Back and Neck Health Unit
Back and Neck Health Unit was established in 2013. The unit provides treatment services to patients who have disc and spine problems, mechanical back and neck pain, and have difficulty in performing daily life activities and social roles. Patients who are admitted to our unit are treated with physiotherapy and rehabilitation approaches that include manual therapy, different exercises, relaxation and yoga programs after physiotherapy-specific evaluations are done. To patients, the basic anatomy and mechanics of the spine, the definition and importance of proper posture, the causes of back and neck pain, importance of correct exercise and relaxation techniques are also taught and, work and lifestyle modifications and appropriate sports choices for the protection of general health are advised. In addition, special yoga programs are applied for patients with back and neck problems and healthy people for protective purposes. As well as the treatment of back and neck problems, due to importance of protection from waist and neck problems, consultancy and training services are provided to various organizations and municipalities in line with their request.
Burn Unit
Burn Unit was established in 2016. In cooperation with the Department of General Surgery, the Faculty of Medicine, Hacettepe University Hospital, Department 73 Burn Intensive Care Unit during duration of hospital stay, and after discharge burn out patients, are given physiotherapy and rehabilitation services Hacettepe University Faculty of Physical Therapy and Rehabilitation. Patients are followed up physiotherapy and rehabilitation applications involved appropriate positioning, maintaining range of motion, muscle strengthening training, transfers, daily living activities and mobilization after the burn. Rehabilitation program is planned in line with the patient-specific needs by considering the cause of burn, burn area and burn surface.
Cancer Rehabilitation Unit
We treat inpatient persons who are in H.U. Oncology Hospital services, H.U. İhsan Doğramacı Hematology services, adult and children bone marrow transplantation services, and Cancer Rehabilitation Unit in our school we treat outpatient adults and children. Also we are doing research and practise about these patients. In our unit, we carry out physiotherapy and rehabilitation practices for these diseases: lymphomas, leukemias, brain tumors, breast cancers, colorectal cancers, gastric cancers, lung cancers, prostate cancers, liver cancers, pancreas cancers, thyroid cancers, childhood cancers ( leukemias, central nerve system tumors, lymphomas, neuroblastomas, soft tissue sarcomas, wilms’ tumors, bone tumors..)
About these diseases we purpose; decrease problems and adverse effects caused by diseases and medical or surgical treatment, restore and increase physical functions and ıncrease lifetime and quality of life
We perform these implementations; therapeutic, postural re-education, massage, scar mobilization, physiotherapy modalities for pain inhibition, neurodevelopmental treatments for children, sensory, perception and cognitive education, practices intended to independence for activities of daily life activities, orthesis and aid devices, energy conservation techniques for activities of daily life, selecting and education of aid devices for mobilization, family education
We also inform about cancer and risk factors intended to community health and we carry out awareness programmes about physical activity and benefits of exercise.
Cardiopulmonary Rehabilitation Unit
Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Cardiopulmonary Rehabilitation Unit was established in 1971. Individuals who are outpatients or patients hospitalized at Hacettepe University Hospitals due to cardiovascular and respiratory system diseases and/or their risk factors are comprehensively evaluated. Patients education consisting of a wide range of topics, including risk factors for cardiovascular and pulmonary disorders, prevention methods, lifestyle changes, tests and treatment methods, and appropriate guidance for short and long-term benefits of exercise, and the effects of the other treatments (drugs and diet). A comprehensive physiotherapy and rehabilitation program including aerobic exercise involving the heart-lung-musculoskeletal system, muscle strengthening and endurance training, respiratory muscle training, airway clearance techniques and activities of daily living activities are used in the treatment of our patients. We apply cardiopulmonary rehabilitation to patients with asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, rare diseases, myocardial infarction, high blood pressure, heart failure, sleep breathing disorders, pacemaker, and disorders raised from the physical inactivity like obesity and diabetes. Cardiopulmonary rehabilitation applications are performed not only for outpatients but also for inpatients in Hacettepe University Hospitals including intensive care units and acute care, pediatric diseases, surgical units like cardiovascular and thoracic and surgery, and general surgery, infectious diseases, and internal medicine.
