Prosthetics and Orthotics International

December 2006; 30(3): 246 – 256

Consumer opinions of a stance control knee orthosis

KATHIE A. BERNHARDT, STEVEN E. IRBY, & KENTON R. KAUFMAN

Motion Analysis Laboratory, Mayo Clinic, Rochester, Minnesota, USA

Abstract
Stance control knee orthoses (SCOs) have become very popular recently. However, there is little
information regarding opinions of actual orthosis users. The purpose of this study was to quantify the
users’ opinions of a SCO, and see whether factors found important for knee orthoses in past studies hold
true for a stance control orthosis as well. A standardized survey was employed as part of a larger field trial
study of the Dynamic Knee Brace System, a SCO developed by the authors. The Dynamic Knee Brace
System scored well in areas of effectiveness, operability, and dependability, but areas in need of
improvement included weight, cosmesis, and donning and doffing. These findings match well with
previous knee orthosis studies. This study shows that wearing a stance control knee orthosis can be a
positive experience for an orthosis user.

Keywords: Stance control orthosis, knee orthosis, survey, opinion, field trial

Introduction
Knee-ankle-foot orthoses (KAFOs) historically have had a high rejection rate. Authors
have stated that between 58 and 79% of KAFO users stop using their orthosis (Phillips and
Zhao 1993; Kaplan et al. 1996) and that over 40% of users state they are ‘dissatisfied’ with
their orthosis (Fisher and McLellan 1989). Reasons for rejection or dissatisfaction generally
include brace weight and material volume, cosmesis, fit or comfort, or difficulty in donning
and doffing the orthosis (Batavia and Hammer 1990). Interestingly, many people who
continue to use their KAFOs also have similar complaints about the orthosis (Fisher and
McLellan 1989). The frequency of use statistics mirror satisfaction levels with the
device. Many users develop opinions on the device during the first 2 weeks, and up
to half of braces will be rejected during this same period (Fisher and McLellan 1989;
Butler et al. 1983).
Predictors of assistive technology abandonment were formulated by Phillips and Zhao
(1993). In a survey of 227 adults with a physical disability, they found that device performance
was strongly associated with device abandonment. If a device met a user’s expectations for
effectiveness, reliability, durability, comfort, safety, and ease of use, the user was more likely
to keep the device. Factors such as convenience, energy demand, and the need for assistance
were not related to device abandonment.

Correspondence: Kenton R. Kaufman, Motion Analysis Laboratory, Mayo Clinic, Charlton North L-110L, 200 First St. SW,
Rochester, MN 55905, USA. Tel: þ1 507 284 2262. Fax: þ1 507 266 2227. E-mail: kaufman.kenton@mayo.edu

ISSN 0309-3646 print/ISSN 1746-1553 online Ó 2006 ISPO

DOI: 10.1080/03093640600618818
 Consumer opinions of a stance control knee orthosis 247

Batavia and Hammer (1990) investigated the factors consumers consider in determining
the value of a given assistive device. A panel of six consumer experts with mobility
impairments ranked 15 factors related to assistive devices in general. The three most impor-
tant factors were effectiveness, operability, and dependability. Effectiveness was defined
as the device doing what was claimed or enhancing functional capabilities. Operability meant
the device was easy to operate and responded adequately to commands. Dependability was
a measure of the device operating with reasonable accuracy under all conditions. Factors
covering the aesthetics of the device and the need for special training were not ranked as
highly, ending up in the bottom half of ranked factors.
The field of knee orthoses had gone without a significant technological advance since braces
changed from metal and leather fabrication to thermoplastics in the 1970s. Recently,
however, interest in knee orthoses has been renewed by the advent of stance control orthoses.
A stance control orthosis (SCO) keeps the leg locked and rigid during the stance portion
of the gait cycle, but lets the limb flex and extend freely during swing. This is generally
considered an improvement over the conventional locked KAFO because it provides for
a more energy-efficient gait pattern by allowing knee flexion during swing. Several studies
have documented that walking with an SCO is a more energy-efficient way to ambulate than
with a stiff leg (Kaufman et al. 1996; McMillan et al. 2004; Mattsson and Brostrom 1990).
This is because the orthosis user does not have to compensate biomechanically for the
functionally lengthened leg that results from keeping the knee locked during swing.
Since 2002, four orthopedic appliance companies have introduced five versions of a
stance control knee orthosis (Otto Bock Health Care 2004; Becker Orthopedic 2002
Basko Healthcare 2004; Horton Technology Inc. 2004). All five orthoses try to accomplish
the goal of stability during stance yet obtain free knee motion during swing, but use different
mechanisms to achieve this goal. Despite the excitement in the orthotics industry over
these new knee joints and the claimed benefits to those who rely on a knee orthosis, little
evidence exists regarding the biomechanical benefits or opinions of actual KAFO users.
Therefore, the primary goal of this study was to subjectively quantify the user’s opinions of
a stance control orthosis. Further, this study assessed whether the factors found important
by the studies of Batavia and Hammer (1990) and Phillips and Zhao (1993) apply to SCOs
as well.

