). Motor Learning and Performance. Champaign, IL: Human Kinetics.
  14. 14. The Inverted U Principle Good Poor Low Moderate High Performance Arousal Level Duffy, E. (1962). Activation and Behaviour. Oxford, England: Wiley.
  15. 15. Calming Activities • Slow, repetitive VESTIBULAR movements: SWINGING/ROCKING • Proprioceptive Activities (HEAVY WORK): HANGING-ON, CARRYING, PUSHING, PULLING, LIFTING, SQUEEZING, CLIMBING • Deep sustained TOUCH • DEEP PRESSURE: BRUSH, MASSAGE, BEING WRAPPED/SQUEEZED • ORAL MOTOR activities: CHEWING, BLOWING, SUCKING
  16. 16. Alerting Activities • Quick erratic unexpected movements: SWINGING, ROLLING, BICYCLING, DANCING, SPINNING, BOUNCING • Changes in speech & direction + Rotary Movement • Oral Motor activities: eat SOUR, CRUNCHY, BITTER food • LOUD voices, noises or music • Light touch (small surface contact) • Visual Variable: HIGH contraction & intensity • Intense, strong TASTE or SMELL
  17. 17. Consider the “just right challenge.” “A house will stand if the roof is shaky, but falls apart if the foundation is not secure” Ayres, A. Jean (1983). Sensory Integration and the Child. Los Angeles: Western Psychological Services Csíkszentmihályi, Mihály (1998). Finding Flow: The Psychology of Engagement with Everyday Life. New York: Basic Books.
  18. 18. References: Readiness to Learn • Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62(5), 564-573. • Ayres, J., Mailloux, Z., and Wendler, C. (1987). “Developmental dyspraxia: is it a unitary function?” Occupational Therapy Journal of Research, 7, 93-110. • Dunn W. (1997). Implementing neuroscience principles to support habilitation and recovery. In: Christiansen C, Baum C, eds., Occupational Therapy: Enabling Function and Well-Being. 2nd ed. Thorofare, NJ: SLACK Incorporated, 186-232. • Kranowitz, Carol Stock and Miller, Lucy Jane, The Out-of-Sync Child: Recognizing and Coping With Sensory Processing Disorder, Revised Edition. Skylight Press. 2005 • Lupien, SJ, Maheu F, Tu M, Fiocco A, Schramek TE (2007). "The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition". Brain and Cognition 65: 209–237 • Tomcheck, Scott D. and Dunn, Winnie. (2007). “Sensory Processing in Children with and Without Autism: A Comparative Study Using the Short Sensory Profile.” American Journal of Occupational Therapy, 61, 190-200. www.aacandautism.com
  19. 19. Language Connections Auditory Signals Consistent and Unique Motor Patterns Joint Engagement Readiness to Learn Natural Consequences
  20. 20. Joint engagement • JOINT ATTENTION: following or directing the attention of another to an event/object to share an interest • JOINT ENGAGEMENT: Two individuals participating around same object/event • SUPPORTED JOINT ENGAGEMENT: sharing of events & objects without explicitly acknowledging the social partner • COORDINATED JOINT ENGAGEMENT: social partners attend not only to a shared topic but also to each other
  21. 21. Caregiver affect • Harris, Kasari & Sigman 1996 – time spent in joint attention with children who had Down Syndrome led directly related to language development • Siller & Sigman 2002 – strongest predicator of gain in joint attention was the amount of time the mother added undemanding verbalisations to a favourite activity • Kasari, Freeman & Paparella 2006 – joint attention fundamental and sensitive to a child-centred approach
