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57 Cards in this Set
- Front
- Back
Acute cardiovascular responses to exercise
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HR - bpm
Stroke Volume - mL/beat Arteriovenous Oxygen Difference - diff in oxygen saturation leaving heart and returning Cardiac Output - HR x SV = Amount of blood pumped out of the L ventricle Blood Flow Blood Blood pressure |
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Cardiovascular and respiratory system functions
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Exchange gases between blood and atmosphere
Provide O2 to the tissues Remove CO2 and metabolic waste products |
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How does HR respond to ex?
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Increases:
Linearly and proportionally to work rate SNS stimulation From 60-200 Up to HR max HR max ≈ 220 – age Aerobic and resistance Cardiac drift - heart rate increases gradually during sustained sub-max workout |
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How does SV respond to ex?
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Increases:
Up to ~ 50-60% of max work, then plateaus May see further increases in highly trained people Max SV 100-200 mL/beat 25% lower in women Range 50-110 ml/beat @ rest Decreased ventricular filling can make it plateau/decrease |
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SV with exercise
aerobic and resistance |
With exercise, increased venous return, more expansion, ventricular fibers stretch and contract harder, so greater ejection fraction (frank Starling mechanism)
Increased SNS stimulation -> increased norepinephrine -> Ca++ -> cross bridging (faster) Resistance Holding breath during heavy load may decrease venous return |
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Arteriovenous Oxygen difference (a-vO2)
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Difference in O2 content between arterial and mixed venous blood
Rest = 5 mL O2/100mL blood Max exercise = 15-16 mL O2/100 mL blood Difference increases with increasing workload Increase in O2 extraction in exercising muscles |
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Cardiac Output
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Q (L/min) = HR x SV
Rest = 5 L/min Max exercise ≈ 20 L/min Aerobic Initial increase due to HR and SV Later increases due to HR Resistance: workload dependent Lighter loads Similar to aerobic, but smaller effect Heavier loads Small increases due to increased HR |
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Blood Flow
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Blood flow is a function of pressure in system and peripheral resistance
Rest: skin and skeletal muscle get 20% of Q Aerobic Increase in blood flow to skeletal muscles Body temperature increases increase in blood flow Max exercise: up to 80% Q to skeletal muscles and skin Resistance Increased resistance to blood flow = pressure/resistance |
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Blood - during exercise
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Decrease total blood volume
lowers cardiac output Hemoconcentration increases more RBC’s per liter blood |
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Blood Pressure during exercise
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Aerobic
Systolic BP (SBP): increases linearly with work Max 200-240 mmHg Diastolic BP (DBP): no change or slight decrease Resistance Increase in SBP and DBP -Vasoconstriction -Increase in total peripheral resistance |
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Summary of acute cardiovascular effects with exercise: Aerobic
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Increased:
Cardiac output Stroke volume Oxygen uptake Systolic blood pressure Blood flow to active muscles and skin Decreased or no change: Diastolic blood pressure |
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Summary of acute cardiovascular effects with exercise: Resistance - heavy loads
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Resistance - heavy loads
Increased: Heart rate Diastolic blood pressure Systolic blood pressure No change: Oxygen uptake Cardiac output Stroke volume |
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Minute ventilation (VE)
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VE = VT x RR
Volume of air breathed in one minute Rest: 5-7.5 L/min Maximal: 75-200 L/min Increases with exercise immediately Aerobic Light effort: increase in VT Moderate to high effort: RR also increases |
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Respiratory responses to exercise
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Resting air is 5-7.5 liters/minute
tidal volume .5 liters/breath frequency 10-15/minute Air moved inc linearly with inc activity 20-25 liters air/L oxygen used lower 30-35 liters air/L oxygen used higher Max air 75 to 200 liters/minute air moved by lungs Breathing increases between 40 and 60 breaths/min The amount of air moved by lunges can not be used as an indicator of fitness (depends on mass) |
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Metabolic Response to exercise
Oxygen uptake (VO2) |
VO2 = Q x a-vO2
Amount of O2 available and consumed by the body tissue Rest = 3.5 mLO2/kg/min Max = 25-80 mLO2/kg/min Aerobic Resistance: not much change noted |
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Metabolic Response to exercise: Oxygen consumption
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Oxygen consumption Liters per minute
Walking requires 1 L/min or 10 ml/kg/min Jogging doubles Highly trained 4 and 5 L /minute or 80-90 ml/kg/m Females about 15-20% lower Sedentary 20 ml/kg/min |
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Chronic Adaptations to Exercise
-Physiological Adaptations in Muscle: increased strength |
Nervous adaptation
Motor unit recruitment Golgi tendon organs (inhibition/adaptation) Improved coordination antagonist (less active?) Muscular adaptation Increase size (more actin/myosin) hypertrophy of individual fibers > hypertrophy of muscle (connective tissue?) fiber splitting ???? less evidence for hyperplasia and fiber splitting |
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Chronic Adaptations to Exercise
Physiological Adaptations in Muscle: Anaerobic Adaptations |
ATP-PC
enzymes responsible for ATP re-synthesis Glycolysis increase enzymes in 30” group increase muscle buffering |
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Chronic Adaptations to Exercise
Physiological Adaptations in Muscle: Aerobic Adaptations |
Capillaries surrounding muscles fibers Endurance athletes 50%
Myoglobin Increases significantly Mitochondrial “reticulum” increases dramatically Enzymes of oxidation increase SDH (succinate dehydrogenase) 25% inc in ability muscles to oxidize Fat as fuel The ability to store muscle glycogen is inc. Fat droplets in muscle inc |
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Chronic Adaptations to Exercise: Cardiovascular system: HR and SV
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HR: Decrease resting heart rate.
