Strategies that facilitate participation in family activities of children and adolescents with profound intellectual and multiple disabilities: Parents' and personal assistants' experiences

Journal article

Axelsson, Anna Karin, Imms, Christine and Wilder, Jenny. (2014). Strategies that facilitate participation in family activities of children and adolescents with profound intellectual and multiple disabilities: Parents' and personal assistants' experiences. Disability and Rehabilitation. 36(25), pp. 2169 - 2177. https://doi.org/10.3109/09638288.2014.895058
AuthorsAxelsson, Anna Karin, Imms, Christine and Wilder, Jenny
Abstract

Purpose: Participation throughout one’s life plays a significant role for development and emotional well-being. For this reason, there is a need to identify ways to facilitate participation in family activities for children and adolescents with profound intellectual and multiple disabilities (PIMD).

Methods: The study design was qualitative and explorative, based on semi structured interviews with 11 parents and 9 personal assistants of children with PIMD.

Results: The interviews revealed participation-facilitating strategies relating to the children’s/adolescent’s proximal environment, such as “Availability and acceptability of the activity”, “Good knowledge about the child” and a “A positive attitude of people close to the child”, as well as strategies related to the children/adolescents themselves: “Sense of belonging”, “Possible for the child/adolescent to understand”, “Opportunities to influence” and “Feeling of being needed”.

Conclusions: Children and adolescents with PIMD are dependent on support obtained through their environment. The identified strategies, individually adapted through awareness and knowledge by the parents and the personal assistants, provide important evidence to assist our understanding in gaining understanding about how to improve participation in family activities of children and adolescents with PIMD.

Year2014
JournalDisability and Rehabilitation
Journal citation36 (25), pp. 2169 - 2177
PublisherTaylor & Francis
ISSN0963-8288
Digital Object Identifier (DOI)https://doi.org/10.3109/09638288.2014.895058
Scopus EID2-s2.0-84916631689
Page range2169 - 2177
Research GroupSchool of Allied Health
Publisher's version
File Access Level
Controlled
Place of publicationUnited Kingdom
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Reliable classification of functional profiles and movement disorders of children with cerebral palsy
Randall, Melinda, Harvey, Adrienne, Imms, Christine, Reid, Sue, Lee, Katherine J. and Reddihough, Dinah. (2013). Reliable classification of functional profiles and movement disorders of children with cerebral palsy. Physical & Occupational Therapy in Pediatrics. https://doi.org/10.3109/01942638.2012.747584
Development of the mini-assisting hand assessment: evidence for content and internal scale validity
Greaves, Susan, Imms, Christine, Dodd, Karen and Krumlinde-Sundholm, Lena. (2013). Development of the mini-assisting hand assessment: evidence for content and internal scale validity. Developmental Medicine and Child Neurology. https://doi.org/10.1111/dmcn.12212
Reliable classification of functional profiles and movement disorders of children with cerebral palsy
Randall, Melinda, Harvey, Adrienne, Imms, Christine, Reid, Sue, Lee, Katherine and Reddihough, Dinah. (2013). Reliable classification of functional profiles and movement disorders of children with cerebral palsy. Physical & Occupational Therapy in Pediatrics. 33(3), pp. 342 - 352. https://doi.org/10.3109/01942638.2012.747584
Geographical patterns in the recreation and leisure participation of children and youth with cerebral palsy : A CAPE international collaborative network study