  22. 22. References: Joint Engagement • Adamson, Lauren B., Bakeman, Roger and Deckner, Deborah F., (2004). “The development of symbol-infused joint engagement.” Child Development. 75: 1171-1187. • Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; and Romski, MaryAnn. (2009). “Joint Engagement and the Emergence of Language in Children with Autism and Down Syndrome.” Journal of Autism and Developmental Disorder. 39(1): 84-96. • Bakeman R., Adamson L. B. (1984). “Coordinating attention to people and objects in motor-infant and peer-infant interaction.” Child Development. 55: 1278-1289. • Kasari, Connie; Paparella, Tanya; Freeman, Stephanny; Jahromi, Laudan B. (2008). “Language outcome in autism: Randomized comparison of joint attention and play interventions.” Journal of Consulting and Clinical Psychology. 76: 125-137. • Lewy, Arthur L. and Dawson, Geraldine. (1992). “Social stimulation and joint attention in young autistic children.” Journal of Abnormal Child Psychology. 20 (6): 555-567. • Moore, Chris; Dunham, Philip J. and Dunham, Phil. (1995). “Joint Attention Across Contexts in Normal and Autistic Children.” In Sigman, Marian and Kassari, Connie eds. Joint Attention: It’s Origins and Role in Development. London: Psychology Press. www.aacandautism.com
  23. 23. Implementation • Learner-directed intervention • Build on the learner’s interest • Language expansion • Surprising and novel activities • Quick access to large vocabulary • Carefully use barriers
  24. 24. Language Connections Auditory Signals Consistent and Unique Motor Patterns Joint Engagement Readiness to Learn Natural Consequences
  25. 25. Consistent & Unique Motor Patterns • consistent motor pattern used to consistently utter same word → “speaking” is automatic • Do you think about how to move your mouth to form sounds and words? • motor movements to use AAC should be automatic
  26. 26. Motor learning theory Sensory Input Motor Planning Motor Output Stages of motor planning: •Cognitive Stage •Associative Stage •Autonomous Stage Feedback Fitts P.M. and Posner M.I. Human Performance. Brooks/Cole Pub. Co; Belmont, CA: 1967.
  27. 27. QWERTY keyboard
  28. 28. DVORAK keyboard
  29. 29. LAMP Law Every word has a unique motor plan.
  30. 30. Motor Automaticity Automaticity on an AAC device is possible when: • location of icons consistent • moving from one icon to next is predictable Automaticity on an AAC device is NOT possible when: • significant navigation required • continuous visual refocus & reorientation required
  31. 31. Master Page (Environments, Topics & Categories) Communication Pages Special Vocabulary Page Circle Time Clothes Trips to: Dr. Office Cinema Beach Zoo Zoo Animals
  32. 32. Navigation mazeMaster Page (Environments, Topics & Categories) Circle Time Getting Dressed Days of Week/ Months of Year Weather Winter Clothes Activities Dressy / Church Zoo Dr. Office Zoo Animals Movies Zoo Food Reptiles Grocery Store Holidays Airplane Hospital Birthdays School Bus
  33. 33. The student indicates a wide range of emotions and preferences in response to teachers and family through gestures and facial expressions, but rarely communicates beyond this circle Initial trial on a multi-page system encourages expectations for independent communication After a short time, the vocabulary becomes too limiting More vocabulary pages are added with great care Searching for words across multiple pages is hard and confusing to the student. Her staff decides to do more whole-utterance programming The student is unable to navigate independently to and back from environment and activity pages to find needed vocabulary To avoid navigation, more specialized pages are added – defeating the development of motor planning New pages, designed and implemented daily or weekly, require the continuous participation of therapists, parents, teachers and aides Engineered participation in activities replaces conversational use of the device The speech generating device is less and less viewed as a tool for broad- range, independent communication The Navigation Maze Use of the communication aid is deemed successful though it is used only to retrieve pre-stored responses in engineered situations The student’s good pragmatics leads the staff to believe she could use a speech generating device to communicate more independently and with a broader range of people
  34. 34. More or less keys?
  35. 35. More or less keys?
