scholarly journals Balance Comparison between Iranian Elderly with and without Knee Range of Motion Limitations

2021 ◽  
Vol 29 (S1) ◽  
Author(s):  
Ehsan Lohrasbipeydeh ◽  
Soh Kim Geok ◽  
Roxana Dev Omar Dev ◽  
Seyedali Ahrari ◽  
Ong Swee Leong ◽  
...  
Keyword(s):  
Health Care ◽  
Range Of Motion ◽  
Dynamic Balance ◽  
The Elderly ◽  
Static Balance ◽  
Timed Up And Go ◽  
Eyes Closed ◽  
Health Care Practitioners ◽  
Quasi Experimental ◽  
Eyes Open

This study compares the static eye movement (eyes open and eyes closed) and dynamic balance amongst Iranian elderly with and without knee range of motion (ROM) limitations. The method used was a quasi-experimental before/after study. The participants consisted of 30 older Iranian adults, aged 60 or more (10 females and 20 males across two groups of 15 in each group) who were evaluated using the Sharpened Romberg (SR), Timed Up and Go (TUG) tests. An independent t-test was used to compare the descriptive characteristics of the two groups of the elderly. The findings showed substantial alterations in all the measured components between the subjects. The static balance with an open eye (p = 0.028) and closed eye (p = 0.021), as well as the dynamic balance (p = 0.009) between the elderly with and without the limitation of knee ROM, was substantially different. Moving forward, the findings of this study suggested that the balance of the elderly was directly linked to knee ROM, as the elderly without limitations of knee ROM displayed greater stability than the elderly with limitations of knee ROM. Health care practitioners should also understand the ROM of the knee, as individuals with ROM limitations of the knee are more likely to fall due to underlying disorders associated with their balance.

Effects of proprioception training program on balance among patients with diabetic neuropathy: a quasi experimental trial

2021 ◽  
pp. 1-12
Author(s):  
Humaira Iram ◽  
Muhammad Kashif ◽  
Hafiz Muhammad Junaid Hassan ◽  
Salma Bunyad ◽  
Samra Asghar
Keyword(s):  
Diabetic Neuropathy ◽  
Dynamic Balance ◽  
Berg Balance Scale ◽  
Exercise Group ◽  
Walk Test ◽  
Timed Up And Go ◽  
Functional Reach ◽  
Functional Reach Test ◽  
Quasi Experimental ◽  
Eyes Open

Abstract Objective: To determine the effects of proprioception training in improving balance in patients with diabetic neuropathy. Methods: A quasi-experimental design study was conducted at the Safi Hospital Faisalabad for eight weeks from August to December 2019. Out of, 38, 19 patients were placed in exercise group (10 males, 9 females; mean age 64 ± 7.7 years; range 60 to 83 years) and 19 patients were placed in controls group (12 males, 7 females; mean age 63 ± 8.2 years) were included in this study through consecutive sampling technique. Proprioception Training was given to exercise group twice a week for eight weeks and the diabetes awareness campaign was given once a week to the control group. Static and dynamic balance were assessed by using One Leg Standing (OLS) Test with eyes open and closed, Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUGT) and 10-M Walk Test (10-MWT). The data was collected before and after treatment and was compared using independent sample t-test. Results: The finding of the study showed that OLS score with eyes open improved significantly with p<0.05 and does not show improvement with eyes closed p =.073. The dynamic balance from the Berg Balance Scale, Functional Reach Test, Timed Up and Go Test and 10-M Walk Test revealed significant improvement after the balance exercises with p<0.05 Conclusion: It is concluded that proprioception training exercises are effective in improving balance among patients with Diabetic neuropathy. Continuous...

