assessment

The Best Tools to Maximize Your Pilates Assessment

What information can we gather by watching someone perform the goal post?

When assessing the Goal-Post exercise, the client is asked to do three things:

Stand up against the wall with their head against the wall
Bring the arms to 90/90
Bring the arms into a high “V” position

Before cueing the exercise, the first thing to look for is axial alignment. Can the client position their head over their thorax and thorax over their pelvis while maintaining natural lumbar and cervical curves?

After looking at axial alignment, we look to see what is happening in the shoulder region?

What are some of the things required to be able to bring the arms into a 90/90 position and into a “V” overhead?

Shoulder Flexion
Shoulder Rotation
General Shoulder Mobility

Question: What else connects with shoulder mobility?

Answer: Thoracic mobility -This is one of the things to look for first when moving into the goal post as it directly impacts shoulder mobility. If the thoracic spine doesn’t move into extension, the following might be seen:

The head comes away from the wall
The shoulder girdle can’t slide down into its 90/90 position
The back may come away from the wall

Other tests and measures to use to confirm the possibility of a loss of thoracic mobility depend on how other aspects of the movement are functioning.

What can be ruled out?

Could it be a loss of scapular mobility?

Could it be a tight pectoral girdle or a loss of humeral rotation in the shoulder such as a rotator cuff injury?

During the assessment keep in mind, that it could be any of these things and then begin ruling them out.

Video of Brent teaching assessment using the goal-post exercise.

Faulty movement patterns that could be present:

The shoulders hiking up to perform the movement (bilaterally)
The pronation of the shoulders (very common)

Critical Reasoning: Is the client’s limitation in the thoracic spine or in the shoulder girdle? What other tests might we perform to distinguish between the two?

Asymmetries during Assessment:

When you see an asymmetry, you must seek to understand what the asymmetry is due to. You may see a client who can move one arm back nicely but not the other. If there is scoliosis or a spine deformity, the client might have an asymmetry where one shoulder is being rotated forward.

If there is no scoliosis or spine abnormality, then what is happening at the shoulder blade?

Is there a winging of the shoulder blade or poor organization of the shoulder blade?

What is happening at the glenohumeral joint?

How is it in relationship to the rest of the shoulder girdle?

Assessment Tip: Circle back to the client’s history.

Did they have an injury?
Is there any nerve pain? (A brachial plexus lesion could easily cause a limitation in bringing the arm up to 90/90.)

Critical Reasoning: Inquire about the client’s habitual patterns, as some of these daily patterns can create asymmetries, for example:

Someone who is always using the computer mouse with tension the right shoulder.
Someone who sleeps on one side causeing the shoulder to collapse forward.

The PT and medical world uses what’s called “upper limb tension testing”, one of which tests is to bring the arm up to 90/90 and then straighten it. A significant amount of people who have had brachial plexus lesions or a thoracic outlet syndrome lose the ability to bring one side up.

Assessment Tip: When an asymmetry is present in an assessment, remember to put a “red flag” on it. Asymmetry means there could have been an injury or something else going on that is challenging the movement.

Keep in mind – As we Assess we are always:

Ruling out
Asking questions
Seeking to understand: “What possibly might be causing this?”

Get the most out of your Assessment and Earn 24 NPCP CEU’s this Summer!

Join us for our upcoming immersion into Critical Reasoning and Assessment Skills:

Critical Reasoning for Rehabilitation and Post Rehabilitation, held this June in Siler City, NC with Polestar Founder Brent Anderson.

Assessing the Full Squat

by Polestar Pilates7 Comments

Those of you who have been following Polestar for our critical reasoning, case studies, and problem-solving – I invite you to join me in our “Critical Reasoning for Rehabilitation & Post Rehabilitation” course.

Join me for a complete immersion over three days as we dive into assessment skills, the Polestar Assessment Tool (PAT), the International Classification of Function Model (ICF), designing movement programs, hands-on labs, and much more.

I hope to see you there!

— Brent

What are we looking for when assessing the full squat?

Can they perform a full squat?
Can they keep their torso vertical?
Are they able to disassociate at the hip?
Do they have enough ankle dorsiflexion to be able to fully squat without lifting their heels?
Do they understand the concepts and the relationships in the body that add up to the performance of the full squat?