  36. 36. Research Specific to Motor Learning and Speech Generating Devices • Dukhovny, E. and Gahl. S. (2014). “Manual motor-plan similarity affects lexical recall on a speech-generating device: implications for AAC users.” Journal of Communication Disorders, 48, 52-60. • Summary: Neurotypical adults were more successful with recall of motor patterns to access words on SGD when the motor patterns for those words were dissimilar indicating that motor patterns play a role in access speed and recall. “This study provides initial support for the use of motor sequences in SGD-based language production….Developing motor plan automaticity is a complementary and, in later stages of device use, possibly more efficient, approach to reducing the cognitive load of production (Grabowski, 2010). If SGD-based production quickly becomes automatic, as the current study suggests, one implication is that, with continued SGD use, location of symbols on a grid becomes more relevant to fluent SGD production than the internal visual characteristics of the symbols. Therefore, in planning SGD design and intervention, location of symbols on the AAC device, and the resulting motor plans for accessing symbols, must be taken into account along with visual considerations.” www.aacandautism.com
  37. 37. Research Specific to Motor Learning and Speech Generating Devices • Dukhovny, E. "Effect of Size-Centered vs. Location-Centered Grid Design on Aided AAC Productions." Poster session presented at American Speech and Hearing Association Conference; 2015 Nov 12-14; Denver CO. • Summary: Learning of aided AAC displays frequently begins with several large icons, with icon size decreasing as more vocabulary is introduced (“size-centered design”). Another approach introduces small icons from the start, with icon location maintained as new vocabulary is introduced (“location-centered design”). This on-going study compares the effectiveness of these display designs with neurotypical adults. More subjects are needed but location-centered design is trending toward significance for accuracy and speed of access. Findings support using Vocabulary Builder in a complex communication system over providing limited vocabulary in an orientation that will change as language develops. www.aacandautism.com
  38. 38. Implementation • Start with end vocabulary in mind = minimal changes • Limit number of keys if required • Teach words by motor pattern + natural consequences, not symbols • Use least amount of prompting required for learner to successfully complete motor movement
  39. 39. Language Connections Auditory Signals Consistent and Unique Motor Patterns Joint Engagement Readiness to Learn Natural Consequences
  40. 40. Auditory Feedback • consistent auditory feedback linked to consistent motor plan • person receives auditory feedback & has the opportunity for sensory convergence • person can independently produce words and has an active means for language learning • device needs to be word-based to allow segmentation between words to develop References – www.aacandautism.com
  41. 41. Implementation • Be aware of auditory stimulation in environment • Match verbalisations to receptive language of learner • Modelling – receive same natural consequences • Respond to mis-hits
  42. 42. Language Connections Auditory Signals Consistent and Unique Motor Patterns Joint Engagement Readiness to Learn Natural Consequences
  43. 43. Natural Consequences • communication partner provides natural consequence to communication attempt • child has opportunity to integrate sensory feedback to attach meaning to words • meaning is attached to words by what occurs when they are used • responses must be intrinsically motivating
  44. 44. Implementation • Animated & immediate response • Again – respond to mis-hits • Generalise word meanings • Choose first words thoughtfully
  45. 45. Language Connections Auditory Signals Consistent and Unique Motor Patterns Joint Engagement Readiness to Learn Natural Consequences
  46. 46. Expressive Vocabulary size • 2 years 200-300 words • 3 years 1000 words • 5 years up to 2500 words • Teens/adults 10 – 50,000 words • 54 Thousand “actual words” • 750 Thousand in The Oxford English Dictionary • 1 Million + words in the English Language
  47. 47. Core vocabulary - Small number of words - High frequency - Versatile
  48. 48. Banajee, M., DiCarlo, C. and Stricklin, C. (2003). Core Vocabulary Determination for Toddlers. Augmentative and Alternative Communication, 19, 2, 67-73. These 26 core words comprise over 96% of the total words used by toddlers (age 24-36 months) in this study… Word Percentage I 9.5 no 8.5 yes/yea 7.6 mine 5.8 the 5.2 want 5.0 is 4.9 it 4.9 that 4.9 a 4.6 go 4.2 my 3.8 you 3.2 what 3.1 on 2.8 in 2.7 here 2.7 more 2.6 out 2.4 off 2.3 some 2.3 help 2.1 all done/finished 1.0 96.1%
  49. 49. Marvin, C.A., Beukelman, D.R. and Bilyeu, D. (1994). Vocabulary use patterns in preschool children: effects of context and time sampling. Augmentative and Alternative Communication, 10, 224-236.
  50. 50. Boenisch & Soto collected language samples from 30 typically developing 7-14 year old students – including native English and ESL speakers – in typical school day activities. A small core vocabulary represented a large proportion of the total vocabulary… Boenisch & Soto, 2015 Native speakers (10 samples) ESL speakers (10 samples) Top 100 words 72% 74% Top 200 words 82% 84% Top 300 words 87% 89%
  51. 51. The Balandin Sampling collected language samples from 34 non-disabled adults (aged 17-57) across various work sites. They also found that there was a small, stable core vocabulary of 347 words which accounted for 78% of the conversational sample. Balandin, S., & Iacono, T. (1999). Crews, Wusses, and Whoppas: Core and Fringe Vocabulary in Australian Meal-Break Conversations in the Workplace. Augmentative and Alternative Communication, 15, 95-109.