Cerebral Palsy and Pediatric Rehabilitation Unit
Studies in this field in our country first started in the Cerebral Paralysis Unit established in 1971 at Hacettepe University School of Physical Therapy and Rehabilitation and since this date, the basis of the studies in the field of pediatric physiotherapy rehabilitation has been formed. Currently, our unit and faculty operate as a reference center that closely monitors current developments in the world and reflects on service delivery and training. In pediatric physiotherapy and rehabilitation; it is targeted to increase the level of activity and participation of children in the physiological, anatomical and environmental limitations of children with physical disability and support needs up to 18 years of age and rehabilitation of chronic conditions from childhood.
In our unit, it is aimed to increase participation by decreasing the functional deficiencies caused by neurodevelopmental pathologies in general beside CP. Cerebral palsy, motor retardation, congenital brachial plexus injuries, meningomyelocele, torticollis, developmental coordination problem, childhood gait and posture disorders, traumatic brain injury, genetic, congenital and metabolic diseases, resulting in childhood physical disability children are evaluated and taken into physiotherapy and rehabilitation program, and are fallowed by the multidisciplinary rehabilitation team members for a long time as a reference center.
To support the effectiveness of botulinum toxin and different surgical interventions for children with cerebral palsy or alike neuromotor conditions, before and after these interventions, family centered physiotherapy and rehabilitation applications, appropriate assistive devices, equipment and suggestion for solution selection and parent training and home program is given.
In our unit, pediatric physiotherapy and rehabilitation applications, neurodevelopmental assessments, motor and sensory problems, evaluation of body structure and functions from ICF point of view, determination of effects on activity and participation related to child and family are evaluated and individualized physiotherapy and rehabilitation methods are applied. Approaches like the pediatric “Bobath” (Neurodevelopmental therapy), constraint induced movement therapy, technological based therapy, treadmill exercises were used in our unit for normalization of sensory and motor experiences, gaining postural alignment, regulation of muscle tone, improvement of postural reactions, support of normal motor development and improvement of motor control, improvement of ambulation, increase of strength and endurance, and the prevention of soft tissue, joint and posture disorders that may occur.
Developmental and Early Rehabilitation Unit
Studies in this field in our country first started in 1971 with the establishment of the Cerebral Paralysis Unit in Hacettepe University School of Physical Therapy and Rehabilitation. Since then, the unit have been working continuously until now, has formed the core of the studies on pediatric physiotherapy rehabilitation in our country. Recently, the unit serves as a reference center that reflects the developments into education and service presentation by closely following the current developments in the world, and carrying out studies with patient profiles including high risk infants starting from the neonatal period. The Developmental and Early Physiotherapy Unit evaluates and detects neurodevelopmental disorders such as cerebral palsy with the methods “best predictor at the earliest period” and applies the necessary physiotherapy approaches with the targets such as supporting normal motor development and providing motor control, improving ambulation, and providing independent functional activity.
Geriatric Rehabilitation Unit
Patients aged 65 years or older who require “Physiotherapy and Rehabilitation’’ an in the acute and subacute care units of the Internal Medicine Department of Hacettepe University Adult Hospital are referred to the Geriatrics Department Polyclinic for dementia, Alzheimer's Disease, balance and fall problems and mobility problems in daily living activities. The patients who were taken to outpatient or followed up with home program, patients who were referred to our unit due to balance and fall problems from ENT and Audiology Departments constitute our unit profile.
Furthermore, 75. Yıl Nursing Home and Seyranbağları Nursing Home, affiliated to the Ministry of Family and Social Policies, are continuing their education and training activities by observing the physical and administrative conditions of the institution and the life styles of the residents and the services they benefit from with our Term 3 and Term 4 students.
During undergraduate education; "Term 3 - Summer Internship" interns and "Term 4 - Senior Year" interns both in the hospital in clinical settings with different disciplines (geriatrist, nurse, dietitian, psychologist, social workers, occupational therapist, etc.) to work in the nursing home by observing it is our mission to be able to guide physiotherapists and academicians who want to work in this field after graduation.
In order to promote the necessary protective and supportive services for the age groups in all age groups of the society and to promote healthy-quality aging issues, the Ministry of Health, the Ministry of Family and Social Policies, Universities, Municipalities and Non-Governmental Organizations are trying to raise public awareness through-Community Based Rehabilitation and conducting research studies.
