Cook Children’s Neuroscience Research Center, led by Christos Papadelis, PhD, is the recipient of a $50,000 research grant funded by the National Institutes of Health (NIH) through the National Pediatric Rehabilitation Resource Center, also known as CPROGRESS, for a study mapping the brain’s response to robotic-assisted rehabilitation in children with unilateral cerebral palsy.

“We are one of very few centers in the United States mapping changes in the brain as a result of robotic rehabilitation,” Dr. Papadelis said. “It’s not the rehabilitation by itself or the robotic system by itself, but it's the fact that we try to map the brain’s plasticity or what type of plasticity takes place in the brains of these kids in response to the rehabilitation.”    

Cerebral palsy is one of the most common childhood disorders in the United States. About one in every 345 children in the country have some form of the neurological disorder, which affects movement and muscle coordination. The condition can impact the lower or upper extremities, all four limbs or one side of the body. In any case, physical rehabilitation is crucial to maximizing movement and muscle control.

For children with unilateral cerebral palsy, meaning one side of the body is affected, conventional rehabilitation utilizes constraint-induced movement therapy in which the dominant, unaffected limb is immobilized in order to force the paralytic limb to do all of the work. While effective, children aren’t always cooperative with wearing constraint devices and performing this type of repetitive, or what they might call boring, therapy. 

But kids do like video games. As digital natives, they have never known a smart device they couldn’t navigate. For this reason, robotic therapy is emerging as an important rehabilitation tool for children. The digital nature of the bot captures their attention and speaks a language they understand. 

While researchers know robot-assisted rehabilitation has its benefits, there is a lot they still do not know about the application of this type of therapy in the pediatric population.

“There's not much research on how robotics help children with cerebral palsy,” Dr. Papadelis said. “We don’t yet have a gold standard on how much treatment, how many days and how intense it should be in order to have successful outcomes. We want the brain to reorganize based on the rehabilitation, but can this kind of mapping be maladaptive and go in a direction we don’t want it to go?”

Thanks to the NIH grant, Cook Children’s Neuroscience Research Center is studying the use of robot-assisted rehabilitation for children with unilateral cerebral palsy in order to address these uncertainties and establish best practices. 

The robot used is akin to a video gaming system. Using the fingers and hand of the impacted limb, patients manipulate a type of sensor-based robotic joystick while playing a video game generated by the robot’s computer system. The system measures functions such as range of motion, spasticity and strength in order to tailor the interactive video games to the patient and increase engagement. It also uses vibrations to stimulate the patient’s motor sensories.  

“There's a hypothesis that the more information we provide to the somatosensory system in the brain, the better the motor responses,” Dr. Papadelis explained.

While interacting with the robot, patients also undergo an electroencephalography (EEG) study where dozens of electrodes are placed on the scalp to measure the electrical activity of the brain. 

“Using this tool, we are able to map changes in the brain as a result of this rehabilitation. It tells us if the parameters of the treatment are sufficient, or if we need more intense treatment, less intense treatment and whether this type of treatment is beneficial for one child or for all kids,” Dr. Papadelis said. “Kids with cerebral palsy all have different underlying etiologies. For example, some kids have cerebral palsy as a result of stroke. Some as a result of infection or hemorrhage. Because cerebral palsy is an umbrella term, we're trying to understand if this treatment is beneficial and for which group of patients. And, if it's beneficial for this group of patients, how much we should provide them in terms of treatment length.”

Sadra Shahdadian, PhD, a postdoctoral research fellow under Dr. Papadelis’ supervision, serves as co-principal investigator for the study. Drs. Papadelis and Shahdadian hope that at the completion of this one-year grant cycle the research team will have collected enough preliminary data to support their hypothesis and better define the use of robot-assisted rehabilitation in children with cerebral palsy. They also hope their work leads to a larger NIH grant or philanthropic support for a more in-depth and long-term study of pediatric robotic therapy. 

When we hear the word ‘addiction,’ we often think of drugs and alcohol, but in the 21^st century, addiction has taken on a new meaning. Lisa Elliott, Ph.D., psychologist and clinic manager of the Behavioral Health Clinic at Cook Children’s in Denton, says children are becoming addicted to their phones and gaming systems, driving parents to seek help through licensed therapists.