  52. 52. Core Vocabulary Fringe Vocabulary Number of words Small number of words (around 250 – 400) Very large number of words Frequency of use High frequency around 85% Low frequency Applicability across environments Used by all people everywhere, anytime, over and over Applicable to limited environments Applicability across topics Applicable to all topics Applicable to limited topics Types of words Includes a variety of parts of speech eg, verbs, adjectives, pronouns, prepositions etc. Includes mostly proper names and other nouns Why does LAMP focus on core?
  53. 53. Cause & Effect  Generalisation • Start with words that can be incorporated into a motivating activity • Don’t focus on one word until the learner is proficient • AAC device is a tool that allows the child to “babble” and learn about language • Consistent motor patterns result in a consistent auditory signal • Over time child modifies his/her perception of what auditory signal means • eg. words “go” and “stop” have different meanings based on context
  54. 54. Language Connections - Generalisation 1. On “go” all dance around until hear “stop” then freeze 2. In playground say “go” and “stop” for each child to come down slide 3. “Go” and “stop” for spinning/swinging 4. Musical chairs – “go, go, go, go, go” “stop” 5. Wind-up toys released on “go” 6. Play a video on “go”, pause on “stop” 7. Animated PowerPoint of things “going” and “stopping” 8. Make fan “go” and “stop” on command 9. Computer games with mouse click to make things “go” and “stop” 10. Making remote controlled car “go” and “stop”
  55. 55. From the LAMP Manual… Appendices, p87 Find opportunities to target goals – more, stop, go • Engage the child in physical activity in which you provide the “power.” For example, push the child in a swing, bounce him/her on a therapy ball, or push him/her in a wagon. Establish the routine of “stop” and either “go” or “more.” After the child understands the routine, interrupt the routine and wait for child to request action. • Manipulate a small vehicle around the child. Have the child direct the movement through the use of the target words, thus allowing him/her to cause the car to crash, drop off the table, or stop. Once the child has directed the car to stop, do not move it until the child directs you to do so. • Pair exaggerated physical activity with “go” or “more.” Cease the activity in response to “stop.” Do not resume the activity until the child says “go.” Feign exhaustion to encourage the child to say “stop.” John Halloran
  56. 56. From the LAMP manual… Appendices, p83 Examples goals – more, stop, go The child will … 1. Say “more” to request at least five favorite objects or activities (e.g., more swinging, more drink, more food). 2. Say “more” + OBJECT to request favorite objects. 3. Say “more” + ACTION to request favorite activities. 4. Say “stop” to cease at least five different activities being done with him (e.g. stop swinging). 5. Say “stop” to cease an activity being done by the communication partner, which did not involve a specific action being done to the child (e.g., stop the communication partner from pretending to sleep). 6. Say “stop” + ACTION to cease an activity. 7. Say “go” to cause at least five different actions (e.g., start the music, leave the room). John Halloran
  57. 57. Can it be used for LAMP? Does the AAC system have… • A consistent and unique motor pattern for each word • Immediate and consistent auditory feedback • Language connections (lots of vocabulary, available in all settings)
  58. 58. CASE Examples • Potts, M. and Satterfield, B. (2013). “Studies in AAC and Autism: The Impact of LAMP as a Therapy Intervention.” Georgia’s Assistive Technology Act Program June 20, 2013. • Summary: The seven children in this study, who ranged from age three to seven, had a diagnosis of autism or pervasive developmental disorder-not otherwise specified (PDD-NOS) and complex communication needs (CCN). All seven were diagnosed with expressive-receptive language disorder. Four presented with severe/profound apraxia. Two were found to have dysarthria of speech. Each obtained a speech generating device (SGD) and received LAMP therapeutic intervention. Each child demonstrated communication progress. Language samples from six participants revealed gains as measured by mean length of utterance (MLU) within the first year. Other progress was noted in areas such as enhanced receptive vocabulary, spontaneous use of language, natural vocalization, and in the reduction of difficult behaviors and increase in shared attention. • Findings Were Presented: • Satterfield, B. & Halloran, J., Research Insights into LAMP (Language Acquisition through Motor Planning. Institute Designed for Educating All Students (IDEAS) Conference. (St. Simon’s Island, GA. June, 2013).
