vail sport test pdf vail sport test pdf

The results show that the described series of hop tests provide a reliable and valid performance-based outcome measure for patients undergoing rehabilitation following ACL reconstruction, and these findings support the use and facilitate the interpretation ofHop tests for research and clinical practice. Vail Sport Test Scoring One point is given for each criterion completed with proper technique during the time intervals (yes = 1, no = 0) . x[o8 ,`#+( J Athl Train. Symmetry means equal ROM and equal strength. 2020 Oct 15;7(1):83. doi: 10.1186/s40634-020-00298-8. The Reliability of the Vail Sport Test As a Measure of Physical Performance Following Anterior Cruciate Ligament Reconstruction. Younger Patients and Men Achieve Higher Outcome Scores Than Older Patients and Women After Anterior Cruciate Ligament Reconstruction. Clinical Research Laboratory. I2^L*./Oe'Yrx` 8^, The purpose of this clinical commentary is to provide the rehabilitation specialist such a program directed toward safely returning the athlete to alpine skiing. The Journal of orthopaedic and sports physical therapy. How should clinicians rehabilitate patients after ACL reconstruction? Setting up milestones and goals depends on your patient's needs and aspired function. endobj METHODS <> 1 0 obj <>/Metadata 378 0 R/Pages 2 0 R/StructTreeRoot 46 0 R/Type/Catalog/ViewerPreferences 376 0 R>> endobj 378 0 obj <>stream Careers. 2 0 obj 2018 Jan;52(2):128-138. doi: 10.1136/bjsports-2016-096836. Moving from endurance to strength training can start when the athlete shows[14]: Strength is the ability to exert force/torque at a specific speed. 5 0 obj National Library of Medicine Exercises should be light intensity (<50% of 1-RM) high repetitions (15-20) for 3 or more sets with less than 60 seconds of rest, 2-3 times weekly with 48 hours rest between sessions to target type 1 atrophied muscle fibers, due to arthrogenic inhibition[14]. The purposes of this study are 1) to describe a functional test (Vail Sport Test) that includes the evaluation of muscle strength, endurance, power, and movement quality in those patients attempting to return to sports following ACL reconstruction and 2) to assess the reliability of the Vail Sport Test. Garrison JC, Shanley E, Thigpen C, Geary R, Osler M, Delgiorno J. Annals of the Academy of Medicine, Singapore. For each of the test components, a clinician assesses the athlete's . endobj Participants: 3 0 obj 1a, Fig. hbbd``b` Findings indicate that, while unilateral deficits are present in individuals following ACL reconstruction, they may not be evident during bipedal performance or during modified versions of double-limb performance activities. Following the first 6 weeks of acute management after ACL reconstruction, creating a long-term rehabilitation plan can be challenging for physiotherapists. 131 0 obj <> endobj {t#8x"[@QG7{/@=\~H5xu>}%wNu7cqG@pC Wa^*A^iW/*|Js0Br1^~rbn0\P+f; &B^~udO_nhA>wt~wAzpm 7qSTo$/tDy|`G0>;3jH/ Mwc huAF"fS\cs|P:rS 8D#I S'"T4UT. Unauthorized use of these marks is strictly prohibited. 199 Vail Sport Test - Backward Jog -- Texas Health Ben Hogan Sports Medicine Exercises TexasHealthBenHogan 281 subscribers Subscribe Like Share 4.6K views 10 years ago Show more Show more. 1 Since the inception of this test, it has remained unchanged in design but has undergone scoring changes to increase reliability. 378 0 obj <>stream Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA. Developing velocity requires lower resistance, about 30% 1 RM for 6 reps, 1-3 sets with 3 minutes rest. After . 8 0 obj In the acute management phase, there are some considerations to protect the surgical repair and allow healing without compromising ROM. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. 340 0 obj <>/Filter/FlateDecode/ID[<123C55CFD985F54AB0CFEB110C29D7C1>]/Index[308 71]/Info 307 0 R/Length 140/Prev 313627/Root 309 0 R/Size 379/Type/XRef/W[1 3 1]>>stream Hop testing was the most commonly reported functional test following ACL reconstruction and differences between graft types were examined, providing information that may assist providers in determining timing of return to unrestricted sporting activity. Setting: Clinical Research Laboratory. By clicking accept or continuing to use the site, you agree to the terms outlined in our. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Bookshelf endobj ?~t2\muN>7'Y[AG*gCq5!VB7}m%Qn1/O` e.U0^.AA4v_aUU3we3nlcpZEC5Z&NcjcY^,Bj%*^-[eK8pQBaRS(se" 2wH\(/IPXcmwr(PTr,UL(#QKm\9V!AyK7(P.Q%T*&>S)VY9:wY`? %PDF-1.5 % Int J Sports Phys Ther. The reliability of the vail sport test as a measure of physical performance following anterior cruciate ligament reconstruction. x]k6nA_tHd/bg"HFg=_[$ q?X"UInw7WovO>aZoxy:h_b~_={KV0VVuGLU+$)Zsfqm(,t6=I*B:q_^?/3!6wlvDq/[^G]zlrYvzyWX\.yq^RGRZ%#|vZYlg-^v^lK+t^m7d.8w+(jy{''AGs c[y[r IJy"MW6gDF/e4)LD=)9{e ]+y"M__NLB }WZ#Ni);3tr. A test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6months after ACL injury and reconstruction and may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities. cOOPvqzjCp. Complete 10 rep squat / 10 rep leg press with >90% of the predicted 1RM. % JFIF C Starting power training should begin when the athlete shows the following criteria: A different characteristic of muscular strength is power which is a combination of force and velocity. % * Patient must score 46/54 on the test in order to pass Forward Jogging Set Up: Video: Scoring Minute 1 Minute 2 Knee flexion angle is 30o or greater during landing Patient performs repetitions . The Vail Sport Test, originally described by Hagerman and Atkins, 34 is a functional assessment to return to alpine skiing and has been used as a criterion to return to sport, as previously described in the literature. 1}Q4;\j9c^[y^wt;!%Fl{Qbn}?] cQv_bLcK?q]~~n~/|-mIFr;g9]XLj2w.;_|*jh3.zL":'vYbDU-*0}s=$e OC(7qRj+S682ef\d}k"uGdQ{O0O+Vy^_%k!M]1 There was no significant difference between the scores collected in real time and those of the IKDC (p = 0.885). That is usually the journal article where the information was first stated. Epub 2017 Feb 21. The Vail Sport Test is a return to sports assessment that incorporates a series of dynamic multiplanar functional activities against the resistance of a sportcord . endobj Request PDF | The Validity And Reliability Of The Vail Sport Test As A Measure Of Performance Following Anterior Cruciate Ligament Reconstruction | Objectives: To determine the validity and . If any signs of overload was present, return to the previous stage of running progression. 2017 Oct;475(10):2472-2480. doi: 10.1007/s11999-017-5418-2. A total of, Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine. Cristiani R, Mikkelsen C, Edman G, Forssblad M, Engstrm B, Stlman A. Biggs A, Jenkins WL, Urch SE, Shelbourne KD. As a physiotherapist, you have a role in guiding your patient through a long-term rehabilitation plan. Lower extremity muscle strength after anterior cruciate ligament injury and reconstruction. <>/Metadata 536 0 R/ViewerPreferences 537 0 R>> Further examples and more on the progression of exercises are found in table 6 in this article. A test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6months after ACL injury and reconstruction and may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities. and transmitted securely. Please enable it to take advantage of the complete set of features! w.99@nFb[x(A[ SjU-4~*=2m]ri&C|@-E/PueJdk$/brwsOo99" S6r*R1i@&WjK9y@{8p5$4rRCm@uM,2RBrmlLf>=+X4!["R)ju(y[J@u"ZI,Kx{;ZjF* W$[me There is no specific program that is superior to the others, however, there are similar goals within in all rehabilitation programs. Selecting specific strengthening exercises depends on what muscles you want to emphasis. **A systemic review by Andrade et al., (2020) recommend against functional bracing and continuous passive motion.[3]. The test batteries in the current literature show high variability and a lack of essential components necessary for RTS, suggesting a disconnect between recommended guidelines and clinical practice. Cohort study-exploratory methodological research design. Sixty-two per cent of patients who had ACL surgery returned to their previous level of sport at 5 years after ACL reconstruction, and the subgroups that did not return to sport because of fear of re-injury and because of an unstable knee found that the difference in knee outcome scores between these 3 groups were statistically significant. There were no significant difference between the scores collected in real-time and from the kinematic data on the involved limb (p = 0.222). <> Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. Author: Candace Walker . 