Ready, Set, Read – Learn The Skills Required For Reading

Learn The Skills Required For ReadingWe make reading a ritual in our home.  To me, reading is… evening book clubs with friends, foggy mornings with a newspaper (albeit digitally) and a cup of joe, cold nights cozied up with my Kindle, and an entertaining, People magazine at the hair salon. But, for many, reading is not the above; it is not an enjoyable experience to cherish. According to the Department of Education, 32 million adults in the U.S. cannot read. That is 14 percent of the population. Initially, I was shell-shocked at that number. Then, I donned my speech language pathologist hat and recognized – with clarity- that becoming literate is a rigorous, laborious process. In this article, I will discuss the components of literacy, how literacy and language are connected, and how to foster literacy in your home.

Reading, the ability to translate print into meaning, results from two skill sets: decoding (sounding out letters) and comprehension (understanding text).3 Fluent decoding involves a mastery of phonemic awareness skills, such as sound blending (b–a–t = bat), sound manipulation (p-a-t can become t-a-p, by switching initial and final phonemes), sound segmenting (bash = b–a–sh), and rhyming (i.e. cat/mat).

In a perfect world, English would be an alphabetic language with a one-to-one correspondence between the phonemes (sounds) and the graphemes (letters). This would make decoding a breeze.  However, English contains 26 letters and approximately 40 sound units that connect to it. Ever wonder why the word “was” does not rhyme with the word “pass?” Because of English’s complexity, beginner readers must use both phonics and context for decoding accuracy. Decoding provides a bridge between word recognition and reading comprehension, but it is not the “end all, be all.”

Research notes that those who decode rapidly, accurately, and efficiently do not spend a ton of cognitive energy doing so. Because of this, they can focus readily on comprehension. Furthermore, individuals with efficient decoding skills are motivated to read widely; reading is seen as fun. This wide reading enhances their reading skills through practice.

Less fluent readers, however, must focus their attention on decoding, leaving little cognitive energy for comprehension. Reading is not deemed fun, rather more of a chore. These individuals become motivated to avoid reading. This avoidance, in turn, limits the development of their reading skills. As a result, the gap between achieving and non-achieving readers widens throughout school and into adulthood.

Tools To Expand Language Skills

Speech language pathologists view reading as a powerful tool to enhance and expand language skills. Reading exposes children to new words, which leads to increased vocabulary and refined grammatical skills. In therapy sessions, I often use books as pre-learning activities. For example, when facilitating the expression of the spatial term “around,” I first read the book, Whoosh around the Mulberry Bush with my client (receptive learning). Then, I act out the book with the child using props (gross motor). I follow up with a painting activity, having the child illustrate the concept on paper (fine motor). Lastly, I tempt the child into using the new spatial word in a prompted conversation (expression).

This type of activity is suitable for many concepts: color words (i.e. red, peach, aqua), number words (i.e. three, seven, fifty), positional words (i.e. first, third, last), and descriptive words (i.e. wet, dry, smooth). Research reiterates, that a child’s first encounter with an unfamiliar word only leads to partial word knowledge, but each additional encounter is an opportunity for a more complete understanding.

Reading Should Begin From Birth

When should you begin reading to your child? From birth, children benefit from hearing your voice, listening to sounds and rhymes in books, and bonding intimately with you. When reading with your child, the most important thing to do is follow his (or her) lead. Let your child pick the book. Observe him while you read. Is he looking at the book, or is he looking at the toy in the corner? If your child is not attending, change your delivery method.

You may decide to start pointing to the pictures in the book and talking about them instead or decide to make your voice sound silly. You could choose to read in the dark with a flashlight. Or, you might choose reading time is over. With shared reading, you are also teaching your child basic, book-knowledge: reading occurs from left to right, how to hold a book correctly, and that printed words correlate to spoken words. So much valuable learning, yet unintentional, occurs during shared reading time. Don’t give up if your child seems unmotivated by books.

For my son, only books with trains, cars, or construction vehicles sustained his attention (and, I mean for very, very, short intervals). He would literally throw any other books across the room. From 18 months of age to 24 months, I had to use visual prompts such as play dough stuck on the pictures for him to remove, a magnifying glass circling the pictures, or a flashlight pointing at the pictures to keep his attention. Books with flaps and sensory tabs also helped gain his attention. However, by age 3, he was on his way to loving all books, without all the visual prompts too.

