1. Field of the Invention
The present invention relates generally to providing therapy to the region of the jaw, and more particularly, to devices and methods for increasing temporomandibular joint range of motion while strengthening a user's jaw muscles, and for massaging the jaw muscles, optionally at the same time, and additionally to devices and methods for inducing forward mandibular translation for related therapeutic purposes.
2. Description of Related Art
Prior U.S. Pat. No. 5,183,057 and No. 5,562,105, on which I am named as a co-inventor, disclose a particularly effective device for improving temporomandibular joint range of motion. As noted in these related patents, this type of device is useful in many circumstances, one of the most important being as part of post-treatment therapy after medical procedures such as temporomandibular joint surgery, temporary intermaxillary fixation, facial infections, and trauma to the face, and as therapy for other medical conditions affecting the temporomandibular joint. One embodiment of the device uses a hollow bellows pump to force water into a bellows actuator between two hinged members placed between the user's teeth, thus separating the members and opening the user's mouth. The pump bellows is disposed in a separate housing, where it is compressed by a spring to force water into the actuator bellows. The user then bites down on the members to urge them together and force the water back into the pump bellows, after which the biasing spring operates to reopen the user's jaw. Repeatedly closing his or her mouth against the resistance provided by the spring exercises the temporomandibular joint and strengthens the user's jaw muscles.
This device is particularly effective and convenient when used solely in a mode in which the pump is operated by the user to passively stretch his or her jaw muscles to increase temporomandibular joint range of motion. In an embodiment of the patented device designed for that purpose, the hinged members are biased into a closed position and the user inserts the device into the mouth between the upper and lower jaws, after which the user manually squeezes the pump bellows to force the upper and lower jaws apart. When the pump bellows is released, the members are automatically returned to their closed position. But the embodiment described further above, which is designed also to strengthen the user's jaw muscles, is somewhat cumbersome to use and does not permit precise control of the resistance against which the user contracts the jaw muscles or the rate at which the user's jaw is reopened. These can be serious drawbacks since particular care must be taken when exerting these muscles in the circumstances in which the device is used, such as after temporomandibular joint surgery when the jaw is particularly vulnerable to damage if exercised too vigorously.
Other known devices used to manipulate a user's temporomandibular joint to increase range of motion, strengthen jaw muscles, or for other purposes, are shown in the following references:
None of these references discloses a device designed to increase temporomandibular joint range of motion in a manner precisely controlled by the user and at the same time strengthen jaw muscles by permitting repeated motion of the muscles against a calibrated resistance that the user can precisely adjust as part of a controlled exercise program.
Massage therapy can also be an effective treatment for temporomandibular joint and jaw muscle disorders, either alone or in combination with range of motion and/or strengthening exercises. While an individual can self-administer massage, most laymen are not trained in proper massage therapy techniques. Accordingly, self-massage in practice can be largely ineffective. By the same token, using a trained massage therapist can be expensive and inconvenient, and therefore not done with sufficient frequency to have maximum efficacy. Most individuals would likely find it preferable to be able to administer massage therapy themselves in a manner that they can be certain is safe and effective. It would be even more advantageous if massage therapy, with or without the application of heat or cold, could be administered in conjunction with exercises for improving temporomandibular joint range of motion and/or strengthening jaw muscles.
In addition to devices that involve opening and closing the mouth to exercise or administer therapy to jaw muscles, there are also devices that induce translation of the lower jaw (“mandible”) back and forth (that is, in an anterior-posterior plane) to administer therapy to the jaw muscles and increase temporomandibular range of motion. The E-Z Flex™ jaw exerciser referred to above included a translation adapter that could be used to move the mandible forward for therapeutic reasons. U.S. Pat. No. 5,846,212 also discloses a mandible translator intended for therapeutic applications.
The mandibular translation device disclosed in U.S. Pat. No. 5,846,212 comprises two plates mounted for face-to-face sliding motion, with mouthpieces for the upper and lower teeth on the respective plates. That device and the translation adapter for the E-Z Flex™ jaw exerciser are operable only in a modality that requires user manipulation to return his or her mandible rearward to its natural position after being translated forward. In the case of the '212 patent, the user must directly manipulate the plates by hand to translate his or her mandible forward and backward. This gives rise to variations in the amount and/or rate of movement, which can be detrimental in some therapy regimens. In the E-Z Flex™ device the user has to exert a force with his mandible to translate it posteriorly. That may not be acceptable in some therapy regimens in which strictly passive mandible movement is indicated. Alternatively, the user can move the adapter with his or her hands to return the mandible to a non-protruding position, but that will be awkward with the adapter in the user's mouth and could cause injury to tissues associated with the temporomandibular joint.