Hand Surgery Rehabilitation Unit
Hand Surgery Rehabilitation Unit was established in 2002. Clinical service is given to the patients who have traumatic injuries of the upper extremity, obstetric and traumatic brachial plexus paralysis, peripheral nerve lesions, thoracic outlet syndrome, congenital anomalies, upper extremity fractures and soft tissue injuries, hand flexor and extensor tendon injuries, crush trauma, arthritic hand problems, carpal instability, elbow fracture and instability problems. After performing physiotherapy and rehabilitation assessments to these patients, neuromuscular electrical stimulation, biofeedback therapy, electrotherapy and manual therapy for bone and soft tissue are performed. Also many clinical researches contribute to the literatüre. Moreover, preventive and curative rehabilitation approaches are applied to musicians and athletes. In our unit, biomechanical and histological studies are carried out by a multidisciplinary team.
Inpatient Orthopedic Rehabilitation Unit
The Inpatient Orthopedic Rehabilitation Unit was set up in 1983. The unit provides services to patients operated for hip and knee prostheses, fractures, bone and soft tissue tumors, metabolic bone diseases, congenital deformities, developmental disorders, ligament and meniscus injuries and general orthopedic diseases. After physiotherapy and rehabilitation-specific evaluations, early rehabilitation is provided to these patients to increase muscle strength and range of motion, applications for pain reduction, implementation of surgery-specific rehabilitation protocols, teaching the patient or family home program, teaching transfer activities and referral to rehabilitation after discharge.
Neurological Early Rehabilitation Unit
Hospital Neurological Rehabilitation Unit, established in 1991, consists of 3 main units: Neurology Service, Neurology Intensive Care Unit and Acute Stroke Unit.In the 24-bed Neurology Service, demyelinating diseases (such as multiple sclerosis, neuromyelitis optica), movement disorders (such as Parkinson's, dystonias, spinoserebellar ataxia), neuropathies, motor-neuron diseases, neuromuscular diseases, myasthenia gravis, epilepsy and migraine patients are included in physical therapy and rehabilitation program. Patients with diseases such as Pompe disease, Lambert-Eaton myasthenic syndrome and stiff-person syndrome, which are rarely seen in the neurology service, are also included in the rehabilitation programs. In the 9-bed neurology intensive care unit, patient groups such as stroke patients, myasthenic crisis patients, end-stage ALS patients are served. In the acute stroke unit with a capacity of 10 beds, neurological rehabilitation is applied to stroke patients. In addition to the neurology service, we continue to cooperate with psychiatry, internal medicine, infectious diseases, cardiovascular surgery, anesthesia intensive care services. Treatment and follow-up procedures are provided through consultation system with external services. The close cooperation with neurologists and clinical neurophysiologists is actively involved in making decisions about botox applications. The unit staff in the behavioral neurology working group, which consists of neurologists, psychiatrists, physiotherapists and psychologists, also contribute to the treatment of functional movement disorders. In addition, we provide services to outpatients who need neurological rehabilitation. The importance of early neurophysiology-based applications is known for optimal functional gain in neurological diseases. The Hospital Neurological Rehabilitation Unit prepares the patients for the chronic period in the best way with these critical and sensitive period applications. In intensive care units, pulmonary rehabilitation, applications to maintain normal range of motion, soft tissue and joint mobilization, approaches to prevent edema and deep vein thrombosis, tilt table and / or person support mobilization methods are frequently used. In the acute stroke unit, rehabilitation programs based on neurophysiological approaches from the earliest period are aimed at focusing on trunk control, trunk balance and stabilization, soft tissue and joint mobilization techniques, prevention of shoulder subluxation and early mobilization. In other neurological diseases, different methods such as strengthening exercises, sensory training, aerobic training, core stabilization exercises, vestibular rehabilitation are used.
Neurological Rehabilitation Unit
The neurological rehabilitation unit was founded in 2001. In this unit, the various neurological diseases (subacute and chronic Stroke, Multiple Sclerosis, Neuromuscular Diseases, Parkinson's Disease, ALS) are taken into rehabilitation program. Our treatment is aimed to increase the quality of life and independence of the patients with current treatment approaches by making disease-specific assessments. This unit is accepted as a reference unit in Turkey, especially in neuromuscular diseases and ALS disease. In addition, the unit staff has many academic publications on these issues.
