Driving with a Prosthetic Leg

Many people wonder if it’s possible, driving with a prosthetic leg after undergoing an amputation. Limb loss (amputation) affects the ability to control a vehicle. Depending on upper or lower limb amputation, it can affect usage of the steering wheel, controls or pedals, or even your stability in the vehicle. You must be assessed for the level of impact, which will determine the conditions on your license, any vehicle modifications, or additional training with a rehabilitation driving instructor to enable you to drive. Below is some general information to get you started on the journey to get back on the road.

Can you Drive with a Prosthetic Leg?

man driving with a prosthetic leg

Steps to take:

It is a legal requirement that you notify the transport authority in your state or territory of any change in medical condition or surgery that affects your driving, including an amputation where you find yourself driving with a prosthetic leg.

The driver licensing authority in each state and territory has slight variations in its policies and standards. The standards apply to private, commercial, light, and heavy vehicles and motorbikes and you may need to complete multiple driving tests.

To be able to drive a vehicle you must complete a variation of the following steps based on your state/territory:

Make an appointment with your doctor/GP
  • They will need to provide a complete medical record.
  • Fill in any forms from your state/territory authority.
  • You may need additional medical reports from specialists.
Complete off-road assessment
  • Including asking you about your driving and medical history, testing your knowledge of the road rules, and assessing visual, sensory, and thinking abilities.
Complete occupational therapy driving assessment
  • Health professionals such as an accredited occupational therapist assess a patient’s medical fitness to drive to advise the driver licensing authorities about how the patient’s health and medical conditions might affect their driving ability.

(AFTD Guidelines have basic standards for each states process).

User Ability & Car Modifications

Depending on the user’s ability, you can drive a car with the original pedals if you have had a lower limb amputation.

  • You will need to learn how to manoeuvre your limb differently and this may also be dependent on the sensation in your limb for feedback.
  • As you can no longer move your ankle joint you will rely on feedback from your residual limb and proprioception (the feeling of where your limb is in space).

Features of your prosthesis are also important:

  • You should speak to your prosthetist about wanting to drive as they may need to consider this in the componentry used for the prescription of your prosthetic limb.
  • Adaptive equipment can also be installed in many vehicles.
  • Hand-operated brake and accelerator, automatic transmission and height-adjustable seats, etc.
  • Modifications enable many drivers with impairments to operate vehicles safely.
  • Power steering makes driving much easier for upper limb amputees.

License Conditions When Driving with a Prosthetic Leg

You may have a license condition that states you must wear your assistive device, only drive a specific vehicle or you can only drive an automatic vehicle.

Please contact your local state or territory for further information, alternatively, you can contact your state’s amputee association for guidance.

 

Written by:

Darrel Sparke, President of Amputees NSW.

APC would like to thank Darrel Sparke, for collaboration in writing this resource article.

Content created and adapted from:

 

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Diabetic Foot Care

Diabetes and How it can Affect the Foot

Diabetes is a serious complex condition that can affect the entire body, more specifically we cover diabetic foot care and how it can affect you. Diabetes requires daily self-care and if complications develop, diabetes can have a significant impact on quality of life and can reduce life expectancy. Your feet are at risk because diabetes can cause damage to the nerves in your feet, blood circulation, and infection. Having diabetes can increase your risk of foot ulcers and amputations. This damage is more likely if:

  • You have had diabetes for a long time
  • Your blood glucose levels have been too high for an extended period
  • You smoke – smoking causes a reduced blood flow to your feet, wounds heal slowly
  • You are inactive.

If your diabetic foot develops a wound this is known as an ulcer. If a diabetic foot ulcer is left untreated it can lead to an infection known as osteomyelitis inside the body/bone. Early and accurate diagnosis is necessary to ensure effective treatment and to reduce the likelihood of amputation. Improper diabetic foot care can increase the likelihood of amputation and is 15 times more common to occur in people with diabetes.