Methods
Twenty subjects (Table I) were enrolled into the protocol after giving informed consent
according to the institution’s guidelines. Fourteen were male, six were female. The age of
the research participants was 53.2 + 14.8 (range 11 – 76) years, with a BMI of 28.7 + 6.1
(range 19.2 – 40.1, weighed with orthosis on). The majority of the participants were affected
by polio (12/20), but diagnoses also included incomplete spinal cord injury, multiple sclerosis,
industrial or other injury, spina bifida, muscular dystrophy, inclusive body myositis, and
weakness of unknown origin. Fourteen out of the 20 participants were currently using a knee
orthosis, while the remainder were not wearing an orthosis on the affected side. Nine of
these current orthosis users wore a locked KAFO, and the remaining five used a free motion
knee orthosis of some type.
The SCO used in this study was the Dynamic Knee Brace System (DKBS) developed by
the investigators, as described in detail elsewhere (Kaufman et al. 1996; Irby et al. 1999a,
1999b). In short, the device is a small, relatively lightweight, electronically controlled knee
joint that can be installed on a conventional KAFO shell, customized for each user.
The mechanical hardware consists of a wrap spring clutch and a clutch release actuator.
248 K. A. Bernhardt et al.
Table I. Participant demographics.

Gender Age BMI (kg/m2) Diagnosis Current orthosis

M 60 29.9 Polio None

M 70 24.7 Polio/multiple sclerosis None
F 51 34.0 Polio None
M 68 20.6 Polio Free
M 56 27.1 Polio None
M 41 23.2 Spina bifida Locked
M 76 26.1 Polio None
F 53 40.1 Incomplete spinal cord injury Locked
M 11 36.1 Polio Locked
M 46 31.8 Industrial accident/peripheral neuropathy Locked
F 65 26.2 Unknown weakness/neuropathy Free
M 39 19.2 Polio Locked
F 52 23.9 Polio Locked
M 68 31.8 Inclusive body myositis Free
F 55 22.8 Polio Free
M 33 25.2 Incomplete spinal cord injury Locked
M 54 29.7 Polio Locked
F 47 38.4 Multiple sclerosis Free
M 55 26.1 Polio Locked
M 63 38.0 Limb girdle muscular dystrophy None

Average 53 28.7
St Dev 15 6.1
Min 11 19.2
Max 76 40.1

The electronic control system uses a programmable integrated circuit to monitor control
inputs and produce output commands for clutch release. Power for the unit is provided by a
battery pack carried in a pouch worn around the waist (Figure 1).
This study was a component of an overall project design including a 6-month at home field
trial of the DKBS, with laboratory testing at times 0, 3, and 6 months. During the 6 months of
home use, the investigators as well as a licensed orthotist were available to answer questions
and make any necessary fit adjustments to the orthosis. Frequency and duration of DKBS use
was not directed by the investigators. Participants were free to choose between the DKBS
and their personal orthosis during the trial. Therefore, use varied widely among parti-
cipants depending on comfort with various ground and environmental conditions and the
participant’s desire to not limit their activities of daily living. Laboratory tests included
instrumented gait analysis, physical examination including bilateral lower limb strength and
range of motion, and a functional 6-min walk test. Besides these objective measures, a
standardized KAFO user survey was conducted while the participant was in the laboratory for
testing for 0 and 3-month testing.
The subjective survey (Appendix A) was administered by the same investigator (KB) at the
end of the first two laboratory data collections. The survey concentrated on orthosis activities
such as donning and doffing the orthosis, assuming a sitting or standing position, use of
assistive devices, orthosis aesthetics, stability during walking and standing, walking ability
over distance and various terrain, and self-reported daily use of the orthosis. When applicable,
these activities using the DKBS were compared to the participant’s own brace. If a participant
was currently wearing an orthosis of any kind or had worn a brace in the past, they were
invited to compare the DKBS to those orthoses. The interview session was videotaped and
 Consumer opinions of a stance control knee orthosis 249

