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Rehabilitation and Therapy

Physical Therapy Scholarly Projects

2021

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Full-Text Articles in Medicine and Health Sciences

Functional Rehabilitation And Strength Training-Focused Interventions For An Achilles Tendon Rupture And Repair: A Case Report, Anna Murphy May 2021

Functional Rehabilitation And Strength Training-Focused Interventions For An Achilles Tendon Rupture And Repair: A Case Report, Anna Murphy

Physical Therapy Scholarly Projects

Background and Purpose. Current literature identifies a lack of consensus regarding specific rehabilitation protocols following acute Achilles tendon ruptures. This case report highlights the rehabilitation of a patient following an Achilles rupture and surgical repair, who underwent a physical therapy treatment program, focusing on interventions to increase function, strength, and return to activity.

Description. The patient is a 64-year-old male, evaluated in the clinic four weeks following a status-post left Achilles tendon repair surgery, and presented with left ankle pain, decreased left ankle range of motion and decreased left ankle strength. The treatments and interventions used for this …


Left Medullary Stroke And The Effects Of Physical Therapy In The Acute Rehabilitation Setting: A Case Study, Alissa Dahle-Koch May 2021

Left Medullary Stroke And The Effects Of Physical Therapy In The Acute Rehabilitation Setting: A Case Study, Alissa Dahle-Koch

Physical Therapy Scholarly Projects

Background and Purpose. Approximately 800,000 strokes occur each year in the United States, either resulting in death or mild to moderate functional deficits. This case study examines the effectiveness of physical therapy treatment of a patient following a left medullary stroke in the acute rehabilitation setting.

Case Description. The patient was a 72-year-old male with a complex medical history who presented to the acute rehabilitation unit with right-sided weakness, diminished postural control, impaired muscle tone, and paresthesia. His admission was complicated by the onset of delirium during the second week of treatment.

Intervention. Physical therapy treatment provided …


Thoracic Outlet Syndrome Decompression And The Effect Of Physical Therapy In The Outpatient Setting: A Case Study, Kaiann Arellano May 2021

Thoracic Outlet Syndrome Decompression And The Effect Of Physical Therapy In The Outpatient Setting: A Case Study, Kaiann Arellano

Physical Therapy Scholarly Projects

Background and Purpose: Thoracic outlet syndrome (TOS) includes the signs and symptoms in the upper extremity caused by a compression of the brachial plexus, subclavian vein and/or subclavian artery at the thoracic outlet. The thoracic outlet symptoms may present as pain, weakness, numbness, tingling, and early fatigue or heaviness of the arm. Severe and unrelenting symptoms may lead to individuals considering surgical treatment. The purpose of this case report is to present an evidence based strengthening and stretching program for the post-operative care of TOS.

Case Description: This article describes the 10 - week outpatient physical therapy treatment …


Outpatient Physical Therapy Management Of A Patient Following Rotator Cuff Repair, Brianna Erickson May 2021

Outpatient Physical Therapy Management Of A Patient Following Rotator Cuff Repair, Brianna Erickson

Physical Therapy Scholarly Projects

This case report describes a 12-week physical therapy treatment of a patient that arrived to physical therapy following a rotator cuff repair of the right shoulder. The patient was a 43-year-old male who had a torn rotator cuff of the right shoulder following a farming accident.

Purpose: The purpose of this report is to describe the presentation, intervention, and outcomes of the 12-week treatment.

Description: Treatment for this patient included soft tissue mobilizations, joint mobilizations, stretching, and strengthening.

Outcomes. Following treatment, the patient gained strength and range of motion, but he was unable to reach full range …


Acute Care Physical Therapy Rehabilitation Of An 85-Year-Old Male With Three Lower Extremity Amputations: A Case Study, Ashley Bergerson May 2021

Acute Care Physical Therapy Rehabilitation Of An 85-Year-Old Male With Three Lower Extremity Amputations: A Case Study, Ashley Bergerson

Physical Therapy Scholarly Projects

Background and Purpose. This case report describes the acute care management of an 85-year-old male with three consecutive lower extremity amputations and one associated revascularization procedure at attempt of limb salvage. The purpose of this report is to describe the effects of chronic conditions on various body systems and how they relate to physical therapy rehabilitation post-amputation since limited research is present in this area of physical therapy practice.