Diabetic Foot Care & What to Look out for

  • When you have diabetes, you need to take care of your feet every day
  • Daily care can prevent serious complications
  • Check your feet daily for changes or problems
  • Visit a podiatrist annually for a check-up or more frequently if your feet are at high risk

If you see any of the following- get medical treatment that *day*

  • Ulcer
  • Unusual swelling
  • Redness
  • Blisters
  • Ingrown nail
  • Bruising or cuts

If you see any of the following- get medical treatment within 7 days

  • Broken skin between toes
  • Callus
  • Corn
  • Foot shape changes
  • Cracked skin
  • Nail colour changes

Prosthetic Options

If you have had a partial foot amputation you can have a prosthesis custom made to suit your needs. This can also be called a ‘toe filler’ or bootie. The prosthetic device restores the anatomical shape of the foot and can be designed to reduce pressure and restore balance. Speak to your prosthetist about options best suited to you.

diabetes prosthetic foot option

 

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Prosthetic Legs

Individuals with lower limb amputation or limb difference, may use a prosthetic leg to mobilise.

Prosthetic legs come in a wide range of designs, depending on individual circumstances, such as amputation level, residual limb length and size, skin integrity, activity level, body weight, wants, needs and many more.

Prosthetic leg by itself

If an individual is missing part of their lower limb or has a lower limb difference, they may benefit from a this prosthetic. Common amputation/limb difference levels include, but are not limited to, below-knee, above-knee, knee disarticulation, ankle disarticulation, partial foot, hip disarticulation and Proximal Femoral Focal Deficiency (PFFD).

Pictured above is a PFFD socket

Prosthetic legs are generally made up of a socket, which is custom made to the individual’s residual limb, prosthetic components (such as a prosthetic knee and/or prosthetic foot) and connective components, that join the socket and components together. A mould or plaster cast is taken of the individual’s limb, which is then modified, to achieve this custom socket shape.

Man with one prosthetic leg walkingfree standing prosthetic

Osseointegration Surgery

For amputees who have undergone Osseointegration surgery, their prosthetic legs do not incorporate a socket, as their prostheses are “bone anchored”. This means their prosthetic components directly connect to a metal rod which has been surgically inserted into their bone.

This particular prosthesis can be designed to serve multiple purposes, depending on the individual’s wants, needs and abilities. It is common for most people to have an ‘everyday’ prosthetic leg and a ‘waterproof’ prosthetic leg. For those who partake in specific sports or recreational activities, they may also have an additional leg. For example, a running leg with running blade, or a prosthetic leg specifically designed for snow skiing. We are happy to work with you to figure out what type will be best suited to your needs.

Click on the link for more information about Osseointegration 

Prosthetic Leg Wear

It is up to an individual how much or how little they wear their prosthetic leg. However, it is always recommended to remove your prosthetic leg overnight when sleeping. Some users may only use their prosthetic legs for short amounts of time during the day, say for transferring purposes, and may choose to spend the rest of their time in a wheelchair as their main mode of mobility. Others may put their prosthetic leg on in the morning and not take it off until they go to bed at night.

Many users require prosthetic socks to maintain the fit and comfort of their prosthetic leg. Sock use is completely dependent on individual circumstances. Many amputees find their stump volume fluctuates during the day and they must accommodate these fluctuations by adjusting their prosthetic socks to suit. We can provide you with a range of different socks so you can always keep your prosthetic leg fitting well and comfortable.

Prosthetic legs can come in a wide range of colours or designs. Many people choose a fabric or design that they like, which we then incorporate into the final lamination of the socket. Others prefer their prosthetic leg to look as cosmetic as possible, with a colour suited to their skin tone and foam cover shaped to look like their other limb covering their underlying prosthetic components. There are also companies that make 3D printed prosthetic covers that can be fitted to your prosthetic leg.

Click here to find out more about cosmesis for your prosthetic leg

For more information check out our other resource pages, FAQ’s below or contact the team today through our enquiry form.

Prosthetic Leg FAQ’s

How do prosthetics work?

There are many different types of prostheses that all work in different ways, depending on their intended purpose. Most lower & upper limb prostheses incorporate a socket, which is customised to suit the individual’s residual limb, that is then connected to prosthetic components, such as a prosthetic foot, knee joint or terminal device.

What are most prosthetic limbs made of?