A related issue involving mandibular translation is the treatment of obstructive sleep disorders, such as sleep apnea and snoring. A known treatment involves a user wearing a mandibular repositioning device that holds the mandible in a forward protruded position to prevent blockage of the airway to the lungs when the user is sleeping in a supine position. One of the issues in administering this type of therapy is properly fitting such devices to a particular user. Optimally, such devices hold the user's mandible in a forward position the minimum amount necessary to maintain the airway to the lungs open, without placing undue stress on the temporomandibular joint. It is known to pre-measure mandible translation during sleep tests prior to fitting such a device (see, for example, U.S. Pat. No. 6,155,262 and U.S. Publ. No. 2010/0316973), and to take diagnostic images of a user's jaw at different open positions (see for example, U.S. Pat. No. 4,834,112). But it is not known to pre-measure for the minimum amount of mandibular translation that should be imparted by a repositioning device while actually viewing the user's mouth parts as the mandible is held in a forward translated position.
It is an object of the present invention to improve on known devices and methods for increasing temporomandibular joint range of motion and increasing jaw muscle strength, simultaneously if preferred by a user, and also providing a temporomandibular joint/jaw muscle massage device that can be used either on its own or in conjunction with a temporomandibular joint/jaw muscle exercising device.
Thus, a first aspect of the invention relates to a therapeutic exercising device that can simultaneously increase temporomandibular joint range of motion and strengthen jaw muscles of a user. The device comprises a mouthpiece including two bite members, each having a bite platform for insertion into the user's mouth. An expandable enclosure, such as a bellows, expands and contracts between the bite members when air is introduced into and released from the interior of the enclosure. Expanding the enclosure exerts an opening force moving the bite members toward an open position in which they separate the user's upper and lower jaws. A predetermined force biases the bite members toward the open position. This spring biasing force is opposed by a user-adjustable biasing arrangement, which in one embodiment comprises a plurality of elastic members the user selectively attaches to the bite members. The user can attach a desired number of the elastic members to the bite members to exert on the bite members a closing force that will vary depending on the number of elastic members used. A user-operated pneumatic pump, such as a syringe, regulates the introduction of air into the expandable enclosure.
The user can operate this device in a number of ways. For example, the user can employ it as a combination temporomandibular joint range of motion exerciser and jaw muscle strengthening device by using an insufficient number of elastic members to hold the bite members normally closed. In this configuration, the user can manually close the bite members and insert them between his or her teeth. The bite members will be biased open, but the user can control the rate at which they open using the pump (syringe). Then, the user closes his or her mouth against the force biasing the members open to strengthen his or her jaw muscles. The force required to close the members is determined by the number of elastic members in place; that is, by reducing the number of elastic members the user can increase the force required to close the bite members. By attaching enough elastic members to bias the bite members closed, the device is used to increase temporomandibular joint range of motion by expanding the enclosure using the pump. The biasing members force the bite members to close at a rate that depends on the number of elastic members in place, as further controlled by the user via the pneumatic pump.
Another aspect of the invention relates to a therapeutic device for massaging a user's jaw muscles. This device comprises at least two hollow bladders that expand when air under pressure is introduced into their interiors and contract when the air under pressure is released. A wrap holds the bladders in place proximate to jaw muscles of the user, and a user-operated pneumatic pump, such as a syringe, introduces air under pressure into the bladders to expand the bladders and thereby compress jaw muscles of the user. The user reverses the motion of the pump to draw air from the bladders, and then repeats the process to administer a massaging action to the jaw muscles. In one preferred form, the device includes temperature adjusting pads held in place by the wrap against the user's face for applying heat or cold to jaw muscles as they are massaged.
In still another aspect of the invention, the exercising device and massaging device are used together. The pump can be designed to introduce air separately to the expandable enclosure (bellows), on the one hand, and to the bladders, on the other, to permit the user to optimize the combined exercising and massaging actions.