Case Description. The patient had a very extensive and complicated medical history which included type Il diabetes mellites, chronic kidney disease and peripheral artery disease. His primary goal was …


Conservative Treatment And Management Of A Patient With Thoracic Spine Pain And Radiating Symptoms: A Case Report, Brian Illing May 2021

Conservative Treatment And Management Of A Patient With Thoracic Spine Pain And Radiating Symptoms: A Case Report, Brian Illing

Physical Therapy Scholarly Projects

Background and Purpose: Back pain can occur for several reasons. With the increasing prevalence of smart-device use today coupled with sedentary lifestyles, there is an increasing incidence of back pain related to postural deficits associated with device use and extended periods of sitting or inactivity. The purpose of this case study is to investigate the effects of posture and ergonomics and their role in back pain for an office worker.

Case Description: This case study follows the treatment of a 45-year old male over his 4-week episode of care. The chief complaint of the patient was an acute …


Hospital Acquired Deconditioning In A 78-Yeaar Old Individual: A Case Study, Brooke Rehm May 2021

Hospital Acquired Deconditioning In A 78-Yeaar Old Individual: A Case Study, Brooke Rehm

Physical Therapy Scholarly Projects

Background and Purpose: Physical therapy management of older adults following hospitalization is common. Patients tend to show impairments such as generalized weakness, decreased endurance, impaired mobility and gait, and an increase in dependence on others to complete activities of daily living. The purpose of this case study is to examine the physical therapy implications of treating patients with hospital acquired disability. This paper outlines the management of a patient who was newly admitted to skilled nursing facility, following a proximal humeral fracture.

Description: Following her stay at the hospital, the patient was discharged to the skilled nursing facility for …


Simultaneous Bilateral Total Knee Arthroplasty And The Effects Of Physical Therapy In The Outpatient Setting: A Case Study., Erin Syverson May 2021

Simultaneous Bilateral Total Knee Arthroplasty And The Effects Of Physical Therapy In The Outpatient Setting: A Case Study., Erin Syverson

Physical Therapy Scholarly Projects

Background and Purpose: A bilateral total knee arthroplasty (TKA) is a surgical procedure that has seen success in managing end-stage osteoarthritis of the knee joint. This case study evaluates the usefulness of physical therapy following bilateral TKA and deliberates the outcomes the patient experienced.

Case Description: The patient was a 62-year-old male who received postoperative physical therapy in an outpatient orthopedic clinic for a total of 8 weeks. The patient demonstrated decreased bilateral knee range of motion (ROM), decreased bilateral gross lower extremity (LE) strength, increased pain and swelling in both knees, and decreased endurance for ambulation.

Intervention …


A 70 Year Old Male With Left-Sided Flaccidity Following Right Hemorrhagic Cerebrovascular Accident: A Case Study, Hannah Dekrey May 2021

A 70 Year Old Male With Left-Sided Flaccidity Following Right Hemorrhagic Cerebrovascular Accident: A Case Study, Hannah Dekrey

Physical Therapy Scholarly Projects

Background and Purpose: Cerebrovascular accidents (CVAs) are a common medical issue addressed by physical therapists. This case study examines the effectiveness of one rehabilitation plan in an inpatient rehabilitation setting, and explores potential improvements in the method of intervention for patients following a CVA.

Case Description: This patient was a 70-year-old male admitted to an inpatient rehabilitation facility following a right CVA resulting in left-sided flaccidity of upper and lower extremities. He underwent therapy in this facility for five weeks.

Interventions: Conventional therapy interventions were used with this patient. The interventions consisted of a combination of strengthening, …


Effects Of Physical Therapy Following A Right Shoulder Arthroscopy In The Outpatient Orthopedic Setting: A Case Study, Hannah Riveland May 2021

Effects Of Physical Therapy Following A Right Shoulder Arthroscopy In The Outpatient Orthopedic Setting: A Case Study, Hannah Riveland

Physical Therapy Scholarly Projects

Background and Purpose. Shoulder pain is the third most common complaint in the musculoskeletal system. Subacromial impingement syndrome consists of 44-65% of those complaints. This case study examines the effectiveness of physical therapy treatment following a right shoulder arthroscopy including a subacromial decompression, extensive intraarticular debridement, and subpectoral proximal biceps tenodesis in an outpatient orthopedic setting.