Common Movement Faults:

Pitching/leaning forward
Heels lifting off the floor
Lack of Balance
Poor Leg Alignment
Rounded Spine

What are some reasons they might not be able to perform the full squat?

Myofascial restrictions or muscular tightness could inhibit the motion in their spine, ankles, hips, or knees.
They may have a fear of falling or fear of pain.
There could be capsular problems in the ankle, knee, or hip.
The client may have weakness in their lower extremities.

As Well As:

They may have knee pain or previous knee injuries that prevent them from moving into deep knee flexion.
The client may not have enough thoracic extension to stay vertical in such a deep position.
Clients who’ve had a total knee replacement surgery often have restrictions into full knee flexion and will only get 120 or 130 degrees of knee flexion.

How do we know what is important? How do we understand what we see?

Asking questions is key to understanding what you see in your client. The goal is to rule out some of the above reasons to help identify the key issues to focus on. It is also important to seek to understand. Take the time to run through multiple scenarios regarding what is causing the limitations in movement. This practice and more will be workshopped at the upcoming “Critical Reasoning for Rehabilitation & Post Rehabilitation” course with Brent Anderson this June – find out more here.

How do we rule things out?

One of the best ways to rule things out is to go through the reasons one by one and test them individually. Here is how I would rule out the following:

Coordination and lack of awareness:

How to rule out: Use tactile and verbal cueing to see if you can improve the quality of the squat.

Fear of falling or pain:

How to rule out fear or pain: Offer support to decrease load, increase confidence or assist balance.

Lack of control and strength:

How to rule out: Have the client perform a half squat and see if they have the strength to straighten their legs or return from the squat. If it looks extraordinarily strong, this may not be their main issue. You may also try giving them some assistance to mitigate the load and see if their execution improves.

How to rule out: Give your client a hand hold or allow them to perform the squat with balance assistance and see if their movement improves.

How to rule out: Ask your client to be vocal with you. Throughout the movement, inquire why they think they are unable to perform the movement.

Note: If they are lacking ankle dorsi-flexion and hip mobility, you may work toward increasing movement in the ankle and hips to decrease the stress on the knee and hopefully restore some semblance of a normal squat. You can immediately mitigate ankle load by adding a lift under the heels as stated above.

Structural restrictions could inhibit the range of motion in their spine, ankles, hips, or knees:

How to rule out decreased ankle mobility: Put a prop like a wedge under their heels and see if they can move through the squat without issues. If they can, slowly decrease the lift and see how much assistance they need.

How to rule out: Test thoracic extension separately and see if they have the required mobility. I would also look at the strength/control to hold the posture. They may have the spine mobility but not control of it.

What the Research Says

We have seen research by Christopher Powers, Ph.D., PT from USC identifying weak hip abductors and rotators in the deceleration phase of our walking and jumping activities which correlates to knee pathologies.

There are many who teach that the knee should not move in front of the toes when squatting, especially with lifting weights. However, natural human squatting requires the knees to go in front of the foot. We believe that a lot of the inability to comfortably and naturally squat can be attributed to a loss of ankle dorsiflexion which is thought to be a result of a long-term sedentary lifestyle.

Critical Reasoning: Assessing Goal Post

Join Brent Anderson for a deep dive into assessment skills and more.

Creating Positive Movement Experiences for Pilates Clients with MS

by Polestar Pilates1 Comment

Polestar Faculty Nichole Anderson, NCPT has had the pleasure of working with many clients with MS and has enjoyed the constant learning process it has provided.

What Is Multiple Sclerosis?

The National Multiple Sclerosis Society defines MS as a:

“disease that involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS) which includes the brain, spinal cord and optic nerves”.

In other words, MS involves a person’s immune system attacking their nerves. In our huge network of nerves, information has to travel quickly to allow us to act spontaneously. Many nerves are covered in myelin. This both insulates and accelerates the rate at which information travels in the nerve. When the immune system consistently attacks the myelin, it becomes damaged and forms scar tissue (sclerosis), which gives the disease its name. As the disease progresses, the nerve fiber itself can become damaged and destroyed. What does this mean on a larger scale? When the myelin is scarred or the nerve fiber damaged or destroyed, a large number of nerve impulses from the brain and spinal cord are interrupted and/or distorted. All actions in the body and brain are triggered by some sort of nerve impulse which is why symptoms can vary from person to person.