SV: Increase SV – up to 20% heart more efficient Contractility: increase calcium flux and calcium myosin-ATPase activity (decreases?) Cardiac Output: by inc SV since resting HR More pronounced in endurance Athletes- get volume overload |
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Chronic Adaptations to Exercise: Cardiovascular system: Cardiac Output
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Cardiac output: Strength athletes have normal
internal ventricular dimensions, but thicker than normal ventricular muscle that hypertrophies to same extent as skeletal. Maximum Q inc = (from) max SV because max HR changes little |
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Chronic Adaptations to Exercise: Cardiovascular system: AvO2 diff, Blood things
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Arteriovenous oxygen difference:
Increases slightly Blood Flow: Increased because of increase Q Blood Flow to heart less during sub- max due to heart more efficient Blood Pressure: Reduce resting systolic, diastolic, and mean BP. Diastolic and mean pressure dec during max work |
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Chronic Adaptations to Exercise: Physiological Adaptations to the respiratory system
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Static lung volume: changes little
Vital capacity: inc some at expense of residual V Resting air moved by lungs: little difference Tidal volume: increased during max levels Frequency Breathing: slight dec sub-max Inc substantially with max Pulmonary blood flow: Increased Lung diffusion: may inc with max |
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Chronic Adaptations to Exercise: Physiological Adaptations - Oxygen consumption and VO2 max
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Oxygen consumption: same during rest
Relative VO2 @ sub max less due to increase VO2 max VO2 max: Significant increase. 4-93% Inc 20-30% seem reasonable Untrained 32-40 ml/kg/min Related to both increased oxygen delivery to muscles or by increased oxygen extraction from blood by muscles related increase mitochondria and content of the muscle Related to enzyme |
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The systematic and planned performance of bodily movements, postures, or physical activities intended to provide a patient with the means to
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Therapeutic Exercise
The systematic and planned performance of bodily movements, postures, or physical activities intended to provide a patient with the means to Remediate or prevent impairments Improve, restore, or enhance physical function Prevent or reduce health-related risk factors, restrictions, disability Optimize overall health status, fitness, or sense of well-being |
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Patient vs. Client
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PATIENT: With impairments and functional deficits, diagnosed by PT
CLIENT: without diagnosed dysfunction -> promote health and wellness and to prevent dysfunction |
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What are the components of physical function
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Balance/Postural Equilibrium
Cardiopulmonary/Endurance Neuromuscular control/Coordination Mobility/Flexibility Muscle performance Stability Systems of the body that control each of these elements of physical function React, adapt, and develop in response to forces placed on the tissues that make Up the body systems |
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Therapeutic exercise interventions involve the application of
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carefully graded physical stresses and forces that are imposed on impaired body systems, specific tissues, or individual structures in a controlled, progressive, safely executed manner to reduce physical impairments and improve function.
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What are some aspects of safety?
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Patients health history/current health status
Environment Accuracy with which patient performs exercises Therapist proper body mechanics |
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What are past and present models of functioning and disability?