“We have the research that shows there is a chemical addiction as well as a behavioral addiction,” Dr. Elliott said.

“I think the thing that makes it even more dangerous for me is this is happening with young children, very young children, as much as it is with teens and young adults.”

In 2019, the World Health Organization (WHO), voted to include ‘gaming disorder’ as an official condition in the International Classification of Diseases, akin to anxiety, depression, etc. This paved the way for psychologists such as Dr. Elliott to bill insurance providers, making access to care more affordable for many families with health insurance. However, aside from video gaming, adolescents and teens are also glued to their electronic devices. She says remote learning due to the global pandemic has also played a major role in this addiction.

Cheryl, a North Texas mother, says her 12-year-old daughter is obsessed with YouTube. The family is now seeking guidance from a Cook Children’s family therapist.

Cheryl and her husband didn’t allow their daughter to have a cellphone until they believed she needed it for safety purposes. She wasn’t allowed to have any social media accounts, but her parents did allow her to watch TikTok videos.

“She has a cellphone and iPad, but we made sure everything had parental controls and restrictions,” Cheryl said.

When they later deleted the TikTok account out of concern for privacy issues, they allowed her to watch YouTube videos.

“She watches kids playing innocent pranks on each other, and she gets invested in that. She consistently talks about who is dating who and is always looking forward to the next update like she knows the people in the videos,” Cheryl explained.

Cheryl added that her daughter knew exactly when the episodes were coming out and had a fear of missing out on what was next in the lives of her favorite YouTubers.

When the Cheryl and her husband realized their daughter was going behind their back to find ways to watch YouTube, after she’d been instructed otherwise, they decided to reach out for help.

“For me, it was really about correcting that behavior because right now she has this temptation in front of her and she's making bad choices,” Cheryl explained.

Why are young people becoming obsessed with a reality outside of their own? Dr. Elliott believes the global pandemic has a lot to do with this rising trend.

“I think it's pervasive, so it's not just from an academic setting, but it's also how kids are filling their downtime. It's how they're maintaining social relationships, whether they're healthy or not,” Dr. Elliott said.

Cheryl and her husband couldn’t agree more. They don’t have any issues with their daughter’s choice of content. The issue is her actions and what these minor actions could lead to in the future when bigger temptation is put in front of her.

Cheryl’s daughter sees Stephanie Golden, LPC, a therapist at Cook Children’s Alliance. Golden has been working as a mental health professional for 20+ years but says phone and social media addiction is something she has seen more in the last three to four years in her practice. While phone addiction isn’t healthy, Golden believes it is treatable.

“It’s certainly a widespread problem, but I believe one that can be improved upon with boundaries,” Golden said.

Boundaries are exactly what Cheryl believes would be beneficial for her daughter when it comes to her desire to watch YouTube videos.

In a 2019 study released by the Child Mind Institute, 1% to 10% of children and adolescents have excessive and impairing online behavior. This behavior impacts a child’s ability to focus, the hours of sleep they get at night, and their social behavior with others when they aren’t behind a screen.

Cheryl says having a daughter that’s addicted to YouTube and going behind her parent’s back to find ways to watch it is hard because there aren’t resources for this problem specifically.

“It was really hard to figure out what to do and how to handle this,” Cheryl said. “We tried every single thing we could, from taking away her devices and even sitting down with her and asking her what she needed and how we could help.”

Cheryl and her husband struggled even more because they felt their daughter’s actions were ‘minor’ and ‘innocent’ because she wasn’t struggling with substance addiction. However, Dr. Elliot says addiction is handled the same whether it’s social media or something severe like drug use and gambling. She also notes until more research is done, therapists have to continue to rely on coping mechanisms and techniques they’ve used for adults who’ve struggled with addiction for many years. However, she says that it is scary because she doesn’t want to see adolescents fall into deeper temptation in the future.

“My concern is, if children are creating this addictive response, which we know happens, what kind of addictions does this lead into later?” Dr. Elliott asked. “So I'm concerned about the potential risk they might have for other addictions down the road.”

