Frontiers in rehabilitation sciences最新文献

{"title":"Case Report: Robot-assisted gait training with the wearable cyborg hybrid assistive limb 2S size in three children with cerebral palsy.","authors":"Kazushi Takahashi, Hirotaka Mutsuzaki, Tomohiro Nakayama, Mayumi Matsuda Kuroda, Kazunori Koseki, Kenichi Yoshikawa, Junko Nakayama, Haruka Oguro, Ryoko Takeuchi, Masafumi Mizukami, Hiroki Watanabe, Aiki Marushima","doi":"10.3389/fresc.2025.1545105","DOIUrl":"10.3389/fresc.2025.1545105","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, robot-assisted gait training (RAGT) has attracted attention as a rehabilitation method to efficiently improve walking function. The purpose of this case report is to examine whether there is a change in gait function after RAGT with HAL in children with cerebral palsy (CP).</p><p><strong>Methods: </strong>Three children with CP participated in this study. Case 1 was an 8-year-old boy with Gross Motor Function Classification System (GMFCS) level II. Case 2 involved a 9-year-old girl with a class IV GMFCS. Case 3 was that of a 10-year-old boy with class IV GMFCS. RAGT was conducted once a day for 20 min for a total of 11-12 sessions. Gait was assessed before and after RAGT. We assessed using three-dimensional motion analysis and surface electromyography (sEMG). The sEMG signals were recorded from the bilateral tensor fascia lata, gluteus maximus, semitendinosus, and rectus femoris.</p><p><strong>Results: </strong>All cases showed changes in the joint angle and muscle activity in the lower limbs before and after RAGT. In Case 1, the maximum hip extension angle increased from -10.6° to -4.1° at the terminal stance, and the average muscle activity of the gluteus maximus in the right stance phase increased from 22.4% to 30.2%. In Case 2, the maximum extension angle of the left knee joint increased from -43.0° to -26.9°. In Case 3, the maximum hip extension angle increased from -39.9° to -25.9° on the left side and from -35.1° to -18.7° on the right side; the maximum knee extension angle increased from -55.7° to -38.8° on the left side and from -52.1° to -36.9° on the right side.</p><p><strong>Discussion: </strong>A Case 1 had significant hip flexion during gait, but RAGT with HAL emphasized hip extension motion and enabled an efficient gait. As a result, the maximum hip extension angle increased, and the activity of the gluteus maximus muscle in the stance phase increased. Cases 2 and 3 had greater hip and knee joint flexion angles, however increased knee extension angles after RAGT. The increased hip and knee joint extension angles during the stance phase increased the propulsive force propelling the walker forward.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1545105"},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inducing asymmetric gait in healthy walkers: a review.","authors":"Gert Van Der Velde, Henri Laloyaux, Renaud Ronsse","doi":"10.3389/fresc.2025.1463382","DOIUrl":"10.3389/fresc.2025.1463382","url":null,"abstract":"<p><p>Gait symmetry between both legs is a typical hallmark of healthy walking. In contrast, several pathologies induce asymmetry in the gait pattern, regarding both spatial and temporal features. This can be due to either an asymmetrical change of the body morphology-e.g., after an amputation or an injury-or a damage in the brain-such as stroke or cerebral palsy. This deficit in gait symmetry usually induces higher metabolic effort in locomotion and might further accelerate severe comorbidities such as osteoarthritis and low back pain. Consequently, several assistive devices-such as active exoskeletons or prostheses-are currently developed to mitigate gait asymmetry and restore a healthier gait pattern. Typically, the development of such devices requires extensive tests and validations, and it is practically and ethically not always desirable to recruit disabled patients to run these tests in the preliminary stages of development. In this review paper, we collect and analyse the different reversible interventions described in the literature that can induce asymmetry in the gait pattern of healthy walkers. We perform a systematic literature research by exploring five databases, i.e., Pubmed, Embase, Web of Science, Google Scholar, and Scopus. This narrative review identifies more than 150 articles reporting 16 different interventional methods used to induce asymmetric gait pattern in healthy walkers or with the potential to do so. These interventions are categorized according to their mode of action, and their effects on spatiotemporal parameters, joint kinematics and kinetics are summarized adopting a macroscopic viewpoint. Interventions are compared in terms of efficacy, maturity of the results, and applicability. Recommendations are provided for guiding researchers in the field in using each of the identified manipulations in its most relevant research contexts.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1463382"},"PeriodicalIF":1.