Figure 1. Example of the Dynamic Knee Brace System, the investigational stance control orthosis used in this study.
The Dynamic Knee Brace System is comprised of a custom designed wrap spring clutch, an electromechanical
release, a control box, and sensors at the knee (not shown), all fit to a conventional KAFO. A rechargeable lithium-ion
battery pack is typically carried using a waist pack.

later scored in order to perform descriptive statistics (SAS Institute Inc., Cary, NC, USA:
Version 8.2). Only the questions where all participants used a consistent scoring range were
analysed. The numbers of responses to questions vary because not every participant chose one
of the options or gave a single answer to each question. Furthermore, not all participants had
completed the 3-month testing at the time of analysis. A one-sample student’s t-test was used
if responses were normally distributed as determined using a Shapiro-Wilk test; otherwise a
non-parametric sign test was employed. A p-value less than 0.05 was considered significant.
Data were analysed as a whole and also stratified by current orthosis use (none, locked, or
free knee).

Results
The opinions of the research participants were collected immediately after the completion of
visit 1 (0-month) testing (Table II). All participants currently wearing an orthosis said that
donning and doffing the DKBS was more difficult than their own orthosis. Stability while
standing and walking with the DKBS was rated as acceptable to excellent and slightly better
than other braces. All participants considered the orthosis heavy, and it was deemed heavier
than the other knee orthoses used by the participants. Participants noted the cosmesis of the
orthosis was worse than with other orthoses they had used. It was slightly more difficult to sit
down and stand up with the DKBS. The subset of individuals who used a locked brace had
similar opinions; locked KAFO users rated their stability while standing when using the
DKBS as acceptable to excellent, although slightly less stable than with other orthoses. For
free knee orthoses wearers, after visit 1 the only statistically significant comment was that
cosmesis was worse than other orthoses that they had used. For persons not wearing another
brace at visit 1, only the weight was an issue, with these participants finding that the DKBS
was heavy.
250 K. A. Bernhardt et al.
Table II. Consumer opinions of DKBS at initial fitting.

Donning comparison Easier Same More difficult p-value

All users 2 8 6 0.0001
Locked 1 5 3 0.0078
Doffing comparison Easier Same More difficult p-value
All users 0 11 5 50.0001
Locked 0 7 2 0.0039
Orthosis weight Light Acceptable Heavy p-value
All users 2 10 8 50.0001
Locked 2 2 5 0.0156
No orthosis 0 4 2 0.0313
Orthosis weight comparison Lighter Same Heavier p-value
All users 3 2 11 0.0002
Locked 2 1 6 0.0156
Cosmesis Excellent Acceptable Unacceptable p-value
All users 0 18 2 50.0001
Locked 0 8 1 0.0039
Cosmesis comparison Better Same Worse p-value
All users 2 6 8 0.0001
Locked 1 3 5 0.0078
Free knee 1 2 2 0.0327
Stand assist comparison Easier Same More difficult p-value
All users 3 6 5 0.0010
Locked 2 4 3 0.0027
Sit assist comparison Easier Same More difficult p-value
All users 3 6 5 0.0010
Locked 2 4 3 0.0027
Standing stability Excellent Acceptable Unacceptable p-value
All users 9 11 0 0.0010
Locked 3 6 0 0.0313
Standing stability comparison More Same Less p-value
All users 5 7 3 0.0020
Locked 1 4 3 0.0016
Walking stability Excellent Acceptable Unacceptable p-value
All users 5 15 0 50.0001
Locked 2 7 0 0.0156
Walking stability comparison More Same Less p-value
All users 5 8 2 0.0020
Locked 1 5 2 0.0167

Consumer opinions were collected on all aspects of orthosis function using the questionnaire listed in the Appendix.
Only statistically significant findings are reported. Locked, Free knee, No orthosis indicate DKBS compared to current
orthosis used at study enrolment.