Case Description. This patient was a 57-year old male with past medical history of chronic shoulder and back pain. He presented to outpatient physical therapy post-operatively with right upper extremity guarding, pain, weakness, tenderness, and impaired functional mobility.

Intervention. Treatment addressed …


Outpatient Physical Therapy Management Of A Patient With Patellofemoral Pain Syndrome: A Case Study, Hannah Gregg May 2021

Outpatient Physical Therapy Management Of A Patient With Patellofemoral Pain Syndrome: A Case Study, Hannah Gregg

Physical Therapy Scholarly Projects

Background and Purpose This report outlines a patient' s course of physical therapy for knee pain that was consistent with patellofemoral pain syndrome. First, the case discusses the current literature on the diagnosis and treatment of the condition, then describes a narrative of the patient's initial evaluation to his outcomes and discharge, Lastly, it reflects upon his experiences with results in the literature regarding others who have this condition.

Case Description. The patient presented to the outpatient clinic with anteromedial knee pain following a referral from an orthopedic physician. A subjective history and physical therapy examination were performed to reach …


Outpatient Physical Therapy Management Of Lumbar Intervertebral Disc Disorder With Radiculopathy, Kaitlyn Mcclaflin May 2021

Outpatient Physical Therapy Management Of Lumbar Intervertebral Disc Disorder With Radiculopathy, Kaitlyn Mcclaflin

Physical Therapy Scholarly Projects

Background and Purpose. This article summarizes the 6-week outpatient physical therapy management of a patient that experienced a lumbar disc derangement with radiculopathy in the right lower extremity. She experienced a decrease in function, range of motion, and strength following onset of symptoms. The purpose of this article is to outline the interventions utilized in this patient's plan of care in an attempt to return her to caring for children, full-time work, and daily exercise at her prior level of function.

Description. Patient was a 31 -year-old female with 3 children. She worked as a nurse full-time and …


Outpatient Physical Therapy Management Of A Patient Diagnosed With A Severe Left Cerebrovascular Accident (Cva): A Case Study, Jayce Turner May 2021

Outpatient Physical Therapy Management Of A Patient Diagnosed With A Severe Left Cerebrovascular Accident (Cva): A Case Study, Jayce Turner

Physical Therapy Scholarly Projects

Background and Purpose: This article outlines a six-month rural/outpatient physical therapy treatment of a 58-year old female who endured a severe left cerebrovascular accident (CVA) eight months ago. Patient presents with muscle weakness, numbness, reduced tone, notable spasticity, and impaired coordination on her R side as well as impaired language, limited to say 'yes" or "no". Prognosis for the patient was fair, and she is expected to regain minimal prior level of functioning. The purpose of this article is to describe the interventions used for this patient and the consequences they had.

Description: The treatment performed during the …


Outpatient Physical Therapy Management Of A Patient With Left Medial Plantar Myofascial Pain, Kayana Trottier May 2021

Outpatient Physical Therapy Management Of A Patient With Left Medial Plantar Myofascial Pain, Kayana Trottier

Physical Therapy Scholarly Projects

Background and Purpose: This article describes a 6-week outpatient physical therapy management of a 62 year old female who had a posterior tibial tendon Repair with flexor digitorum longus transfer surgery in 2013 on the left foot following foot pain that worsened over the years. The patient presented with decreased left ankle range of motion, strength, activity tolerance, endurance, marked swelling and sharp pain on the medial and plantar surface of left foot. The purpose of this article is to describe the interventions used for this patient and the results from the physical therapy interventions provided.

Description. The …


Outpatient Physical Therapy Management Of A Patient With Relapsing-Remitting Multiple Sclerosis., Lydia Jacobson May 2021

Outpatient Physical Therapy Management Of A Patient With Relapsing-Remitting Multiple Sclerosis., Lydia Jacobson

Physical Therapy Scholarly Projects

Background and Purpose. Multiple sclerosis is a progressive that affects the central nervous system. This case study discusses the clinical decision making and the effectiveness of treatment of physical therapy for a patient with relapsing-remitting multiple sclerosis.

Case Description. This case study describes an 8-week outpatient physical therapy episode of care for a 52-year-old patient with relapsing remitting multiple sclerosis. The patient presented to physical therapy secondary to balance deficits and muscles spasms in her thoracic spine. Physical therapy interventions included resistive, balance, endurance, and gait exercises.

