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Physical Therapy

University of New England

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Full-Text Articles in Medicine and Health Sciences

Muscle Energy Techniques As Part Of A Comprehensive Plan Of Care For A Patient With Hip And Knee Osteoarthritis: A Case Report, Daniel White Dec 2019

Muscle Energy Techniques As Part Of A Comprehensive Plan Of Care For A Patient With Hip And Knee Osteoarthritis: A Case Report, Daniel White

Case Report Posters

Osteoarthritis (OA) is a chronic musculoskeletal condition which affects over 27 million Americans. The hip and knee joints are most affected by OA. Many risk factors are modifiable in the development of OA. While muscle energy techniques (MET) are commonly used to treat lumbopelvic dysfunction, limited evidence exists for its use as part of a comprehensive plan of care in patients with OA. The purpose of this case report was to describe the management of a patient with mild/moderate OA utilizing a comprehensive plan of care including MET.


Balance And Strength Interventions For An Individual Post Left Sided Mca Cva: A Case Report, Annie Mckenzie Dec 2019

Balance And Strength Interventions For An Individual Post Left Sided Mca Cva: A Case Report, Annie Mckenzie

Case Report Posters

Cerebrovascular accident (CVA), or stroke, is the fifth leading cause of death in the United States (US) with more than 140,000 deaths each year. It is the leading cause of long-term disability in the US, reducing functional mobility in more than half of all stroke survivors ages 65 or older. This condition costs the US approximately 34 billion dollars a year and it is estimated to increase to 108 billion per year by 2025. Strokes are caused by the interruption of the blood supply to the brain, which occurs when a blood vessel ruptures (hemorrhagic stroke) or is blocked by …


Comprehensive Physical Therapy Management Of Chronic Low Back Pain With Associated Remote Right Hamstring Injury: A Case Report, Emily Larson Dec 2019

Comprehensive Physical Therapy Management Of Chronic Low Back Pain With Associated Remote Right Hamstring Injury: A Case Report, Emily Larson

Case Report Posters

Low back pain (LBP) is a health condition associated with back, core, and hip muscle dysfunction as well as reduced lumbar range of motion. Core muscle stabilization, hip abductor strengthening, and lumbar range of motion are all effective techniques for treating patients with chronic LBP. Lumbar muscular imbalance can lead to hamstring injury because of change in the functional load. The purpose of this case report was to review a therapeutic exercise approach to the treatment of chronic low back pain after a remote hamstring injury, including a focus on lumbar and core stabilization, lumbar and hamstring stretching and hamstring …


Treatment Of A Work-Related Superior Glenoid Labral Repair: A Case Report, Alexandra Touri Dec 2019

Treatment Of A Work-Related Superior Glenoid Labral Repair: A Case Report, Alexandra Touri

Case Report Posters

A superior glenoid labrum tear is a common injury in the shoulder. The highest incidences of superior labrum tear from anterior to posterior (SLAP) lesions occur in individuals from 20-29 years old and 40-49 years old. Common signs and symptoms include: instability in the joint, shoulder dislocations, pain with overhead activities, decreased range of motion, and loss of strength. SLAP lesions are less commonly seen in the workplace. There is little detail/research about which joint mobilizations/therapeutic exercises are most beneficial for this population. The purpose of this case report is to explore the post-operative PT management of a Workers’ Compensation …


Tissue Plasminogen Activator Effects On Stroke And Physical Therapy Outcomes In Acute Care: A Case Report, Lindsey Leboeuf Dec 2019

Tissue Plasminogen Activator Effects On Stroke And Physical Therapy Outcomes In Acute Care: A Case Report, Lindsey Leboeuf

Case Report Posters

An ischemic stroke occurs when blood flow to an area of the brain is restricted by a blood clot. Symptoms include: Numbness or weakness on one side of the body, facial droop, trouble speaking, and trouble walking. Patients can also display decreased balance, ataxia, flaccidity, spasticity, inattention or neglect, and visual changes. Patients who can identify these symptoms within 3 hours of their onset can be eligible to receive tissue plasminogen activator (tPA). tPA works by dissolving the blood clot to enhance blood flow in the brain which helps decreases the damage caused by the stroke. Patients who receive tPA …


Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report, Mckenna Young Dec 2019

Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report, Mckenna Young

Case Report Posters

Antiphospholipid Antibody Syndrome is an autoimmune disease which causes the body to produce antibodies that attack phospholipids, a type of fat. It leads to high rates of blood clot formation in arteries and veins. High rates of blood clots cause stroke, which can lead to balance concerns and increased falls. Fall rates among individuals with chronic disease peak between age 45-64. Fall risk factors include reduced mobility level, imbalance, age, number of co-morbidities, duration of diagnosis, and sex. The purpose of this case report is to investigate a comprehensive physical therapy program that focused on increasing independence and reducing fall …


Return To Golf In A 71-Year-Old Female After A Mako Robotic-Arm-Assisted Unicompartmental Knee Arthroplasty: A Case Report, Katelyn Austin Dec 2019

Return To Golf In A 71-Year-Old Female After A Mako Robotic-Arm-Assisted Unicompartmental Knee Arthroplasty: A Case Report, Katelyn Austin

Case Report Posters

Knee osteoarthritis (OA) is the most common joint disorder in the elderly. Unicompartmental knee arthroplasties (UKA) have been increasing in prevalence at a rate of 30% each year. Robotic-arm-assisted UKAs increases the accuracy of implant positioning compared to traditional techniques which helps with a quicker recovery. Little literature on UKAs, but total knee arthroplasty (TKA) interventions should focus on knee range of motion (ROM), strengthening, gait training, icing, and a home exercise program (HEP). There are good outcomes for return to golf post TKA, but no information about UKAs. The purpose of this case report was to look at the …


Physical Therapy Management Of Low Back Pain In A Young Female With Ankylosing Spondylitis Associated With Hla-B27 Antigen: A Case Report, Jake Adkins Dec 2019

Physical Therapy Management Of Low Back Pain In A Young Female With Ankylosing Spondylitis Associated With Hla-B27 Antigen: A Case Report, Jake Adkins

Case Report Posters

Ankylosing spondylitis (AS) is a form of arthritis characterized by chronic inflammation of the axial skeletal system that causes back pain and loss of mobility with strong potential for slow, eventual spinal fusion. It affects 0.2-0.5% of the United States population and has no known cure, yet greater than 60 genetic components are involved. HLA-B27 is a genetic component highly correlated with AS. Its presence creates inflammatory response at bony attachment sites of tendons, ligaments, and joint capsules.Presentation can vary widely and may include intermittent and/or significant back pain and stiffness across multiple body segments for long periods of time, …


The Use Of Tai Chi With Conventional Therapy Practices For An Individual Presenting With Hemiparesis Post-Stroke: A Case Report, Ashley Pollina Dec 2019

The Use Of Tai Chi With Conventional Therapy Practices For An Individual Presenting With Hemiparesis Post-Stroke: A Case Report, Ashley Pollina

Case Report Posters

No abstract provided.


Blood Flow Restriction Therapy And A Comprehensive Home Exercise Program Following An Acl And Meniscal Repair: A Case Report, Kathryn Demoor Dec 2019

Blood Flow Restriction Therapy And A Comprehensive Home Exercise Program Following An Acl And Meniscal Repair: A Case Report, Kathryn Demoor

Case Report Posters

Every year in the United States, up to 60 per 100,000 people sustain an anterior cruciate ligament (ACL) tear. Medial meniscus tears have been reported in roughly 60% of the ACL tear population, while lateral meniscus tears have been reported in approximately 30%. Blood flow restriction therapy (BFRT) has shown improved strength and muscle hypertrophy with low load exercises by occluding blood flow at the proximal thigh. A minimally structured physical therapy (PT) program with a home exercise program (HEP) has been shown to be more effective at 3 months after ACL reconstruction (ACLR) compared to standard PT sessions alone. …


Acute Inpatient Rehabilitation Of A Patient Following A Pontine Stroke With Limited Recorded Medical History: A Case Report, Russell Curl Dec 2019

Acute Inpatient Rehabilitation Of A Patient Following A Pontine Stroke With Limited Recorded Medical History: A Case Report, Russell Curl

Case Report Posters

795,000 strokes occur annually in the United States, or one every 4 seconds. Impairments following a stroke may include deficits in strength, coordination, sensation, and language skills. Expected impairments of pontine strokes include hemiplegia, sensorimotor dysfunction, ataxic hemiparesis, and dysarthria. There is little current research on pontine strokes. The purpose of this case report is to outline the physical therapy plan of care and response to treatment for a patient following a pontine stroke in the acute inpatient rehabilitation unit of a hospital.