Effects of cognitive and physical loads on dynamic and static balance of older adults under single, dual and multi-task conditions

2019 ◽  
Author(s):  
Hamid Allahverdipour ◽  
Iman Dianat ◽  
Galavizh Mameh ◽  
mohammad Asghari Jafarabadi
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Cognitive Task ◽  
Dynamic Balance ◽  
The Elderly ◽  
Static Balance ◽  
Timed Up And Go ◽  
Task Conditions ◽  
And Control ◽  
Single Versus

Abstract Background: The aim of this study was to evaluate the effects of cognitive and physical loads on dynamic and static balance of older adults under single, dual and multi-task conditions. Methods: The effects of single versus combined (dual-task and multi-task) cognitive (to speak out the name of the weekdays in a reverse order) and physical (with three levels including handling weights of 1kg, 2kg and 3kg in each hand) loads on dynamic and static balance of 42 older adults (21 males and 21 females), aged ≥ 60 years were studied. Dynamic and static balance measures were evaluated using the Timed Up and Go (TUG) and stabilometer (sway index) tests, respectively. Results: The TUG speed of female participants was generally slower than that of male participants. Cognitive task influenced the participants’ dynamic balance during the dual-task conditions, while the static balance was not affected in this phase. The dynamic and static balance measures were more influenced when performing the multi-tasks than when doing the dual-tasks. The effects of various levels of physical demand on the dynamic balance varied greatly under dual- and multi-task conditions. Conclusions: The findings add to the understanding of the factors influencing the elderly balance and control under cognitive and physical functioning.

scholarly journals An observational study of balance and proprioception function in patients with spinocerebellar ataxias type 3

2020 ◽  
Author(s):  
Xia-Hua Liu ◽  
Ying Li ◽  
Hao-Ling Xu ◽  
Arif Sikandar ◽  
Wei-Hong Lin ◽  
...  
Keyword(s):  
Postural Control ◽  
Dynamic Balance ◽  
Body Sway ◽  
Static Balance ◽  
Clinical Test ◽  
Spinocerebellar Ataxias ◽  
Balance Test ◽  
Eyes Closed ◽  
Eyes Open ◽  
Type 3

Abstract BackgroundPostural instability is one of the most disabling features of spinocerebellar ataxias type 3 (SCA3) and often leads to falls that reduce mobility and functional capacity. This study aimed to quantitatively analyse static and dynamic balance and proprioception function on postural control in patients with SCA3 using the Pro-kin system and optimise rehabilitation programmes for them.MethodsEight-one clinically diagnosed SCA3 patients (38 women, 43 men; aged 39.00 ± 9.66) and 62 healthy controls were studied and evaluated using the Pro-kin system (PK254P, Tecnobody S.r.l, Dalmine, Italy). The measurements included (1) a static balance test in two visual feedback conditions: eyes open (EO) and eyes closed (EC); (2) a dynamic balance test measuring limits of stability (LOS); and (3) a proprioception function test to obtain proprioceptive measurements on a multiaxial balance evaluator for both right and left lower limbs.ResultsCompared to controls, SCA3 patients showed significantly higher values of all static balance outcome variables with eyes open and eyes closed, implying postural instability. SCA3 patients showed significantly higher values in the standard deviation of body sway along the medio-lateral (ML) axis and in the velocity of body sway along the anterior-posterior (AP) axis. The overall scores and the scores for all eight LOS components were significantly lower in the SCA3 patients than in the controls. The mean values of AP index (API), ML index (MLI), Stability index (SI) and average trace error (ATE) were significantly greater in SCA3 patients compared to HC subjects, while API showed a trend toward higher values.ConclusionsSCA3 patients have a significant postural control disorder, and are likely to fall on the AP plane and prefer performing postural adjustments in the ML direction; a decreased proprioception function in the knee and ankle is also evident. Visual cues and proprioception should be emphasized in balance rehabilitation training. Attention should also be paid to improve muscle strength and range of motion.Trial registrationThe Chinese clinical test registration center. ChiCTR1800020133. Registered 15 december 2018 - Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=33950

scholarly journals An Investigation of the Effects of Exercises Applied on Unstable Surfaces on High School Students