Outcomes. Following 8 weeks of physical therapy the patient's balance, …


Outpatient Physical Therapy Management Of A Patient With Left Hip Femoroacetabular Impingement: A Case Study, Mark Geerdes May 2021

Outpatient Physical Therapy Management Of A Patient With Left Hip Femoroacetabular Impingement: A Case Study, Mark Geerdes

Physical Therapy Scholarly Projects

Background and Purpose: Femoroacetabular impingement (FAI) syndrome is a motion related clinical disorder of the hip in which there is premature contact between the acetabulum and the proximal femur. This case study evaluates the effectiveness of physical therapy as a first line treatment for FAI and discusses the patient outcomes based on the chosen interventions. The results can be used to better understand the most appropriate interventions for conservative FAI treatment.

Case Description: The patient was a 15-year-old male student athlete who presented to physical therapy with left anterior and lateral hip pain.

Interventions: The rehabilitation program …


The Effectiveness Of Physical Therapy Intervention Modeled After The Scroth Method And Fits Concept For Treatment Of Radicular Symptoms Secondary To Mild Scoliosis In A 16-Year Old Female., Mary T. Gray May 2021

The Effectiveness Of Physical Therapy Intervention Modeled After The Scroth Method And Fits Concept For Treatment Of Radicular Symptoms Secondary To Mild Scoliosis In A 16-Year Old Female., Mary T. Gray

Physical Therapy Scholarly Projects

Background and Purpose. Physical therapy as an intervention for scoliosis typically involves a method-based scoliosis specific approach to treatment that requires extensive training such as the Schroth method or FITS concept. The purpose of this study is to determine if physical therapy treatment alone, when modeled after the Schroth method and FITS concept can be an effective treatment method for lumbar radiculopathy and pain secondary to mild scoliosis.

Case Description. The patient featured in this case report is a 16-year-old female with a medical diagnosis of scoliosis and fibro-lipoma on her filum terminal. The patient had a Cobb …


Parkinson’S Disease And Lumbar Compression Fracture Physical Therapy Management: A Case Report., Mckinley Bender May 2021

Parkinson’S Disease And Lumbar Compression Fracture Physical Therapy Management: A Case Report., Mckinley Bender

Physical Therapy Scholarly Projects

Background and purpose: Parkinson's disease is a slow, variable, progressive, neurodegenerative disease. It is the most common serious movement disorder in the world. Falls are common in people with Parkinson's disease and may lead to devasting outcomes such as compression fractures. This article describes the outpatient physical therapy course of a 76-year-old female patient with Parkinson's disease whom sustained a L3 lumbar compression fracture from a fall. It also discusses the outcomes she obtained as a result of physical therapy intervention.

Case Description: The patient presented to physicat therapy with decreased overall strength, gait difficulty with decreased foot clearance, …


Outpatient Physical Therapy Management For A Full Thickness Sutraspinatus Tendon Tear: A Case Study, Samantha Miller May 2021

Outpatient Physical Therapy Management For A Full Thickness Sutraspinatus Tendon Tear: A Case Study, Samantha Miller

Physical Therapy Scholarly Projects

Background and Purpose. This article describes the 14-week physical therapy treatment of a pre- and postoperational full thickness supraspinatus tendon tear of a 45-year-old female. The four muscles of the rotator cuff provide stabilization to the glenohumeral joint of the shoulder. These muscles are the supraspinatus, infraspinatus, teres minor, and the subscapularis. l In the United States, roughly 460 000 rotator cuff repair surgeries occur each year and they are the second most common orthopedic procedure. 2 Past research studies have shown that a full recovery from this surgery takes 3 to 6 months, with factors such as integrity …


Bilateral Patellofemoral Pain Syndrome And The Effects Of Physical Therapy In The Outpatient Setting: A Case Study, Paige Mriden May 2021

Bilateral Patellofemoral Pain Syndrome And The Effects Of Physical Therapy In The Outpatient Setting: A Case Study, Paige Mriden

Physical Therapy Scholarly Projects

Background and Purpose: Patellofemoral pain syndrome (PFPS) is characterized by musculoskeletal-related knee pain localized to the anterior retropatellar and/or peripatellar area of the knee. This case study describes the physical therapy management of bilateral PFPS. The results can be used to understand examination, evaluation, and interventions to treat PFPS.