King, Gillian, Imms, Christine, Palisano, Robert, Majnemer, Annette, Chiarello, Lisa, Orlin, Margo, Law, Mary and Avery, Lisa. (2013). Geographical patterns in the recreation and leisure participation of children and youth with cerebral palsy : A CAPE international collaborative network study. Developmental Neurorehabilitation. https://doi.org/10.3109/17518423.2013.773102
Is participation among children with intellectual disabilities in outside school activities similar to their typically developing peers? : A systematic review
Shields, Nora, King, Matthew, Corbett, Monique and Imms, Christine. (2013). Is participation among children with intellectual disabilities in outside school activities similar to their typically developing peers? : A systematic review. Developmental Neurorehabilitation. https://doi.org/10.3109/17518423.2013.836256
Further evidence of validity of the Modified Melbourne Assessment for the neurologically impaired children aged 2 to 4 years
Randall, Melinda, Imms, Christine and Carey, Leeanne. (2012). Further evidence of validity of the Modified Melbourne Assessment for the neurologically impaired children aged 2 to 4 years. Developmental Medicine and Child Neurology. 54(5), pp. 424 - 428. https://doi.org/10.1111/j.1469-8749.2012.04252.x
Looking to the future: Adolescents with cerebral palsy talk about their aspirations - A narrative study
Cussen, Amy, Howie, Linsey and Imms, Christine. (2012). Looking to the future: Adolescents with cerebral palsy talk about their aspirations - A narrative study. Disability and Rehabilitation. 34(24), pp. 2103 - 2110. https://doi.org/10.3109/09638288.2012.672540
Prospective study of the participation patterns of Grade 6 and Year 8 students in Victoria, Australia in activities outside of school
McMullan, Sarah, Chin, Rachel, Froude, Elspeth Heather and Imms, Christine. (2012). Prospective study of the participation patterns of Grade 6 and Year 8 students in Victoria, Australia in activities outside of school. Australian Occupational Therapy Journal. 59(3), pp. 197 - 208. https://doi.org/10.1111/j.1440-1630.2012.01013.x
Bimanual behaviours in children aged 8-18 months: A literature review to select toys that elicit the use of two hands
Greaves, Susan, Imms, Christine, Krumlinde-Sundholm, Lena, Dodd, Karen and Eliasson, Ann-Christin. (2012). Bimanual behaviours in children aged 8-18 months: A literature review to select toys that elicit the use of two hands. Research in Developmental Disabilities. 33(1), pp. 240 - 250. https://doi.org/10.1016/j.ridd.2011.09.012
Hopes and Aspirations for Leisure and Living :Adolescents with Cerebral Palsy Talk about the Future
Cussen, Amy, Imms, Christine and Howie, Linsey. (2011). Hopes and Aspirations for Leisure and Living :Adolescents with Cerebral Palsy Talk about the Future. Australian Occupational Therapy Journal. 58(Suppl s1), pp. 75 - 75. https://doi.org/10.1111/j.1440-1630.2011.00938.x
Linking cerebral palsy upper limb measurements to the international classification of functioning disability and health
Hoare, Brian, Imms, Christine, Randall, Melinda and Carey, Leeanne. (2011). Linking cerebral palsy upper limb measurements to the international classification of functioning disability and health. Scandinavian Journal of Rehabilitation Medicine. 43(11), pp. 987 - 996. https://doi.org/10.2340/16501977-0886
Leisure Participation Patterns of Children in Victoria Australia
Chin, Rachel, McMullen, Sarah, Froude, Elspeth Heather and Imms, Christine. (2011). Leisure Participation Patterns of Children in Victoria Australia. Australian Occupational Therapy Journal. 58(Suppl s1), pp. 101 - 101. https://doi.org/10.1111/j.1440-1630.2011.00938.x
Factors Influencing Children's Readiness to Enter School :Views From Early Childhood Educators
Froude, Elspeth Heather, Imms, Christine, Merrigan, C, Joffe, Beverly, Heine, Chyrisse and Serry, Tanya. (2011). Factors Influencing Children's Readiness to Enter School :Views From Early Childhood Educators. Australian Occupational Therapy Journal. 58(Suppl s1), pp. 23 - 23.