Prosthetic legs and other limbs are made up of different parts, which in turn are made up of different materials. Prosthetic sockets are commonly made using fibreglass or carbon fibre. Most prosthetic feet are made of carbon fibre. Titanium, aluminium and steel are common materials that connective prosthetic components are also made up of.

What does it feel like to have a prosthetic leg?

We manufacture our prostheses to try and make them as lightweight, tight fitting and comfortable as possible. As prostheses are unique and customised to each individual, each amputee would likely have different sensations and experiences of what using their prosthesis feels like.

How strong are prosthetic legs?

We ensure that your prosthesis is rated to your body weight and select components that are suited to your weight, activity and impact level.

 

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What Materials are Commonly used for Prosthetics?

The prostheses that are delivered to our clients are broken down into two groupings of prosthetic materials. The top of a prosthesis is a custom manufactured socket which is fabricated onsite within the APC prosthetic workshop. Moving downwards on the prosthesis is the second grouping of materials including structural components, prosthetic joints (i.e. hands/feet) and everyday consumables (i.e. liners/knee sleeves). These are always client-specific and ordered from a variety of prosthetic wholesale providers around the globe. Read below to find out further information on these materials used for prosthetics.

Materials used for Prosthetics

1. Prosthetic Sockets

Diagnostic Socket

To begin the journey of a definitive prosthesis, our clients are initially fit with a ‘Diagnostic Socket’ which is manufactured from their plaster cast. The primary aim of this socket is to optimise the socket fit, refine the alignment and ensure the prosthesis absolutely meets all necessary functional and comfort goals.

Materials Used for prostheticsA diagnostic socket utilises materials in prosthetics which are suitable for a short-term trial period. These include thermoplastic sheets which are heat blistered and vacuumed onto the clients plaster cast. Following this step, the socket is attached to a lamination anchor which provides the connection between the custom-manufactured prosthetic socket and the remaining prosthetic componentry (ie. Prosthetic foot). To ensure safety and security, the anchor is secured to the socket. This can be done in a variety of ways from wrapping it in a fibreglass bandage, laminating carbon fibre or fibreglass over it. Once this is achieved, the diagnostic socket is ready for a short trialling period!

 

Utilising a rigid thermoplastic is beneficial in two ways. Firstly, it allows for reheating and adjustment so that pressure areas can be relieved. Secondly, the clear plastic allows the prosthetist to inspect the fit across the entire residual limb whilst the prosthesis is donned.

Definitive Socket

Once the prosthetic socket fit and alignment have been optimised, the diagnostic socket is ‘duplicated’ creating an identical plaster mould which allows our client to continue to wear their prosthesis whilst an APC technician concurrently manufactures their ‘definitive socket’. In addition, the duplication process allows for an identical alignment to likewise be captured which streamlines the definitive fitting process and removes the need for major alignment adjustments.

The materials used for prosthetics and the definitive socket vary considerably depending on the client’s presentation, suspension method and socket interface. Irrespective of these variables, all definitive sockets will undertake at least 2 separate laminations, they can manufacture with a single lamination however 2 is more common with varying amounts of prosthetic materials.

The plaster cast will be first either sealed with lacquer, a compressible liner, PETG or a flexible inner depending on what the prosthetist has deemed most suitable to the client. Next, a client-specific amount of carbon fibre, aramid fibre or fibreglass braid/matte is laid onto the socket and reinforced with unidirectional carbon fibre tape. It’s then sealed under vacuum with an acrylic resin which penetrates and solidifies the material. The initial lamination is focused on creating a strong, structured framework.

As the alignment has been duplicated in a jig transfer, the lamination anchor is attached in a similar process to diagnostic sockets. However, for the fabrication of the definitive socket, a great deal of detail and attention is paid to create a cosmetic appearance with the use of foam and putties.

The second lamination utilises similar materials to the first, however, its focus instead shifts towards strength and security of the lamination anchor to the socket. Importantly, each lamination is completely different because every client presents slightly differently in terms of, mobility, weight and intended activities (such as running).

Specialised Sockets (Design)

Many clients opt for a specific design to finish their prosthetic sockets ranging from Indigenous Art to sports teams – there is such a variety! Clients are encouraged to bring in fabrics, old t-shirts or designs which they desire on their final socket.