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, treatment, and functional outcomes for two adolescent female patients with lupus myelitis: a case report.","authors":"Deanna Claus, Andrew McCoy, Denesh Ratnasingam, Cristina Saez, Gabriel Tarshish, Cristina Sarmiento","doi":"10.3389/fresc.2025.1454381","DOIUrl":"10.3389/fresc.2025.1454381","url":null,"abstract":"<p><strong>Introduction: </strong>Transverse myelitis is a rare neurologic complication associated with systemic lupus erythematosus (SLE), also known as lupus myelitis. Little is known about the optimal treatment regimen for the disease or the functional outcomes after diagnosis, especially for pediatric patients.</p><p><strong>Methods: </strong>A retrospective case series at a large, academic pediatric tertiary care center was performed to describe the clinical presentation, diagnostic approach, early treatment, and functional outcomes in two pediatric patients diagnosed with lupus myelitis as a presenting sign of new-onset SLE.</p><p><strong>Results: </strong>Description of baseline patient characteristics, presenting symptoms and clinical features, laboratory work-up and neuroimaging findings, immunomodulatory therapy, complications, and rehabilitation functional outcomes are described for two adolescent patients diagnosed with lupus myelitis. Both patients presented with features that were initially mistaken for other neurologic conditions. The combination of longitudinally extensive lesions of the spinal cord on neuroimaging and laboratory findings suggestive of an autoimmune process ultimately led to the diagnoses of lupus myelitis and new-onset SLE. Both patients received intravenous and oral corticosteroids, plasmapheresis, rituximab, cyclophosphamide, intravenous immunoglobulin, and acute intensive rehabilitation including physical therapy, occupational therapy, and speech therapy. Both patients demonstrated marked functional improvement in domains of self-care and mobility in the setting of acute inpatient rehabilitation.</p><p><strong>Discussion: </strong>While this diagnosis has been described in adult literature, there is limited evidence regarding management or functional outcomes for pediatric cases of lupus myelitis. Collaboration between rheumatology and rehabilitation teams allowed for a coordinated approach to achieve medical and functional goals. Early diagnosis, treatment, and acute inpatient rehabilitation led to significant improvement in functional outcomes for the two pediatric patients in this study.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1454381"},"PeriodicalIF":1.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Adaptive coping strategies for rehabilitation of people with non-specific chronic lower back pain or non-specific chronic neck pain.","authors":"Chinonso Nwamaka Igwesi-Chidobe, Loveness Anila Nkhata","doi":"10.3389/fresc.2025.1551777","DOIUrl":"10.3389/fresc.2025.1551777","url":null,"abstract":"","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1551777"},"PeriodicalIF":1.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of provider feedback on quality improvement in rehabilitation services: an interrupted time series analysis.","authors":"Anne-Lene Sand-Svartrud, Hanne Dagfinrud, Johanne Fossen, Heidi Framstad, Eirik Lind Irgens, Hild Kristin Morvik, Joseph Sexton, Rikke Helene Moe, Ingvild Kjeken","doi":"10.3389/fresc.2025.1564346","DOIUrl":"10.3389/fresc.2025.1564346","url":null,"abstract":"<p><strong>Introduction: </strong>Quality improvement in rehabilitation is needed due to unwarranted variations and suboptimal service coordination. Audit and feedback strategies are commonly used to improve healthcare quality, but evidence of their effectiveness in rehabilitation settings is limited.</p><p><strong>Objective: </strong>To evaluate the impact of an audit and feedback strategy on rehabilitation quality, as measured by a set of quality indicators (QIs) specifically designed for rehabilitation.</p><p><strong>Methods: </strong>Interrupted time series analysis was conducted across 16 Norwegian institutions delivering specialized rehabilitation for long-term diseases. Patient-reported rehabilitation quality data was collected continuously before and after a provider feedback intervention, while provider-reported quality was measured once before and after the intervention. We compared 11 pre- and 9 post-intervention observations, each spanning 3 weeks, over a 15-months study period.</p><p><strong>Results: </strong>The analyses included 2,415 patients, with 1,444 (59.8%) pre-intervention and 971 (40.2%) post-intervention. Mixed model analyses revealed that the mean differences in patient-reported QIs between the pre- and post-intervention phase were small and statistically non-significant. The expected impact model, including a gradually higher quality after the feedback to institution managers and clinical team members, was not confirmed. We observed variations in service quality among institutions, also post-intervention. The lowest pass rates were observed for indicators addressing the follow-up, involvement of external services and next of kin.