Reading is a learned skill

Reading is a skill that must be learned, like swimming. It is not innate; we must help our children develop mastery over time. We must be their best cheerleader. We must be their facilitator. That said I believe that reading, most importantly, is a time to bond with your child, a time to listen to your child, and a time to enjoy your child’s company. As we all know to well, time flies – soon enough our children will not need nor want our help. Currently, at our house, reading is a nightly ritual. One we all anticipate and enjoy. It marks the end of our day, winds us down from the stressors in our lives, and gives us time to snuggle and chat.

I encourage you to make reading a ritual in your home.

Aimee Brigham, MCD, CCC-SLP

References:
1. US Department of Education, Statistic Brain, August 22, 2016.
2. “Literate.” Merriam-Webster.com. Merriam-Webster, n.d. Web. 19 Aug. 2014.
3. Chard, D., Pikulski, J., Templeton, S., (2000). From Phonemic Awareness to Fluency: Effective Decoding Instruction in a research Based Reading Program. Houghton Mifflin Reading.
4. Harris, T.L., Hodges, R.E. (1995). The literacy dictionary: The vocabulary of reading and writing.
5. Anglin, J.M. (1993). Vocabulary development: A morphological analysis. Monographs of the Society for Research in Child Development. 58(10, Serial no. 238.).
6. Cunningham, A.E. & Stanovich, Kieth (1986). What reading does for the mind. American Educator, 22, 8-17.

Stuttering: When to seek out a Speech Language Pathologist

Stuttering

Aimee Brigham, MCD, CCC-SLP

The Hollywood blockbuster, The King’s Speech, illustrated – with acute accuracy – the impact of stuttering on self-worth, friendships, and daily activities. Individuals who stutter face speech challenges that fluent speakers take for granted. The boy who must cope after a caller hangs up on him because he cannot say hello; the woman who does not get a promotion because she cannot speak fluently to her team; the man who takes a factory job so he does not have to speak with others; the girl who orders vanilla ice cream because she knows she cannot say chocolate; the child who responds, “I don’t know,” to the teacher’s question because he cannot answer fluently. Stuttering interferes with school, work, and social interactions. In addition, some individuals who stutter report fear or anxiety about speaking and frustration about the time and effort required to speak.

What is stuttering?

Stuttering is defined as an abnormally high frequency and/or duration of stoppages in the forward flow of speech. On the opposite speech continuum, fluency is the rate, rhythm, and ease with which a person speaks. Please note that everyone experiences dysfluent speech at times. This is normal. Children -when tired- become dysfluent. Adults -when nervous or stressed- become dysfluent. In fact, after reading this article, you will notice dysfluencies in your speech. If the dysfluencies become commonplace, struggled, and/or avoided, a stuttering classification is possible.

As a parent and a speech therapist, I readily noticed dysfluencies in both of my children’s speech (more prominent with my son) during the preschool years. The dysfluencies started around the age of 2.5-3 years. And, interestingly, research states that the majority of stuttering begins between speech onset and puberty, most often between the ages of 2 and 5 years. You may be thinking, “I bet you were worried?” And, if you knew me, you would know that I have the ability worry about anything-literally. I fretted over my daughter’s name, Rayna, starting with an /r/ for years (it is a family name). The phoneme /r/ is a tricky phoneme to correct. Stuttering, however, I was not distressed about. This is why…

First off, the prevalence of stuttering (total number of stuttering cases at a specified time) is extremely low, 1% in pre-pubertal school children. The incidence of stuttering (the total number of people who have stuttered at some time in their lives) is 5%. The difference between the incidence and the prevalence indicates that most people recover from stuttering episodes.

Secondly, preschool children typically demonstrate some word and phrase repetitions, interjections, and revisions in their speech. In other words, dysfluency is the norm for young children acquiring language complexity. In order to express thoughts and ideas, one must process information relevant to the topic, organize thoughts into a grammatically correct form, and establish accurate semantics (vocabulary). Dysfluencies can “buy time” for the novice speaker.