Specialised Sockets (Waterproof)

As an Island Nation with blistering summers, waterproof prostheses are essential! The lamination process is largely similar; however, it includes two additional laminations to finish with a cosmetic appearance which reflects the sound side limb. The APC technician precisely shapes foam around the socket according to the client’s measurements. This process removes the need for standard tube clamps and pylons which rust in water-based environments.

Specialised Sockets (Cosmetic Finish)

Similarly, to a waterproof prosthesis, a cosmetic finish utilises a foam which is shaped by an APC technician according to client measurements. Tracings of the sound side limb can be taken to ensure the prosthesis is as aesthetically appeasing as possible.

Specialised Sockets (Recreational)

Recreational socket materials used for prosthetics

The initiation of the National Disability Insurance Scheme (NDIS) has allowed many clients the opportunity to explore a recreational prosthesis such as running blades, rock climbing arms/legs, weight-lifting arms, surfing legs, cycling legs and many more. The custom design and materials used in prosthetics, allow for many recreational prostheses to be achieved.

Final and definitive prostheses reflect the great deal of detailed hours undertaken by both the prosthetist and technician to create custom-manufactured prosthetic sockets.

2. Prosthetic Componentry

Underneath the prosthetic socket is the second grouping of prosthetic materials – componentry. These are manufactured on a large scale by prosthetic wholesale companies across the globe producing materials in prosthetics such as feet/hands, connective componentry, pins/locks, valves, pylons, adaptors, liners etc.

Importantly, despite being mass-produced, the prosthetist orders componentry which specifically meet a client’s presentation, goals and intended activity. For example, one prosthetic foot may entail up to 10 different weight categories, it’s essential to obtain the current category for the client to ensure the best possible outcome.

I. Feet

  • Wood, plastic, and foam are usually materials used in prosthetic feet designed for individuals who have low activity levels and require stability
  • Carbon fibre feet is also one of the materials used in prosthetic feet designed to meet one’s functional needs for shock absorption and energy efficiency

II. Connective Componentry

  • Aluminium, stainless steel, carbon and titanium are materials used in prosthetic connective componentry.
  • Standard adapters are used to build the prosthesis, connecting the socket to a prosthetic joint and/or to a terminal device/foot.
  • Functional adapters such as torsion and rotation adapters help make every day and/or recreational activities easier for patients by expanding the abilities of their prostheses.

For more information on materials used for prosthetics please get in contact with the team below!

 

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Lower Limb Amputation

Lower Limb and Leg Amputation is a life changing experience. Our APC Prosthetics team are here to help with every step of this journey. Our philosophy is to work with new amputees to comprehensively assess their needs, establish their requirements and deliver the appropriate solutions.

The first phase of the prosthetic rehabilitation process is what is known as an Interim Prosthesis. This process typically begins approximately 6 weeks after the leg amputation when the wound has sufficiently healed. Following the use of a stump shrinker (a specialised compression sock for amputees) to stabilise the limb, our prosthetic team will then go through the process of making a plaster cast of the residual limb, which is modified for each client to achieve a comfortable socket.

There are many methods of suspending a prosthesis to the limb and the prosthetist will select the most appropriate for the client/patient. The socket is attached with various connective componentry to a prosthetic foot. Like with suspension systems, there are hundreds of feet available, and the prosthetist will prescribe a prosthetic foot that best suits the ability, potential and goals of the patient.

When the interim prosthesis is ready, the client will return for their first prosthetic fitting where our team will assess the socket-fit and determine optimal alignment. It is expected that the residual limb will go through changes in shape and volume for the first months, which means the first prosthesis will undergo regular modification. For more information around lower limb amputation and leg amputation, please fill out the contact form below and one of our amazing team members will get in touch with you.

For more information on Lower Limb Prosthetics please read more here.

 

Young child receiving advice around leg amputation

 

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Prosthetic Knee

The Prosthetic knee mechanisms for above knee amputees have had some impressive technological enhancements in technology available in previous decades and continues to do so. These improvements which has helped improve the functionality and safety of the prosthetic knee. Most notably in these improvements is Microprocessor controlled knees (MPK’s). Technological enhancements have integration of hydraulic and pneumatic which is present in most modern-day knees. This allows the knee units to become adaptable to the surrounding area which is imperative when walking on slopes and stairs.