It is another object of the invention to provide a mandible translation adapter that can be used with the above described therapeutic exercising device to provide controlled mandibular forward (anterior) and backward (posterior) translation that is adaptable to a variety of exercise and therapy regimens. To that that end, a mandibular translation device comprises a mandible frame including a mandible actuating plate and a mandible actuating arm having a mandible retainer for engaging the user's mandible and a maxilla frame including a maxilla bearing plate and a maxilla contacting arm for engaging the user's maxilla. The frames move relative to each other in a first direction to protrude mandible anteriorly relative to the user's maxilla, and an adjustable biasing arrangement exerts a force determined by the user on the frames in a second direction opposite to the first direction. In one particular aspect of the invention, the exercising device with features as discussed above can be used to move the frames in the first direction.
In yet another aspect of the invention the mandible translation adapter is calibrated to indicate the amount of forward mandible translation and made of non-ferrous materials so that images can be taken of a user's mouth parts while the adapter is in place to determine the minimum amount of forward translation necessary to impart for the treatment of obstructive sleep apnea, snoring, and other conditions involving airway restriction, such as mandibular retrognathia (a retruded mandible), that are typically treated by performing surgical advancement of the mandible. This application of the device permits prediction of the placement of the retruded mandible prior to surgery into an ideal forward translated position.
This Summary is provided to introduce in a simplified form a selection of concepts relating to the subject matter described herein that are further described below in the Detailed Description of Preferred Embodiments. It is not intended necessarily to identify key or essential features of the invention, nor as an aid in determining the scope of the claimed subject matter.
The objects of the invention will be better understood from the detailed description of its preferred embodiments which follows below, when taken in conjunction with the accompanying drawings, in which like numerals and letters refer to like features throughout. The following is a brief identification of the drawing figures used in the accompanying detailed description.
One skilled in the art will readily understand that the drawings are not strictly to scale, but nevertheless will find them sufficient, when taken with the detailed descriptions of preferred embodiments that follow, to make and use the present invention.
As already noted, the invention has numerous aspects. One is a jaw exerciser that can be used as an active exercise device that strengthens jaw muscles by providing resistance against which the user closes his or her mouth, a passive exercise device that gently opens a user's mouth to restore or increase range of motion of the user's jaw, or a device that can function in both capacities at the same time. Another aspect is a jaw massager operated by the user to apply a gentle massaging action to jaw muscles for therapeutic effect, either with or without the application of heat or cold during the massage. In a third aspect, the jaw massager can be used in conjunction with the jaw exerciser to further enhance the beneficial effects of the invention for a user. In a fourth aspect, a mandible translation adapter for the jaw exerciser can be used in exercises and therapeutic applications in which the mandible moves forward from a normal position and back again. An optional use of the translation adapter permits optimal fitting of a mandibular repositioning device used in treating sleep disorders such as obstructive sleep apnea and snoring.