20 There are a total of four components of the test that include a single-leg squat for 3 minutes (Video 1), lateral bounding for 90 seconds (Video 2), and forward/backward jogging for 2 minutes each (Videos 3 and 4). $[A`M A&Zb @2`@&F!# * Garrison JC, Shanley E, Thigpen C, Geary R, Osler M, Delgiorno J. Int J Sports Phys Ther. You . endobj The ACL rehabilitation plan has 9 Phases: Time frames vary among different sports. Compared with matched healthy controls, the participants who underwent ACLR demonstrated an inferior objective profile at RTS, consisting of deficits in surgical limb loading, self-reported outcomes, and strength. 2012 Feb;7(1):20-30. Purpose: To test single leg endurance strength and evaluate patellar tracking. ,(s*@ ;@p'D2g g.wxaCOi!o\/~iwY_\R>9 ~:KmPDP\ S@YVPc^4?~)=TJ`sK+lvS|o%SMm 9 A/naYMM@&(gq[`-RKsUBH$m,'MCkOo0_^x0?W~6}Xlz*i:EsTJbcW#xsH/,x.29YgeULX!N$MS"7a4F.AaonTl@^O.l1wnxg(wYap_@s{T'\i*\eTG4@4c,lra;.$-mhJ]sKMDhK[)Ktq^u-1]~ vo!,bA endstream endobj startxref Table 1. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 1 0 obj <>/Metadata 430 0 R/ViewerPreferences 431 0 R>> Three major. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The findings indicate that patients are not fully rehabilitated 11months after ACL reconstruction, and it is suggested that functional testing should be performed both under non-fatigued and fatigued test conditions. <>>> This criteria-based protocol incorporates a dynamic assessment of baseline limb strength, patient-reported outcomes, functional knee stability, bilateral limb symmetry with functional tasks, postural control, power, endurance, agility, and technique with sport-specific tasks and serves as a foundation to expand future evidence-based evaluation. <> Microsoft Word 2016 Participants performance on the Vail Sport Test was graded by an experienced rater in real-time, and simultaneously recorded by a three-dimensional (3D) motion capture system. The relatively low rate of return to competitive sport despite the high rates of successful outcome in terms of knee impairment-based function suggests that other factors such as psychological factors may be contributing to return-to-sport outcomes. Principles of postoperative anterior cruciate ligament rehabilitation. 2012; 7(1):20-30. 1 0 obj 15 reps single leg squat from a 10 inch step/box, Anterior reach on the Y-Balance test within 8 cm difference from the opposite leg, Back squat/Leg press at 80% of the predicted 10 RM, Anterior reach distance within 4 cm difference from the opposite leg on the Y-Balance test, Quad girth within 1 cm compared to the contralateral side, Hamstrings/Quad ratio 60%, using a handheld dynamometer. b+-~G6I4l#/o*>zw,wq(iY}{o=.(I_Pq/|^WmU=T.>Wy*#nK}u1{M)^$P?J ?H[]?|BlCgaAgM7W;Hcp3TOwkvi1xQ8*BN8kvt5 lwGl9-!BVCu 1"g3(-`E2HjCHTh^_B^Mv#)v n5-ZbRq [C:2z9;~d7sGU[{[H*m4A1R'sC'R~Bp1y>-X5j56wQ. <> The relatively low rate of return to competitive sport despite the high rates of successful outcome in terms of knee impairment-based function suggests that other factors such as psychological factors may be contributing to return-to-sport outcomes. It requires heavy to moderate loads (60-67% of 1-RM), with frequent increase of resistance, either by external weight or single leg posture. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. Due to the inadequacy of current return-to-sport tests, the Vail Sport Test (Fig. Epub 2016 May 31. This study aims at reviewing the available literature on reliability and validity of existing subjective test protocols, and first recommendations for the use of different subjective screening test methods are given. Knee Surgery, Sports Traumatology, Arthroscopy. $m]5+vQ' 6 $L!phy|p^/g'zvtr1xA^$d4qr2|zFvwvw_3rrv.