2019 ◽  
Vol 7 (6) ◽  
pp. 77
Author(s):  
Ali Ozuak ◽  
Kamil Erdem
Keyword(s):  
High School ◽  
High School Students ◽  
Dynamic Balance ◽  
Economic Status ◽  
Soccer Players ◽  
Control Group ◽  
Static Balance ◽  
School Students ◽  
Eyes Closed ◽  
Eyes Open

In this study, it was aimed to determine the effects of plyometric exercises applied on unstable platforms on static and dynamic balances of soccer players who continued their high school education. In the study, male soccer players with similar socio-economic status between the ages of 14 and 16 formed the study group (SG; n=24; age=15.08±1.36) and the control group (CG; n=22; age=15.22±1.62). Static Balance Eyes Open (SB-EO), Static Balance Eyes Closed (SB-EC) and Dynamic Balance tests (DB) were applied on the SG and CG as pre- and post-tests for both dominant leg (DL) and non-dominant leg (NDL). SG athletes were subjected to plyometric exercises on unstable surfaces for sixteen sessions that were integrated into the physical education lessons in high school while CG athletes performed only a traditional soccer training program. As a result of the statistical analyses, when the pre-post test scores of the SG were examined, dynamic balance-dominant leg (DB-DL; p=0.03), dynamic balance-non-dominant leg (DB-NDL; p=0.03), static balance eyes open-dominant leg (SB-EO-DL; p=0 01), static balance eyes closed -dominant leg (SB-EC-DL; p=0.03) and static balance eyes closed-non-dominant leg (SB-EC-NDL; p=0.01) measurements were found statistically significant (p<0.05) while the CG had statistical improvements only in SB-EO-DL measurements (p=0.03). When the differences between the two groups were examined, only SB-EC-DL measurements were found statistically significant in favor of the SG (p=0.03). In conclusion, especially the improvement of DL observed in the SG is important for optimum performance considering that it is necessary to use both legs effectively in soccer. Considering the multitude of activities performed on a single leg in soccer, it is thought that the increase in bilateral balance can improve the skills that determine soccer performance in difficult conditions such as dribbling, shooting and passing.

scholarly journals Immediate Effect of Balance Taping Using Kinesiology Tape on Dynamic and Static Balance after Ankle Muscle Fatigue

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 162 ◽  
Author(s):  
Hyun-Su Choi ◽  
Jung-Hoon Lee
Keyword(s):  
Muscle Fatigue ◽  
Surface Area ◽  
Dynamic Balance ◽  
Ankle Injuries ◽  
Static Balance ◽  
Static State ◽  
Eyes Closed ◽  
Ankle Muscle ◽  
Eyes Open ◽  
Dynamic States

The objective of this study was to investigate whether ankle balance taping (ABT) applied after muscle fatigue-inducing exercise can cause immediate improvements in dynamic and static balance. A total of 31 adults (16 males and 15 females) met the inclusion criteria. The experiment was designed using a single-blinded, randomized controlled trial. Changes in static and dynamic balance were measured before and after inducing muscle fatigue in the ankles and after ABT or ankle placebo taping (APT). After ankle muscle fatigue-inducing exercise, both the ABT and APT groups showed significant increases in surface area ellipses in the static state with eyes open (p < 0.05), and significant increases in surface area ellipses in the static and dynamic states with eyes closed (both p < 0.05). After taping of the fatigued ankle, surface area ellipses decreased significantly when eyes were open and closed in the static and dynamic states, but only in the ABT group (p < 0.05). Static balance was significantly different between groups (eyes open, 36.2 ± 86; eyes closed, 22.9 ± 46.7). Dynamic balance was significantly different between groups (eyes open, 68.6 ± 152.1; eyes closed, 235.8 ± 317.6). ABT may help prevent ankle injuries in individuals who experience muscle fatigue around the ankles after sports and daily activities.

scholarly journals Examination of the effects of swimming exercises and thera-band workouts on dynamic and static balance in children between 7-12 years of age7-12 yaş arası çocuklarda yüzme egzersizi ve thera-band çalışmalarının dinamik ve statik dengeye etkisinin incelenmesi