The detailed description that follows is intended to provide specific examples of particular embodiments illustrating various ways of implementing the claimed subject matter. It is written to take into account the level of knowledge of one of ordinary skill in the art to which the claimed subject matter pertains. Accordingly, certain details may be omitted as being unnecessary for enabling such a person to realize the embodiments described herein. It will also be understood that terms indicating direction or orientation, such as “lower,” “upper,” “top,” “bottom,” “left,” right,” etc., may be used to facilitate the description of these exemplary embodiments. The use of such terms does not imply that the claimed subject matter is limited to a particular orientation of the structure being described
Referring first to
Referring particularly to
The device 10 further includes a pneumatic pump, taking the form of a syringe 30 in the present embodiment. The hollow cylindrical body platform 32 of the syringe has an open end 34 that accepts a plunger 36 that slides inside the body 32, in sealing relation thereto through the seal 38 at the end of the plunger disposed within the body 32. At its other end outside the plunger body 32 the plunger includes a handle 39 by which a user can operate the plunger 36 by sliding it to and fro within the cylindrical platform. (Typically, the plunger 36 will be removable from the syringe body 32 for replacement or cleaning.) The otherwise closed end 40 of the syringe body 32 is connected in airtight fashion to a valving arrangement 42, shown in more detail in
Finally, the device includes a user-adjustable biasing arrangement 60 that in the present embodiment comprises a plurality of elastic members 62 that resemble rubber bands, although they may be made of different materials for reasons related to their use in the present invention. For example, it may be necessary to make the elastic members of a material that accounts for any allergies of a user. It is also preferable to make the elastic members of dimensions and of a material that will provide a precise amount of force when in place on the mouthpiece. In addition, the material should be chosen so that the amount of force each elastic band exerts when it place will remain substantially constant over a period of time during which the device is used. An example of a suitable material is silicone, latex-free elastic. In use the elastic members fit into the grooves 26 on the upper and lower bite members 14 and 16. They are under tension when in place and each provides a predetermined amount of force biasing the bite members toward their closed position, against the force of the spring discussed above that provides a biasing force tending to separate the bite members. The therapeutic jaw exercising device 10 can be set up in two basic configurations. In one the closing force on the bite members 14 and 16 exerted by the adjustable biasing arrangement 60 (comprising one or more elastic bands in the present embodiment) is insufficient to hold the bite members closed against the built-in force biasing them open. The device in this configuration will be referred to for convenience as the “active jaw exerciser.” In the other basic configuration the adjustable biasing arrangement 60 hold the bite members closed against the built-in force biasing them open. The device in this configuration will be referred to for convenience as the “passive jaw exerciser.” It will be understood that this terminology is for ease of reference only, and is not limiting as the manner is which the device can be used in any particular configuration.
As just noted, in this configuration the closing force provided by the elastic members 62 in place in the grooves 26 is insufficient to hold the bite members closed against the built-in force biasing them toward their open positions. In this configuration one or more of the elastic members 62 are placed in the grooves 26 as shown in
To appreciate one way this can be done, consider the valving arrangement 42 connecting the interior of the syringe body 32 to the interior of the expandable bellows 22 through the tube 52. As already noted, the valve handle 46 is rotatable about its axis 47 to a first position shown in
Thus, if the user places the valve handle 46 in this intermediate position (with the valve handle 46 pointing downward), the bite members can be squeezed together by hand against the force biasing them apart, without causing the syringe plunger to move. The syringe plunger 36 is placed at a location intermediate its travel in the syringe body 32 while the valve handle 46 is in the first position (
An alternate manner of setting up the device to use it in the active jaw exerciser mode is by initially moving the valve handle 46 to its first position (see
Additionally, the user may wish to increase jaw range of motion in connection with recovering from a medical procedure after which the jaw muscles are inflamed or otherwise limited in the amount of stress to which they can be subjected. Accordingly, the device in this mode provides substantial flexibility of application by enabling a user to generate controlled passive jaw motion to increase range of motion in the early stages of a rehabilitation program, and then to strengthen the jaw muscles and improve jaw function as the rehabilitation progresses.
In that regard, it will be appreciated that a particular advantage of the device resides in the ability of the user to set the amount of force needed to close the bite members against the force biasing them open. This is done by using a different number of elastic members 60. If more members are used, then less force need be applied by the jaw muscles to close them. If the device is provided with elastic bands having predetermined properties, then a health care professional can instruct the patient to use a particular number of members adapted to the patient's condition. In an alternate embodiment, different members could have different properties and be color coded to indicate the degree of biasing force each one provides. In that case the patient would be instructed to use an elastic member of a particular color in his or her therapy. An alternate manner of increasing the force required to close the bite members would be by manually resisting closure using the syringe.
In the above configuration, the device both strengthens jaw muscles by having the user close his or her mouth against a resistance provided as discussed above, and passively exercises the jaw joint and jaw muscles of the user and increases their range of motion as the bite members are permitted to open. In addition, the device permits the user to adjust the force needed to close the bite members, as well as control the rate at which they are permitted to open.
To set up the device in this configuration, a sufficient number of elastic bands 60 are used to overcome the built-in force biasing the bite members into their open positions. Alternatively, a single, optionally color-coded elastic band made specifically for that purpose could be included to make the device more convenient to use. In any case, the user rotates the valve handle 46 to its first position (
Of course, the above only describes one embodiment of an active/passive jaw exercise device according to the present invention. It will be appreciated by those skilled in the art that the purposes and effects of the invention can be realized by embodiments other than the one described above.