#HQ9-9$WWovwwrc_;+EhN4)AS[B$mXgZ-XSzHc5l'G8=y?xO/wxw A prospective cohort study design. Predicting outcomes and time-frames, using your clinical experience and clinical reasoning skills, for each goal is also part of your role. Supplies: Sport Cord (Topp er Sports Medicine, black cord) GoniometerStopwatch Description: The Athlete will perform single knee bends with cord resistance to 60 at a cadence of 1 second up and 1 second down for a goal of 3 minutes. There was a significant difference for the uninvolved limb (p = 0.015). Copyright 2019 Elsevier Ltd. All rights reserved. 17 3l5U( G$|{viar3#r6}kguwy< 2 0 obj DOI: 10.1016/j.ptsp.2019.05.001 Corpus ID: 174805383; The validity and reliability of the Vail Sport Test as a measure of performance following anterior cruciate ligament reconstruction. Setting: This study aims at reviewing the available literature on reliability and validity of existing subjective test protocols, and first recommendations for the use of different subjective screening test methods are given. HHS Vulnerability Disclosure, Help The following is a suggested weekly plan for an athlete requires strong lower body as the top priority, cardiovascular fitness, core stability and upper body strength: Accordingly, the plan includes 4 lower body strengthening sessions, 2 cardio sessions, 2 pool sessions, 2 core sessions, 2 upper body strengthening sessions. Disclaimer. Rushing rehabilitation may lead to adverse complications such as increased inflammation and loss of ROM[9]. <> Regardless of the donor site, both knees should be incorporated throughout the rehabilitation process. endobj Back leg squat/Leg press for 10 rep at >70% of the predicted 10 RM. 0 <> endobj The intermediate rehabilitation phase goals: Quadriceps Index :''the ratio of involved-side quadriceps strength to uninvolved-side quadriceps strength"[4]. a dissertation . %PDF-1.7 % By the end of this phase your patient must be able to[14]: Anterior cruciate ligament (BTB) rehabilitation guideline [12], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. Dietvorst M, Brzoskowski MH, van der Steen M, Delvaux E, Janssen RPA, Van Melick N. J Exp Orthop. 1c, Fig. hW_o6*zldIC>Hq%Yv.LWKbe8aLjk$%S endobj The International Journal of Sports Physical Therapy | Volume 7, Number 1 | February 2012 | Page 22 triple hop indices.16 In addition, the quadriceps strength of these patients was correlated with . Thomas AC, Villwock M, Wojtys EM, Palmieri-Smith RM. Endurance is the ability to exert work for prolonged time and resist fatigue. stream When refering to evidence in academic writing, you should always try to reference the primary (original) source. Would you like email updates of new search results? sharing sensitive information, make sure youre on a federal %PDF-1.5 in the graduate school of the . Kokmeyer et al. This test will be completed in reverse order (A to C to B to A) to make sure the patient is planting with both the involved and uninvolved foot. The Reliability of the Vail Sport Test As a Measure of Physical Performance Following Anterior Cruciate Ligament Reconstruction. school of physical therapy In most cases Physiopedia articles are a secondary source and so should not be used as references. 4 0 obj 2 0 obj Post-operative criterion based rehabilitaiton of ACL repairs: A clinical commentary. What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction. The decision to return an athlete to sports following anterior cruciate ligament reconstruction can be controversial. Annals of the Academy of Medicine, Singapore. measure the time it takes to patient to complete the test. &!7\,=(*B0(`e8X8V.rI90C6v^AH\q ^>)7.9I(l@sRaBuv?A0 8d+1${T MeSH The validity and reliability of the Vail Sport Test as a measure of performance following anterior cruciate ligament reconstruction The results of this study showed good reliability and partially support the validity of the Vail Sport Test as a measure of readiness to return to play. A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II). 