The following list represents typical dysfluencies seen in preschool-aged children:
Repetitions – sound (h-h- hat), syllable (buh-buh- boy), or one-syllable words. (I-I-I was going).
Interjections- use of “fillers” (Let’s get – um- um – you know – pizza tonight for hmmm dinner).
Revisions – changing the sentence/phrase structure (I eat- I ate an apple).

Lastly, incipient stuttering has different characteristics than typical dysfluencies. It is characterized by more within-word dysfluencies, sound prolongations, and broken words. Charles Van Riper, a renowned speech therapist who also stuttered, stated, “It is the broken word that characterizes the majority of the stutterer’s difficulty.”

The following is a list of atypical dysfluencies:
Blocks/Broken words – stoppage of airflow or speech (Yesterday, I w—-ent to school.)
Prolongations – sustained articulation of a sound for lengthy amount of time (sssssssee ssssssssaw.)
Incomplete phrases – the thought and content of an utterance are not completed, and it is not an instance of phrase repetition (She was-and after she got there, he came)

Since most children who stutter, begin so around 2 ½ years of age, you may find yourself wondering what you can or should do as a parent if you notice your child’s speech becoming “bumpy.” Here is my professional advice.

If the dysfluencies fall mainly into the typical dysfluency examples and your child is not showing signs of struggle, I suggest you focus on indirect approaches to fluency. These include slowing your rate of speech down when speaking to your child, maintaining eye contact during dysfluencies, toning down excessive stimulation in the environment during communicative interactions, and allowing your child to finish his/her thoughts unassisted. Allow a few months to pass, as the pre-school years (2.5 years to 4 years) are usually a time of significant language growth. Reassess. If the dysfluencies get worse or continue long term, it may be time to see a speech therapist for a formal evaluation of speech fluency.

If the dysfluencies seem excessively frequent, struggled, and some atypical dysfluencies are noted, a formal evaluation may be warranted. Once the assessment is complete, fluency treatment approaches will be recommended based on the child’s needs and the family’s communication patterns. For preschool children who stutter, parent involvement in the treatment process is essential, as is a home treatment component.

Risk Factors:
Sex of child – boys are at higher risk for persistence of stuttering than girls.
Family history of persistent stuttering.
Time duration – stuttering lasting longer than 6 to 12 months, or minimal improvements over several months.
Age of onset-children who start stuttering at age 3½ or later.
A co-occurring speech and language impairment.


Do you have questions about stuttering?

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References:
Andrews, G (1983). Stuttering: A review of research finding=gs and theories circa 1982. Journal of Speech and Hearing Disorders, 48, 226-246.

Ezrati-Vinacour, R., Platzky, R., & Yairi, E. (2001). The young child’s awareness of stuttering-like disfluency. Journal of Speech, Language, and Hearing Research, 44(2), 368-380.

Kraft, S. J., & Yairi, E. (2011). Genetic bases of stuttering: The state of the art, 2011. Folia Phoniatrica et Logopaedica, 64, 34-47.

Mansson H. (2007). Complexity and diversity in early childhood stuttering. In J. Au-Yeung & M. Leahy (Eds.), Proceedings of the Fifth World Congress on Fluency Disorders (pp. 98-101). Dublin, Ireland: The International Fluency Association.

Mewherter, M. (1012). Cincinnati Children’s Hospital Medical Center: Best evidence statement: Evidence based practice for stuttering home programs in speech-language pathology.

Ntourou, K., Conture, E. G., & Lipsey, M. W. (2011). Language abilities of children who stutter: A meta-analytical review. American Journal of Speech-Language Pathology, 20(3), 163-179.

Peters, T.J., & Guitar, B. (1991). Stuttering: An integrated approach to its nature and treatment. Baltimore, MD: Williams & Wilkins.

Shapiro, David (1999). Stuttering Intervention: A collaborative journey to fluency freedom. Austin, TX: PRO-ED.

Van Riper, C. (1982). The Nature of Stuttering (2nd ed). Englewood Cliffs, NJ: Prentice-Hall.

Yairi, E., & Ambrose, N. (2005). Early childhood stuttering for clinicians by clinicians. Austin, TX: PRO-ED.

Yaruss, J. S., LaSalle, L. R., & Conture, E. G. (1998). Evaluating stuttering in young children: Diagnostic data. American Journal of Speech-Language Pathology, 7(4), 62-76.

Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update. Journal of Communication Disorders, 37(1), 35-52.

Play with your children to build language

Play with your kids to build language

Aimee Brigham, MCD, CCC-SLP

Did you know that playing with your children builds language?

When parents observe therapy sessions, they often remark, “What fun! Playing all day.” They are absolutely right. Pediatric, speech-language pathologists love to play. What sometimes goes unrecognized is that this type of play can be hard work for both the client and the clinician. Speech therapists often use goal oriented play in their sessions, whether it is aimed at teaching a child to articulate /s/ accurately, or modeling the use of irregular past tense markers, or increasing comprehension of 2-step directions, or engaging a child in a turn-taking activity. In fact, most pediatric goals are initiated and practiced during playful interactions because “play offers an opportunity to organize intervention episodes that engage children and facilitate practice (Adler 2012).”

Throughout my practice, I have witnessed many children who need to learn how to play. For them, playing did not come innately or by watching others play. Playing is the way friendships are woven in youth. And, every parent wants his or her child to play with other children. Some children do not demonstrate the ability to stack blocks, to talk on a make-believe phone, to feed a baby doll, or to take turns with a peer. Intervention targeting play foundations is an important speech and language goal for these children. Leslie Adler adds, “Playing is one of the primary occupations of children, and when they are playing they are participating in life (Adler, 2012).” Stating the position of the American Academy of Pediatrics, Kenneth Ginsburg says, “Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth (Ginsburg, 2007).” As one can see, the common phrase, “Let’s play!” is quite complex when underway.

What is Play?

Play is a process – the outcome is not as important as the process itself.
Play is child-initiated. Activities are created for no other reason than experimentation.
In play, everything and anything can happen: a sheet over a table becomes a castle and the little girl inside the princess. Functions of objects are transformed.
Play becomes an arena for testing rules, both logical and illogical. Rules freely appear and disappear in play.
Play is an activity of the mind. Children may become deeply engrossed in play and find it difficult to stop. (S.C.Hurwitz, 2003)

Free play, play that is child-driven, rambunctious, and unstructured, is the most important kind of play (S.C. Hurwtiz 2003). During free play, children learn new vocabulary and increase auditory comprehension skills. They practice cognitive skills including, problem solving, creativity, and self-regulation. Social skills are demonstrated during play when a child initiates, interacts, and compromises with his or her communicative partner. In addition, strategies to cope with feelings of excitement, fear, anger, and frustration are vented during play. Children are constantly learning and growing during play. “Having control over the course of one’s own learning, as in free play, promotes desire, motivation, and mastery (Erikson, 1985).”
Now let’s talk about being successful when playing, as success is very important. Without a feeling of success, participation and engagement decrease. Some children may revert to atypical types of play, such as repetitive play and self-stimulating play. For play to remain organic and fun, scaffolding, giving support, is necessary. Scaffolding can take many forms, from altering the environment to encourage play or decreasing distractions to encourage focused attention. Using visual aids to assist in play sequences and modeling language needed for games and playful interactions are also considered scaffolds.

Stages of play:

Exploratory Play (around 6-8 months) – At this stage, children are becoming familiar with objects through observation and exploration. This play is not goal oriented. Children are motivated to understand more about the objects in play. Fingering, mouthing, banging, and listening are witnessed at this stage.
Constructive Play (around 12 months) – Here, children manipulate their environment to build things. Toys are used for their intended purpose (building with blocks, drawing with markers, digging in sand, brushing a doll’s hair). Constructive play develops imagination, problem-solving skills, fine motor skills, and self esteem(R. Owens 2011).
Symbolic Play (around 18 months)–Children use objects to represent other objects in play. They may use a block as a train or a plastic banana as a telephone.
Rules and Games (school aged) – Children impose rules and roles during play at this stage. Self-regulation, cooperation, and flexibility are needed (Frost 2004). Here, children are seen role-playing life scenarios, making rules to pretend games, and playing games with set rules.

