If the lines on the left side are left uncrossed, it indicates left visual neglect. Its just not going to be that effective. Sequences of progressive difficulty levels were used, the easiest sequences progressing stepwise from right to left at the same height and the most difficult ones randomly alternating between all possible positions. We will never sell your email address, and we never spam. Patients were administered various neglect tasks (see below) on two separate days within 1 week. This type of training stems from the observation that neglect patients generally show very limited attention and exploration behavior toward the contralesional hemispace. (1996), who found improvements in test performance as well as in functional status linked to the timing of the training and additional to general rehabilitation. Your 17 page packet of free visual perception worksheets can be accessed below. 18, 95106. Sensory seek and find. The CT app has helped me gather my confidence by building on and reinforcing old forgotten skills. Plus, cover the Does and Don't when reporting abuse or neglect.If this is pdf. doi:10.1111/j.1600-0404.2009.01194.x, Ldavas, E., Shallice, T., and Zanella, M. T. (1997). Selective and integrated rehabilitation programs for disturbances of visual/spatial attention and executive function after brain damage: a neuropsychological evidence-based review. 7:162. doi:10.3389/fnhum.2013.00162, Bonato, M., Priftis, K., Marenzi, R., Umilt, C., and Zorzi, M. (2012). If you are looking for more visual perception worksheets, youll love everything in the Visual Processing Bundle! The whole experience has been great.. Preserved semantic access in neglect dyslexia. I am very interested in this, and I always work with my patients to help them to reduce the impact of unilateral visual neglect. Recovery from aphasia and neglect. Click here to learn more about the CT app . doi:10.1016/S0028-3932(96)00066-8, Luaut, J., Halligan, P., Rode, G., Rossetti, Y., and Boisson, D. (2006). Neglect assessment as an application of virtual reality. Simple! Neurosci. WebVisual scanning is a pre-requisite skill for so many learning activities including finding answers in books, reading left to right, copying from the board to paper, worksheets etc. Given the absence of a no-treatment control group, it can not be excluded that improved performance on the assessment tasks is due to spontaneous recovery, testretest learning effects, or an interaction between these factors. Less forgetting to dress the affected side, but more issues acknowledging environmental cues on the affected side. Large screen digit detection. Over a period of 2 years, 53 RH patients showing neglect symptoms as observed by their therapists and/or found in early neuropsychological screening, were referred for further assessment. Each page has a highlighted bar on the left to be used as an anchor. Hum. 14, 403419. Orienting of attention in left unilateral neglect. To do so is infringement of copyright law. doi:10.1016/j, Kim, D. Y., Ku, J., Chang, W. H., Park, T. H., Lim, J. Y., Han, K., et al. My OT Spot uses cookies to improve your experience. Four or more omissions were considered as indicative for neglect. doi:10.1080/713755496, Thimm, M., Fink, G. R., Kst, J., Karbe, H., and Sturm, W. (2006). Visual Scanning Therapy Activities This free handout is useful for SLPs working with people who are experiencing left neglect and visual inattention. However, often it is not possible to predict whether improved awareness may be expected in an individual patient as a result of the training. True hemispatial neglect occurs most commonly in the left visuospatial field, while a similar condition on the other side is typically classified as right inattention vs. a true neglect (more details on this below). 81, 15961615. Exp. Int. sent right to your inbox! Exp. Nijboer, T. C. W., Kollen, B. J., and Kwakkel, G. (in press). For instance, the addition (and gradual reduction) of spatial cues regarding their actual lateral position and a built-in control or brake function might be helpful for patients who have difficulties performing the dual task. doi:10.1053/apmr.2000.19240, Cicerone, K. D., Dahlberg, C., Malec, J. F., Langenbahn, D. M., Felicetti, T., Kneipp, S., et al. (2009) report a medium to large effect of visuospatial training. Have them trace the most direct route between two points. Training sessions consisted of four standard tasks and additional control or experimental tasks. Hemineglect can cause a person many difficulties, and can even pose a safety risk. In an extensive review of 18 different treatments for neglect and their rationales, in which not only randomized controlled trials but also multiple baseline single case studies were included, Luaut et al. Ferro, J. M., Mariano, G., and Madureira, S. (1999). doi:10.1161/01.STR.30.6.1196, Broeren, J., Samuelsson, H., Stibrant-Sunnerhagen, K., Blomstrand, C., and Rydmark, M. (2007). On the screen, a driving scene was projected. doi:10.1212/WNL.30.5.509, Singh-Curry, V., and