Strength And Movement Interventions For A Female Patient With Neck And Upper Back Pain: A Case Report, Ross Kulick Dec 2019

Strength And Movement Interventions For A Female Patient With Neck And Upper Back Pain: A Case Report, Ross Kulick

Case Report Posters

No abstract provided.


Interdisciplinary Administration Of Lsvt-Big By A Physical Therapist And Occupational Therapist On A Patient With Parkinsonism: A Case Report, Shelby Clare Dec 2019

Interdisciplinary Administration Of Lsvt-Big By A Physical Therapist And Occupational Therapist On A Patient With Parkinsonism: A Case Report, Shelby Clare

Case Report Posters

The clinical diagnosis of parkinsonism is “the presence of at least two of the four cardinal signs: resting tremor, rigidity, bradykinesia, and postural instability.” Symptoms often lead to limited functional mobility. Patients who have unilateral bradykinesia with hypokinesia, changes in gait, balance, and decreased quality of life have positively responded to Lee Silverman Voice Technique (LSVT) BIG treatment according to Rehabilitation Research and Practice. LSVT-BIG focuses on increasing movement amplitude to achieve bigger, faster, and more precise movements in an attempt to restore normal movement patterns. The purpose of this case study is to describe interdisciplinary treatment of LSVT-BIG on …


Outpatient Physical Therapy Management Of A Patient Following A Severe Left Middle Cerebral Artery Infarction: A Case Report, Ryan Parnell Dec 2019

Outpatient Physical Therapy Management Of A Patient Following A Severe Left Middle Cerebral Artery Infarction: A Case Report, Ryan Parnell

Case Report Posters

A cerebral vascular infarction (CVI) is a loss of blood flow to an area of the brain, which results in cell damage and/or death. The most common occluded artery is the middle cerebral artery (MCA). The incidence of falls within one year following a CVI can be as high as 42-60%. CVIs are a leading cause of long-term disability in the United States. CVIs account for 1 in every 19 deaths in the United States. Common impairments include: abnormal/slow gait, weakness, sensory loss, and decreased endurance. Common gait abnormalities include, genu recurvatum, foot drop,decreased stance phase, and foot slap on …


Oncologic And Orthopedic Rehabilitation For A Pancreatic Cancer Survivor Following Total Knee Arthroplasty Revision: A Case Report, Kelsey Dumond, Amy J. Litterini Dec 2019

Oncologic And Orthopedic Rehabilitation For A Pancreatic Cancer Survivor Following Total Knee Arthroplasty Revision: A Case Report, Kelsey Dumond, Amy J. Litterini

Case Report Posters

An estimated 80% of cancer survivors undergoing chemotherapy or radiation to manage their cancer will experience cancer-related fatigue (CRF). The majority of cancer survivors are elderly – a population frequently affected by osteoarthritis (OA). Physical activity is the most recommended and evidence-based non-pharmacologic intervention for CRF. Strong evidence exists for lower-extremity resistance and functional exercise following Total Knee Arthroplasty (TKA). Evidence suggests utilization of targeted exercise prior to extensive abdominal surgery, such as a pancreaticoduodenectomy, improves post-operative functional outcomes. The purpose of this case report is to describe physical therapy management for total knee arthroplasty revision and Whipple procedure prehabilitation …


Incline Treadmill Training For A Crush Ankle Injury With An Open Wound: A Case Report, Anna Prokity Dec 2019

Incline Treadmill Training For A Crush Ankle Injury With An Open Wound: A Case Report, Anna Prokity

Case Report Posters

Within the industrial workplace, soft tissue injuries to the ankle are common. The ankle is the second most commonly injured region in the body. Past research has shown that average time away from work was 2.5 weeks for a lateral ankle sprain, with 90% of individuals having full return to work at six weeks. Therapeutic activities are part of a comprehensive physical therapy (PT) plan of care that contribute to reintegration into a normal work-load. Treadmill training with an incline has been shown to reduce ankle stiffness and improve active range of motion. There is a paucity of research investigating …