Cheryl and her husband also struggled with the guilt of putting their daughter in therapy because they didn’t want to take a seat of a child who might’ve needed the resources more.

“She isn’t suicidal and she isn’t depressed,” Cheryl said. “But I had to remind myself that we are putting her into counseling so she can learn skills and those skills can be applied to other areas of her life as well.”

Golden agrees with that sentiment and says in situations like this, she also gives guidance to families/parents.

“Set boundaries around cell phone usage and be consistent with the rules,” Golden said. “Following suggestions from experts can help protect a child’s mental health.”

Dr. Elliott adds another reason boundaries are important is that peer pressure and the need to fit in as at an all-time high. The Child Mind Institute reports 81% of teens say social media makes them feel more connected to their friends.

Cheryl agrees her daughter fits into that category.

“When we ask her why she wants it so bad or feels the need to sneak around to get what she wants, she tells us all of her friends in class are on YouTube all the time on their devices,” she said.

Dr. Elliott urges all parents to keep a very close eye on children’s social media and device use. She says not only can addiction to devices impact schoolwork, it can affect social relationships with others. When a child’s brain is still developing, she says children need healthy and appropriate social interactions to learn empathy, how to relate and communicate, as opposed to learning unhealthy social skills through a device/gaming system.

Cheryl understands the importance of limited screen time and says adolescents don’t fully understand phone etiquette, and how to properly interact with their peers and it is important to set an example and put boundaries into place at an early age.

As Chery’s daughter continues to see Golden, and the family works through this issue, Golden says it’s important to “face the issue with compassion, understanding and firm kindness.” She goes on to add “We don’t always like to have rules, but it’s often healthy and good for us when we follow them.”

Find more technology guidelines from Dr. Elliott shares with her patients from the American Association of Pediatrics below.

• Birth to Pre-School Years
  • There should be no technology from birth to 3 years.
  • Any screen time at this age impairs social communication, development, and attachment to family members.
  • This age should be devoted to social development, sensory-motor skills, and reading skills.
  • Limited exposure may be introduced at 4 years with only high-quality programming.
  • American Academy of Pediatrics (AAP) cautions that all technology programs should be watched with their children.
  • Parents have to lead by example: Do not check messages at the dinner table, do not become absorbed by devices, look at people when they are talking – children notice and mimic everything!
  • Never undervalue unstructured “free play.”
  • Parents should not give their children a tech device as a reward for good behavior. Children must learn to self-soothe.
  • Appropriate activities for 4 year olds
    • Periodically use eReader for storytime.
    • Allow limited access to electronic toys that educate and teach numbers, letters, and vowel sounds.
    • Utilize mobile apps/tech devices for sorting shapes and finding objects.
  • It is critical children engage in physical play, have social engagements and read books!

• Grade School Age Years
  • Create a balance between technology, along with social and physical play.
  • AAP recommends no more than two hours of screen time per day with close parental supervision! And that should be less during the younger grade school ages.
  • It is critical to watch alongside your kids to point out messages that are not congruent to your values.
  • Parents need to designate media-free spaces, including bedrooms, meal times, and playtimes.
  • Screen time should be quality; age-appropriate, share your values, and engage your child’s imagination.
  • Never make screens a reward or consequence.
  • Encourage other activities such as free play outside, playing sports, creating hobbies, arts and crafts, and social activities.
  • Appropriate activities for grade school
    • The goal is to teach responsible use.
    • Use internet under supervision only.
    • Create tech-free talk each day.
    • Institute strict time limit restrictions and rules for use.
    • Monitor computer homework; eliminate all technology when screen time rules are broken.
    • Children need to stay involved with school activities and friends.
    • Model appropriate technology behavior

• Preteen and Teen Years
  • It is critical parents model appropriate technology behavior – they have to practice what they preach.
  • Parents need to establish the rule that their children will agree to “friending” them on social media platforms.
  • Parents should have access to passwords.
  • Maintain open dialogue about what is and is not appropriate sharing on social media platforms.
  • Parents and their tween/teens should develop a social media contract that includes expectations, violations as well as discipline for violations. Try out this great free tool from @AmerAcadPeds: http://www.healthychildren.org/MediaUsePlan
  • Bedrooms should be tech-free, all devices should be removed from bedrooms at night.
  • Snapchat is the most difficult platform to monitor – may be wise not to allow this platform.
  • It is imperative to teach your children about the potential consequences of their postings on social media platforms.