Husain, M. (2009). This technique is aimed at achieving symmetry in left and right detection times. The presence of neglect is generally associated with poor functional outcome after stroke (Jehkonen et al., 2006; DiMonaco et al., 2011; Vossel et al., 2012). There are 26 letter pages and 10 number pages for single item cancellation. Here are 5 suggestions: Download a FREE printable at the end of this post to challenge visual scanning skills. Additional driving simulator training beyond 6 weeks might turn out to be necessary to allow the generalization of training results. WebThese 40 cognitive therapy worksheets work on visual scanning and attention. Ann. This app is the perfect fit if you want to improve your speaking, memory, or general mental sharpness. New York: Mouton de Gruyter. More Visual Scanning Activities you will love: Bubble Wrap Math Maze Alberts Test is a visual neglect screen that requires patients to cross out lines on a single piece of paper. Cereb. Disabil. *Correspondence: M. E. van Kessel, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, Netherlands e-mail: me.vankessel@mst.nl, Novel insights in rehabilitation of neglect, View all
Unilateral neglect: further validation of the baking tray task. Virtual reality tasks are also used as a rehabilitation tool (see Tsirlin et al., 2009 for a recent review). Cortex 40, 441450. Assess, treat, and document with more confidence and ease, Visual neglect is most often the result of right-hemisphere brain damage, resulting in inattention to the left side. I wanted to pull all of the worksheets together (along with a few new ones added to the bunch) to create a 25 page packet of visual perception worksheets. Rehabil. Implications for clinical follow-up and treatment trials. Figure 1. Some may even come up with elaborate excuses for why they accidentally bumped into a table they didnt notice. MENTAL IMAGERY. (in press) point out that 40% of the neglect patients still show visuospatial neglect 1 year after stroke, indicating that rehabilitation of this disorder is of great importance. They could only see or imagine the parts that would have been on their right. Left unilateral neglect as a disconnection syndrome. Neurology 30, 509517. Left neglect (a type of hemispatial neglect) refers to a disorder of attention that causes a person to have difficulty noticing, attending to, and responding to stimuli on the left side of their body. Additionally, it can be helpful to take the person to a neuropsychologist, who can assess them and help them learn to accept their condition. Letter cancelation. This condition is often called left visual neglect. Behavioural Inattention Test: Manual. A person with left neglect often doesnt even realize they have a problem. The following are a few activities you can do to help the person improve awareness of their neglected side. Our results seem in concordance with previous studies evaluating TSVS (Pizzamiglio et al., 1992; Antonucci et al., 1995; Paolucci et al., 1996). Visual Spatial-Relations. Neurology 23, 658664. A pair of vertically aligned horizontal rectangular bars of equal length was printed on each page. In other words, the patients knew the entire square by memory, but they couldnt access all of it at once. Guidelines as to the use and fading of cues were provided in the manual. For instance, neglect symptoms have been shown to vary with arousal and sustained or vigilant attention (Robertson et al., 1997; Samuelsson et al., 1998; Robertson, 2001) as well as with task complexity (Deouell et al., 2005; Vuillemier et al., 2008). During visual scanning training, these patients learn to consciously pay attention to contralesional target stimuli. Neurosci. Teach the following visual neglect reading strategies to your patients: FINGER SCANNING. Both still cause problems with the left side, but a person with visual field loss can typically tell something is wrong, and will usually compensate by moving their head around. Assessment of spatial attention and neglect with a virtual wheelchair navigation task. (2008, 2012) describe a virtual reality lateralized attention task (VRLAT) in which patients had to navigate through a VR environment while seated in front of a flat screen display in a powered wheelchair treadmill. Jannink, M. J., Aznar, M., de Kort, A. C., van de Vis, W., Veltink, P., and van der Kooij, H. (2009). Neglect patients typically fail to explore the contralesional half-space. Two of them even complained that the dual task was unpleasant and had the impression that they were not improving. J. Clin. For the covariance structure, we opted for unstructured (see also Rietveld, 2005). The use of verbal and auditory cues was gradually faded during the training. In the present study, it will be investigated whether the effectiveness of the standardized TSVS protocol (Pizzamiglio et al., 1990, 1992) might be further enhanced using the CVRT-TR. Perform ADLs in front of a mirror in addition to practicing transfers and mobility to