2018 ◽  
Vol 15 (3) ◽  
pp. 1443 ◽  
Author(s):  
Hilal Kılınç ◽  
Mehmet Günay ◽  
Şeyhmus Kaplan ◽  
Akan Bayrakdar
Keyword(s):  
Dynamic Balance ◽  
Test Group ◽  
Exercise Group ◽  
English Summary ◽  
Static Balance ◽  
Eyes Closed ◽  
Post Test ◽  
Eyes Open ◽  
The Difference ◽  
Experimental Group

The aim of this study was to investigate the effects of swimming exercises and theraband workouts on dynamic and static balance in children aged 7-12 years. The study was conducted with 20 subjects aged 7-12 who were interested in swimming for at least 2 years and engaged in swimming training on a regular basis for 5 days per week. Informed consent was obtained from the parents and trainers of the participants about their voluntary participation. Participants were randomly divided into 2 groups. Swimming and theraband workouts were made to the 1. group (n=10), only swimming exercises were made to the 2. group (n=10). In this study, anthropometric measurements and static and dynamic balance measurements were taken. The study was carried out in the Van Olympic Swimming Pool. The analysis of the data in-group and intergroup measurements were performed. There was statistically significant improvement between the variables in the theraband exercise group. Developments were thought to be influenced by the specificity of the movements. The experimental group showed a statistically significant in the eyes open front-to-back swing %28,85, eyes closed front-to-back swing %6,66, the average speed of eyes open front-to-back swing %20,12, the eyes open front-to-back swing body balance %15,83, eyes open left to right swing %14,66, eyes open left to right swing speed %22,30, anterior experimental group %1,91 and posterolateral experimental group %4,54. The difference between the posterolateral and anterior post-test groups was observed. Test*group interaction was observed at the speed of  eyes open front-to-back and left to right swings. This interaction was due to intra-group developments in the experimental group. As a result, theraband studies examined under the name of swimming and core exercise in children athletes were thought to play an important role in the development of static and dynamic balance. Extended English summary is in the end of Full Text PDF (TURKISH) file.ÖzetBu çalışma 7-12 yaş arası çocuklarda yüzme egzersizi ve tereband çalışmalarının dinamik ve statik dengeye etkisini incelemek amacıyla yapılmıştır. Çalışma en az 2 yıl yüzme branşı ile ilgilenen ve haftada 5 gün düzenli olarak yüzme antrenmanı yapan yaşları 7-12 arasında olan 20 denek ile gerçekleştirilmiştir. Katılımcıların velilerinden ve antrenörlerinden gönüllü katılımları ile ilgili aydınlanmış onamları alınmıştır. Katılımcılar rastgele yöntemle 2 gruba ayrılmışlardır. 1. gruba (n=10) yüzme ve tereband çalışmaları, 2. gruba (n=10) sadece yüzme egzersizleri yaptırılmıştır. Çalışmada antropometrik ölçümler ile statik ve dinamik denge ölçümleri alınmıştır. Çalışma Van Olimpik yüzme havuzunda uygulanmıştır. Verilerin analizinde grupiçi ve gruplararası ölçümler gerçekleştirilmiştir. Tereband egzersiz grubunda değişkenler arasında istatistiki olarak anlamlı gelişme görülmüştür. Gelişmelerin hareketlerin spesikfikliğinden etkilendiği düşünülmektedir. Deney grubunun göz açık öne arkaya salınım %28,85, göz kapalı öne arkaya salınım %6,66, göz açık öne arkaya salınım ortalama hızı %20,12, göz açık öne arkaya salınım gövde dengesi %15,83,  göz açık sağa sola salınım %14,66, göz açık sağa sola salınım hızı %22,30, Anterior %1,91 ve Posterolateral deney grubunda %4,54 oranında istatistiki olarak anlamlı bir artış göstermiştir. Posterolateral ve anteriorda son test gruplar arası farklılık gözlemlenmiştir.  Göz açık öne arkaya salınım ve göz açık sağa sola salınım hızında test*grup etkileşimi gözlenirken, bu etkileşim deney grubundaki grup içi gelişimlerden kaynaklanmaktadır. Sonuç olarak, çocuk sporcularda yüzme ve core egzersiz adı altında incelenen tereband çalışmalarının statik ve dinamik denge geliştirme de önemli rol oynadığı düşünülmektedir.