Microprocessor Controlled Knees

prosthetic knee

MPK’s are currently implementing designs of a multi-axial knee units which has shown increased stability without the drawback of higher energy expenditure. These improvements made to prosthetic knees allows our prosthetists to create a prosthesis that works to best achieve the most out of your lifestyle and goals that you want to achieve. Along with the enhancements with prosthetic knees, there is now a variety of socket design styles, suspension methods, prosthetic feet, and knee units; your prosthetist will work closely with you to find the most appropriate style based upon your level of amputation, functional capabilities, goals, and activities that you enjoy to the best of your abilities.

 

Knee prostheticsSome of our designs such as our recreational limb was put together for a client that has dreams about hitting the slopes and waves with their prosthesis.

However, in trying to achieve the best outcome for our clients we are willing to above and beyond in creating the best prosthesis to suit your needs. Another one of our designs showcases a Rheo Knee with a revofit boa dial (seen above) which helps to bring relief to the limb and reducing the energy needed to walk and control rotation. To read more on lower limb prosthetics click here.

Prosthetic Knee FAQs

How many hours can you wear a prosthetic knee?

This is completely dependent on the individual user and their needs, wants and abilities. Lots of people wear their prosthetic knee from when they first wake up in the morning until they are ready to go to bed at night. Other people might only wear theirs for certain activities during the day, such as transferring from bed to wheelchair. Most importantly, a prosthesis should not be worn when sleeping as this can cause unwanted pressure areas to the residual limb.

What is the routine maintenance required for a prosthetic knee?

We recommend that prosthetic users are reviewed at least every 6-12 months for regular maintenance and upkeep of their prosthesis. This time frame may vary depending on individual circumstances, such as change in body weight, body fluid, volume fluctuations, change in activity level, etc. If you are experiencing any issues with your prostheses it is recommended to call our clinic and make an appointment straight away to have your prosthetic knee reviewed and adjusted accordingly.

How are prosthetic knees attached to the body?

The most common way a prosthetic knee is attached to the body is through a prosthetic socket. This is a custom-made socket made from a plaster cast or mould taken of your residual limb. It is modified in a way to ensure comfort and fit when wearing and has attachments for distal prosthetic components. For amputees who have undergone Osseo-Integration surgery, they do not need a socket, as their prosthetic components attach to a metal rod which has been surgically inserted into the bone of their residual limb.

 

 

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Prosthetic Foot

Prosthetic Foot & Ankle

The human foot-ankle is a very complex functional unit. It provides stability as well as flexibility and utilises muscle to generate energy for efficient and comfortable walking. Through the improvements and advancements in the making of the prosthetic foot made to the design and manufacturing of prosthetic feet. These improvements allow for much more energy efficient and improvements in walking.

Each client is unique and every one of them has different needs and lifestyles as it is vital to choose the most appropriate prosthetic foot to achieve maximum comfort and function. Material used in this prosthetic is lighter and more durable which results in an improved comfort and function. Not only just making prosthetic feet but the customisation of amputee fins for those clients who have a passion for getting into the water and swimming or surfing for example. To find out more about our Lower Limb Prosthetics click here.

prosthetic foot

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Care for your Skin

How to clean your residual limb

Being a new amputee now requires you to take care of the skin on your residual limb. We have created a simple 3 step process that shows how to best clean your residual limb. A combination of washing the limb with soap and moisturising the limb regularly will not only make it easier to wear your prosthesis, but will also reduce the frequency of rashes, bacterial infections etc., from appearing on your residual limb. For more information about other skin issues, please download the Residual limb care guide at the bottom of the page.

Step 1: Wash with a mild soap (pH = less than 7)

Step 2: Moisturise after wash to prevent dryness. Only apply moisturiser in the evening.

Tip: If you are a new amputee or have high volume fluctuations in your limb, it’s recommended to shower at night. The heat of the shower and your limb hanging down can make it harder to don your prosthesis in the morning when most users experience their highest volume of the day already. Give it a go!

Care for your Prosthesis

Upper Limb (UL) users: Your socket should be cleaned weekly. You should regularly clean the hand and/or cosmetic glove.