Who Gets Multiple Sclerosis?

Without getting too deep into the epidemiology of MS, here are a few facts:

MS is a very difficult disease to diagnose. There are currently no single tests for MS. Because of this challenge, MS is often misdiagnosed or not diagnosed at all. Most epidemiological statistics on MS are estimates.
Most people are diagnosed between the ages of 20 and 50.
In general, MS is more common in areas further from the equator. There are many communities far from the equator that have little to no reported incidences of MS.
MS is at least 2-3 times more common in women than men.
Genetic factors seem to play a large part in determining who develops MS.
As with many diseases, MS is believed to be triggered by an environmental factor, as yet unidentified, in a person who is genetically predisposed to respond.

What Are The Common Symptoms?

Because of the variety of symptoms associated with MS, every client with MS will have different struggles in regard to movement. That being said, there are a few things that are very common in clients with MS:

Foot drop: This is where there is weakness in the muscles that dorsi-flex the ankle. When this progresses, walking can be dangerous as there is an increased fall risk.
Numbness: This is often one of the earliest and most common symptoms of MS. It can be numbness anywhere in the body, face, and extremities. It can cause the affected area to be disconnected and difficult to control. We will discuss later some ways to facilitate movement when certain body parts are numb.
Fatigue: In a movement class, this often means being unable to do high repetitions of movements, especially at a high load.
Weakness: This can occur from basic deconditioning of muscles that aren’t used due to damage to the nerves that stimulate them. Weakness can also occur when a client with MS has gotten overheated or fatigued.
Spasticity: This is when there is an involuntary muscle spasm that can cause prolonged rigidity in the limb that is spasming.

Considerations For Working With Clients With Multiple Sclerosis

Keep it cool!: A warm room can create a challenging movement experience for someone with MS and can even precipitate a flare-up.
Take frequent breaks: Even if your client feels like they can keep going, it is important to take frequent rests to avoid fatigue.
Spot, Spot, Spot!: While this is dependent on ability because MS frequently causes numbness, it is important to spot any moving apparatus that can slip out of a hand, off a foot, and onto your face

Suggestions For Building A Session

Warm up with hand and foot stimulation and movement. Depending on ability, I either do this for clients or have them do it to themselves. This can include:

toe pulling, tapping the bottoms of the feet with fingers
vigorous rubbing of the feet and ankles
interlacing fingers with toes and making circles
active movement of the ankle such as tracing the alphabet in the air with each foot.

Hand stimulation and movement: This is a great time to move an area that we don’t traditionally “exercise” in Pilates. I like to have people move through tight fists to hands stretching wide, followed by “piano fingers”. This can look like playing a fake piano slowly and quickly, getting some individual movement in each digit. After getting some movement, I give them some free time to self-massage their hands, rubbing them together vigorously. Another good activity can be kneading the palm of one hand with the other, and interlacing the fingers and squeezing.

Allow Transfers To Become A Part Of The Class

Depending on how far the disease has progressed, one of the most challenging parts of a class can be the transfer of one position to another. I like to discuss strategies for making these transitions. This could be gazing, moving from sitting to standing, maybe pausing somewhere in the middle of a transfer to do some movement there. It can also be supportive to allow time for clients to settle into the next position, allowing them to rest from the transition. This is also great because it is functional and allows clients to have strategies for getting out of sticky situations when they are going through their daily lives. I also like to help my clients explore their breath by spending time in each class breathing and working on the movement of the diaphragm and ribcage.

Work Safely On Balance

Use the equipment to your advantage! I often pull the tower bar through to the back and attach the safety strap. This creates a solid bar they can hold to practice heel raises or balancing on one leg. I also find the Core Align to be a great tool for working with clients with MS as it enables reciprocal leg movement with the support of a ladder to hold on to.

Support Distant Extremities :

Use velcro straps to connect feet to the footbar and hands to dowels if there is too much numbness in the feet or hands to hold on well.
Utilize Y-straps to secure both feet and hands when doing work with springs and pulleys.
Use therabands to hold thighs together for bridging, pelvic clock, and other exercises that require legs to be still. This is only necessary if the client is struggling to connect to their legs.
Use your tactile cues to bring awareness to less responsive areas. With your client’s permission, palpate areas that are not connecting well to help them find their feet, hands, legs, etc before going into a movement.