The affidavit included in one of the tweet's details an adult here in North Texas engaged in inapproapriate behavior with a 15-year old child in New Jersey.

It reads: “The victim stated he was playing Minecraft on his computer…and was contacted by a person wanting to chat.”

According to the affidavit, the conversation between the victim and the adult then moved to Skype which led to grooming, sexual messaging and even sexually explicit photos and videos being exchanged.

This is so awful I hate to even post it. But, it is so important to know what kind of predators are out there and what they are doing to connect with your kids.

Predators know what is cool. They know more than you do about what your kids are into.

They know how to reach kids and they will use whatever means necessary to connect with them.

Any app or game with a chat function that is connected to the Internet is a portal for exposure to terrible people with terrible ideas. Be aware and monitor! Turn off the chat function or have your child play in offline mode where able.

Of course, there’s more to evaluating an app or game than just the risk of exposure. Here are some general guidelines for evaluating both for your child.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

“What have you been up to this summer? Did you play outside at all or has it been all video games?”

“Pretty much video games.”

“Oh cool, what kind of games do you like? Sports?”

“No, stuff like Call of Duty and Grand Theft Auto.”

It would be one thing if I was having this conversation with a teenager (still not ideal) but this CHILD was 7 years old.

Twenty years ago, considering TV alone, a study estimated that children see 8,000 murders and 100,000 acts of violence before middle school. With the TV, movies, social media and video games available today, there is no telling what that number would equal.

Studies are clear that exposure to virtual violence increases aggressive behavior and thoughts. Yet, the means by which children can be exposed to virtual violence seem to increase exponentially every year. A recent statement from the American Academy of Pediatrics encouraged pediatricians to talk with families about virtual violence and to provide guidance for how to address virtual violence in well-child visits. I read through it and, frankly, was tempted to throw it out with some of the other policy statements, etc. that I don’t think apply to me. Here are four reasons why I NEARLY ignored the new virtual violence policy statement:

1. I have too much to do in a checkup as it is. It’s true that there are a lot of things to cover in a checkup and it’s possible that I won’t get to the topic of virtual violence every time, but when I can I should.

2. Kids are dealing with real-life violence. I work in a clinic where tragically, for some kids, being exposed to virtual violence might be a good day for them. Again, we need to provide the best possible pediatric care for the patient in front of us. If a child needs to be physically safe that should take priority but if, for another, virtual violence is their biggest risk, we should address that as well.

3. Kids have started with violent media before I even get a chance. See conversation above. This may be a real concern, but it means that I should start the conversation earlier, not ignore it all together.

4. Parents who let their kids be exposed probably don’t care about what I have to say about it. It’s possible that one parent is concerned and the other not. Perhaps my information and support might be enough to cut down on or eliminate virtual violence exposure.

I’ve always had casual conversation about media with my patients. Despite my reluctance to focus on this, I think it’s an important piece of information for parents to consider for their children. Here are some tips that you can use to help decrease you child’s exposure to virtual violence:

1. Start early engagement with your child about screen time and habits. If you let your child watch unlimited screen time as a one year old, imposing strict restrictions on anything related to screens later only gets harder.

2. Co-watch almost everything with your child. I get it. I’m a parent and I’m tired of watching kid shows. I’d rather be on Twitter. But if there’s anything new or potentially risky, I watch it or play it with my kids.

3. Don't let your child play first person shooter games or any game where the goal is violence or killing. They don't have the ability to separate real vs. virtual violence and their growing and developing brains cannot handle that level of exposure.

At best, the mom is rolling her eyes and pulling her phone out to hand to her screaming child.

“Children under 2 years of age should have no screen time and after 2 years, we should limit screen time to 2 hours per day.”

There is the common summary statement that can be taken out of the AAP Policy Statement on Children, Adolescents and the Media.

Is this realistic?

Is this practical?

Is anyone listening to anything we say?