Functional School-Based Physical Therapy Management For A Child With Pallister-Killian Syndrome: A Case Report, Cheryl R. Espinosa, Molly Collin Dec 2019

Functional School-Based Physical Therapy Management For A Child With Pallister-Killian Syndrome: A Case Report, Cheryl R. Espinosa, Molly Collin

Case Report Posters

Pallister-Killian Syndrome (PKS) is a rare genetic disorder caused by an additional short arm in chromosome 12. PKS affects multiple systems, which can impact a child’s development. Common clinical manifestations include: hypotonia, visual impairment, hearing loss, coarse facial features, intellectual disability, and congenital heart defects. Improvements in gross motor function have resulted from physical therapy (PT) and rehabilitation involving neurodevelopmental treatment (NDT). Research is limited on the effects of PT interventions to promote standing and ambulation for children with PKS. The purpose of this case report was to describe school-based PT interventions for a child with PKS, which involved standing …


Inpatient Rehabilitation For A Cancer Survivor Following A Lumbar Spinal Fusion Secondary To A Pathological Fracture: A Case Report, Nicole Marczak, Amy J. Litterini Dec 2019

Inpatient Rehabilitation For A Cancer Survivor Following A Lumbar Spinal Fusion Secondary To A Pathological Fracture: A Case Report, Nicole Marczak, Amy J. Litterini

Case Report Posters

Pathologic fractures are considered a skeletal-related event of bone metastasis. Bone metastases indicate a shorter prognosis with the survival rate varying from 6-53 months, depending on the primary type of cancer. Indications for surgery include spinal instability, vertebral collapse with or without neurologic deficit and intolerable pain that is not responsive to conservative treatment. Palliative physical therapy (PT) is provided to the patient and their family to offer education, optimize their functional independence and provide comfort and support. The purpose of this case report was to describe the plan of care for a man with advanced cancer to bone status-post …


Home Health Physical Therapy For A 90-Year-Old Patient Following Transient Ischemic Attack: A Case Report, Kendra Stephens Dec 2019

Home Health Physical Therapy For A 90-Year-Old Patient Following Transient Ischemic Attack: A Case Report, Kendra Stephens

Case Report Posters

Transient ischemic attack (TIA) is an episode of focal brain dysfunction that is temporary (<24 hrs.) and is due to a dysfunction of an arterial territory of the brain. Its most common symptoms include facial droop, arm weakness, and speech difficulty. An estimated 200,000 to 500,000 people per year experience a TIA in the U.S. After having TIA, 1/3 of them will have a stroke within a year. About 25% of people will die within a year after a TIA. While research for secondary prevention of stroke is clear for pharmacological and surgical interventions, there is limited research on non-pharmacological interventions. The purpose of this case report was to describe the immediate home health physical therapy (PT) management of an elderly community-dwelling patient following a TIA.


Restoring Functional Mobility Following A Ruptured Abdominal Aortic Aneurysm: A Case Report, Grace Laughlin Dec 2019

Restoring Functional Mobility Following A Ruptured Abdominal Aortic Aneurysm: A Case Report, Grace Laughlin

Case Report Posters

An abdominal aortic aneurysm (AAA) is a dilation of the abdominal aortic artery greater than three centimeters involving all layers of the vessel wall. There are two surgical options for treatment of AAA: open repair and endovascular aneurysm repair (EVAR). An endoleak is a complication following EVAR when blood leaks into the aneurysm sac. A type III endoleak occurs when there is a defect between parts of endografts causing an increase in the systemic pressure in the aneurysm sac. The purpose of this case report was to describe the physical therapy (PT) plan of care of an elderly patient following …


Physical Therapy Intervention For An Elderly Patient With Comorbidities Following Surgical Fixation Of A Femoral Neck Fracture: A Case Report, Yu-Min Chou Dec 2019

Physical Therapy Intervention For An Elderly Patient With Comorbidities Following Surgical Fixation Of A Femoral Neck Fracture: A Case Report, Yu-Min Chou