scholarly journals Concussion History and Balance Performance in Adolescent Rugby Union Players

2021 ◽  
pp. 036354652199870
Author(s):  
Mark Matthews ◽  
William Johnston ◽  
Chris M. Bleakley ◽  
Richard J. Davies ◽  
Alan T. Rankin ◽  
...  
Keyword(s):  
Dual Task ◽  
Inertial Sensor ◽  
Dynamic Balance ◽  
Rugby Union ◽  
Static Balance ◽  
Balance Performance ◽  
Eyes Closed ◽  
History Of ◽  
Concussion History ◽  
Rugby Players

Background: Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players. Hypothesis: Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes ( x, y, and z). Results: Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; P = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; P = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- ( P = .47) and dual-task ( P = .67) conditions. Conclusion: Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.

scholarly journals The Effect of Pilates Training on the Balance of Elderly

2019 ◽  
Vol 1 (16) ◽  
Author(s):  
Kristina Zaičenkovienė ◽  
Renata Rakovaitė
Keyword(s):  
Dynamic Balance ◽  
Step Test ◽  
Control Group ◽  
Static Balance ◽  
Study Group ◽  
Timed Up And Go ◽  
Physically Active ◽  
Before And After ◽  
Four Square ◽  
And Control

Research background. Falling is one of the most important problems in the elderly’s mobility disorder, which is most often affected by the loss of balance. It is known that Pilates exercises could help to increase the deep muscle strength, improve posture and proprioception, which affects the improvement of the balance. Objective – to evaluate the effects of Pilates exercises on the elderly’s static and dynamic balance. Methodology. The study population consisted of 20 volunteers, men and women, who were divided into Pilates exercises (n = 10, age 65.1 ± 2.6) and control (n = 10, age 68.6 ± 4.9) groups. The study group participated in Pilates classes 2 times per week for six weeks (session duration 60 minutes). The control group did not participate in any physical activity, but they were physically active as usually in their daily life. The main outcome measures were assessed before and after the intervention. The static balance was assessed by measuring posturographic parameters using the force platform, dynamic balance was measured with the Timed up and Go Test (TUG) and the Four Square Step Test (FSST). Results. The results showed signifcant improvement in static balance of the experimental group after the Pilates exercises during standing tests when the feet were apart, eyes opened and closed and when the feet together with eyes opened, and when the foot was in front of the other foot. The results of the control group did not differ during both tests. The results of both groups did not differ in the static balance tests before and after the study, but after the Pilates exercises, the results of the Pilates group signifcantly differed from the control group test results when the feet were in shoulder line with open eyes. The results of the dynamic balance after Pilates exercises signifcantly improved in both tests in the study group. Before the study, there were not statistically signifcant differences in the dynamic balance results between the groups. Conclusions. Six-week Pilates exercises had a positive effect on the elderly’s static and dynamic balance.Keywords: Pilates training, static balance, dynamic balance.

Biomechanical Response to External Biofeedback During Functional Tasks in Individuals With Chronic Ankle Instability

2021 ◽  
Author(s):  
Danielle M. Torp ◽  
Abbey C. Thomas ◽  
Tricia Hubbard-Turner ◽  
Luke Donovan
Keyword(s):  
Real Time ◽  
Plantar Pressure ◽  
Ankle Instability ◽  
Static Balance ◽  
Eyes Closed ◽  
Visual Biofeedback ◽  
Time Integral ◽  
Pressure Time ◽  
Eyes Open ◽  
Functional Task