In May, a meeting of the best minds in the use of media in pediatrics set out to answer these questions as well as look at recent research on the use of screens in children and teenagers.

In order to get information about the meeting out quickly, AAP News released a summary of some of the thoughts that came out of the meeting.

If you read the headlines that were generated as a result of the statement, you might have heard:

“Pediatricians think all screen time is OK. Go for it!”

“Pediatricians finally admit that they were dead wrong and outdated when they said toddlers shouldn’t use screens.”

“Pediatric guidelines now changed to allow for more screen time, at earlier ages.”

Unfortunately, we don’t always get the time to fully explain our message and the media doesn’t always get it right.

Here are my takeaways from the statement that I hope better reflect the intent of the authors:

1. What you might have heard: “Pediatricians think all screen time is OK. Go for it!”

What it should have said: “We need to continue to be careful about the amount of time children are on screens. Guiding them toward quality apps and games that are more than just watching a video is important. Watching and playing alongside your children helps to enrich the experience for the family as a whole.”

2. What you might have heard: “Pediatricians finally admit that they were dead wrong and outdated when they said toddlers shouldn’t use screens.”

What it should have said: “The benefit of screen time for toddlers is an ongoing topic of research but it is clear that children continue to learn best from interacting with and talking to other humans. One of the major risk of screen time is the time take away from rich interaction with parents and other caregivers.”

3. What you might have heard: “Pediatric guidelines now changed to allow for more screen time, at earlier ages.”

What it should have said: “While this statement is not a new guideline, it does highlight the AAP commitment to following new research in regards to screen use and helping to relay that information to parents as soon as possible. As more information comes available, we will update our guidelines to reflect current studies in the context of practical media use for children.

Do continue to follow this debate because the guidelines are likely to change over time. (P.S. That’s what guidelines should do in a new and heavily researched field.)

Don’t go out and buy your 1 year old her own iPad.

“Stop Slouching!”

Why is my kid’s posture so poor?

THE PROBLEM

Do you get sick and tired of telling your child to sit up straight? Do you ever wonder why so many kids these days have slouched posture and often complain of back pain?

Let’s take a moment to think about a child’s typical day during the week.

1. They spend six hours a day at a desk in school. Most of this time is spent writing notes or typing with their hands in front of them and their head looking down.
2. When they are not in school, much time is spent playing video games, playing on their smartphones, surfing the Internet on the computer or texting. Again, arms are in front of them and head is down
3. They carry around a backpack that often weighs almost as much as they do and often times wear it low, resting on their low back or bottom. Backpacks should weigh no more than 10 percent of their body weight, be worn on both shoulders and fit snuggly to their back.

In April of 2012 – Archives of Pediatric and Adolescent Medicine published an article stating that only 51 percent of children went outside to walk or play per day with either parent.

Another national study found that the average American age 8-18 plays video games for greater than 13 hours per week. Studies also show that children today spend half as much time outdoors as their parents did when they were young. These kids prefer to stay inside to watch TV, surf the Internet, listen to music and even do their homework, rather than go play outside.

How it affects the kids

The positions discussed above, which kids are in for a large majority of their day, place the muscles on the front of their chest into a shortened position. After a while, it is difficult to stretch those muscles back out to attain proper posture independently. Tight muscles on the front of their chest cause them to continue to sit with their shoulders rounded forward and thus the cycle continues. The muscles in the front of their neck also become tightened, pulling their head forward. A forward head can also cause the muscles at the base of the skull in the back of the head to become tense.

Unfortunately, the inactivity caused by the increased time spent indoors also contributes to a poor core. The core consists of the muscles around the center of your body that help your back stay up straight. Without an active core, it is very difficult to maintain good posture and fatigue will set in quickly. A weak core in combination with prolonged periods of inactivity will likely lead to a cycle that is difficult to break, causing poor posture.

What to do

Have a homework station set up for kids. Doing homework on the bed or floor often makes posture worse and increases the curvature of their back while they are sitting. Kids should sit in a chair where their feet can touch the floor and their hips and knees are at 90 degrees. The table height should be so that their forearms are able to rest comfortably while they are working so that their shoulders can relax.