In today’s world of after-school schedules and modern technology, children seem to be playing less and less. Technology, screen time, has replaced time spent playing alone, with a friend, or with a sibling. In addition, free play in school is sneakily being redefined as choice time or center time in an effort to keep classrooms calm with engaged students. School districts are reducing recess time and creative arts time to focus on mathematics and reading (Dillon, 2006). Pediatricians want children playing more; they want children interacting with peers and increasing their fun, rambunctious, free-play (Ginsburg 2007). Right now, you may be asking, “How can I increase free play in the home?”
Here’s how…Be silly, get creative, and have fun with your kids. Schedule times in the day where children are expected to play alone for short intervals, younger children may require scaffolding and very short intervals to be successful at independent play. It is OK for children to state they are “bored.” Sometimes when children are “bored” they are really thinking, problem solving, and reflecting on life events. And mostly, play should not be work. The point of play is that is has no point.

Play Temptations by Stage:

Exploratory play – Schedule times in the day where you can sit, eye-level and face to face, with your child and explore toys. Seek out objects that make noise, have cause and effect, and are brightly colored. Model language and exploration during play.

Constructive play – Sensory bins (i.e. sand, water, rice) are great for this level of play. Model pouring, shoveling, burying, and stirring. Watch your child to see what interests her/him, model language and expand on his/her verbalizations.

Symbolic play – Promote pretend play activities by setting up an environment of play, such as a barber-shop, a doctor’s clinic, or a pizza parlor. Help your child make symbolic items to be used in play. For example, a pizza oven can be made from an used gift box; play dough can pizza dough.

Rules and Games – Research shows that visual aids help children create imaginary play and promote language (Adler 2012). Make imaginary play bins: bins filled with scarves, eyeglasses, and silly slippers. Place a large mirror in the play space, children love watch themselves acting silly. Have a box of old-school board games available: chutes and ladders, operation, connect four, Hi-Ho Cherrio, etc.

Resources
Adler, L. “Linking Play to Function: Utilizing NDT and SI Strategies to Facilitate Functional Skills Through Play.” Education Resources. 2012 p.1-10.
Dillon S. Schools cut back subjects to push reading and math. New York Times. March 26, 2006;1:1.
Erickson, R. J. (1985). Play contributes to the full emotional development of the child. Education, 105(3), 261-263.
Frost, Joe L., Pei-San Brown, John A. Sutterby, Candra D. Thornton. The Developmental Benefits of Playgrounds. Olney, MD: Association for Childhood Education International, 2004. p. 25.

Ginsburg, Kenneth. The Importance of Play in Promoting Healthy Childhood Development and Maintaining Strong Parent-Child Bonds, Pediatrics.2007, 199:182-191.
Hurwitz Sally C. To be successful: let them play! Child Educ. 2002/ 2003;79:101–102.
Metrocom International (Producer) for Michigan Television. (2007). Where do the children play? [DVD]. Ann Arbor: Regents of the University of Michigan.
Owens, Robert. Language Development: An Introduction. Allyn and Bacon, 2001. Print.
*Why Do Children Play?” Mesa Community College. The Developmental Psychology Student NetLetter. http://www.mesacc.edu/dept/d46/psy/dev/Spring98/earchild/index.html > 27 Aug. 2010.

Twick o’ Tweet – The Science Behind Sound Distortions

Halloween

Aimee Brigham, MCD, CCC-SLP

Ever notice a child’s speech pattern that sounds, for lack of better terms, off? If not, you may notice this nuance October 31st, Halloween. The all so familiar Halloween jingle contains two, very tricky phonemes: /r/ and /l/. A phoneme is defined as a unit of sound that distinguishes one word from another. The phonemes /r/ and /l/ are called- liquids. Liquids are made when the tongue produces a partial closure in the mouth, resulting in a resonant, vowel-like consonant. In fact, liquids can even act as the sound carrier in a word, such as in the word, battle.

How important are these liquids in our speech pattern? Research states that seven consonants /n,t,s,r,d,m,z/ account for over half of all the consonant occurrences in our language (Shriburg and Kwiatkowski, 1983). The liquid /l/ also occurs very frequently in connected speech; it is ranked the 9th most frequent phoneme in the English language (Shriburg and Kwiatkowski, 1983). As one can see, these two liquids can affect intelligibility greatly if they are not mastered.