</p><p><strong>Conclusions: </strong>In this multicentre study, the audit and feedback intervention did not lead to improvements in the quality of rehabilitation services, as measured by changes in QI pass rates covering health service structures, processes and patient outcomes.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov [NCT03764982].</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1564346"},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early functional proprioceptive stimulation in high spinal cord injury: a pilot study.","authors":"Florence Martinache, Anne-Claire de Crouy, Arnaud Boutin, Jacques Duranteau, Bernard Vigué","doi":"10.3389/fresc.2025.1490904","DOIUrl":"10.3389/fresc.2025.1490904","url":null,"abstract":"<p><strong>Introduction: </strong>The first months following a spinal cord injury (SCI) are crucial for promoting recovery. However, patients with high SCIs often require prolonged stays in intensive care units (ICUs), delaying optimal rehabilitation due to limited resources. This study examined the safety, feasibility, and effects on spasticity and muscle atrophy of an early rehabilitation technique using non-invasive sensory stimulation and called functional proprioceptive stimulation (FPS).</p><p><strong>Materials and methods: </strong>Ten SCI patients were included in this randomized pilot study, with five receiving early FPS and five receiving sham stimulation. Both groups were treated using the Vibramoov, consisting of 12 computer-synchronized vibrators placed on the lower limbs. Treatment sessions lasted 30 min, four times a week, for up to 8 weeks. Spasticity was assessed using the Modified Ashworth Scale, Tardieu Scale, Spinal Cord Assessment Tool for Spastic Reflexes, and a patient self-evaluation with a visual analog scale. Muscle atrophy was evaluated through ultrasonography of rectus femoris thickness and cross-sectional area. The duration of the follow-up period ranged from 6 months to 1 year.</p><p><strong>Results: </strong>Treatment began early, with a median of 4 days post-injury for both groups. The number of adverse events was similar between groups, with none linked to the intervention. No medium-term effects on spasticity or muscle atrophy could be identified. However, our results show a tendency toward a beneficial short-term effect of FPS on spasticity, observed for all spasticity measurements.</p><p><strong>Discussion: </strong>This pilot study shows that early FPS is feasible and safe for SCI as early as the intensive care unit stage. We demonstrated that FPS induced a transient relaxation and spasticity reduction that could potentially enhance a rehabilitation session administered shortly after it, but larger studies are needed to determine the medium and long-term effects.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, identifier (NCT05094752).</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1490904"},"PeriodicalIF":1.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A bibliometric analysis of perioperative rehabilitation research between 2005 and 2024.","authors":"Juan Li, Fen Su, Qing Zhang, Guiqi Song","doi":"10.3389/fresc.2025.1524303","DOIUrl":"10.3389/fresc.2025.1524303","url":null,"abstract":"<p><p>Effective rehabilitation can improve the prognosis of surgical patients, thereby enhancing their medical experience. In recent years, relatively more research is been carried out in this field; therefore, it is necessary to use bibliometric analysis to understand the development status and main research hotspots of perioperative rehabilitation, so as to determine the role of rehabilitation in the perioperative period. All documents related to perioperative rehabilitation and published from 2005 to 2024 were retrieved from the Web of Science Core Collection (Woscc). Number of articles, countries/regions, institutions, journals, authors, and keywords were analysed using VOSviewer and CiteSpace. A total of 829 studies on perioperative rehabilitation were included in the bibliometric analysis. The number of articles has steadily and rapidly increased since 2016. Over time, the publication outputs increased annually. There are 532 keyword nodes in total, of which the five keywords that appear most frequently are \"surgery\" \"rehabilitation\" \"Outcome\" \"management\" and \"complications\". Research on the perioperative rehabilitation has developed rapidly. This study provides necessary information for researchers to understand the current status, collaborative networks, and main research hotspots in this field. In addition, our research findings provide a series of recommendations for future studies.