draw attention to the affected side (Reed, 2014). If you like our content, youll love our ebook and newsletters! Neurobiol. For now, grab your visual perception printables, and start working on those visual skills! This post offers tasks, strategies, and resources to treat visual neglect. The occurrence of one or more omissions was considered as indicative for neglect. Lane tracking. (2004a). However, while they may present similarly, the two are separate conditions that require different treatments. The patient can also draw a map of their current location (e.g., home, skilled nursing facility). Moreover, in another TSVS evaluation study, Piccardi et al. This questionnaire consisted of 19 items describing common problems associated with neglect (for instance bumping into door frames) (Towle and Lincoln, 1991). doi:10.1016/S0010-9452(08)70203-X. Attentional load and visual neglect. Click here to get instant access. Patients were asked to bisect 20 horizontal lines (printed on a A4 sheet of paper) by placing a pencil mark as close to the center of the line as possible (Schenkenberg et al., 1980). WebThe Left Neglect Therapy Bundle includes 50+ pages of activities that may be used to target left visual attention and awareness. 62, 4556. Patients were asked to cross out 21 lines (2.5 cm) printed on a A3 sheet of paper (Albert, 1973). Also, large within-patient variability in test performance is reported. Patients with a first intracerebral infarction or hemorrhage admitted for clinical multidisciplinary rehabilitation to one of four local rehabilitation centers in the Netherlands were eligible for this study. Click here to learn more about Visual Processing Lab and to sign up. Corbetta and Shulman (2011) suggest that neglect results from a dysfunction of the distributed and interacting cortical networks responsible for the control of both spatial and non-spatial attention processes. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs. In a famous experiment on visual neglect, patients who were familiar with the Piazza del Duomo square in Italy were asked to imagine themselves standing at one end of the square, facing away from the cathedral. Med. What OT topics are you most interested in? Neuropsychol. Get instant access to our TBI recovery tips ebook with 20 pages of helpful advice by signing up below. Singh-Curry and Husain (2009) point out that a frontoparietal system might allow the flexible reconfiguration of behavior between maintaining attentive control and responding to salient stimuli. The use of verbal and visual cues was progressively reduced. In Table 2, the training schedules for the experimental and control groups are displayed, including the number of minutes per task for each session. Neuropsychol. This time, when they described what they remembered, the landmarks they mentioned were the ones on the other, previously neglected, side, which was now to their right. As can be seen in Table 3, patients in both groups taken together showed significantly improved performances on almost all paper-and-pencil tasks. Neuropsychol. UNDERLINE OR HIGHLIGHT. I make no guarantees about the information and recommendations provided herein. 6:110. doi:10.3389/fnhum.2012.00110, Bartolomeo, P., Thiebaut de Schotten, M., and Doricchi, F. (2007). Robertson and Frasca (1992), for instance, assume that neglect patients are particularly vulnerable to a deterioration of performance in the face of additional attentional load because of this association. Pairs of stimuli of different lengths were randomly used. doi:10.1037/a0028674, Buxbaum, L. J., Palermo, M. A., Mastrogiovanni, D., Read, M. S., Rosenberg-Pitonyak, E., Rizzo, A. Other VR methods include desktop simulator tasks or head-mounted devices. If you have any other interventions you like to use, be sure to leave them in the comments at the end! Where you wont need Bunsen burners or safety goggles! Neurosci. One popular explanation for this suggests that the right parietal lobe attends to space on both sides of the body, while the left side only attends to the right. The Visual Processing Bundle has everything you need to work on underlying visual processing skills so you can help students with classroom tasks like copying written work, letter reversals, and messy handwriting in fun and engaging ways! Nevertheless, no significant correlations were found between pre- and post-training performances and differences in pre- vs. post-training performance on the one hand and post-onset time on the other. (1990) envisages 8 weeks of training. Brain networks of visuospatial attention and their disruption in visual neglect. The primary research question of the present study was whether dual task training could contribute to an improvement of TSVS training results, as measured by various neglect tasks. Here are 5 suggestions: Download a FREE printable at the end of this post to challenge visual scanning skills. Therapy can help improve visual attention. Reliability and validity of the Virtual Reality Lateralized