Neurosurgery Rehabilitation Unit
Neurosurgery Rehabilitation Unit started to work actively in 1990. In the unit, acute rehabilitation services are offered to the patients hospitalized in 1 intensive care unit, 3 adult units and 1 pediatric service of Neurosurgery Department. In addition, patients coming from the neurosurgery outpatient clinic are followed up with a home program. Rehabilitation in neurosurgery services usually involves the acute period. Treatment programs are created and administered by physiotherapists and treatments continue until the patient is discharged or referred to another center. The goals of rehabilitation applications in our unit are to prevent complications, increase functional capacity, ensure independence in daily living activities, accelerate the return to profession and reduce economic losses. To accomplish these goals, pulmonary rehabilitation, in-bed positioning, bandage applications, treatments for spasticity, neurophysiologic approaches (Bobath, Brunnstrom, Margaret Johnstone, PNF), ataxia rehabilitation, Dietz's rehabilitation approaches (for patients with tumors), spinal cord rehabilitation programs, special rehabilitation programs for pediatric patients, scoliosis and physiotherapy and rehabilitation applications for cervico-lumbar health are used in our unit.
Orthopedic Rehabilitation Unit ( For Out Patient)
This unit was established by Hacettepe University School of Physical Therapy and Rehabilitation in 1994 within the scope of the continuation of the Early Rehabilitation Unit, which was previously initiated for inpatients in Hacettepe University Orthopedics and Traumatology services and, it is applied early and late term treatment and preventive rehabilitation approaches for discharged patients. Orthopedic rehabilitation unit is a reference center in its field with its well-established institutional background and qualified academic staff, as well as its contributions to undergraduate and graduate education.
In the Orthopedic Rehabilitation Unit, rehabilitation of various developmental disorders, biomechanical problems and deformities or functional deficiencies of musculoskeletal system; rehabilitation of conditions related to macrotrauma such as fracture, dislocation, injury or sprain, and conditions related to microtrauma such as overuse syndrome or musician's hand; rehabilitation of all pathologies of the vertebral column, including low back and neck pain, scoliosis and kyphosis; conservative or postoperative rehabilitation of meniscus, ligament, tendon and nerve injuries; rehabilitation after joint replacement and reconstruction surgery; rehabilitation of various metabolic and congenital bone diseases including osteoporosis; rehabilitation of other musculoskeletal injuries and problems following conservative or surgical treatment.
The orthopedic rehabilitation unit performs rehabilitation in all of these specialized fields and conducts a team work colloborated with all other medical units in an interdisciplinary principles.
This unit is mostly in contact with departments of orthopedics and traumatology, spine surgery, hand and micrsurgery surgery, plastic and reconstructive surgery, sports medicine, rheumatology, physical medicine and rehabilitation.
After evaluating physiotherapy and rehabilitation for these patients, heat, light and electrotherapy modalities, manueL therapy (massage, manipulation and mobilization techniques), different exercise programs, neurophysiologic treatment approaches, treatment protocols specific to some orthopedic conditions (suc as total knee endoprosthesis, anterior cruciate ligament and meniscus injuries, femoro-accessabular impingement syndrome), specific exercise programs for low back and neck problems, functional activities and home exercise programs are applied.
Orthosis and Biomechanics Unit
Established in 1969, Orthotics and Biomechanics Unit is a unit that aims to enable our students to graduate as an individual trained in this field in our faculty that educates physiotherapists in light of scientific, cultural and ethical values. In parallel with the workshops carried out in our unit, we offer orthosis applications produced in line with the principles of biomechanical science for the benefit of the society and contribute to the national economy.
It aims to produce quality, functional, contemporary, and cost effective orthoses for patients and provide rehabilitation services to improve the quality of life of patients. Thanks to the physiotherapist clinicians and researchers trained in the field of orthotics and biomechanics, it works multidisciplinary with various medical sciences and contributes to the field by producing research and projects both within its own body and with other departments.
Clinical applications within the unit are specific clinical evaluations to determine the needs of the patients, determination of appropriate orthotic approach, orthosis application, rehabilitation of the patient using orthosis, regular control and orthosis usage, repair and care and treatment of patient and family education about the parameters affecting the treatment.