Numerous adaptations of the present embodiment are possible, providing the user with multiple options for jaw rehabilitation. Examples of adaptations and modifications other than any already alluded to include (but are not limited to) the following:
Referring to
The device 80 further includes a pneumatic pump in the form of a syringe 30 and valving arrangement 42 that can be identical to the syringe used in the embodiment described above in connection with
The bladders 82R and 82L are prepared for use by emptying them of air. This can be done either by removing the syringe plunger from the syringe body or placing the valve in the intermediate position (see above) so that the interiors of the bladders are in communication with ambient air. The user then presses down with his or her hands on the bladders until the air in them is evacuated. The bladders are placed in the pockets in the wrap W and the wrap W is secured around the user with the bladders in the proper positions as shown in
The device 80 can include heat or cold packs that are held against the user's face by the wrap W while a massaging action is applied by the bladders. Hot or cold packs (not shown in the drawings) can be prepared in advance to permit both massaging of the jaw muscles simultaneously with the application of hot or cold therapy. The hot/cold packs would be of a conventional material that can be placed in a freezer or in a microwave oven to provide the appropriate thermal stimulation prior to using the jaw muscle massaging device. In a preferred embodiment the hot/cold packs would be specially designed to fit in the previously described pockets to be held between the air bladder in the pocket and the user's skin. Thus, when the user operates the device to perform jaw muscle massage as previously described, the hot/cold packs provide simultaneous application of heat or cold therapy to the muscles for added therapeutic benefit.
Accordingly, the jaw muscle massaging device as herein described is designed to provide the user with a simple method of massaging tight, sore, tender jaw muscles that are in a high state of tension, with the physical compression and subsequent relaxation of the jaw muscles though the inflation and deflation of the air bladders being under the sole control of the user. The insertion of hot and/or cold packs permits the user to simultaneously apply heat and massage or cold and massage to further apply these modalities to the jaw muscles.
While the above describes a particular embodiment of a jaw massaging device and a method for using same according to the present invention, it will be appreciated by those skilled in the art that the purposes and effects of the invention can be realized by embodiments other than the one described above. For example, the device just described could be used to massage jaw muscles (with or without hot/cold therapy) on only one side of the jaw. A device for such an application could have a suitable valve replacing the “Y” separator 90, so that an individual having spasm and/or tightness on only one side of the jaw could change the valve position so as to allow air to be directed only to one bladder, providing massage and hot/cold therapy just to muscles on the side of the jaw with the operative bladder. Alternatively, the user could apply the massage, with or without hot/cold therapy, to one side for a specified amount of time, and the change the valve handle 46 to apply the appropriate therapy to the other side of the jaw for a specified amount of time.
Another aspect of the invention involves using the jaw exerciser depicted in
The combined device 100 incorporates a jaw exerciser 10 and a jaw massager 80 in accordance with to the embodiments discussed above. They are identified in
As shown in
Therefore, the combined use of the jaw exerciser and jaw muscle massager with application of hot/cold therapy provides the user with a combination of modalities that can be used simultaneously depending on the goal of the therapy. The numerous variations that exist with the combined device include:
Of course, the above only describes one embodiment of a combined jaw exerciser/massager according to the present invention. It will be appreciated by those skilled in the art that the purposes and effects of the invention can be realized by embodiments other than the one described above. For example, if the user wants to simultaneously increase jaw range of motion and reduce jaw muscle spasm, the combined device can achieve this. The user would passively stretch the jaw open with the exerciser, and simultaneously provide massage and heat and/or ice to the jaw muscles. Alternatively, if the goal was to strengthen weak jaw muscles while reducing jaw muscle soreness, the user can actively close against the open exerciser (with control of the amount of resistance through the use of a predetermined number of elastic bands, as discussed further above), and simultaneously provide jaw muscle massage, with the option of hot and/or cold modalities.