Keep In Mind That No Two Days Are Alike

What may have been strengths one day may be weaknesses other days. The temperature outside, activities of the day before, stress and other external influences can vastly affect the capabilities of clients with MS from day to day. It is always important to check in, and to allow for progress to be relative

Connect with Polestar Educator Nichole Anderson on social media @nicholemoves.

This article includes information from The National MS Society Nationalmssociety.org

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What is the Oov?

by Polestar Pilates7 Comments

Most of you have probably noticed or at least heard about our newest piece of equipment, the Oov. All of us were rather skeptical going into the course.

We thought, “do we really need to learn how to use another piece of equipment?”

I thought I had already allocated enough money and sacrificed weekends towards continuing education but with some encouragement from my peers I, as well as my colleagues decided to embark on the Oov journey. I’m sure glad I did! The following highlights just some of the benefits and features the Oov provides.

A cradle for your spine

This is the analogy I have been using for describing the Oov. The shape of the Oov is engineered to match the natural spinal curves of your body. Unlike a foam roller, the Oov is made from compliant foam so it is comfortable. Once a client is positioned on the Oov, they are essentially in what we refer to as a “neutral spine.” This is wonderful for us as manual therapists and movement instructors because we no longer need to “clog” the neurologic system with cues about where your spine and pelvis are in space.

Balancing your stability

The Oov is shaped to be an unstable surface. So while it “cradles your spine,” it also challenges your rotational stability, which is functional for many of our daily activities. Since the shape and material of the Oov keeps the spine in an elongated, neutral position, we can easily train clients out of dysfunctional, habitual movement patterns. More importantly, clients gain new awareness of these patterns which is a challenging aspect of our treatment paradigms.

Free your shoulders

Unfortunately, our modern world promotes unhealthy posture. Freedom and coordination of the muscles around the neck and shoulders are important for a healthy, functioning spine. The Oov was designed to allow the shoulder blades to move freely while laying on it. We can train a client’s head, neck and shoulder alignment while challenging the neuromuscular system to recognize a new, healthy position of the spine.

Home exercise

Teaching clients how to perform exercises at home can be tricky. One quandary I experience as a physical therapist is when patients report not doing their home exercise program because they were not sure if they were doing it correctly. This is where the Oov comes in handy. Many of the “core strengthening” exercises we prescribe can be performed on the Oov without proprioceptive confusion. Purchasing an Oov for home is an affordable option for physical therapy and fitness clients alike.

(How to make sure your Clients are doing their Homework?)

Sandy Vojik is a physical therapist and Polestar Pilates practitioner. She is a native of Riverside, IL and currently resides in Salt Lake City. She loves creating positive physical and mental changes in her patients by tailoring her evaluation and treatment techniques to meet every clients’ unique needs. Sandy has found the Oov to benefit clients presenting with impairments ranging from neurologic deficits to athletic injuries. For upcoming Oov courses, click here.

Educator Highlight Shelly Power

by Polestar Pilates4 Comments

Shelly Power is the Director of Curriculum for Polestar Pilates. She has been teaching Pilates since 1992 and has lead teacher trainings since 2000. Shelly’s unique and rich teaching style includes aspects from her specialization in NLP communication and experience teaching dance and movement to children. We sat down with Shelly to learn more about her, including her love of backpacking, sailing, yoga and travel.

Polestar: What do you love about teaching?

SP: I love being part of the a-ha moments. It doesn’t matter if it’s in a weekly class or teacher training, when a student is able to do something that they weren’t able to do before, or understands something about their body or a movement that they hadn’t known before, that is really powerful.

Polestar: What is your movement background?

SP: Former competitive swimmer, gymnast and professional dancer.

Polestar: What are your current inspirations?

SP: Functional movements (that have been en vogue recently) like Animal Flow, Ido Portal and certainly Runity which uses movements that everyone should be able to do to help us get in shape to run pain free. Sadly we cannot all do basic squats, push ups, and lunges because we stopping doing and practicing them. So, I have been practicing them, and I can do them along with a decent handstand and amazing cartwheels!

Polestar: Why Pilates?