They should be in the same sitting posture for the computer and the screen should be at eye-level to keep their head in a good position as well. There are shelves made to lift computer screens up to eye-level, however, a large dictionary will often do the trick, as well.

The American Heart Association’s recommendation for physical activity for children is at least 60 minutes of moderate-vigorous intensity aerobic activity at least every day. As a parent, try to encourage your child to be active for at least one hour a day, either at school or at home. If you cannot find the time for your child to perform 60 minutes of straight activity, try to perform at least 30 minutes of activity twice per day.

It is never normal for a child to experience back pain or consistent headaches. If your child is experiencing either of these symptoms and is not actively being treated by a healthcare provider, please discuss these concerns with their doctor. Physical therapy can assist with improving posture and core strength to eliminate back pain.

Related information

• Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS)
• Dynamic stretching
• The basics of sports injury prevention for kids
• The essential backpack 

“When a child plays an electronic game and receives frequent intermittent rewards, their brains release dopamine – a neurotransmitter that is closely related to reward motivated behavior,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of the Cook Children’s Behavioral Health Clinic in Denton. “In school or in other social situations, a child does not normally receive these rewards, making it more difficult for them to stay focused in a non-technology based situation.”

Elliott believes this is a factor contributing to the recent rise in ADHD. She said she is concerned about gadgets, especially video games, and what they could be doing to harm our children.  By allowing so much focus on technology and mobile devices, children aren’t learning to hold their attention without some type of reward.

Whatever the cause is, Elliott offers four simple ways to prevent the damage that gadgets could be causing your child:

1.Remove any screens from the bedroom.

2.Pay attention to the content your child is viewing, especially violence.

3.Set limits on screen time each day. The American Academy of Pediatrics recommends screens be kept out of kids' bedrooms and children should be limited to less than two hours per day of screen time. For children under 2 years of age, all screen media exposure is discouraged.

4.Create healthy playtime such as outdoors or being active.

These simple changes may make the difference in how your children perform this school year.And while your kids may be upset now, they'll thank you later.

About the source

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children's Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appoinment with her, call 682-885-3917.

About the author

Caroline Gayler volunteers in the public relations department at Cook Children’s Health Care System. She is a senior at TCU majoring in Strategic Communications. 

My family consists of five media junkies. I am not even going to pretend we aren't. When our kid’s pediatrician, Dr. Kim Mangham, called to ask me about blogging about media this summer, I couldn't hear her because our TV was too loud.

I thought we had it under control. My family is very active. The kids play sports and swim. We go to different events and activities together all the time. But despite being so active, with all the hand-held games, TVs, computers, laptops, smart phones, tablets and video game consoles, we still manage to cram in A LOT of media time during the day.

The week before Dr. Mangham called, I had taken all my kids (11, 10 and 6) to their annual well check appointment. (Taking all three kids at the same time to their well check was either my most genius or dumbest idea yet. The jury is still out. It was crazy.)

I did give myself props because I remembered to charge everyone’s device of choice before the well check. So while everyone played on their devices, Dr. Mangham discussed with us summer safety and attempted to explain the importance of reducing media time. Dr. Mangham also mentioned that two of her patients’ parents were considering going media free for the summer. I allegedly said something agreeable to this statement and by the next week Dr. Mangham called to ask if I wanted to blog about my attempts to go media free.

I panicked. I didn't mean like really go media free. How would we go screen free? How would my kids talk to their friends? What about FaceTime with the grandparents? Use all those educational apps? What am I going to do if someone calls and I need to talk? Just not turn on the TV to their favorite program? Those Minecraft houses don't build themselves you know! How am I going to tell them? We are flying in July and I have a big meeting tomorrow!! How do you do this? Cold turkey? Reduce but not eliminate? What would we all do if we are not connected to the world?

The more questions I came up with, the more I realized that in our house media is a crutch.

We are going to try it. And our goal? To simply try and find a healthy balance when it comes to our media consumption on a daily basis

I am not sure how our journey is going to play out. Plan A (because plan A always works right?) is to reduce. We will limit our media to one hour a day,  with a chance to EARN up to another hour. Hey, maybe my baseboards will get cleaned this summer!

First things first. I have to break it to the family. Screen time as they know it is about to change!!