In addition, our unit is responsible for providing physiotherapy students with the opportunity to develop and apply theoretical knowledge in the field, to develop research and projects and to lead graduate students in this field.
Our unit's intensive clinical studies include foot health, congenital or acquired foot-ankle, knee and hip problems, scoliosis and kyphosis, spine deformities, orthosis in hand-injured individuals, ambulation in handicapped children and adults using up-to-date assessment and treatment in many aspects, such as orthosis and assistive device applications to improve functionality.
Pediatric Neuromuscular Diseases Unit
The Pediatric Neuromuscular Diseases Unit which was established by Ayşe KARADUMAN, PT, PhD, Prof. in 1991, initially providing services to children and adults for hereditary neuromuscular diseases, has been providing physiotherapy and rehabilitation services for pediatric neuromuscular diseases such as Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Hereditary Motor and Sensorial Neuropathy, Limb Girdle Muscular Dystrophy, Fascioscapulohumeral Muscular Dystrophy, , Congenital Muscular Dystrophy, since 2001. In addition, the unit has the feature to be the first in Turkey to conduct of clinical trials in this area. The unit accepts patients across the country and also works in cooperation with physiotherapists, other health professionals, relevant public institutions, ministries, hospitals and non-governmental organizations, and municipalities on the physiotherapy and rehabilitation of neuromuscular diseases. It is also a member of the international research network in the rare neuromuscular diseases group. The unit also provides Professional practice education as an elective course to physiotherapy students during the education and training period. The Pediatric Neuromuscular Diseases Unit is currently conducting both clinical and academic studies at national and international level with 3 faculty members who are the founders of the Neuromuscular Diseases Research Association, specialized in the neuromuscular field, and who have the title as international clinical evaluators, and 3 research assistants, all of whom are continuing their doctorate education. Since 2017, it organizes national or international Congress of Neuromuscular Diseases each year.
Prosthetics and Biomechanics Unit
The Prosthesis and Biomechanics Unit was established in 1967. In the unit, prosthetic production and rehabilitation services are provided to patients who have congenital or subsequent limb loss for any reason. It is aimed to reach the highest level of independence in daily life and return to social roles with prosthetic applications performed following technological developments and rehabilitation. Prosthetic rehabilitation with multidisciplinary approach are given to patients in 5 stages. The necessary evaluation and treatment approaches are applied to the upper and lower extremity amputees with preoperative, postoperative, pre-prosthetic, prosthetic training and follow up prosthetic physiotherapy and rehabilitation. In the unit, suitable prosthesis for amputees in all age groups, including children, adults and geriatrics, are planned and necessary rehabilitation services are provided according to the age. In the Prosthetics and Biomechanics Unit, students, prosthetic technicians and physiotherapists are trained in the field of prosthetic rehabilitation as associate degree, undergraduate and graduate, and scientific studies and projects are produced. In addition to prosthetic applications; physiotherapy and rehabilitation and technology related consulting service is also provided for related institutions and organizations. In order to ensure the full participation of amputees in social life, necessary job modifications, recreational activities and reccomendation for sports are the aims of the unit. Design and rehabilitation of appropriate sports prosthesis is applied especially for amputees interested in sports.
Rheumatologic Rehabilitation Unit
The Rheumatologic Rehabilitation Unit began clinical practice in the Hacettepe University Rheumatology Department as outpatient clinic in 2004, and Pediatric Rheumatology Department followed it in 2005. Since 2008, the biopsychosocial model which emphasize the importance of the relationship between pain and emotion has been adopted in this unit’s clinical practice. Our unit has been using core stabilization exercises since 2004. The innovation of the biopsychosocial model was completed with the addition of dance therapy-authentic movement and pain management information to core stabilization exercises in 2009-2010 and the method was named as “Cognitive Exercise Therapy Approach (BETY)”. This method includes dance therapy-authentic movement, core stabilization exercises, pain management, physical awareness, affirmation sentences during exercise and sexual information management. This approach, which became a book under the name of “Cognitive Exercise Therapy Approach (BETY) in Rheumatic Diseases” in 2014, was registered as a trademark by Turkish Patent Institute in 2015. Since 2016, it has taken part in the literature and has been given as a doctoral course. With this approach, rheumatologic rehabilitation unit serves adult and pediatric rheumatology patients and conducts academic studies. In addition to individual patient training, rheumatic patients are supported with group exercise sessions 3 days a week in a regular basis for years. With this aspect, it sets an important example in our country and in the world.
In our unit, rehabilitation services are provided to patients with rheumatologic diseases (Rheumatoid Arthritis, Ankylosing Spondylitis, Fibromyalgia, Osteoarthritis, Gout, Systemic Lupus Erythematosus, Scleroderma, Osteoporosis, Vasculitis, Juvenile Idiopathic Arthritis, Myositis etc.) and some diseases affecting musculoskeletal system such as scoliosis and posture disorders.
Our most important goals are to teach strategies for coping with disease and pain, to maintain regular exercise habits and to ensure that people take individual responsibility in treatment in the frame of biopsychosocial approach. Our unit guides the patient in life with the disease and helps the patient to take an active role in the management of the disease by developing a sense of trust in the multidisciplinary health care team.
Sports Physiotherapy Unit
Sports Physiotherapy Unit is a unit where professional athletes and individuals that are recreationally interested in sports are assessed, sport-specific exercise programs are provided, post-injury rehabilitation program and safe return to sports are facilitated. In addition, individualized studies are carried out in order to create exercise awareness in healthy individuals and/or any patients.
Swallowing Disorders Unit
Swallowing Disorders Unit was established by A. Ayşe Karaduman and Numan Demir in 2000 at the Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation. Patients with swallowing disorders have been referred to the Swallowing Disorders Unit from the departments of otorhinolaryngology, gastroenterology, neurology, surgery, chest diseases and geriatrics, and also from the related units of faculties of health sciences and dentistry within our university hospital and also other external centers since its establishment, The physiotherapy and rehabilitation of swallowing disorders and oromotor dysfunctions due to neurological diseases, structural disorders, cancer, trauma, psychosomatic disorders are performed in both pediatric and adult patients in the Swallowing Disorders Unit. As a result of multidisciplinary study, the Hacettepe University Swallowing Disorders Research and Application Center (YUBAM) was established on 29 November 2012 under the Rectorate of Hacettepe University. The implementation unit activities of YUBAM are continuing at Hacettepe University İhsan Doğramacı Children's Hospital with the support of our unit. In addition to patient services, studies on swallowing disorders, projects, training seminars, workshops and congresses are regularly organized. Our unit has international project cooperation with European Society for Swallowing Disorder. Numerous scientific papers, scientific articles and book chapters on swallowing and chewing disorders have also been published. The unit continues its activities with six lecturers.
Women’s And Men’s Health Physiotherapy and Rehabilitation Unit
“Women’s and Men’s Health Physiotherapy and Rehabilitation Unit” has been serving at Hacettepe University, Faculty of Physical Therapy and Rehabilitation since 1992 with a wide range of subjects similar to the world examples. In our unit, undergraduate, graduate and doctoral education and preventive and therapeutic services are provided in the field of Physiotherapy and Rehabilitation in Women and Men's Health.
In the field of Obstetric Physiotherapy and Rehabilitation, physical activity and exercise during pregnancy, childbirth education and problems during pregnancy are considered.
In the field of Urological Physiotherapy and Rehabilitation, urinary incontinence, neurogenic bladder and urological surgeries are considered.
In the field of Gynecological Physiotherapy and Rehabilitation, menstrual disorders, pelvic organ prolapse, menopause and gynecological surgeries are considered.
In the field of Physiotherapy and Rehabilitation for Vascular Problems, chronic venous insufficiency and lymphedema are considered.
In the field of Physiotherapy and Rehabilitation for Gastrointestinal Problems, ırritable bowel syndrome, constipation and fecal incontinence and gastrointestinal surgeries are considered.
In the field of Physiotherapy and Rehabilitation for Sexual Dysfunctions, disparonia, orgasm, erection and ejaculation disorders are considered.
Inn addition to these main areas, other special issues discussed in our unit; problems affecting connective tissue and autonomic nervous system, fibromyalgia, headache, insomnia, Reynaud phenomenon, infertility and aesthetic problems.
In our unit, massage (classical massage, connective tissue massage, manual lymph drainage), mobilization, exercise, electrotherapy and kinesiotape applications are also performed.