SP: First I love how the movements feel in my body, so that’s selfishly number one. In the bigger picture though, I really appreciate how connected the different movements are and how we can use the equipment to assist movement in so many different ways. Obviously we can change springs and change the size of movement but there are so many other ways we can leverage our bodies and the equipment to help us achieve our goals.

Polestar: What do you hope to convey in your teaching?

SP: Everyone is different, Perfection isn’t the goal. If it’s difficult, maybe you need to change how you’re doing it or thinking about it, Know what you are trying to achieve.

Polestar: Where would you love to vacation to?

SP: Wind River Mountains, Thailand, South Island NZ, South Africa…

Polestar: Do you have a favorite quote?

SP: “Never allow a person to tell you no who doesn’t have the power to say yes,” and, “do one thing every day that scares you.” Both by Eleanor Roosevelt.

Polestar: Describe your movement style…

SP: Elegant (except when doing yoga at 6:30 in the morning!)

Polestar: What are your favorite apparatus?

SP: Pilates Chair and GYROTONIC® Pulley Tower.

Polestar: What are you reading?

SP: Buddha and Einstein Walk Into a Bar: How New Discoveries About Mind, Body, and Energy Can Help Increase Your Longevity, by Guy Joseph Ale When Breath Becomes Air, by Paul Kalanithi, MD. Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease, by Robert H. Lustig, MD.

Polestar Pilates Transition/Bridging with Shelly Power

What Are The Best Exercises for Scoliosis?

by Polestar Pilates6 Comments

Polestar Educator, Physical Therapist, and certified C2 Schroth therapist Lise Stolze offers further insight to Scoliosis and working with Scoliosis clients. For all upcoming continuing education courses with Polestar visit: Polestar Continuing Education

Most asked questions scoliosis clients ask me about exercise:

Should I perform some exercises just on one side?
Should I choose exercises that rotate me to the opposite direction of the curve?
Should I do an extra set of movements to one side?
I just saw research that side plank exercises can reduce curve degrees…should I be doing these?

To answer these questions we must understand how scoliosis affects movement.

What is the Pathomechanism of Idiopathic Scoliosis? (the short version!)

I will be brief since this is a whole course in itself! We know that Idiopathic (no known cause) Scoliosis (IS) is a 3 dimensional spinal disorder that begins with anterior vertebral wedging due to RASO (relative anterior spinal overgrowth) during bone development. We also know that the rotational component of scoliosis exists as both inter-vertebral torsion (rotation of one vertebra relative to another) and intravertebral torsion (an internal rotational distortion within each vertebra), most notably at the apical vertebra (the vertebra most deviated laterally from the vertical axis that passes through the sacrum).1 This distortion contributes to less joint motion at the apex of the curve and more at the transition points of the curve. We see this to a greater degree in adults and to a lesser degree in adolescents who have a more flexible curve before bone maturity. This is apparent in a supine lateral flexion X-ray that assesses curve flexibility.

Three Goals for our Clients with Scoliosis

Movement educators can keep 3 goals in mind when choosing exercises for clients with IS:

Achieve better postural alignment along the central axis
Provide a safe fitness option to increase flexibility, strength and fluid movement
Support sports, recreation and functional activities that enhance quality of life

**We Can Improve Posture Through Exercise!**

Better posture can be achieved by emphasizing the most fundamental principles of all intelligent movement disciplines: axial elongation and breathing. Scoliosis curve concavities are constantly under compression by gravity. Axial elongation encourages a natural re-alignment of the spine by using neuromuscular activity to reduce multi-plane compression and collapse of the concave side of the scoliosis curves. Once the concavities (which include the ribs) are expanded, then breath can be used to further open the collapse through:

Tactile cueing of the concavities
Unilateral nostril breathing
Guided imagery

The most effective position to learn decompression of the concavities is in a spinal neutral position, out of gravity. Once there is neuromuscular re-patterning, movement can then be transferred to functional positions against gravity like standing, sitting, walking, squatting and lifting where it is more difficult to maintain axial decompression. There are many neutral spine exercises in the Pilates and yoga environment that can be used in this initial phase of re-patterning.