Context Altered biomechanics displayed by individuals with chronic ankle instability (CAI) is a possible cause of recurring injuries and posttraumatic osteoarthritis. Current interventions are unable to modify aberrant biomechanics, leading to research efforts to determine if real-time external biofeedback can result in changes. Objective To determine the real-time effects of visual and auditory biofeedback on functional-task biomechanics in individuals with CAI. Design Crossover study. Setting Laboratory. Patients or Other Participants Nineteen physically active adults with CAI (7 men, 12 women; age = 23.95 ± 5.52 years, height = 168.87 ± 6.94 cm, mass = 74.74 ± 15.41 kg). Intervention(s) Participants randomly performed single-limb static balance, step downs, lateral hops, and forward lunges during a baseline and 2 biofeedback conditions. Visual biofeedback was given through a crossline laser secured to the dorsum of the foot. Auditory biofeedback was given through a pressure sensor placed under the lateral foot and connected to a buzzer that elicited a noise when pressure exceeded the set threshold. Cues provided during the biofeedback conditions were used to promote proper biomechanics during each task. Main Outcome Measure(s) We measured the location of center-of-pressure (COP) data points during balance with eyes open and eyes closed for each condition. Plantar pressure in the lateral column of the foot during functional tasks was extracted. Secondary outcomes of interest were COP area and velocity, time to boundary during static balance, and additional plantar-pressure measures. Results Both biofeedback conditions reduced COP in the anterolateral quadrant while increasing COP in the posteromedial quadrant of the foot during eyes-open balance. Visual biofeedback increased lateral heel pressure and the lateral heel and midfoot pressure-time integral during hops. The auditory condition produced similar changes during the eyes-closed trials. Auditory biofeedback increased heel pressure during step downs and decreased the lateral forefoot pressure-time integral during lunges. Conclusions Real-time improvements in balance strategies were observed during both external biofeedback conditions. Visual and auditory biofeedback appeared to effectively moderate different functional-task biomechanics.

scholarly journals Applying the Minimal Detectable Change of a Static and Dynamic Balance Test Using a Portable Stabilometric Platform to Individually Assess Patients with Balance Disorders

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 402 ◽  
Author(s):  
Juan De la Torre ◽  
Javier Marin ◽  
Marco Polo ◽  
José J. Marín
Keyword(s):  
Center Of Pressure ◽  
Balance Control ◽  
Dynamic Balance ◽  
Static Balance ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Balance Test ◽  
Balance Disorders ◽  
Eyes Closed ◽  
Specialist Physician

Balance disorders have a high prevalence among elderly people in developed countries, and falls resulting from balance disorders involve high healthcare costs. Therefore, tools and indicators are necessary to assess the response to treatments. Therefore, the aim of this study is to detect relevant changes through minimal detectable change (MDC) values in patients with balance disorders, specifically with vertigo. A test-retest of a static and dynamic balance test was conducted on 34 healthy young volunteer subjects using a portable stabilometric platform. Afterwards, in order to show the MDC applicability, eight patients diagnosed with balance disorders characterized by vertigo of vestibular origin performed the balance test before and after a treatment, contrasting the results with the assessment by a specialist physician. The balance test consisted of four tasks from the Romberg test for static balance control, assessing dynamic postural balance through the limits of stability (LOS). The results obtained in the test-retest show the reproducibility of the system as being similar to or better than those found in the literature. Regarding the static balance variables with the lowest MDC value, we highlight the average velocity of the center of pressure (COP) in all tasks and the root mean square (RMS), the area, and the mediolateral displacement in soft surface, with eyes closed. In LOS, all COP limits and the average speed of the COP and RMS were highlighted. Of the eight patients assessed, an agreement between the specialist physician and the balance test results exists in six of them, and for two of the patients, the specialist physician reported no progression, whereas the balance test showed worsening. Patients showed changes that exceeded the MDC values, and these changes were correlated with the results reported by the specialist physician. We conclude that (at least for these eight patients) certain variables were sufficiently sensitive to detect changes linked to balance progression. This is intended to improve decision making and individualized patient monitoring.

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