Bracing and splinting interventions in the upper limbs of people with cerebral palsy
Imms, Christine. (2011). Bracing and splinting interventions in the upper limbs of people with cerebral palsy. Developmental Medicine and Child Neurology. 53(4), pp. 293 - 294. https://doi.org/10.1111/j.1469-8749.2010.03881.x
A Systematic Review of the Measurement Properties of the Personal Care Participation, Assessment and Resource Tool (PC-Part)
Darzins, Susan, Imms, Christine and Di Stefano, Marilyn. (2011). A Systematic Review of the Measurement Properties of the Personal Care Participation, Assessment and Resource Tool (PC-Part). Australian Occupational Therapy Journal. 58(Suppl s1), pp. 127 - 128. https://doi.org/10.3109/09638288.2012.690819
Preliminary evidence supports the validity of the strength-dexterity test as a unidimensional scale measuring fingertip force coordination in children and adolescents
Imms, Christine and van Hartingsveltd, Margot. (2011). Preliminary evidence supports the validity of the strength-dexterity test as a unidimensional scale measuring fingertip force coordination in children and adolescents. Australian Occupational Therapy Journal. 58(6), pp. 317 - 319. https://doi.org/10.1111/j.1440-1630.2011.00952.x
Children and Youth with Myleomeningocele's Independence in Managing Clean Intermittent Catheterization in Familiar Settings
Donlau, Marie, Imms, Christine, Mattsson, Gunilla, Mattsson, Sven, Sjors, Anna and Falkmer, Torbjorn. (2011). Children and Youth with Myleomeningocele's Independence in Managing Clean Intermittent Catheterization in Familiar Settings. Developmental Medicine and Child Neurology. 100(3), pp. 429 - 438. https://doi.org/10.1111/j.1651-2227.2010.02044.x
Goal directed training of activity performance
Hoare, Brian and Imms, Christine. (2010). Goal directed training of activity performance. In In Dodd, Karen J., Imms, Christine and Taylor, Nicholas F. (Ed.). Physiotherapy and occupational therapy for people with cerebral palsy : A problem-based approach to assessment and management pp. 130-145 Mac Keith Press.
The young adult with complex disability
Scoullar, Barbara and Imms, Christine. (2010). The young adult with complex disability. In In Dodd, Karen, Imms, Christine and Dodd, Barbara J. (Ed.). Physiotherapy and occupational therapy for people with cerebral palsy : A problem-based approach to assessment and management pp. 245-259 Mac Keith Press.
Botulinum Toxin A as an Adjunct to Treatment in the Management of the Upper Limb in Children with Spastic Cerebral Palsy (UPDATE)
Hoare, Brian, Wallen, Margaret, Imms, Christine, Villanueva, Elmer, Rawicki, Hyam and Carey, Leeanne. (2010). Botulinum Toxin A as an Adjunct to Treatment in the Management of the Upper Limb in Children with Spastic Cerebral Palsy (UPDATE). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD003469.pub4
Psychometric Properties of the 'Extended' Melbourne Assessment of Unilateral Upper Limb Function Based on Rasch Analysis
Randall, Melinda, Pallant, Julie, Imms, Christine and Carey, Leeanne. (2010). Psychometric Properties of the 'Extended' Melbourne Assessment of Unilateral Upper Limb Function Based on Rasch Analysis. Developmental Medicine and Child Neurology.
Impact of Transition to High School on Leisure Participation of Adolescents with Cerebral Palsy
Imms, Christine, Reilly, Sheena, Carlin, John and Dodd, Karen. (2010). Impact of Transition to High School on Leisure Participation of Adolescents with Cerebral Palsy. Developmental Medicine and Child Neurology. 52(2), pp. 22 - 22.
Introduction to the clinical reasoning approach of the book
Imms, Christine, Dodd, Karen and Taylor, Nicholas. (2010). Introduction to the clinical reasoning approach of the book. In In Dodd, Karen J., Imms, Christine and Taylor, Nicholas F. (Ed.). Physiotherapy and occupational therapy for people with cerebral palsy : A problem-based approach to assessment and management pp. 1-6 Mac Keith Press.
Modified constraint induced therapy for young children
Wallen, Margaret and Imms, Christine. (2010). Modified constraint induced therapy for young children. In In Dodd, Karen J., Imms, Christine and Taylor, Nicholas F. (Ed.). Physiotherapy and occupational therapy for people with cerebral palsy : A problem-based approach to assessment and management pp. 114-129 Mac Keith Press.
Measure twice, cut once : Understanding the reliability and validity of the clinical measurement tools used in health research
Imms, Christine and Greaves, Susan. (2010). Measure twice, cut once : Understanding the reliability and validity of the clinical measurement tools used in health research. In In Liamputtong, Pranee (Ed.). Research methods in health : Foundations for evidence-based practice pp. 173-195 Oxford University Press.
What is cerebral palsy?
Imms, Christine and Dodd, Karen J.. (2010). What is cerebral palsy? In In Dodd, Karen J., Imms, Christine and Taylor, Nicholas F. (Ed.). Physiotherapy and occupational therapy for people with cerebral palsy : A problem-based approach to assessment and management pp. 7-30 Mac Keith Press.