Therefore, any combination of these modalities can be achieved with the device shown in
A number of other parts of the mandible frame 102 are important to the mandible translation adapter aspect of the present invention. A mandible actuating arm 113 extends from a proximal end 113a (see
The maxilla frame 104 is typically molded as integral part, using the same material as the mandible frame 102 for ease and convenience of manufacture. It comprises a maxilla frame bearing plate 120 and a maxilla contacting arm 122. The maxilla frame bearing plate 120 optionally includes indexing rib 121a and 121b on either side (see
The maxilla contacting arm 122, which is an important component of the mandible translation adapter aspect of the present invention, extends from a proximal end 122a (see
The posts 116 and 126 form part of a user-adjustable biasing arrangement 140 that in the present embodiment further includes a plurality of elastic members 142. In similar fashion to the jaw exerciser 10 embodiment described already, the elastic members 142 resemble rubber bands, although they may be made of different materials for reasons related to their use in the present invention. As discussed, it may be necessary to make the elastic members 142 of a material that accounts for any user allergies. In use the elastic members 142 fit over the posts 116 and 126 on either side of the translation adapter, as best seen in
The mandible frame 102 and the maxilla frame 104 can be assembled in any manner preferred by one skilled in the art, and it will be readily apparent that there are many ways of constructing a mandible translation adapter with the salient features just described and depicted in the drawings. For example, one manner of constructing the translation adapter would make the front guide 108 in a main guide section 108a and a separate guide closure 108b. In this example, the maxilla contacting arm 122 is placed in face-to-face contact with the mandible actuating arm 113. With the parts thus in place, the front guide closure 108b would be secured in place on the main guide section 108b in any suitable fashion, preferably by a suitable adhesive. Fasteners could also be used either instead of or in addition to an adhesive, although non-ferrous fasteners would be required for the optional use of the translation adapter discussed below in connection with
One of the principal advantages of the mandibular translation adapter 100 is that in a preferred embodiment it can be used with the jaw exercising device 10 for exercise and therapy of the jaw muscles and surrounding tissues involved in posterior-anterior movement of the mandible. This can be appreciated from
The translation adapter 100 is capable of providing a variety of exercise modalities in this configuration. One basic modality involves passive stretching of the temporomandibular joint in the anterior-posterior direction. In this exercise, repeatedly pressing the syringe plunger 36 into the syringe body 30 moves the mandibular actuating plate 106 and the maxilla frame bearing plate 120 apart and thus causes the mandible to protrude in the anterior direction to a position such as that illustrated in
The elastic bands 142 also permit the translation adapter 100 to be used for actively exercising the temporomandibular joint in the anterior-posterior direction. That is, the user can place a number of elastic bands over the posts 116 and 126 in accordance with the resistance desired, Either with or without the assistance of the jaw exercising device 10, the user can move his or her mandible forward against the resistance provided by the one or more elastic bands. The user can hold the mandible in place against the resistance for a desired length of time and then permit it to return to the normal position. Having the jaw exercising device in place as shown in
In contrast,
A translation adapter in accordance with the present invention provides foremost a device for exercising a user's jaw muscles by movement of the user's mandible against resistance in the anterior direction, while at the same time permitting the passive stretching of the jaw muscles in the same direction offered by prior art mandible translation devices. In addition, the translation adapter is made even more versatile by including measuring indicia for fitting an mandibular repositioning appliance that provides the minimum amount of anterior translation to achieve its purpose and thus avoids unnecessary stress on the user's jaw.
The present invention provides a user with a wide variety of therapeutic options. As discussed in the above Background section, prior devices, while generally effective for the purposes for which they were intended, do not provide the flexibility of operation that is most advantageous in developing a program of therapy for the wide variety of existing jaw and facial conditions. The various devices and their variations as described herein, and the methods of using them, provide a medical practitioner with myriad therapeutic options, and provide the capability of changing therapies for any particular individual as his or her recovery or therapy progresses.
Those skilled in the art will readily recognize that only selected preferred embodiments of the invention have been depicted and described, and it will be understood that various changes and modifications can be made other than those specifically mentioned above without departing from the spirit and scope of the invention, which is defined solely by the claims that follow.
This application claims the benefit of U.S. provisional application No. 61/523,146, filed Aug. 15, 2011, which application is incorporated herein by reference.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US2012/050538 | 8/13/2012 | WO | 00 | 9/23/2013 |
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WO2013/025587 | 2/21/2013 | WO | A |
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20140018710 A1 | Jan 2014 | US |
Number | Date | Country | |
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61523446 | Aug 2011 | US |