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past – focuses on a spectrum of disablement
Nagi model (injury limits function, ability) ICIDH (... Impaired disability and handicap) NCMRR Present ICF companion (ICD) International Classification of Functioning, Disability and Health |
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What is the benefit of the ICF model (as opposed to others)
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Arrows are bi-directional, shows that PT can have impact on activities and participation
Addresses entire person, not focused on labeling with specific disease, but its effects and how to influence them (The classification system provides a process for developing Impairment/function-based diagnoses that guide the treatment Of individuals with health conditions) activity is at the center of the ICF framework (see visual representation) |
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What are components of the ICF
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Impairment in Body Function
Impairment in Body Structure Activity limitation Participation restriction Contextual Factors Environmental Personal Body functions and structures Activities and Participation Functioning and Disability |
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Components of Functioning and Disability Models and Applications in Physical Therapy
-some history |
Back-in-the-day: focus on Elimination and Remediation of Disability
Then more Promotion of well-being Preventing or reducing risk factors 1990s - clinical decision making and standardized terminology Became the practice act - 2001 Guide to PT (document of consensus for best practice) |
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ICF - Health Conditions
(Pathological/Pathophysiological Conditions) |
Health Conditions
(Pathological/Pathophysiological Conditions) Acute or chronic diseases, disorders, or injuries Active pathology that disrupt body’s homeostasis |
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Model - Impairments/ body function and body structure
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Consequences of pathological conditions and encompass the signs and symptoms
That reflect abnormalities at the body system, organ, and tissue level Body function and body structure Primary and secondary - primary is direct effect, secondary is consequence Musculoskeletal Neuromuscular Cardiovascular/P Integumentary |
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Common musculoskeletal physical impairments
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Pain
Weakness Decreased endurance Limited ROM due to Restricted jt capsule Restricted periarticular tissue Decreased muscle length Jt hyper mobility Faulty posture Muscle strength imbalance |
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Common cardiovascular physical impairments
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Decreased aerobic capacity
Impaired circulation Pain with sustained physical activity (intermittent claudication) |
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Common Neuromuscular Physical Impairments
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Pain
Impaired balance Incoordination Delayed motor development Abnormal tone Ineffective, inefficient functional movement strategies |
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Common integumentary physical impairments
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Skin hypomobility
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Patient management and clinical decision-making: An interactive relationship
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Clinical Decision-making
Clinical Prediction Rules (CPR’s) Evidence-Based practice Conscientious, explicit, and judicious use of current best evidence in making decisions about the care of an individual patient Identify problem Search literature Analyze evidence Integrate with expertise Incorporate into patient management Assess outcomes |
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Clinical Prediction Rules
Classic Example |
Predictive factors help establish diagnosis
Improve accuracy of diagnosis Identify subgroup of patients most likely to benefit from a particular approach Classic Example: A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study Patients were most likely to benefit from spinal manipulation if they met 4 of 5 of the following criteria: Symptom duration of less than 16 days No symptoms distal to the knee Score of less than 19 on fear –avoidance measure At least one hypomobile segment At least one hip with more than 35* of IR |
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A Patient Management Model
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Examination
History Systems Review table 1.3 Specific tests and measures Evaluation of data collected Diagnosis box 1.12 Diagnostic process Diagnostic category Prognosis and Plan of Care Setting goals and outcomes in plan of care Intervention Coordination, communication, and documentation Procedural interventions |
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Strategies for Effective Exercise and Task-specific Instruction
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Preparation for Exercise Instruction
Concepts of Motor Learning: A foundation for Exercise and Task-specific Instruction Adherence to Exercise |
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Preparation for Exercise Instruction
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Does the patient believe exercises will lessen symptoms
Is the patient concerned ex will be uncomfortable Is patient accustomed to engaging in regular exercise |
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Motor learning
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Motor Learning – a complex set of internal processes that involves the acquisition and relatively permanent retention of a skilled movement or task through practice
Motor performance v. motor learning? Acquisition v. retention |
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Aspects showing that motor learning has occurred
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Understand the task or goal
Able to activate the motor system Be able to retrieve motor memories over time Be able to perform a slight variation of the task in a new context |
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Types of Motor Tasks
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Types of motor tasks
Discrete-recognizable beginning and end. Serial task- discrete movements combined with particular sequence “eat with a fork” Continuous task-repetitive uninterrupted movements “walking, cycling” |
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Closed vs. Open Environment
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Closed environment: objects around patient and surface on which task is performed do not move
EX: sitting with support and working at a desk; eating at home Permits greater focus and self-pacing; predictable Open environment: objects or other people are in motion; or, support surface is unstable while performing task EX: ascending/descending stairs in public or crowded area Unpredictable, match pace to environmental demands; loss of control |
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Inter-trial variability in the environment: absent or present
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Inter-trial variability in the environment: absent or present
In a constant, unchanging environment, there is little opportunity for variability (absent) Environment is predictable Attention to task is minimal if skill is well-learned If the environment changes from one trial to the next, variability increases (present) |
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Body stable or body transport
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Body stable or body transport
Analysis of the task from the person perspective Must the body be stable/stationary or moving? Stable = simple task Donning shoes/socks while seated on a firm surface Body movement from one place to another = complex EX: walking, transfer from wheelchair to another surface |
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Manipulation of objects: absent or present
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Manipulation of objects: absent or present
Does the task involve UE manipulation of objects? |
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Stages of motor learning
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cognitive
associative Autonomous |
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Cognitive Stage of motor learning
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Cognitive stage – What do I need to do? What are the demands of the task? How do I do it?
Learning Thinking about components of a skill, feel of the skill Attentional demands are high High rate of error |
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Associative Stage of Motor Learning
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Associative stage – I understand what I need to do
Refining Consistency and efficiency evolving Modify and vary performance May perform under varied environmental demands Decreased error rate; self-correcting; problem-solving; less need for feedback |
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Autonomous Stage of Motor Learning
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Autonomous stage - I’ve got this down!
Skill performed automatically No attention required to perform the task May multi-task or execute with varied task and environmental demands |
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Variable that Influence Motor Learning-Considerations for Exercise Instruction and Functional Training
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Pre-practice
Understand the purpose Practice Part vs whole Block, random, random/blocked Feedback Intrinsic feedback – NOT from therapist Augmented feedback-verbal or tactile Knowledge of performance vs know of results Feedback schedule-timing and frequency |
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Factors That Influence Adherence to an Exercise Program
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Patient-related factors
Factors related to the health condition or impairments Program-related variables Strategies to Foster Adherence |