Attention Test in assessing hemispatial neglect in right-hemisphere stroke. Scand. Psychiatr. Flashlight games. Med. It explains the development of the system of commerce across the Atlantic Ocean by discussing the economic theory of mercantilism. It also changes the way space is represented in the brain. WebThese 40 cognitive therapy worksheets work on visual scanning and attention. Visual neglect treatment is often complicated by patients reduced awareness of their deficit, also known as anosognosia.. Therefore, following any information or recommendations provided on this website are at your own risk. This aids in training the person to look through the side of the lens being ignored. The definition of unilateral neglect is that it is a condition, after damage to one brain hemisphere occurs, where the person becomes unaware of and inattentive to one side of the body. B. doi:10.1080/01688639208402543, Pizzamiglio, L., Fasotti, L., Jehkonen, M., Antonucci, G., Magnotti, L., and Boelen, D. (2004). This means the person cannot detect objects or sounds on the opposite side that their brain injury occurred. Each page has 10 letters/numbers to find and cancel out. Post training assessments were scheduled 1 or 2 weeks after the end of the training. Other signs that someone is suffering from left neglect include: Neglect doesnt only affect a persons interaction with the left side of their environment, however. doi:10.1080/09638280410001663058, Bailey, M. J., Riddoch, M. J., and Crome, P. (2004). No significant differences were found between asymmetries before and after training [CVRT: F(1, 24.7) = 0.09, CVRT-D: F(1, 18.1) = 1.32] or between groups [CVRT: F(1, 25.6) = 0.73, CVRT-D: F(1, 21.4) = 0.01]. (1995). Watch it with your eyes, keeping your head still! Thank you the information was very informative. In a Cochrane review excluding all studies that were not considered properly randomized controlled trials, Bowen and Lincoln (2007) conclude that there is insufficient evidence to support the effectiveness of specific cognitive rehabilitation approaches for reducing disabilities due to neglect (see also Rohling et al., 2009; Paci et al., 2010). Neurol. doi:10.1159/000107941, Karnath, H.-O., Fruhmann, B. M., Kuker, W., and Rorden, C. (2004). However, in two reviews of cognitive rehabilitation, Cicerone et al. J. Rehabil. Cereb. Encourage caregivers to sit on the affected side. Rehabil. Similar correlations were also computed between the post-onset period (in days) and pre-training as well as post-training performances. DISCLAIMER. Reading and copying training. I need to send it via email as the packet is a large file. (1989). Combining TSVS with additional dual task training might provide tools for accomplishing a higher degree of automation of scanning strategies and contribute to the enhancement of training results. Acta Neurol. Arch. There are quite a few interventions to do with your patient experiencing unilateral neglect. 26, 471477. RH neglect patients tend to misread the first syllables. Use Visual Attention Therapy s blinking signal on the left side to draw the users eyes to the left. Therefore, when the right side is damaged, the loss is much more noticeable. Its often easier to read larger text. Click here to access the Visual Processing Bundle. Neurol. Last updated on March 23, 2021. You can use it on your own or in between sessions with your speech therapist. Trace pictures on a light box. Its a 3-day series of emails that covers EVERYthing about visual processing. (1992). WebCognition: Visual Attention and Scanning Created by The Speech Booster This pack is perfect for neurological patients with neglect, decreased attention, decreased scanning, or difficulty with letter identification. I hope this article helps you when youre new and out in the field treating on your own (or in your Level II Fieldwork). For example, after first introducing the centering technique during two or three training sessions in the fourth week of training using the TSVS digit detection task, the automatization of this skill might be further practiced using the CVRT-TR on a daily basis. Great for SNF or hospital settings. Design by Elementor, Left Neglect After Brain Injury: Causes, Symptoms, and Recovery, deny that their left arm is part of their body, Eating only from the right side of their plate, Brushing only the right side of their hair, Ignoring people speaking from their left side, Constantly or frequently having their head and eyes turned to the right, with cues needed to turn their head to the left. 243, 308314. Before any recommendation can be made about the use of these tasks for training, further research is needed. In an alertness training program used by Thimm et al. I Spy is one of the easiest, most portable visual scanning activities to practice active visual scanning and search techniques while still having fun. Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. In the next section, well show you how to do some of these exercises yourself at home. J. Neurol. In concordance with the abovementioned findings of Deouell et al. Copyright 2023 ADULT SPEECH THERAPY | Powered by Astra WordPress Theme, How to Make a Memory Book (free template). Table 2. (2000, 2005) recommend visual scanning training as a practice standard for the treatment of neglect. In the present study, an attempt is made to further extend the scope of standardized TSVS by combining it with additional dual task training. (2006) also recommend the evaluation of combinations of existing methods. In other words, because the right hemisphere processes both sides of the body, it can compensate for damage to the left hemisphere. There are multiple ways to approach unilateral neglect, and reading up all you can on it can really help you to understand the neurological aspects of it. Mixed models analyses were performed for relevant measures with time (before vs. after training) as a within subjects factor and condition (control vs. experimental) as a between-subjects factor (N = 15, 14). Ignoring some letters or the complete first syllable, or (in case of left non-words) reading the original word as if no letters had been replaced in the first syllable were considered errors. Top. Visual Figure-Ground The same procedure and covariance structure are used in all Mixed Models analyses reported throughout the Results section. Twenty-nine subacute right hemisphere stroke patients were semi-randomly assigned to an experimental (N = 14) or a control group (N = 15). Use your finger to scan the text as you read from left to right. This pdf. Significantly increased scores on paper-and-pencil tasks as well as on a semi-structured observation scale (Zoccolotti et al., 1992) were found after TSVS (Pizzamiglio et al., 1992; Antonucci et al., 1995). In the control condition, patients trained with a lane tracking task two times a week during 6 weeks. Whether you struggle with aphasia, memory loss, or critical thinking, the CT Speech & Cognitive Therapy App can help. 24, 337345. Unilateral neglect is potentially dangerous for the patient due to impaired mid-line orientation and postural control during mobility. This experiment shows that neglect is not a problem with the persons actual vision, but with the brains ability to process and attend to the left side. These patients were asked to name objects projected on both sides of the road. Stroke Rehabil. Included What is Left Neglect? 30, 650660. Visualize the space of your visual deficit (e.g. However, no differences were observed between conditions. It might be worthwhile to evaluate which patients might really benefit from dual task training. Have your patient cross out specific items in a series of letters, numbers, or symbols. Start with these simpler visual neglect tasks to practice scanning strategies and to increase confidence. Visual neglect is a disorder that causes inattention to one side of the visual field (either the left or right side, although most commonly left). 86, 16811692. doi:10.1177/026921559100500208, Tsirlin, I., Dupierrix, E., Chokron, S., Coquillart, S., and Ohlmann, T. (2009). The present results suggest that all patients had trained enough to show some improvement on most of the paper-and-pencil tasks as well as the simplest driving simulator subtasks, i.e., lane tracking and the detection of left stimuli in the CVRT single task. CONNECT-THE-DOTS. Phys. Furthermore, various authors describe that deficits in non-spatial attentional processes not only occur in association with neglect (for instance in the case of impaired arousal). on their affected side to encourage attention to that side.USING THEIR GOOD SIDE. Cochrane Database Syst. Auditory sustained attention is a marker of unilateral spatial neglect. Refer to occupational therapy, physical therapy, or asha.org for more information on these treatments. According to Corbetta and Shulman (2011), lesions in the RH that cause neglect impair non-spatial functions mediated by a ventral frontoparietal attention network. WebSeveral interventions aimed at reducing neglect symptoms have been described, like visual scanning training, prism adaptation, limb activation training, and non-invasive brain stimulation techniques (see Zoccolotti et al., 2011; Kerkhoff and Schenk, 2012; Fasotti and Van Kessel, in press, for reviews). Deficits of contralesional awareness: a case study on what paper-and-pencil tests neglect. Cortex 42, 973982. As in standardized TSVS, the mere amount of training time might be crucial also in dual task training (Antonucci et al., 1995; Kerkhoff, 1998). 