Case Report Posters

More than 300,000 elderly people over age 65 required hospitalization due to hip fracture in 2016. More than 95% of hip fractures are the result of falls. Strength training programs are suggested for geriatric patients with surgical fixation following hip fracture. Returning to prior level of function and quality of life is the primary goal of rehabilitation for geriatric patients recovering from a hip fracture. Complex comorbidities such as heart failure, diabetes, and extensive medical history will lead to a poor prognosis for recovery. Literature is limited on adverse responses or hardware failure in physical therapy patients following open reduction …


Physical Therapy Interventions To Increase Independence With Functional Mobility For An Older Individual With Spinal Stenosis: A Case Report, Eleni Bautz Dec 2019

Physical Therapy Interventions To Increase Independence With Functional Mobility For An Older Individual With Spinal Stenosis: A Case Report, Eleni Bautz

Case Report Posters

Spinal stenosis includes narrowing of the spinal canal which can affect nerves and other structures that pass through. Symptoms commonly associated with spinal stenosis are pain and paresthesia into the lower extremities. Spinal stenosis is diagnosed through patient history, clinical findings, and/or physical tests. Literature supports the use of physical therapy (PT) for conservative treatment in decreasing signs and symptoms of spinal stenosis The purpose of this case report was to describe a comprehensive physical therapy program with goals to decrease pain and improve functional mobility for a patient diagnosed with lumbar spinal stenosis living a sedentary lifestyle.


Combining A Comprehensive Physical Therapy Program And Electroshock Therapy For A Patient With Plantar Fasciitis: A Case Report, Kathryn Piersiak Dec 2019

Combining A Comprehensive Physical Therapy Program And Electroshock Therapy For A Patient With Plantar Fasciitis: A Case Report, Kathryn Piersiak

Case Report Posters

Plantar fasciitis (PF) affects 2 million Americans per year and 10% of the population over a lifetime. PF is inflammation to the thick, fibrous connective tissue originating on the medial calcaneal tubercle extending to the metatarsal heads of the foot. A comprehensive physical therapy (PT) plan of care (POC) of proximal strengthening, distal stretching and soft tissue massage (STM) has been shown to improve PF symptoms. Extracorporeal shockwave therapy (ESWT) is a non-invasive modality that uses sound waves to create a controlled microtrauma to the impaired tissue to stimulate a healing response and microvascularization. ESWT has shown to be effective …


Early Mobilization And Functional Mobility Training For A Patient With Triple Vessel Coronary Artery Bypass Grafting: A Case Report, Cody Hall Dec 2019

Early Mobilization And Functional Mobility Training For A Patient With Triple Vessel Coronary Artery Bypass Grafting: A Case Report, Cody Hall

Case Report Posters

Coronary artery bypass grafting (CABG) is a widely used procedure (200,000 annual cases in the US)1 in individuals with Coronary artery disease (CAD). CAD is a build-up of plaque in the blood vessels that supply the heart, which can result from diabetes, smoking, and a vast number of other conditions. The procedure involves harvesting blood vessels (usually autografts of the patient’s saphenous vein) and surgically attaching them to the aorta and the poorly perfused area of the heart, bypassing the damaged vessels. Early mobility is now the standard of care in physical therapy (PT) practice following CABG, however some clinicians …


Blood Flow Restriction Therapy For The Treatment Of An Acl Reconstruction With A Meniscal Repair: A Case Report, Nicole Victor Dec 2019

Blood Flow Restriction Therapy For The Treatment Of An Acl Reconstruction With A Meniscal Repair: A Case Report, Nicole Victor

Case Report Posters

ACL tears make up ~50% of all knee injuries. Meniscal tears are second to ACL injuries in regards to prevalence. Following an ACL reconstruction, high-load resistance training is often used to increase muscle strength. However, rehabilitation after a meniscal repair calls for a longer period of immobilization in order to prevent early loading of the meniscus. Blood Flow Restriction Therapy (BFRT) used in conjunction with low intensity resistance training can produce increased muscle mass of the quadriceps muscles without adding load and stress to the meniscus. While evidence has shown positive results with the use of BFRT after an ACLR, …


Functional Mobility Interventions For A Bariatric Patient With Necrotizing Fasciitis: A Case Report, Jakub Cwalinski Dec 2019