The Side Plank Research Controversy

A research article was published in 2014 claiming that scoliosis curves can be reduced by doing side planks on the convex side of the curve, and was sensationalized in a WSJ article.² But the research had many flaws³ and while interesting, it cannot make that claim. Muscular activity on both the concave and convex side of a scoliosis curve is inefficient and exercises that address each side are optimal for IS, including the Side Plank. Consider benefits of the Side Plank based on curve type:

Single Major Thoracic Curve: performing side plank on the convex thoracic side (concavity up) can help strengthen elongated muscles on this side by placing them in a relatively shortened position, and helps to open the concave side, working these muscles eccentrically.
Double Curve, Primary Thoracic: the same can be true for the thoracic curve but now the lumbar curve may be more compressed and specific cueing and/or modification of the exercise must be considered.
Double Curve, Primary Lumbar: performing side plank on the convex lumbar side may be beneficial, but the thoracic curve may be more compressed, and will require special cueing or modification.
Single Curve – Lumbar or Thoraco-lumbar: performing side plank on the lumbar or thoraco-lumbar convex side may strengthen elongated muscles on this side by placing them in a relatively shortened position and helps to open the concave side, working these muscles eccentrically.
Adult with Degenerative Scoliosis (Lumbar): receive the same benefits as Single Lumbar curve but if there is a lateral instability (listhesis), then this exercise may not be indicated.

In all curve types, performing the Side Plank on the concave side of the primary curve is much more challenging but also beneficial. This brings us to the importance of performing a scoliosis assessment to determine the curve type. In the case of adult degenerative scoliosis, an X-ray must be obtained and collaboration established with a health care practitioner who has a deep working knowledge of scoliosis evaluation and management.

Safe Exercises for Spine Mobility

Life takes us out of neutral spine…shouldn’t we train our scoliosis clients how to move their spine effectively out of neutral? The answer is of course yes…. but which movements and how much? This depends on your assessment of the client: Are they in pain? How much movement does the apex of each curve have? What is the curve type? What other muscle imbalances or injuries exist? What are their goals? Considering that the scoliosis spine tends to move more at the transition points and less at the apices, we may want to limit end range movements and emphasize elongation in postural shapes that minimize compression of the curve concavities. This will be more difficult for those with a double curve. So it is important to make critical decisions with your client based on your evaluation and their goals.

Recreation and Sports: Can it Be Done with Scoliosis?

Everyone with scoliosis should be free to enjoy activities that increase quality of life! What does you client love to do? Sports activities such as dance and gymnastics involve many compressive spine positions for scoliosis….as do golf and tennis. Each person must be evaluated for the risk that their chosen activity may have on their scoliosis. Considerations for age, curve type, activity frequency, and muscle imbalances must be made. Clients should be educated about scoliosis spine mechanics and progressions to help them make an informed decision about the activity they choose. A fitness or movement session with your client could focus on training to maintain axial elongation and openness of the concavities during sport. Just as likely and equally important, a session could simply focus your client back to their center line!

Education and the Need for Individualized Programs

Polestar founder Brent Anderson, PT, PhD, OCS reminds us of the importance of working within our own scope of practice. It is crucial to invest in your education to increase your effectiveness and level of safety with your scoliosis clients. Find a professional you can partner with, join a network of practitioners with like interests, and take courses to keep yourself current with scoliosis research. If you are the client, make sure that your Pilates teacher or therapist has the training to create safe and effective exercise programs for you and your needs.

For all Upcoming Continuing Education Courses: Continuing Education with Polestar

References: ¹Dickson RA, Lawton JO, et al. The pathogenesis of idiopathic scoliosis. Biplanar spinal asymmetry. J Bone Joint Surg Br. 1984;66(1):8–15. ² Fishman LM, Groessl EJ et al. Serial case reporting yoga for idiopathic and degenerative scoliosis. Global Advances in Health and Medicine. 2014;3(5):16-21. ³ Salvatore M, Zaina F, et al. Letter to the editor: Serial case reporting yoga for idiopathic and degenerative scoliosis. Global Adv Health Med.2015;4(1):79-80.

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Lise Stolze, MPT, DSc PMA®-CPT, is a certified C2 Schroth therapist, Polestar Educator, and owner of Stolze Therapies in Denver, CO. She has co-created Pilates Adaptations for people with Scoliosis with Schroth Scoliosis Therapist and BSPTS educator Hagit Berdishevsky, PT, MSPT, DPT, Cert. MDT. Lise has been published with her research on Pilates and Low Back Pain.