Eight Weeks of Occupational Therapy Home Programme, Compared to No Programme, Resulted in Improved Achievement of Child and Family- Selected Goals by Children with Cerebral Palsy
Imms, Christine, Cowan, Rebecca, Ertekin, Elvan, Klein, Gabi-Leigh and Galvin, Jane. (2010). Eight Weeks of Occupational Therapy Home Programme, Compared to No Programme, Resulted in Improved Achievement of Child and Family- Selected Goals by Children with Cerebral Palsy. Australian Occupational Therapy Journal. 57(6), pp. 444 - 445. https://doi.org/10.1111/j.1440-1630.2010.00907.x
Assessing Bimanual Performance in Young Children with Hemiplegic Cerebral Palsy : A Systematic Review
Greaves, Susan, Imms, Christine, Dodd, Karen and Krumlinde-Sundholm, Lena. (2010). Assessing Bimanual Performance in Young Children with Hemiplegic Cerebral Palsy : A Systematic Review. Developmental Medicine and Child Neurology. 52(5), pp. 413 - 421. https://doi.org/10.1111/j.1469-8749.2009.03561.x
Repeat Botulinum Toxin-A in the Upper Limb of Children with Hemiplegia : A Randomized Controlled Trial
Olesch, Christine, Greaves, Susan, Imms, Christine, Reid, Susan M. and Kerr, Graham. (2010). Repeat Botulinum Toxin-A in the Upper Limb of Children with Hemiplegia : A Randomized Controlled Trial. Developmental Medicine and Child Neurology. 52(1), pp. 79 - 86. https://doi.org/10.1111/j.1469-8749.2009.03387.x
Intensive Upper Limb Therapy Following Botulinum-A in Young Children with Hemiplegic Cerebral Palsy : Results from a Randomised Controlled Trial
Hoare, Brian, Imms, Christine and Carey, Leeanne. (2010). Intensive Upper Limb Therapy Following Botulinum-A in Young Children with Hemiplegic Cerebral Palsy : Results from a Randomised Controlled Trial. Developmental Medicine and Child Neurology. 52(Suppl s2), pp. 13 - 13. https://doi.org/10.1111/j.1469-8749.2009.03595.x
Modified constraint-induced movement therapy or bimanual occupational therapy following injection of botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper
Hoare, Brian, Imms, Christine, Rawicki, Hyam and Carey, Leeanne. (2010). Modified constraint-induced movement therapy or bimanual occupational therapy following injection of botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper. BMC Neurology. 10(1), pp. 58 - 78. https://doi.org/10.1186/1471-2377-10-58
The adult years
Dodd, Karen J., Taylor, Nicholas F. and Imms, Christine. (2010). The adult years. In In Dodd, Karen J., Imms, Christine and Taylor, Nicholas F. (Ed.). Physiotherapy and occupational therapy for people with cerebral palsy : A problem-based approach to assessment and management pp. 260-281 Mac Keith Press.
Overview of therapy
Dodd, Karen, Imms, Christine and Taylor, Nicholas F.. (2010). Overview of therapy. In In Dodd, Karen J., Imms, Christine and Taylor, Nicholas F. (Ed.). Physiotherapy and occupational therapy for people with cerebral palsy : A problem-based approach to assessment and management pp. 40-72 Mac Keith Press.
Stability of caregiver-reported manual ability and gross motor function classifications of cerebral palsy
Imms, Christine, Carlin, John and Eliasson, Ann-Christin. (2009). Stability of caregiver-reported manual ability and gross motor function classifications of cerebral palsy. Developmental Medicine and Child Neurology. 52(2), pp. 153 - 159. https://doi.org/10.1111/j.1469-8749.2009.03346.x
Characteristics influencing participation of Australian children with cerebral palsy
Imms, Christine, Reilly, Sheena, Carlin, John and Dodd, Karen. (2009). Characteristics influencing participation of Australian children with cerebral palsy. Disability and Rehabilitation. 31(26), pp. 2204 - 2215. https://doi.org/10.3109/09638280902971406
Newborn individualised developmental care and assessment programme for infants born less than 32 weeks' gestation did not improve neurodevelopmental outcomes at one and two years more than standard developmental care
Imms, Christine and Brown, Nisha. (2009). Newborn individualised developmental care and assessment programme for infants born less than 32 weeks' gestation did not improve neurodevelopmental outcomes at one and two years more than standard developmental care. Australian Occupational Therapy Journal. 56(6), pp. 439 - 441. https://doi.org/10.1111/j.1440-1630.2009.00824.x
Factors influencing participation of children with cerebral palsy in Australia
Imms, Christine, Reilly, Sheena, Carlin, John and Dodd, Karen. (2009). Factors influencing participation of children with cerebral palsy in Australia. Developmental Medicine and Child Neurology. 51(2), pp. 23 - 24.