Transtibial (BK) users: Your socket should be cleaned weekly.

Transfemoral (AK) Users: Your socket should be cleaned daily.

 

How to clean your socket & components

When cleaning your socket, wipe your socket with a damp cloth and a mild detergent and dry it thoroughly before you put it back on. It is not necessary to use an antiseptic to clean your socket.

Tip: Never use Dettol or other solvents to clean your socket or liner.

 

Wet/Dirty Prosthesis: It’s important to clean the components as well as the socket. Tip your prosthesis upside down to empty any water out of the foot shell. Use a shoe horn to lever off the foot shell. Remove, clean and dry the spectra sock (nylon sock between the foot shell and carbon fibre foot). Rinse out and dry the foot shell. Put the spectra sock back over the carbon fibre foot and use a shoe horn to reattach the foot shell.

 

Cosmetic Cover: If you have a cosmetic cover, it is important to keep this clean as well. A hard cover can generally be cleaned in the same manner as your socket. A soft/foam cover with stockings – you can wash the stockings as you would any hosiery/delicates. Wipe the foam with a slightly damp cloth and allow to dry before redonning the stockings.

Tip: Remember, keeping your prosthesis clean and drying after getting wet is crucial for maintaining longevity of the components and preventing rust or damage.

Support Services

Physiotherapy, Occupational Therapy & Exercise Physiology

Physiotherapy is currently available onsite at APC ‘s Alexandria and Northmead offices to assist amputees in varying stages of their prosthetic usage:

  • Gait re-education from initial fitting of the first prosthesis through to advanced functioning (eg. return to recreational activities, running, gym programs).
  • Upgrading/teaching the use of a new prosthetic prescription.
  • A program for the use of micro-processor knee joints.

Physiotherapy at APC Prosthetics is provided by Cathy Howells, a registered physiotherapist with a special interest in amputee rehabilitation and over 30 years’ experience working exclusively with amputees.

It is important as an amputee or someone with limb difference to maintain good muscle strength, flexibility and stability, to ensure your ability to use your prosthesis continues well into your later years. Working regularly with a physio throughout your life as a prosthetic user, can act as a reminder to engage the muscles you may not be using as much as you should be, or to help you kick some bad gait habits you may have developed. OTs can help you learn how to use your prosthesis (especially Upper Limb) for specific tasks and training, along with recommending any modifications that need to be made to your home or car. EPs are great for ongoing amputee targeted training, or if you have a sport or recreational activity you would like to learn to get back to or start doing since being an amputee.

How you access a physiotherapist and other allied health services depends on your funding.

  • ENABLE: https://www.enable.health.nsw.gov.au/
    • A referral from your GP will be required, you can get 5 free PT visits per year if you are on a care plan. We can assist by writing a referral to back up your need for this support service.
  • NDIS: https://www.ndis.gov.au/
    • Talk to your planner at your next plan review to ensure there is sufficient funding available for the number of visits you require for the length of plan. Your prosthetic AT Assessment and request will advocate for any additional services deemed necessary for you to succeed with your prosthesis and goals.
  • INSURANCE: This will be negotiated with your case manager.
  • PRIVATE: There is always the option to go directly to a PT etc if covered by private health insurance or by paying directly. Your prosthetist can write a letter of referral/handover to communicate with your chosen provider in order to best help you succeed.

Medical Services 

The team at APC Prosthetics work closely with your rehabilitation specialist to ensure you receive the best treatment outcomes based on your health, healing and any other medical conditions that may affect your prosthetic use. Due to the long history of APC attending many amputee clinics for over 20 years, we have solid communication and a multidisciplinary team approach that leads to the quality service you will receive.

 

Support Services:

  • LIMBS4LIFE: https://www.limbs4life.org.au/
    • Limbs4Life is a charity that provides peer support options, amputee resources and wellbeing information. They also provide independent support to help you navigate disability and health-care system. They also offer social events and activities for amputees of all ages.
  • AMPUTEES NSW: https://www.amputeesnsw.org.au/
    • Amputees NSW is a volunteer based community organisation that provides support to anyone affected by limb difference. They aim to improve access to quality programmes, and news of upcoming events.

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