1b, Fig. 2016 May;51(5):425-7. doi: 10.4085/1062-6050.51.5.11. Early Operative Versus Delayed or Nonoperative Treatment of Anterior Cruciate Ligament Injuries in Pediatric Patients. ~. Anterior Cruciate Ligament Rehabilitation and Return to Sport: How Fast Is Too Fast? endobj MpTp954A6eT! official website and that any information you provide is encrypted 1173185, Selecting Proper Exercises and Parameters. for the degree of doctor of philosophy . Methods: A prospective cohort study design. Rehabilitation for patients following ACL reconstruction: Arthrofibrosis following ACL reconstructionreasons and outcome. Good inter-session reliability (ICC = 0.787) was found for the involved limb. Int J Sports Phys Ther. 0 This . Federal government websites often end in .gov or .mil. Hetsroni I, Wiener Y, Ben-Sira D, Iacono AD, Marom N, van Stee M et al. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. uuid:0145AEDA-8081-4B56-969A-0706CADDFBEE 3 0 obj The evidence is rich in ACL-rehabilitation protocols. It could be described as a vicious cycle of abnormal loading pattern leading to loss of strength, resulting in more abnormal loading patterns. %%EOF government site. Construct validity was assessed using the reference standards of the camera system and the IKDC short form. S.C]} When setting a weekly plan, consider the priorities for your athlete and the required levels of different physiological characteristics. From a clinical perspective, the results of this attempting to return to sports following ACL reconstruction and 2) to assess the reliability of the Vail Sport Test. Age, gender, quadriceps strength and hop test performance are the most important factors affecting the achievement of a patient-acceptable symptom state after ACL reconstruction. The Vail Sport Test has great potential to be an optimal test for safely returning athletes to sports. DOI: 10.4236/health.2017.910104 1420 Health recommendations concerning the use of the tests and to verify the quality crite-ria. The findings indicate that patients are not fully rehabilitated 11months after ACL reconstruction, and it is suggested that functional testing should be performed both under non-fatigued and fatigued test conditions. The Vail sports test will give you an idea how your patient loads his/her injured knee which will reflect on running. stream Alter-G treadmill or pool running is helpful when you want to start with partial weight-bearing, progressing 5% each session till full weigh-bearing. <>/Metadata 500 0 R/ViewerPreferences 501 0 R>> Bethesda, MD 20894, Web Policies Increasing running tolerance should be gradual and slow for up to 4 weeks. Demographics and descriptive results for Vail Sport Test, By clicking accept or continuing to use the site, you agree to the terms outlined in our. International journal of sports physical therapy, PURPOSE/BACKGROUND Save 1.6K views 11 months ago Rehabilitation to Sports Performance - A Criterion Based, Functional Testing Algorithm for Return to Sport Success The video provides an overview of the Vail. A problem may arise when the surgical graft is obtained from the contralateral leg. 4 0 obj reconstruction . ACL rehabilitation progression: where are we now? endobj <> This site needs JavaScript to work properly. 1 . Int J Sports Phys Ther. endobj Functional outcomes suggest that a subgroup of noncopers require additional supervised rehabilitation to pass stringent criteria to return to sports. stream (18) conducted an analysis on the prevalence of injuries in World Cup Ski Racing, finding that 9.8 injuries occurred for every 1,000 runs taken, 38% of which were to the knee. 1ea-e) was developed to assess an athlete's ability to perform four major sport-specific functional activities: (1) single leg squat, (2) lateral bounding, (3) forward running, and (4) backward running). Regaining full ROM for both knees should be aimed during rehabilitation. The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction. stream PMC Alter-G treadmill or pool running is helpful when you want to start with partial weight-bearing, progressing 5% each session till full weigh-bearing. Design: The purposes of this study are 1) to describe a functional test (Vail Sport Test) that includes the evaluation of muscle strength, endurance, power, and movement quality in those patients attempting to return to sports following ACL reconstruction and 2) to assess the reliability of the Vail Sport Test. 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 No Difficulty Slight Difficulty Moderate Extreme Unable to do Twisting/pivoting on invloved leg Deep squatting Heavy work (push . <> 11/2017 . Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). ,I)rK7KlM///mKzQd(MN6dh,t&gqh17_aiGWE+y&D]/-un..1]*9n>}}YSkt[|I L|Y>O/)Vwd4UaPq4fE]mtgEDL_W7&r0xpufoO z(^aCsl [_B8RE=;/ #u BI1h4IW'A6td~_--bw*_v8 6k-w3HOC.msl5B.[qo].d|DP# x R!R"s3cHNuq,n|;5m:#hrWs#q;v6%SV%eumNGpG Hu.Z&ERkG.#1AY+@V&>iQDC@- \S~P_K2iV_V("Zy=eEVs(Jw(. endstream endobj startxref A criterion-based postoperative protocol was derived based on current evidence regarding rehabilitation following cruciate ligament reconstruction and evidence regarding lower extremity rehabilitation principles and injury prevention and allowed the patient to return to competitive athletics. The Vail sports test will give you an idea how your patient loads his/her injured knee which will reflect on running[14]. Accessibility Comparing the injured knee to the other side and trying to reach as much as possible symmetry is essential for recovery and return to function. Progress each week by increasing a minute of running and decrease a minute of walking, till the athlete is able to run for a progressive 20 minutes. A comprehensive RTS decision-based model for sports medicine practitioners is discussed that assesses risk of reinjury from multiple factors and determines the clinicians threshold for acceptable risk. These criteria are based upon quality criteria such as efficiency, utility and }, author={James Craig Garrison and Ellen Shanley and Charles A. Thigpen and Ryan Geary and Mike Osler and Jackie Delgiorno}, journal={International journal of sports . The purposes of this study are 1) to describe a functional test (Vail Sport Test) that includes the evaluation of muscle strength, endurance, power, and movement quality in those patients. Diagnostic accuracy of handheld dynamometry and 1-repetition-maximum tests for identifying meaningful quadriceps strength asymmetries. Return to sport test Weeks 20-24 (Prior to 6-month follow-up appointment) Test Dynamic Valgus * (Y/N) R L % Y-Balance Leg length (ASIS to medial . endstream endobj 2 0 obj <> endobj 46 0 obj <> endobj 376 0 obj <> endobj 48 0 obj <> endobj 47 0 obj <> endobj 52 0 obj [51 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 63 0 R 63 0 R 65 0 R 65 0 R 67 0 R 67 0 R 69 0 R 69 0 R 71 0 R 71 0 R 75 0 R 77 0 R 79 0 R 81 0 R 83 0 R 86 0 R 87 0 R 88 0 R 89 0 R 91 0 R 93 0 R 95 0 R 97 0 R 98 0 R 99 0 R 104 0 R 104 0 R 106 0 R 106 0 R 108 0 R 108 0 R 110 0 R 110 0 R 112 0 R 112 0 R 116 0 R 117 0 R 118 0 R 120 0 R 122 0 R 124 0 R 126 0 R 128 0 R 132 0 R 134 0 R 136 0 R 138 0 R 140 0 R 144 0 R 146 0 R 148 0 R 150 0 R 152 0 R 156 0 R 158 0 R 160 0 R 162 0 R 164 0 R 167 0 R 169 0 R 171 0 R 173 0 R 175 0 R 177 0 R 180 0 R 182 0 R 184 0 R 186 0 R 188 0 R 190 0 R 193 0 R 195 0 R 197 0 R 199 0 R 201 0 R 203 0 R 206 0 R 208 0 R 210 0 R 212 0 R 214 0 R 216 0 R 219 0 R 221 0 R 223 0 R 225 0 R 227 0 R 229 0 R 232 0 R 234 0 R 236 0 R 238 0 R 240 0 R 242 0 R 245 0 R 246 0 R 247 0 R 248 0 R 250 0 R 251 0 R 252 0 R 254 0 R 256 0 R 258 0 R 260 0 R 263 0 R 265 0 R 267 0 R 269 0 R 271 0 R 273 0 R 274 0 R 275 0 R] endobj 277 0 obj [276 0 R 278 0 R 279 0 R 280 0 R 281 0 R 282 0 R 283 0 R 284 0 R 285 0 R 286 0 R 287 0 R 288 0 R 289 0 R 293 0 R 295 0 R 296 0 R 297 0 R 298 0 R 299 0 R] endobj 301 0 obj [300 0 R 302 0 R 304 0 R 311 0 R 312 0 R 313 0 R 314 0 R 315 0 R 316 0 R 317 0 R 319 0 R 303 0 R 318 0 R 310 0 R 309 0 R 307 0 R 306 0 R] endobj 321 0 obj [320 0 R 322 0 R 323 0 R 324 0 R 328 0 R 330 0 R 332 0 R 334 0 R 336 0 R 338 0 R 340 0 R 342 0 R 344 0 R 346 0 R 348 0 R 350 0 R 352 0 R 353 0 R 354 0 R 355 0 R] endobj 320 0 obj <> endobj 322 0 obj <> endobj 323 0 obj <> endobj 324 0 obj <> endobj 328 0 obj <> endobj 330 0 obj <> endobj 332 0 obj <> endobj 334 0 obj <> endobj 336 0 obj <> endobj 338 0 obj <> endobj 340 0 obj <> endobj 342 0 obj <> endobj 344 0 obj <> endobj 346 0 obj <> endobj 348 0 obj <> endobj 350 0 obj <> endobj 352 0 obj <> endobj 353 0 obj <> endobj 354 0 obj <> endobj 355 0 obj <> endobj 50 0 obj <> endobj 41 0 obj <>/MediaBox[0 0 612 792]/Parent 2 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/StructParents 3/Tabs/S/Type/Page>> endobj 42 0 obj <>stream