Speech mechanics involve complex motor sequences where timing and placement is critical for clear articulation of phonemes. Most children move through developmentally appropriate misarticulations when acquiring speech (See chart). Misarticulations can take many forms: substitutions – switching one phoneme for another (child says gog for dog), omissions – simply omitting a phoneme from word (oran for orange), and distortions – articulating a sound that is similar to the targeted phoneme (fis for fish), and additions – adding a sound (bulack for black).

The phoneme /r/ tends a nightmare for speech pathologists. Why?  First off, /r/ makes very different sounds depending on where it is located in a word. For example, take the /r/ in robot versus the /r/ in court verses the /r/ in butter. In the therapy setting, /r/ is often broken down into Prevocalic /r/ and Vocalic /r/.

Secondly, the articulators for /r/ are difficult to visualize when modeling productions. Unlike /f/ which is clearly visible to the discerning eye, the articulators for /r/ are hidden in the oral cavity and complicated to explain to young children. Moreover, /r/ can be made using two very different tongue placements: retroflex position (tongue curled) and bunched-back position (tongue humped). Many speakers use both positions depending on the location of /r/ in the word or phrase; in connected speech, efficiency trumps.

Luckily, the other liquid phoneme /l/, although difficult, is a bit easier to correct. The phoneme /l/ is a lingual-alveolar, meaning the tongue tip touches the alveolar ridge while the vocal cords add voicing. Many speech therapists will use other lingual alveolar sounds /t,d,n/ to elicit a clear /l/ production. Past research states that most children articulate adult consonants around age 8-9, once permanent teeth are in place. (Templin, 1957).

When developing motor speech goals, developmental norms, stimuability, and occurrence in speech should be considered. The late Pam Marshalla, a speech-sound expert, states, “Using the norms as a basis of deciding when to enroll clients in therapy is a remnant of an earlier age. Stimulability and readiness are more important determining factors today.”

What is the importance of articulating sounds accurately? Children who exhibit speech distortions appear younger, as a result conversations may be unintentionally simplified. Also, children with speech sound disorders have an incomplete representation of the speech sounds that make up language. For example, if a child says gog for dog they may not understand that three, different phonemes make up the word dog. This misrepresentation affects phonemic awareness, the ability to manipulate sounds in words.

Literacy research stresses that phonemic awareness is linked directly to reading mastery. Articulation errors can affect reading fluency as well. Fluency is the ability to read with speed, accuracy, and proper expression (Rasinski, 2009). Children with articulation errors work harder to decode words because they often lack sound to letter correspondence (Justice, 2006). “Readers who have not yet achieved automaticity in word recognition (fluency) must apply a significant amount of their finite cognitive energies to consciously decode the words they encounter while reading. Cognitive attention or energy that must be applied to the low-level decoding task of reading is cognitive energy that is taken away from the more important task of comprehending the text. Hence, comprehension is negatively affected by a reader’s lack of fluency.” (LaBerge & Samuels, 1974)

So, as one can see, a little misarticulated sentence can have a huge impact not only on a child’s speech but also on his/her education. There are many reasons children exhibit misarticulations some organic, such as hearing loss, and some unexplained. If you notice your child misarticulating sounds, you may want to have a speech pathology assessment to see if treatment is warranted.

References:

Bleile, K. Manual of Articulation and Phonological Disorders. San Diego: Singular, 1995.

Justice, L. (2006).  Evidence-Based Practice, Response to Intervention, and the Prevention of Reading Difficulties.  Language, Speech, and Hearing in Schools, 37,284-297.

LaBerge, D., & Samuels, S.J. (1974). Toward a theory of automatic information processing in reading. Cognitive Psychology, 6, 293-323.

Rasinski, T., Rikli,A., & Johnston, S. (2009). Reading fluency: more than automaticity? More than a concern for the primary grades? Literacy Research and Instruction, 48, 350-361.

Shriburg and Kwiatkowski. “Computer-Assissted Natural Process Analysis: Recent Issues and Data.” Assessing and Treating Phonological Disorders, Current Approaches. vol. 4, 1983, p 397.

Smit, A. B., & Hand, L., & Freilinger, J. J., & Bernthal, J. E., & Bird, A. (1990). The Iowa articulation norms project and its Nebraska replication. Journal of Speech and Hearing Disorders, 55, 779–798.

Templin, M. C. (1957). Certain Language Skills in Children: Their Development and Interrelationships. Minneapolis: University of Minnesota.

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