The consumer opinions were collected again after they had been given some time to
accommodate to the orthosis (Table III). After visit 2 (3-month), participants once again said
the DKBS was more difficult to don and doff than other orthoses. Standing and walking
stability with the DKBS was rated as acceptable to excellent, and slightly better than other
orthoses. The DKBS was considered heavy, and participants with previous orthosis use said it
was heavier than their others. Users stated that the cosmesis of the orthosis was again slightly
less than acceptable and worse than in other orthoses. Participants currently wearing an
orthosis said that their ability to stand up was the same as with past orthoses, but it was slightly
 Consumer opinions of a stance control knee orthosis 251
Table III. Consumer opinions of DKBS at follow-up (3-month) visit.

Donning comparison Easier Same More difficult p-value

All users 0 5 7 0.0005
Locked 0 4 2 0.0313
Doffing comparison Easier Same More difficult p-value
All users 0 9 3 0.0005
Locked 0 5 1 0.0313
Orthosis weight Light Acceptable Heavy p-value
All users 1 3 10 0.0002
Locked 0 2 4 0.0313
Orthosis weight comparison Lighter Same Heavier p-value
All users 1 0 11 0.0010
Cosmesis Excellent Acceptable Unacceptable p-value
All users 0 9 5 0.0001
Locked 0 4 2 0.0313
Cosmesis comparison Better Same Worse p-value
All users 0 6 6 0.0005
Locked 0 3 3 0.0313
Stand assist comparison Easier Same More difficult p-value
All users 2 7 2 0.0039
Sit assist comparison Easier Same More difficult p-value
All users 2 5 4 0.0039
Locked 1 4 1 0.0117
Standing stability Excellent Acceptable Unacceptable p-value
All Users 6 8 0 0.0078
Standing stability comparison More Same Less p-value
All users 5 6 1 0.0156
Locked 2 3 1 0.0422
Walking stability Excellent Acceptable Unacceptable p-value
All users 3 9 2 0.0010
Locked 2 3 1 0.0422
Walking stability comparison More Same Less p-value
All users 5 4 2 0.0313
Locked 1 3 2 0.0127

Consumer opinions were collected on all aspects of orthosis function using the questionnaire listed in the Appendix.
Only statistically significant findings are reported. Locked orthosis used at study enrollment.

more difficult to sit down with the DKBS. Those who had been wearing a locked knee
orthosis considered donning and doffing more difficult than with a standard KAFO. Locked
KAFO users said their standing stability was slightly better than in a locked orthosis. Walking
stability was rated acceptable to excellent, although slightly less stable than with past orthoses.
Sitting down was found to be the same with the DKBS when compared to a locked KAFO.
For free knee orthosis wearers and those participants not wearing an orthosis, no items were
statistically significant.
When combining data from all participants over multiple visits, opinions of the
DKBS did not change significantly over time. Opinions on all questions at the beginning
and at the 3-month point of the home trial period were roughly the same. For that reason
the consumer opinions at the 6-month period are not reported since there were no changes
reported.
252 K. A. Bernhardt et al.

As a whole, the participants were satisfied with the stability of the DKBS during both
walking and standing, even rating it slightly better than the ones worn in the past. The only
exception was with the locked KAFO user group. At the first visit, they had a little less
confidence in their standing stability, yet slightly more confidence in their walking stability as
compared to their locked orthosis. After the second visit, their opinions had switched, with
these participants noting the DKBS had better standing stability and slightly worse walking
stability than a locked KAFO.