  59. 59. Research Specific to the LAMP™ Approach • Neno, C., Ellawadi, A., Cargill, L., Lyle, S. & David, A. (2016). "Vocabulary Development in School-Age Augmentative and Alternative Communication (AAC) Users." Poster presented at the American Speech-Language Hearing Association Annual Conference, Philadelphia, PA. • Summary: Researchers collaborated to design and study the effects of a fully immersive Language Acquisition through Motor Planning (LAMP)-based classroom. Eight participants were in kindergarten and first grade and spent two hours in a classroom co- taught by three speech-language pathologists and a special educator. The classroom focused on instruction of a set of core vocabulary words instructed across a variety of sensory and scientific/discovery activities. The immersive portion of this classroom took place in large-scale language around a SMARTBoard projecting the Words for Life language program that an adult would model the sequences of the vocabulary being used by the teacher. The findings of this study indicated an upward trend in total use and duration of use of the devices, total number of words used and the frequency of different words used. The most significant data trend (compared to control classrooms) is that the greatest language use was shown after the program had ended indicating that this 8-week intensive program "set the stage" for further language growth. www.aacandautism.com
  60. 60. Research Specific to the LAMP™ Approach • Bedwani, M., Bruck, S, Costly, D. (2015). “Augmentative and Alternative Communication for Children with Autism Spectrum Disorder: An Evidence-Based Evaluation of the Language Acquisition through Motor Planning Programme." Cogent Education. 2(1). • Summary: Eight participants received intervention with the LAMP approach and SGD for five weeks. All of the children had received previous intervention prior to the study (up to 9 years) yet only 25% of them were able to comment at the baseline assessment. At post-program assessment, all subjects showed significant vocabulary increase, all were requesting using a symbolic means of communication (on the device or using spoken language) and 100% of the children were developing social communication through commenting. Other social communication improvements were also observed in gaining attention (75%), expressing feelings (75%) and greetings (87%). All of the children were independently communicating and were not restricted to vocabulary that had been taught to them. 75% of the children were observed to be using phrases on their device by week 5 of implementation and two of the children in the study were observed at the week 9–10 post-program assessment to be using words with multiple meanings in the right context. There were a range of other outcomes that parents, teachers and speech pathologists observed and reported including an increase in joint attention, interest, motivation and engagement with others, an overall increase in willingness to communicate and an overall increase in play and social communication. For some of the children, this was the first time they were able to communicate and participate in social situations. Behavior was also reported to have improved with a corresponding decrease in frustration as a result of improved expressive communication. www.aacandautism.com
  61. 61. Research Specific to the LAMP™ Approach • Pulliam, M. H. (2010). “The initial and renewed impact of an AAC device, using the LAMP approach, on an individual with autism spectrum disorder.” Master’s thesis. Arkansas State University, Jonesboro, Arkansas. • Summary: Case study of a child who used the LAMP approach, then an alternate approach, and the LAMP approach again several years later. Vocabulary increase was only noted during the periods where the LAMP approach was implemented. The same study was published recently in a peer-reviewed journal but they focused on the AAC device rather than the treatment approach. www.aacandautism.com
  62. 62. Research Specific to the LAMP™ Approach • Stuart, S. and Ritthaler, C. (2008). “Case Studies of Intermediate Steps/Between AAC Evaluations and Implementation.” Perspectives on Augmentative and Alternative Communication, 17, 150-155. • Summary: Informal case studies on two children who began using the LAMP approach with a Vantage SGD with a secondary evaluation/therapy center outside of the schools where they received primary services. Both children showed communication improvement while using the LAMP approach. Difficulties with coordinating services with the primary team and modifications that were made to accommodate the primary team are discussed. www.aacandautism.com
  63. 63. LAMP videos & resources • www.youtube.com/user/LindseyCargill • www.youtube.com/user/AACandAutism/ • https://www.aacandautism.com/

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