Functional Mobility Interventions For A Bariatric Patient With Necrotizing Fasciitis: A Case Report, Jakub Cwalinski

Case Report Posters

Necrotizing Fasciitis is a life threatening soft tissue infection that is characterized by a rapid spreading infection of the subcutaneous tissue. Symptoms include red or purple skin in the affected area, severe pain, fever, and vomiting. Typically, the infection enters the body through a break in the skin such as a cut or burn. Surgical debridement is the mainstay of treatment for necrotizing fasciitis. Intravenous antibiotics are started immediately upon diagnosis. The purpose of this case report is to describe functional mobility interventions for a bariatric patient with necrotizing fasciitis.


Joint Stability And Proprioception Training To Reduce Chronic Pain For A Female Patient With Hypermobile Ehlers-Danlos Syndrome: A Case Report, Ashley Tullo Dec 2019

Joint Stability And Proprioception Training To Reduce Chronic Pain For A Female Patient With Hypermobile Ehlers-Danlos Syndrome: A Case Report, Ashley Tullo

Case Report Posters

Ehlers-Danlos Syndrome (EDS) is a heritable connective tissue disorder with many subtypes. Hypermobile EDS (hEDS), the most common subtype, is characterized by generalized joint hypermobility, musculoskeletal impairments, systemic involvement, and a familial history of EDS. Due to the many subtypes of EDS, and general hypermobility, a categorization of all terms was created called the Hypermobility Spectrum Disorder. Patients present with physical, psychological, and central nervous system impairments reducing their quality of life (QoL). The purpose of this case report was to describe the interventions utilized for a 28-year-old female with hEDS and chronic pain with the intention of reducing symptoms …


Physical Therapy Management Of A Patient With Unilateral Headache, Neck, And Shoulder Pain Who Presents With Undiagnosed Mastoiditis: A Case Report, Alexandr Kostenko Dec 2019

Physical Therapy Management Of A Patient With Unilateral Headache, Neck, And Shoulder Pain Who Presents With Undiagnosed Mastoiditis: A Case Report, Alexandr Kostenko

Case Report Posters

Mastoiditis is an infection and inflammation of the mastoid cells. If left untreated, mastoiditis can lead to intracranial complications and ultimately death. Diagnosis is confirmed with imaging such as computed tomography or magnetic resonance imaging. Common symptoms include earache, retroauricular pain, headache, mastoid tenderness, hearing loss, and discharge from the ear. Mastoiditis is typically managed with antibiotics, but may require mastoidectomy which is the surgical removal of the mastoid bone. The purpose of this case report is to illuminate the signs/symptoms of Mastoiditis as well as Cervicogenic Headaches and their commonalities which include overlapping site of cervicalgia.


Rehabilitation And Prosthetic Training For An Individual With Bilateral Lower Extremity Amputations Due To Peripheral Vascular Disease: A Case Report, Morgan Bessette Dec 2019

Rehabilitation And Prosthetic Training For An Individual With Bilateral Lower Extremity Amputations Due To Peripheral Vascular Disease: A Case Report, Morgan Bessette

Case Report Posters

Peripheral vascular disease (PVD) is a condition in which there is a disruption of blood flow to the extremities. Common causes of PVD include: hypertension (HTN), smoking, cardiac disease and/or diabetes. 12 to 20% of the population greater than 60 years old are affected by PVD. PVD can cause intermittent claudication or critical limb ischemia (CLI) and is therefore the most common cause of lower extremity amputation (LEA). Individuals with diabetes are at even greater risk of LEA. The purpose of this case report is to describe the physical therapy (PT) interventions and prosthetic training for a patient with bilateral …


Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report, Mckenna Young Dec 2019

Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report, Mckenna Young

Case Report Papers

Background and Purpose: The main focus of chronic disease in healthcare has typically been about treatment of the disease itself, with little attention given to secondary injuries that result from the chronic disease process. As these individuals age, the risk of secondary injuries increases. This is costly and adds to the caregiver burden. The purpose of this case report was to investigate a comprehensive physical therapy (PT) program focused on rehabilitation for a female with chronic disease who sustained a femoral fracture following her most recent fall. Case Description: A 42-year-old female presented to outpatient PT following a right femoral …