Discussion
Overall opinions of the DKBS were positive, and the results of this study suggest that the
work by Batavia and Hammer (1990) and Phillips and Zhao (1993) hold true for a stance
control orthosis as well. The survey questions that can be equated to effectiveness,
reliability, and durability (factors found important by Phillips and Zhao [1993]) had
favourable outcomes. The DKBS scored well on its own and in comparison to the
alternatives of a locked KAFO, free knee orthosis, or none at all. This study shows that
using a SCO can be a positive experience for an orthosis wearer. Carefully matching a
patient’s physical capabilities to an appropriate knee joint mechanism can only further
improve the experience. Very few concerns were raised over effectiveness, operability, and
dependability of the DKBS; the factors deemed most important by Batavia and Hammer
(1990). Many study participants went so far as to say that if a SCO was reliable and made
it easier to walk, then some added weight or material volume at the knee would be
acceptable. In fact, a number of the participants who considered the DKBS heavy also
noted that it did not feel as heavy compared to a locked orthosis when the stance
control mechanism was activated. The need for additional gait training with this orthosis,
although a considerable time investment for both the user and the investigators, would not
be enough of a concern to discourage SCO use, given the previous report by Batavia and
Hammer (1990). The most common complaints (weight, cosmesis, and donning
and doffing difficulty) match well with the concerns reported in previous studies (Fisher
and McLellan 1989; Batavia and Hammer 1990). According to Phillips and Zhao (1993),
the factors where the DKBS scored poorly would not lead to eventual abandonment
of the SCO.
The statistically significant points regarding knee joint size and weight were not wholly
unexpected. Throughout the course of the study, all participants mainly commented on the
size, weight, and appearance of the knee joint. Because the DKBS joint was significantly larger
than a typical KAFO hinge, there was some difficulty noted in clothing selection. However,
weight or limb alignment restrictions were not placed on the study inclusion criteria, thereby
allowing nearly all interested parties to be included. Using the CDC criteria for body mass
index (CDC 2004) 35% of the research participants could be considered overweight, 30%
obese, and 5% severely obese. Based on patient selection criteria for the five commercially
available SCOs, nearly half of the participants in this study would not qualify for at least one of
these models because of their weight, the presence of a flexion contracture, or poor varus-
valgus alignment (Otto Bock Health Care 2004; Becker Orthopedic 2002 Basko Healthcare
2004; Horton Technology Inc. 2004). By placing more stringent restrictions on who could
use such a KAFO, the size of the DKBS joint could be significantly reduced. In fact, limited
early testing was successfully completed by the authors with a much smaller version of the
DKBS (Kaufman et al. 1996). The electronic controller and battery unit could also be made
smaller in the future, with size currently being limited mainly by the production cost for
the research components.
 Consumer opinions of a stance control knee orthosis 253

Donning and doffing of the DKBS was generally considered difficult, especially in
comparison to other orthoses. Most participants attributed this to the fact that there is the
addition of a battery to connect and disconnect when using an electromechanical orthosis.
Interestingly, over the course of the study, many of the participants came up with their own
way of carrying the battery other than the waist pack provided in order to make donning and
doffing the orthosis easier. Some of the DKBS users also noted some difficulty getting dressed
when wearing the orthosis under investigation, since the battery cord needed to be routed
from the carrying location to the control box.
Based on the results presented here, a few changes to the DKBS would improve overall
consumer satisfaction. While the subject population was happy with the operation and stability
of the DKBS, the size and weight of the knee joint will need to be addressed. Producing
multiple sizes and load capacities of the DKBS joint will allow many KAFO wearers to use a
much smaller, lighter in weight version of the SCO used in this study. Likewise, reducing the
size of the electronic controller and battery pack will improve the consumer’s opinion of its
cosmesis. By making these relatively minor changes to the SCO joint which has otherwise
made a favourable impression, satisfaction with the DKBS would hopefully increase.

Acknowledgements
This study was supported by NIH Grant R01 HD30150, the Muscular Dystrophy
Association, and the Mayo Foundation. The authors also wish to thank Prosthetics
Laboratories and Prosthetic Orthotic Center, both of Rochester, MN, USA for their
assistance with participant recruitment and KAFO fabrication and fitting. Kaufman and Irby
are the inventors of technology used in this research, the technology has been licensed, and
they have received royalties on it.