Sensory processing abilities of children who have sustained traumatic brain injuries
Galvin, Jane, Froude, Elspeth and Imms, Christine. (2009). Sensory processing abilities of children who have sustained traumatic brain injuries. American Journal of Occupational Therapy. 63(6), pp. 701 - 709. https://doi.org/10.5014/ajot.63.6.701
The relationship between physical performance and self-perception in children with and without cerebral palsy
Ziebell, Melanie, Imms, Christine, Froude, Elspeth, McCoy, Anne and Galea, Mary. (2009). The relationship between physical performance and self-perception in children with and without cerebral palsy. Australian Occupational Therapy Journal. 56(1), pp. 24 - 32. https://doi.org/10.1111/j.1440-1630.2008.00775.x
The evidence-base for upper extremity intervention for children with cerebral palsy
Imms, Christine. (2008). The evidence-base for upper extremity intervention for children with cerebral palsy. In In A.C.Eliasson and P, Burtner (Ed.). Improving hand function in cerebral palsy : Theory, evidence and intervention pp. 396 - 417 Mac Keith Press.
Children with cerebral palsy participate: A review of the literature
Imms, Christine. (2008). Children with cerebral palsy participate: A review of the literature. Disability and Rehabilitation. 30(24), pp. 1867 - 1884. https://doi.org/10.1080/09638280701673542
Establishing validity of a modified Melbourne assessment for children ages 2 to 4 years
Randall, Melinda, Imms, Christine and Carey, Leeanne. (2008). Establishing validity of a modified Melbourne assessment for children ages 2 to 4 years. American Journal of Occupational Therapy. 62(4), pp. 373 - 383. https://doi.org/10.5014/ajot.62.4.373
Review of the children's assessment of participation and enjoyment and the preferences for activity of children
Imms, Christine. (2008). Review of the children's assessment of participation and enjoyment and the preferences for activity of children. Physical & Occupational Therapy in Pediatrics. 28(4), pp. 389 - 404. https://doi.org/10.1080/01942630802307135
Activity level assessment of the upper limb in children with hemiplegic cerebral palsy : Treatment innovation and its impact on measurement
Hoare, Brian, Imms, Christine and Carey, Leeanne. (2008). Activity level assessment of the upper limb in children with hemiplegic cerebral palsy : Treatment innovation and its impact on measurement. 2008 AusACPDM Conference : Broadening the Scope. Brisbane, Queensland, Australia 10 - 13 Apr 2008 Australasian Academy of Cerebral Palsy and Developmental Medicine. pp. 1-10
Diversity of participation in children with cerebral palsy
Imms, Christine, Reilly, Sheena, Carlin, John and Dodd, Karen. (2008). Diversity of participation in children with cerebral palsy. Developmental Medicine and Child Neurology. 50(5), pp. 363 - 369. https://doi.org/10.1111/j.1469-8749.2008.02051.x
Participation of Australian Children with Cerebral Palsy in Activities Outside School
Imms, Christine, Reilly, Sheena, Carlin, John and Dodd, Karen. (2008). Participation of Australian Children with Cerebral Palsy in Activities Outside School. Developmental Medicine and Child Neurology. 50(113), pp. 17 - 17.