Case Description: The patient was a 76-year-old female that reported progressive pain in both knees. She demonstrated weak hip abductors and extensors, tenderness upon palpation to bilateral pes anserine, bilateral ITB, and bilateral medial joint line with increased lateral tibial torsion on the left and a positive Hamstring 90-90 test. …


Outpatient Management Of Low Back And Neck Pain With Radicular Symptoms, Riley Ryan May 2021

Outpatient Management Of Low Back And Neck Pain With Radicular Symptoms, Riley Ryan

Physical Therapy Scholarly Projects

Background and Purpose. Neck and back pain are very prevalent in the world today. This pain can range mild to debilitating. The purpose of this case study is to examine the use of physical therapy for patients with neck and back pain.

Case Description. A 49 year old female with neck and back pain with radiculopathy. The patient presented with decreased cervical range of motion, kyphotic posture with rounded shoulders and forward head and was seen for a total of six weeks. (20 visits).

Intervention. The treatment of the patient involved education on posture/body mechanics/exercises, manual therapy techniques, modalities …


Chronic Low Back Pain With Possible Si Involvement And Weak Abdominals: A Case Study, Stacy Remer May 2021

Chronic Low Back Pain With Possible Si Involvement And Weak Abdominals: A Case Study, Stacy Remer

Physical Therapy Scholarly Projects

Background and Purpose: Chronic, non-specific low back pain is highly prevalent and is a cause for a large proportion of medical expenses along with many people’s pain and disability. This case report presents a variety of interventions implemented for a patient with low back pain and her reaction to therapy.

Case Description: The case study presents a 42 y/o mother to three children. Her pain began about two years ago and has been persistent throughout that time. She has tried many different forms of treatment through medical physicians, physical therapy, and massage therapy but nothing has had long-term relief of …


Weakness Secondary To Pneumonia/Sepsis In An Elderly Individual: A Case Study, Winter Monette May 2021

Weakness Secondary To Pneumonia/Sepsis In An Elderly Individual: A Case Study, Winter Monette

Physical Therapy Scholarly Projects

Background and Purpose. Maintaining functional activity is the most important aspect for geriatric patients wishing to preserve their independence. Muscle strength decreases rapidly within the sixth and seventh decade. This is when some older individuals have difficulty with activities such as walking, balance and transfers. Additional issues such as disease, injury or inactivity can increase the speed of this decline. Although functional change is usually observed with aging, hospitalization can cause further complications to function even if the patient’s admitted condition has been resolved. The purpose of this case report is to look at the role of physical therapy in …


Analyzing The Accelerated Physical Rehabilitation Of A Patient Status Post Periacetabular Osteotomy And Femoral Derotation Osteotomy, Zachary Burtsfield May 2021

Analyzing The Accelerated Physical Rehabilitation Of A Patient Status Post Periacetabular Osteotomy And Femoral Derotation Osteotomy, Zachary Burtsfield

Physical Therapy Scholarly Projects

Background and Purpose: The purpose of this case is to analyze the accelerated treatment of a periacetabular osteotomy in a patient who requires up to six surgical corrections to his femoracetabular joint compared to a standard treatment protocol.

Case Description: The patient was a 20 year old martial artist presenting with bilateral hip dysplasia seeking physical therapy following a periacetabular osteotomy with a femoral derotation osteotomy.

Intervention. Therapeutic exercise and neuromuscular reeducation techniques were included in treatment to improve range of motion, strength, balance, and gait.

Outcomes: The patient was able to increase range of motion and strength …


Outpatient Physical Therapy Management Of A Patient With A Work-Related Hand Contusion, Brianne Halstead May 2021

Outpatient Physical Therapy Management Of A Patient With A Work-Related Hand Contusion, Brianne Halstead

Physical Therapy Scholarly Projects

Background and Purpose. Work-related traumatic hand injuries can range from minor cuts or burns to more serious injuries involving man and machine interaction. The hands are a vital part of daily life, and injuries to this area may present significant decreases in functional abilities. Because of the variance in severity and lack in specific research, this injury may pose a unique challenge to physical therapists.