References
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devices. J Rehabil Res Dev 27:425 – 436.
Becker Orthopedic. 2002. Practioner training materials.
Butler PB, Evans GA, Rose GK, Patrick JH. 1983. A review of selected knee orthoses. Br J Rheumatol 22:109 – 120.
CDC. Body Mass Index Calculator. 2004. http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm, National Center for
Chronic Disease Prevention and Health Promotion.
Fisher LR, McLellan DL. 1989. Questionnaire assessment of patient satisfaction with lower limb orthoses from a
district hospital. Prosthet Orthot Int 13:29 – 35.
Horton Technology Inc. 2004. Stance Control Orthosis. http://www.stancecontrol.com/patient_criteria.htm
Irby SE, Kaufman KR, Mathewson JW, Sutherland DH. 1999a. Automatic control design for a dynamic knee brace
system. IEEE Trans Rehabil Eng 7:135 – 139.
Irby SE, Kaufman KR, Wirta RW, Sutherland DH. 1999b. Optimization and application of a wrap spring clutch to a
dynamic knee-ankle-foot orthosis. IEEE Trans Rehabil Eng 7:130 – 134.
Kaplan LK, Grynbaum BB, Rusk HA, Anastasia T, Gassler S. 1996. A reappraisal of braces and other mechanical aids
in patients with spinal cord dysfunction: results of a follow-up study. Arch Phys Med Rehabil 47:393 – 405.
Kaufman KR, Irby SE, Wirta RW, Sutherland DH. 1996. Energy efficient knee-ankle-foot orthosis: a case study.
J Prosthet Orthot 8:79 – 85.
Mattsson E, Brostrom LA. 1990. The increase in energy cost of walking with an immobilized knee or an unstable
ankle. Scand J Rehabil Med 22:51 – 53.
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stance control orthosis. J Prosthet Orthot 16:6 – 13.
Otto Bock Health Care. 2004. Otto Bock Free Walk Orthoses. http://www.healthcare.ottobock.com/info_download/
pdf/647H351.pdf
Phillips B, Zhao H. 1993. Predictors of assistive technology abandonment. Assist Technol 5:36 – 45.
254 K. A. Bernhardt et al.
Appendix A
DKBS Users Survey

Dynamic Knee Brace System

Patient Response Form
To be completed at 0, 3, and 6 months

Name: ___________________________
Date: ____________________________
Lab ID #: ________________________

How much assistance do you need to put the brace on?

1. Independent
2. Minimal
3. Moderate
4. Maximum
As compared to previous orthosis, this is
1. Easier
2. Same
3. More difficult
4. N/A
How much assistance do you need to take the brace off?
1. Independent
2. Minimal
3. Moderate
4. Maximum
As compared to previous orthosis, this is
1. Easier
2. Same
3. More difficult
4. N/A
Would you say that the weight of the brace is
1. Light
2. Acceptable
3. Heavy
As compared to previous orthosis, this is
1. Lighter
2. Same
3. Heavier
4. N/A
Would you say the looks of the brace are
1. Excellent
2. Acceptable
3. Unacceptable
 Consumer opinions of a stance control knee orthosis 255

As compared to previous orthosis, it is

1. Better looking
2. Same
3. Worse looking
4. N/A

How much assistance do you need to assume a standing position?

1. None
2. Minimal
3. Moderate
4. Maximum

As compared to previous orthosis this is

1. Easier
2. Same
3. More difficult
4. N/A

How much assistance do you need to assume a sitting position?

1. None
2. Minimal
3. Moderate
4. Maximum

As compared to previous orthosis this is

1. Easier
2. Same
3. More difficult
4. N/A
How is the stability of the brace while standing?
1. Excellent
2. Acceptable
3. Unacceptable
As compared to previous orthosis, this is
1. More stable
2. Same
3. Less stable
4. N/A
How is the stability of the brace while walking?
1. Excellent
2. Acceptable
3. Unacceptable
As compared to previous orthosis, this is
1. More stable
2. Same
3. Less stable
4. N/A
256 K. A. Bernhardt et al.

How far can you walk in the brace before feeling fatigued? ________
To go this far is
1. Easy
2. Acceptable
3. Difficult
As compared to previous orthosis, this distance is
1. Easier
2. Same
3. More difficult
4. N/A
________________________________________________________________________________
Do you use an assistive device to ambulate (e.g., cane, walker, etc)?
If yes, what do you use?
________________________________________________________________________________

On average, how often and for how long have you used the brace?
And how far would you walk on these days?
________________________________________________________________________________

Did you have any redness or skin irritation from the brace?
If so, did you take action to solve the problem (please explain)?
________________________________________________________________________________

For the following activities, please note if you can do them independently or need an assistive
device while using the brace.
Standing: ______________
Limited (household) ambulation: ______________
Level surfaces (indoor only): ______________
Level and uneven terrain (indoor and outdoor): ______________
Stairs: ______________
________________________________________________________________________________

Do you ever use a wheelchair?

If so, for short or long distances?
________________________________________________________________________________
Other comments: