{"id":11047,"date":"2026-04-10T10:42:30","date_gmt":"2026-04-10T10:42:30","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/tamine-capato\/"},"modified":"2026-04-22T14:58:13","modified_gmt":"2026-04-22T14:58:13","slug":"tamine-capato","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/tamine-capato\/","title":{"rendered":"Tamine Capato"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":12304,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-11047","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"Clinical Assessment and Management of Balance Impairments in Parkinson\u2019s disease","samenvatting":"Er is geen Nederlandse samenvatting beschikbaar. De Engelse samenvatting vind je <a href=\"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/tamine-capato\/\">hier<\/a>.","summary":"Balance and gait impairments in Parkinson\u2019s disease (PD) improve only partially with pharmacological and surgical treatment. Therefore, non-pharmacological interventions such as physiotherapy are important elements in the overall clinical management. In this thesis, I aimed to study the clinical assessment and management of balance and falls in PD by developing and evaluating a novel intervention to improve both balance and gait. Second, I established patient profiles (subgroups) and tailored doses of a balance intervention. Third, I reported the effects of cueing on freezing of the upper limbs.\n\nClinical assessment\nFalls are common in Parkinson\u2019s disease (PD), and can result in fall-related injuries, fear of falling, loss of physical activities and ultimately in a reduced quality of life. To break this vicious cycle, an individually tailored treatment program aimed at improving balance and prevent falls is needed. This starts with a thorough clinical examination\u2013 not only to determine why the person with PD falls and which risk factors for falls are present, but also to evaluate its impact on the person\u2019s quality of life. Chapter 2 provides tips and tricks how clinicians can identify extrinsic and intrinsic risk factors for falls and how stereotypical fall patterns can be recognized. I discussed how a preceding transient loss of consciousness can be identified and I presented its differential diagnosis. Finally, I described a battery of clinical tests that help to unravel the underlying mechanism of a fall. After the clinical examination the clinician can prescribe a falls prevention program tailored to the identified contributing factors, which may include a change in pharmacological treatment, or prescription of adequate non-pharmacological treatment. Falls in PD are typically multifactorial in nature, and clinicians should therefore not stop searching for contributing mechanisms when one risk factor has been identified. In addition, as the disease progresses, additional intrinsic risk factors might develop, so repeated assessments remain necessary.\n\nKey message\nFalls in persons with Parkinson\u2019s disease are the combined result of intrinsic and extrinsic risk factors, which can be unraveled by a combination of subjective and objective assessments, and which subsequently constitute the starting point of a personalized treatment program tailored to each individual\u2019s unique set of risk factors.\n\nClinical balance management\nIn chapter 4, I performed a prospective, single-blind, randomized clinical trial to study the effectiveness of balance training with and without rhythmical auditory cues. In this large study PD participants were randomly assigned to one of three groups: (1) multimodal balance training supported by rhythmical auditory stimuli (RAS-supported); (2) regular multimodal balance training without rhythmical auditory stimuli (Regular); and (3) control intervention involving a general education program (protocol described in chapter 3). Training was performed for 5 weeks, 2 times\/week. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by a single, blinded assessor at baseline, immediately post intervention, and after one and 6-months follow-up. Our study reported two important new findings. First, we showed that RAS-supported multimodal balance training is more effective than regular multimodal balance training in improving balance. We suspect that RAS-supported multimodal balance training stimulates residual motor-cognitive abilities in PD more effectively than regular multimodal balance training. Second, the training effects (particularly those of RAS-supported multimodal balance training) were maintained up to 6-months follow-up. The improvements on the MBEST-scores were not only significant, but also exceeded the previously found standard error for a test-retest measurement and minimal clinically relevant difference.\n\nKey message\nIn chapter 4, I evaluated the RAS-supported multimodal balance training and regular multimodal balance training. Both training interventions improved balance performance, compared to controls (educational program). RAS-supported multimodal balance training was more effective than regular multimodal balance training. Only the RAS-supported multimodal balance training group retained the effects at long-term follow-up (6 months). This study provided class II evidence that combining physiotherapy with auditory cues (multimodal balance training) has greater and more prolonged effects than regular physiotherapy alone in improving balance performance in PD.\n\nClinical determinants: subgroups and severity\nTo fulfill the potential of non-pharmacological interventions in Parkinson\u2019s disease (PD), individually tailored treatment is needed. RAS-supported multimodal balance training can improve balance and gait in PD, but it is unclear whether both freezers and non-freezers benefit. Previous subgroup analyses showed that PD participants with freezing of gait (FOG) may respond differently to non-pharmacological interventions compared to non-freezers. In chapter 5, I reported on a secondary subgroup analysis for freezers and non-freezers, based on my previously describes large randomized controlled trial (chapter 4). In both freezers and non-freezers, both RAS-supported multimodal training and regular training significantly improved the Mini-BESTest scores compared to baseline and compared with the control group. The improvement was larger for RAS-supported training compared to regular training, for both freezers and non-freezers. Only the RAS-supported training group retained the improvements compared to baseline measurements at 6-month follow-up, and this was true for both freezers and non-freezers. Taken together, this secondary analysis suggested that adding rhythmic auditory stimuli to balance training is beneficial for both freezers and non-freezers, at least in persons with mild to moderate disease stages.\n\nKey message\nRAS-supported multimodal training is effective in improving balance performance in both freezers and non-freezers with mild to moderate disease stages.\n\nEvidence of the effectiveness of physiotherapy in people with advanced stage of PD is sparse. Current physiotherapy guidelines provide no recommendations on the specific approach for the HCY4 subgroup. It is unclear whether multimodal balance training is also effective in people with advanced PD (Hoehn & Yahr stage 4). In chapter 6, I performed an exploratory prospective, single-blind, randomized clinical trial to study the effectiveness of multimodal training with and without rhythmical auditory stimuli in people with advanced PD. People with Parkinson\u2019s disease in Hoehn & Yahr stage 4 were assigned randomly into two groups: (1) RAS-supported intervention and regular intervention. Training was performed for 5 weeks, 2 times\/week. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by a single, blinded assessor at baseline, immediately post intervention, and after one and 6-months follow-up. Immediately post-intervention, both intervention groups improved significantly on the MBEST scores, without differences between both intervention modalities. In both groups, results were retained at one-month follow-up. At 6-months follow-up, the effects were retained only in the RAS-supported intervention group. For both intervention groups, no improvements were found on secondary outcome measures for gait.\n\nOur study highlights that multimodal balance training (both with and without rhythmical auditory stimuli) is feasible in patients with advanced disease stages, as it did not result in falls and serious adverse events. We found a minimally clinically relevant difference for the MBEST test, which means that the average improvement (both immediately post-intervention and at one-month follow-up) was clinically relevant. Taken together, our findings further supports the importance of non-pharmacological intervention in the management of axial problems as gait and balance in people with PD in advanced stages (HCY4).\n\nKey message\nBoth RAS-supported multimodal balance training and regular multimodal balance training improve balance in people with PD in advanced disease stages. Effects appear to sustain longer in the RAS-supported training group.\n\nNovel concept in cueing approach\nFreezing of gait (FOG) in PD is not restricted to walking. Indeed, patients can also experience freezing in the upper limbs (FOUL). In chapter 7, I described a case report of a 64-year-old woman with a 30-year history of PD (HCY stage 4). Despite optimal pharmacological and non-pharmacological treatment, she experienced FOG multiple times a day, which improved markedly in the presence of external cueing. During several upper limb tasks, the patient experienced the same \u201cgluing\u201d sensation as during FOG. The patient was able to overcome the FOUL-episodes by applying external and internal cueing strategies, similar to cueing strategies implemented for FOG.\n\nKey message\nPeople with PD can able to overcome freezing in the upper limbs by applying external and internal cueing strategies, similar to cueing strategies implemented for freezing of gait.\n\nResumo em Portugu\u00eas (in Portuguese)\nAs defici\u00eancias de equil\u00edbrio e da marcha na doen\u00e7a de Parkinson (DP) melhoram apenas parcialmente com o tratamento farmacol\u00f3gico e cir\u00fargico. Portanto, as interven\u00e7\u00f5es n\u00e3o farmacol\u00f3gicas, como a fisioterapia, s\u00e3o elementos importantes no manejo cl\u00ednico geral. Nesta tese, primeiramente tive como objetivo estudar a avalia\u00e7\u00e3o cl\u00ednica e o manejo do equil\u00edbrio e das quedas na DP, desenvolvendo e avaliando uma nova interven\u00e7\u00e3o para melhorar o equil\u00edbrio e a marcha. Em seguida, estabeleci perfis de pacientes (subgrupos) e doses personalizadas de uma interven\u00e7\u00e3o de equil\u00edbrio. Por fim, relatei os efeitos do est\u00edmulo no congelamento dos membros superiores.\n\nAvalia\u00e7\u00e3o cl\u00ednica\nAs quedas s\u00e3o comuns na doen\u00e7a de Parkinson (DP) e podem resultar em les\u00f5es relacionadas \u00e0s quedas, medo de cair, diminui\u00e7\u00e3o de atividades f\u00edsicas e, por fim, redu\u00e7\u00e3o da qualidade de vida. Para quebrar esse ciclo vicioso, \u00e9 necess\u00e1rio um programa de tratamento individualizado com o objetivo de melhorar o equil\u00edbrio e prevenir quedas. Isso come\u00e7a com um exame cl\u00ednico completo - n\u00e3o apenas para determinar por que a pessoa com DP cai e quais fatores de risco para quedas est\u00e3o presentes, mas tamb\u00e9m para avaliar seu impacto na qualidade de vida da pessoa. O Cap\u00edtulo 2 fornece dicas e truques sobre como os cl\u00ednicos podem identificar fatores de risco extr\u00ednsecos e intr\u00ednsecos para quedas e como padr\u00f5es estereotipados de queda podem ser reconhecidos. Eu discuti nesse cap\u00edtulo como uma perda transit\u00f3ria de consci\u00eancia pode ser identificada e tamb\u00e9m apresentei como fazer seu diagn\u00f3stico diferencial. Finalmente, descrevi uma bateria de testes cl\u00ednicos que ajudam a desvendar o mecanismo subjacente de uma queda. Ap\u00f3s o exame cl\u00ednico, o m\u00e9dico pode prescrever um programa de preven\u00e7\u00e3o de quedas adaptado aos fatores contribuintes identificados, que pode incluir uma mudan\u00e7a no tratamento farmacol\u00f3gico ou a prescri\u00e7\u00e3o de um tratamento n\u00e3o farmacol\u00f3gico adequado. As quedas na DP s\u00e3o tipicamente de natureza multifatorial e, portanto, os m\u00e9dicos n\u00e3o devem parar de buscar mecanismos de causa apenas quando um fator de risco \u00e9 identificado. Al\u00e9m disso, conforme a doen\u00e7a progride, fatores de risco intr\u00ednsecos adicionais podem se desenvolver, portanto, avalia\u00e7\u00f5es peri\u00f3dicas continuam sendo necess\u00e1rias.\n\nMensagem chave\nQuedas em pessoas com doen\u00e7a de Parkinson s\u00e3o o resultado combinado de fatores de risco intr\u00ednsecos e extr\u00ednsecos, que podem ser desvendados por uma combina\u00e7\u00e3o de avalia\u00e7\u00f5es subjetivas e objetivas e que, subsequentemente, constituem o ponto de partida de um programa de tratamento personalizado adaptado ao conjunto \u00fanico de risco de cada indiv\u00edduo fatores.\n\nGerenciamento cl\u00ednico do equil\u00edbrio\nNo cap\u00edtulo 4, realizei um ensaio cl\u00ednico prospectivo, simples-cego e randomizado para estudar a efic\u00e1cia do treinamento de equil\u00edbrio com e sem pistas auditivas r\u00edtmicas. Neste grande estudo, os participantes com DP foram aleatoriamente designados a um dos tr\u00eas grupos experimentais: (1) treinamento de equil\u00edbrio multimodal apoiado por est\u00edmulos auditivos r\u00edtmicos (RAS-supported); (2) treino de equil\u00edbrio multimodal regular sem est\u00edmulos auditivos r\u00edtmicos (Regular); e (3) interven\u00e7\u00e3o de controle envolvendo um programa de educa\u00e7\u00e3o geral (protocolo descrito no cap\u00edtulo 3). O treinamento foi realizado durante 5 semanas, 2 vezes \/ semana. O desfecho prim\u00e1rio foi a pontua\u00e7\u00e3o do Mini-BESTest (MBEST) imediatamente ap\u00f3s o per\u00edodo de treinamento. As avalia\u00e7\u00f5es foram realizadas por um \u00fanico avaliador cego no in\u00edcio do estudo, imediatamente ap\u00f3s a interven\u00e7\u00e3o e ap\u00f3s um e 6 meses de acompanhamento. Nosso estudo relatou duas novas descobertas importantes. Primeiro, mostramos que o treinamento de equil\u00edbrio multimodal apoiado por RAS \u00e9 mais eficaz do que o treinamento de equil\u00edbrio multimodal regular para melhorar o equil\u00edbrio. Suspeitamos que o treinamento de equil\u00edbrio multimodal apoiado por RAS estimula as habilidades motoras cognitivas residuais em DP de forma mais eficaz do que o treinamento de equil\u00edbrio multimodal regular. Em segundo lugar, os efeitos do treinamento (particularmente aqueles do treinamento de equil\u00edbrio multimodal apoiado por RAS) foram mantidos at\u00e9 o acompanhamento de 6 meses. As melhorias nos escores MBEST n\u00e3o foram apenas significativas, mas tamb\u00e9m excederam o erro padr\u00e3o encontrado anteriormente para uma medi\u00e7\u00e3o de teste-reteste e diferen\u00e7a m\u00ednima clinicamente relevante.\n\nMensagem chave\nNo cap\u00edtulo 4, avaliei o treinamento de equil\u00edbrio multimodal apoiado por RAS e o treinamento de equil\u00edbrio multimodal regular. Ambas as interven\u00e7\u00f5es de treinamento melhoraram o desempenho do equil\u00edbrio, em compara\u00e7\u00e3o com os controles (programa educacional). O treinamento de equil\u00edbrio multimodal suportado por RAS foi mais eficaz do que o treinamento de equil\u00edbrio multimodal regular. Apenas o grupo de treinamento de equil\u00edbrio multimodal suportado por RAS manteve os efeitos no acompanhamento de longo prazo (6 meses). Este estudo forneceu evid\u00eancias de classe II de que a combina\u00e7\u00e3o de fisioterapia com pistas auditivas (treinamento de equil\u00edbrio multimodal) tem efeitos maiores e mais prolongados do que a fisioterapia regular sozinha na melhoria do desempenho do equil\u00edbrio em DP.\n\nDeterminantes cl\u00ednicos: subgrupos e gravidade da DP\nPara alcan\u00e7ar o potencial das interven\u00e7\u00f5es n\u00e3o farmacol\u00f3gicas na doen\u00e7a de Parkinson (DP), \u00e9 necess\u00e1rio um tratamento individualizado. O treinamento de equil\u00edbrio multimodal com suporte de RAS pode melhorar o equil\u00edbrio e o ganho em DP, mas n\u00e3o est\u00e1 claro se os freezers e n\u00e3o freezers se beneficiam. An\u00e1lises de subgrupos anteriores mostraram que os participantes com DP com congelamento da marcha (FOG) podem responder de forma diferente \u00e0s interven\u00e7\u00f5es n\u00e3o farmacol\u00f3gicas em compara\u00e7\u00e3o com os n\u00e3o congeladores. No cap\u00edtulo 5, apresentei uma an\u00e1lise de subgrupo secund\u00e1ria para freezers e n\u00e3o freezers, com base em meu grande ensaio cl\u00ednico randomizado descrito anteriormente (cap\u00edtulo 4). Em ambos os freezers e n\u00e3o freezers, o treinamento multimodal apoiado por RAS e o treinamento regular melhoraram significativamente as pontua\u00e7\u00f5es do Mini-BESTest em compara\u00e7\u00e3o com a linha de base e em compara\u00e7\u00e3o com o grupo de controle. A melhora foi maior para o treinamento apoiado por RAS em compara\u00e7\u00e3o com o treinamento regular, tanto para freezers quanto para n\u00e3o freezers. Apenas o grupo de treinamento com suporte de RAS manteve as melhorias em compara\u00e7\u00e3o com as medi\u00e7\u00f5es da linha de base no acompanhamento de 6 meses, e isso foi verdadeiro para freezers e n\u00e3o freezers. Tomados os resultados em conjunto, esta an\u00e1lise secund\u00e1ria sugere que adicionar est\u00edmulos auditivos r\u00edtmicos ao treinamento de equil\u00edbrio \u00e9 ben\u00e9fico para freezers e n\u00e3o freezers, pelo menos em pessoas com est\u00e1gios de doen\u00e7a leves a moderados da DP.\n\nMensagem chave\nO treinamento multimodal apoiado por RAS \u00e9 eficaz para melhorar o desempenho do equil\u00edbrio em freezers e n\u00e3o freezers com est\u00e1gios de doen\u00e7a leves a moderados.\n\nAs evid\u00eancias da efic\u00e1cia da fisioterapia em pessoas com DP em est\u00e1gio avan\u00e7ado s\u00e3o escassas. As diretrizes atuais de fisioterapia n\u00e3o fornecem recomenda\u00e7\u00f5es sobre a abordagem espec\u00edfica para o subgrupo H & Y4. N\u00e3o est\u00e1 claro se o treinamento de equil\u00edbrio multimodal tamb\u00e9m \u00e9 eficaz em pessoas com DP avan\u00e7ada (Hoehn & Yahr est\u00e1gio 4). No cap\u00edtulo 6, realizei um ensaio cl\u00ednico prospectivo explorat\u00f3rio, simples-cego e randomizado para estudar a efic\u00e1cia do treinamento multimodal com e sem est\u00edmulos auditivos r\u00edtmicos em pessoas com DP avan\u00e7ado. Pessoas com doen\u00e7a de Parkinson no est\u00e1gio 4 de Hoehn & Yahr foram designados aleatoriamente em dois grupos: (1) interven\u00e7\u00e3o apoiada por RAS e interven\u00e7\u00e3o regular. O treinamento foi realizado durante 5 semanas, 2 vezes \/ semana. O desfecho prim\u00e1rio foi a pontua\u00e7\u00e3o do Mini-BESTest (MBEST) imediatamente ap\u00f3s o per\u00edodo de treinamento. As avalia\u00e7\u00f5es foram realizadas por um \u00fanico avaliador cego no in\u00edcio do estudo, imediatamente ap\u00f3s a interven\u00e7\u00e3o e ap\u00f3s um e 6 meses de acompanhamento. Imediatamente ap\u00f3s a interven\u00e7\u00e3o, ambos os grupos de interven\u00e7\u00e3o melhoraram significativamente nos escores MBEST, sem diferen\u00e7as entre as duas modalidades de interven\u00e7\u00e3o. Em ambos os grupos, os resultados foram retidos no acompanhamento de um m\u00eas. No acompanhamento de 6 meses, os efeitos foram mantidos apenas no grupo de interven\u00e7\u00e3o com suporte de RAS. Para ambos os grupos de interven\u00e7\u00e3o, n\u00e3o foram encontradas melhorias nas medidas de resultados secund\u00e1rios para marcha.\n\nNosso estudo destaca que o treinamento do equil\u00edbrio multimodal (com e sem est\u00edmulos auditivos r\u00edtmicos) \u00e9 vi\u00e1vel em pacientes em est\u00e1gios avan\u00e7ados da doen\u00e7a, pois n\u00e3o resultou em quedas e eventos adversos graves. Encontramos uma diferen\u00e7a minimamente clinicamente relevante para o teste MBEST, o que significa que a melhora m\u00e9dia (imediatamente ap\u00f3s a interven\u00e7\u00e3o e no acompanhamento de um m\u00eas) foi clinicamente relevante. Tomados em conjunto, nossos achados ap\u00f3iam ainda mais a import\u00e2ncia da interven\u00e7\u00e3o n\u00e3o farmacol\u00f3gica no manejo de problemas axiais como marcha e equil\u00edbrio em pessoas com DP em est\u00e1gios avan\u00e7ados (H & Y4).\n\nMensagem chave\nTanto o treinamento de equil\u00edbrio multimodal apoiado por RAS quanto o treinamento de equil\u00edbrio multimodal regular melhoram o equil\u00edbrio em pessoas com DP em est\u00e1gios avan\u00e7ados da doen\u00e7a. Os efeitos parecem durar mais tempo no grupo de treinamento apoiado por RAS.\n\nNovo conceito na abordagem com pistas\nO congelamento da marcha (FOG) na DP n\u00e3o se restringe \u00e0 caminhada. Na verdade, os pacientes tamb\u00e9m podem experimentar congelamento nos membros superiores (FOUL). No cap\u00edtulo 7, descrevi um relato de caso de uma mulher de 64 anos com uma hist\u00f3ria de DP de 30 anos (HCY est\u00e1gio 4). Apesar do tratamento farmacol\u00f3gico e n\u00e3o farmacol\u00f3gico ideal, ela experimentou FOG v\u00e1rias vezes ao dia, que melhorou acentuadamente na presen\u00e7a de dicas externas. Durante v\u00e1rias tarefas de membro superior, a paciente experimentou a mesma sensa\u00e7\u00e3o de \u201ccolagem\u201d que durante FOG. A paciente foi capaz de superar os epis\u00f3dios FOUL aplicando estrat\u00e9gias de cueing externas e internas, semelhantes \u00e0s estrat\u00e9gias de cueing implementadas para FOG.\n\nMensagem chave\nPessoas com DP podem superar o congelamento nos membros superiores aplicando estrat\u00e9gias de dicas externas e internas, semelhantes \u00e0s estrat\u00e9gias de dicas implementadas para o congelamento da marcha.","auteur":"Tamine Capato","auteur_slug":"tamine-capato","publicatiedatum":"29 juni 2022","taal":"EN","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/taminecapato?iframe=true","url_download_pdf":"","url_epub":"","ordernummer":"FTP-202604101038","isbn":"978-94-6423-873-","doi_nummer":"","naam_universiteit":"Radboud Universiteit","afbeeldingen":12304,"naam_student:":"","binnenwerk":"","universiteit":"Radboud Universiteit","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/11047","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=11047"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/11047\/revisions"}],"predecessor-version":[{"id":11048,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/11047\/revisions\/11048"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/12304"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=11047"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=11047"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}