Description. This case study describes the six-week outpatient physical therapy management of a 58-year-old male who sustained a hand contusion from a work-related injury. The patient presented with decreased strength, decreased range of …


Outpatient Physical Therapy Management Of A Chronic Incomplete Spinal Cord Injury: A Case Report, Erin Bussman May 2021

Outpatient Physical Therapy Management Of A Chronic Incomplete Spinal Cord Injury: A Case Report, Erin Bussman

Physical Therapy Scholarly Projects

Background and Purpose. An incomplete cervical spinal cord injury is a lesion to the Cl-C7 area of spinal cord that does not result in a complete disconnection of the spinal cord and brain. Around 18,000 individuals are affected by a spinal cord injury in the United States each year, typically due to traumatic injury such as a motor vehicle accident, falls or violence. Each case presentation can be different with their impairments and functional limitations. Physical Therapists are vital in the examination and evaluation process to determine the severity of impairments secondary to the injury and the overall effects …


Lateral Knee Pain In A Female Runner: A Case Study, Cassidy Steinessen May 2021

Lateral Knee Pain In A Female Runner: A Case Study, Cassidy Steinessen

Physical Therapy Scholarly Projects

Background and Purpose. Knee pain is the most common site for lower extremity injuries in runners, especially female runners. Knee pain is defined by a variety of conditions, one of which is patellofemoral pain syndrome (PFPS). The purpose of this case report is to follow the six-week management of a distance runner with left lateral knee pain, with a suspected diagnosis of PFPS.

Case Description. The patient is a 37-year-old female who was seeking treatment for left knee pain with secondary pain in her right hip that she had been experiencing for over six months. She was found …


Bankart Labral Repair Rehabilitation Using Fascial Counterstrain, Proprioceptive Neuromuscular Facilitation, And Range Of Motion: A Case Report, Lauren Mcintosh May 2021

Bankart Labral Repair Rehabilitation Using Fascial Counterstrain, Proprioceptive Neuromuscular Facilitation, And Range Of Motion: A Case Report, Lauren Mcintosh

Physical Therapy Scholarly Projects

Background and Purpose: This case study will address the use of fascial counterstrain, proprioceptive neuromuscular facilitation (PNF), and range of motion (ROM) to rehabilitate an arthroscopic anterior Bankart labrum repair in a pediatric patient. Bankart labral tears are defined as an anteroinferior tear of the labrum, frequently caused by multiple anterior shoulder dislocations. Fascial counterstrain can be used in post-surgical patients to reduce swelling, decrease healing time, and reduce pain. PNF and ROM allow the patient to return to a functional lifestyle and are included in most protocols provided by the surgeon. The purpose of this study is to demonstrate …


Outpatient Physical Therapy Rehabilitation Of A Patient With Ehlers-Danlos Syndrome And Received A Total Knee Arthroplasty, Jacob Todd May 2021

Outpatient Physical Therapy Rehabilitation Of A Patient With Ehlers-Danlos Syndrome And Received A Total Knee Arthroplasty, Jacob Todd

Physical Therapy Scholarly Projects

Background and Purpose. Total knee arthroplasties (TKA) remain the gold standard of surgical interventions to the knee and are often used to treat the knee joint for arthritic changes along with therapeutic exercise.

Case Description. This case report describes the physical therapy rehabilitation of a 48-year-old female post left T KA due to increased instability, afthritic changes, and pain caused by her EDS combined with her high BMI. The patient previously had her right knee replaced with a TKA and was acquainted with the rehabilitation process and familiar with all of the therapeutic exercises and proper progression of …


Acute Inflammatory Demyelinating Polyneuropathy And Physical Therapy Management In Acute Care: A Case Study, Kaley Stotz May 2021

Acute Inflammatory Demyelinating Polyneuropathy And Physical Therapy Management In Acute Care: A Case Study, Kaley Stotz

Physical Therapy Scholarly Projects

Background. Acute inflammatory demyelinating polyneuropathy (AIDP) is the most prevalent variation of Guillain-Barre Syndrome. It is a neurological disorder in which the immune system attacks the peripheral nervous system resulting in demyelination and subsequent ineffective nerve transmission. Currently there is a lack of evidence supporting the most effective early physical therapy treatment interventions.

Purpose. The purpose of this case study is to present the early physical therapy intervention provided in the acute care setting for a patient with AIDP.

Description. This case study describes a five-day inpatient physical therapy management of a 37-year-old male who was diagnosed …