6, 1925. Moreover, a repeated evaluation of the patients performances with our assessment measures could have been useful. Youll find reproducible sheets to address figure-ground, form constancy, visual discrimination, as well as oculomotor skills like saccadic movements. In the CVRT-TR, a large screen driving simulation task was added to the computerized digit detection task used in the standardized TSVS protocol (Pizzamiglio et al., 1990). Assessment of post-stroke extrapersonal neglect using a three-dimensional immersive virtual street crossing program. During visual scanning training, these patients learn to consciously pay attention to contralesional target stimuli. (2000). Thus, computer-based dual tasks, even though not always showing resemblance to contexts of daily living, have high diagnostic potential in the assessment of neglect and its recovery (Schendel and Robertson, 2002; Bonato and Deouell, 2013). A Mixed Models analysis was also performed for a total score computed from the semi-structured scales for extrapersonal and personal neglect. Five or more omissions and a difference of two or more between contralesional and ipsilesional omissions were considered as indicative for neglect. [training manual]. Family and caregivers can help a person with visual problems. Visual Attention However, again, MannWhitney U tests did not show significant differences between groups on any score, neither before nor after training. Future research might focus on increasing the amount of dual task training, the implementation of progressive difficulty levels in driving simulator tasks, and further exploration of relationships between dual task training and daily functioning. Teach the following visual neglect reading strategies to your patients: FINGER SCANNING. Phys. Buxbaum et al. The experimental group was administered the same training schedule, but in weeks 46 of the training, the TSVS digit detection task was combined with lane tracking on the same projection screen, so as to create a dual task (computerized visual reaction time task designed for training). Neurosurg. However, MannWhitney U tests did not show significant differences between groups on either of these scores, neither before nor after training. 24, 209215. J. Int. Free Visual Perception Packet Visual perception is made up of several areas that are crucial to development, learning, and functioning. In line with this idea, it was found that computerized dual tasks elicit more contralesional omissions (Bonato et al., 2012, 2013) and slower contralesional reaction times (RTs) (Deouell et al., 2005) than single paper-and-pencil tasks. Although the eyes can see, the brain fails to pay attention to that side. The CVRT-TR was designed on the basis of two diagnostic tasks, i.e., a single and a dual CVRT task (CVRT and CVRT-D, respectively). Spatially nonselective attention deficits in unilateral neglect and their implications for rehabilitation. At the end of this article, youll also find exercises you can do at home to combat neglect. Check out our bestselling tool by clicking the button below: Copyright 2023 All rights Reserved. An index score was computed, in which the difference between rightward and leftward biased responses was divided by 26. Spontaneous recovery of neglect is mostly reported in the first weeks after stroke (Ferro et al., 1999; Appelros et al., 2004b; Jehkonen et al., 2007). Use your finger to scan the text as you read from left to right.MENTAL IMAGERY. It is unclear why some patients benefit from the training while others do not. WebThe Left Neglect Therapy Bundle includes 50+ pages of activities that may be used to target left visual attention and awareness. Neuropsychologia 44, 12301246. This was slightly adapted for use in the present study. (2012). Reading aloud helps you notice if you accidentally skip words or a line of text. Worksheets & tasks from The Adult Speech Therapy Starter Pack, Visual Attention Therapy App by Tactus Therapy (Image from the App Store). Rev. This impairment may in turn induce abnormalities in an anatomically linked dorsal frontoparietal network that controls spatial attention. Well, I have a solution to your problem! READ MAPS. Declutter floors and tabletops. The upper and lower bar of each pair were mirrored copies of each other. Visual attention, visual spatial relations, visual closure, visual discrimination, If you are reading something you own (not a library book! Visual Scanning Therapy Activities Finally, Akinwuntan et al. More Visual Scanning Activities you will love: Bubble Wrap Math Maze On Thursdays and Fridays, the TSVS large screen scanning task was (partly or as a whole) replaced by either the lane tracking or CVRT-TR task. Farn et al. Left neglect (a type of hemispatial neglect) refers to a disorder of attention that causes a person to have difficulty noticing, attending to, and responding to stimuli on the left side of their body. During visual scanning training, these patients learn to consciously pay attention to contralesional target stimuli. Three types of driving simulator tasks were used during the assessment. Bowen, A., and Lincoln, N. B. Pace yourself and remember to give your healing brain extra time to process information. In may cases, the patients show functional recovery. Included What is Left Neglect? TSVS consisted of four standardized tasks (digit detection, reading/copying, copying drawings, and figure description).
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