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1524303"},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of family directed power mobility on self-care, mobility, and social function in very young children with severe multiple developmental impairments.","authors":"Juan Aceros, Guilherme M Cesar, Ayshka Rodriguez, Mary Lundy","doi":"10.3389/fresc.2025.1551536","DOIUrl":"10.3389/fresc.2025.1551536","url":null,"abstract":"<p><strong>Introduction: </strong>Children with impaired mobility often experience negative impact on overall development leading to depression, social isolation, and perceived lower quality of life.</p><p><strong>Objective: </strong>Our study explored the effects of Power Mobility Devices (PMD), in the form of modified ride-on toy cars with two distinct activation/steering technologies, on functional independent and social function in young children with severe multiple developmental impairments.</p><p><strong>Methodology: </strong>Twelve children (age range 12-54 months) with neuromuscular, musculoskeletal, and genetic diagnoses, and metabolic progressive diseases participated. Significant cognitive, visual, or communication impairment was not exclusionary. Two types of activation and steering modifications (proportional control joystick and line follower technologies) were provided. Paired samples <i>t</i>-test contrasted pre-post functional capabilities after three months of PMD use in both Pediatric Evaluation of Disability Inventory scales of Functional Skills and Caregiver Assistance, each with the subscales self-care, mobility, and social/cognitive.</p><p><strong>Findings: </strong>Improvements were observed in all three subscales for Functional Skills (significant 9.8% increase in self-care, 21.4% in mobility, and 17.5% social/cognitive) and Caregiver Assistance (significant 35.4% increase in self-care).</p><p><strong>Conclusion: </strong>These quantitative results support findings of previous studies analyzing qualitative data, suggesting that early power mobility interventions provide positive improvements in the quality of life of children with severe developmental disabilities.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1551536"},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of elbow flexion torque using equilibrium optimizer on feature selection of NMES MMG signals and hyperparameter tuning of random forest regression.","authors":"Raphael Uwamahoro, Kenneth Sundaraj, Farah Shahnaz Feroz","doi":"10.3389/fresc.2025.1469797","DOIUrl":"10.3389/fresc.2025.1469797","url":null,"abstract":"<p><strong>Background: </strong>The assessment of limb joint torque is essential for understanding musculoskeletal system dynamics. Yet, the lack of direct muscle strength measurement techniques has prompted previous research to deploy joint torque estimation using machine learning models. These models often suffer from reduced estimation accuracies due to the presence of redundant and irrelevant information within the rapidly expanding complex biomedical datasets as well as suboptimal hyperparameters configurations.</p><p><strong>Methods: </strong>This study utilized a random forest regression (RFR) model to estimate elbow flexion torque using mechanomyography (MMG) signals recorded during electrical stimulation of the biceps brachii (BB) muscle in 36 right-handed healthy subjects. Given the significance of both feature engineering and hyperparameter tuning in optimizing RFR performance, this study proposes a hybrid method leveraging the General Learning Equilibrium Optimizer (GLEO) to identify most informative MMG features and tune RFR hyperparameters. The performance of the GLEO-coupled with the RFR model was compared with the standard Equilibrium Optimizer (EO) and other state-of-the-art algorithms in physical and physiological function estimation using biological signals.</p><p><strong>Results: </strong>Experimental results showed that selected features and tuned hyperparameters demonstrated a significant improvement in root mean square error (RMSE), coefficient of determination (R²) and slope with values improving from 0.1330 to 0.1174, 0.7228 to 0.7853 and 0.6946 to 0.7414, respectively for the test dataset. Convergence analysis further revealed that the GLEO algorithm exhibited a superior learning capability compared to EO.</p><p><strong>Conclusion: </strong>This study underscores the potential of the hybrid GLEO approach in selecting highly informative features and optimizing hyperparameters for machine learning models. These advancements are essential for evaluating muscle function and represent a significant advancement in musculoskeletal biomechanics research.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1469797"},"PeriodicalIF":1.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Surface EMG and other measurement techniques in rehabilitation research and practice: are new educational programs needed?","authors":"Marco Tramontano, Sheng Li, Roberto Merletti","doi":"10.3389/fresc.2025.1565879","DOIUrl":"https://doi.org/10.3389/fresc.2025.1565879","url":null,"abstract":"","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"6 ","pages":"1565879"},"PeriodicalIF":1.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}