Goal-Directed Training: Linking Theories of Treatment to Clinical Practice for Improved Functional Activities in Daily Life
Mastos, M., Miller, K., Eliasson, Ann-Christin and Imms, Christine. (2007). Goal-Directed Training: Linking Theories of Treatment to Clinical Practice for Improved Functional Activities in Daily Life. Clinical Rehabilitation. 21(1), pp. 47 - 55. https://doi.org/10.1177/0269215506073494
Critically Appraised Papers : Parents of Children with Developmental Coordination Disorder (i) Experienced Uncertainty as they Come to Understand their Children and (ii) Described a Trajectory of Changing Difficulties as their Children Got Older
Imms, Christine, Poulsen, Anne and Case-Smith, Jane. (2007). Critically Appraised Papers : Parents of Children with Developmental Coordination Disorder (i) Experienced Uncertainty as they Come to Understand their Children and (ii) Described a Trajectory of Changing Difficulties as their Children Got Older. Australian Occupational Therapy Journal. 54(3), pp. 242 - 244.
Participation of Children Who Have Cerebral Palsy
Imms, Christine, Reilly, Sheena and Carlin, John. (2007). Participation of Children Who Have Cerebral Palsy. Developmental Medicine and Child Neurology. 49(111), pp. 33 - 34.
Group-Based Task-Related Training for Children with Cerebral Palsy: A Pilot Study
Crompton, Jodi, Imms, Christine, McCoy, Anne, Randall, Melinda, Eldridge, Beverly, Scoullar, Barbara and Galea, Mary. (2007). Group-Based Task-Related Training for Children with Cerebral Palsy: A Pilot Study. Physical & Occupational Therapy in Pediatrics. 27(4), pp. 43 - 65. https://doi.org/10.1300/J006v27n04_04
Constraint-Induced Movement Therapy in the Treatment of the Upper Limb in Children with Hemiplegic Cerebral Palsy: a Cochrane Systematic Review
Hoare, Brian, Imms, Christine, Carey, Leeanne and Wasiak, Jason. (2007). Constraint-Induced Movement Therapy in the Treatment of the Upper Limb in Children with Hemiplegic Cerebral Palsy: a Cochrane Systematic Review. Clinical Rehabilitation. 21(8), pp. 675 - 686. https://doi.org/10.1177/0269215507080783
Being in Pain: a Phenomenological Study of Young People with Cerebral Palsy
Castle, Kirstyn, Imms, Christine and Howie, Linsey. (2007). Being in Pain: a Phenomenological Study of Young People with Cerebral Palsy. Developmental Medicine and Child Neurology. 49(6), pp. 445 - 449. https://doi.org/10.1111/j.1469-8749.2007.00445.x
Critically Appraised Paper: Helping Adults with Schizophrenia or Schizo-Affective Disorder Stop Smoking Resulted in Positive Short-Term Health Benefits
Imms, Christine and Nichol, Maggie. (2007). Critically Appraised Paper: Helping Adults with Schizophrenia or Schizo-Affective Disorder Stop Smoking Resulted in Positive Short-Term Health Benefits. Australian Occupational Therapy Journal. 54(1), pp. 75 - 76.
Editorial: Critically Appraised Papers Related to Children with Autism
Wallen, Margaret and Imms, Christine. (2006). Editorial: Critically Appraised Papers Related to Children with Autism. Australian Occupational Therapy Journal. 53(3), pp. 237 - 238.
Daily Activities of families with a child with Severe Autism Revolved Around the Need to Occupy and Pacify the Child: Families Felt Robbed of Meaning and Satisfaction in Family Life: Commentary
Imms, Christine, Rodger, Sylvia and Ziviani, Jenny. (2006). Daily Activities of families with a child with Severe Autism Revolved Around the Need to Occupy and Pacify the Child: Families Felt Robbed of Meaning and Satisfaction in Family Life: Commentary. Australian Occupational Therapy Journal. 53(2), pp. 136 - 137.
Searching for Evidence in Pediatric Occupational Therapy Using Free versus Subscription Databases: A Comparison of Outcomes
Lovarini, Meryl, Wallen, Margaret and Imms, Christine. (2006). Searching for Evidence in Pediatric Occupational Therapy Using Free versus Subscription Databases: A Comparison of Outcomes. Physical & Occupational Therapy in Pediatrics. 26(3), pp. 19 - 38. https://doi.org/10.1300/J006v26n03_03
Editorial: The International Classification of Functioning, Disability and Health: They're Talking Our Language
Imms, Christine. (2006). Editorial: The International Classification of Functioning, Disability and Health: They're Talking Our Language. Australian Occupational Therapy Journal. 53(2), pp. 65 - 66.