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Journal of Medical and Biological Engineering
https://doi.org/10.1007/s40846-023-00835-7
ORIGINAL ARTICLE
Practically Feasible Sensor‑Embedded Kinetic Assessment Piano
System forQuantifying Striking Force ofDigits During Piano Playing
Kuan‑YinLai1· Chieh‑HsiangHsu1,2· Yu‑ChenLin3· Chung‑HungTsai4,5· Cheng‑FengLin6· Li‑ChiehKuo1,2,5,7·
Fong‑ChinSu1,7
Received: 21 August 2023 / Accepted: 18 October 2023
© The Author(s) 2023
Abstract
Purpose Understanding the pathogenesis of playing-related hand disorders through investigations based on coordination
and biomechanical perspectives is indispensable. This study aimed to establish a sensor-embedded kinetic assessment piano
system (SeKAPS) and conduct reliability and validity tests for this system. In addition, the differences in digit coordination
between professional pianists and non-musicians were investigated.
Methods Twelve subminiature load cells were embedded in the middle of the 12 corresponding keys of an upright piano. A
customized calibrated system with a load cell was used to establish the criterion-related validity of the SeKAPS. The reli-
ability of the SeKAPS was determined by 22 volunteer pianists. The other ten professional pianists and ten non-musicians
were recruited to indicate the feasibility of the SeKAPS to distinguish the performing differences between groups.
Results The R2 values of regression analyses for the load cells were 0.993–0.999 (p < 0.001), indicating high validity. The
ICC values of the modified keys were 0.82–0.93, indicating high reliability. The results indicate that SeKAPS is accurate in
detecting the striking force of digits during piano playing. Significant differences existed in the mean peak force and mean
CVs of the peak force of the specific digits between the two groups. The results showed differences in finger control strate-
gies between the pianists and non-musicians.
Conclusion The SeKAPS may provide a valuable assessment for assisting pianists in understanding digit force control and
movement strategies to achieve efficient digit coordination.
Keywords Pianists· Digit coordination· Kinetic measurement· Sensors· Piano
1 Introduction
Playing piano requires highly skilled and coordinated hand
movements. However, pianists often suffer from playing-
related musculoskeletal disorders [1–11] because of rapid
and repetitive movements of the wrist and hand for an
extended period. These movements lead to symptoms such
as pain, weakness, and numbness of the hand, particularly
the thumb, ring, and little fingers [3, 12–19]. Studies on the
biomechanical performance of pianists have been empha-
sized since the late 1920s. The literature on kinematic stud-
ies of pianists is still insufficient, and there is a lack of strong
evidence and rationale to address the importance of the rela-
tionship between kinematics and piano-playing-related inju-
ries. Only a few studies have investigated hand postures and
finger movements of pianists while playing assigned musi-
cal compositions using electrogoniometers, camcorders,
or three-dimensional motion capture systems [20–27]. Lee
* Li-Chieh Kuo
jkkuo@mail.ncku.edu.tw
* Fong-Chin Su
fcsu@mail.ncku.edu.tw
1 Department ofBiomedical Engineering, College
ofEngineering, National Cheng Kung University,
Tainan701, Taiwan
2 Department ofOccupational Therapy, College ofMedicine,
National Cheng Kung University, Tainan701, Taiwan
3 Department ofOccupational Therapy, Da-Yeh University,
Changhua, Taiwan
4 Department ofFamily Medicine, An-Nan Hospital, China
Medical University, Tainan, Taiwan
5 Institute ofAllied Health Sciences, College ofMedicine,
National Cheng Kung University, Tainan, Taiwan
6 Department ofPhysical Therapy, College ofMedicine,
National Cheng Kung University, Tainan, Taiwan
7 Medical Device Innovation Center, National Cheng Kung
University, Tainan, Taiwan
K.-Y. Lai etal.
1 3
examined the relationships between anthropometry and kin-
ematics, such as the hand length, hand width, finger length,
active finger span, wrist ulnar deviation, and hand weight,
with the performance of a scale in thirds [28]. However,
these studies focused on investigating the performance of a
single joint or segment without a comprehensive or system-
atic analysis of hand performance during piano playing [29].
Moreover, it is worth investigating the effect of the reac-
tion forces on the movements of the thumb or fingers during
striking computer keyboards and piano keys because many
hand injuries result from unbalanced contact forces between
the digits and objects in awkward postures. Early tools that
were typically used to inspect the force exerted by the hand
included dynamometers and strain-gauge-instrumented
transducers. Electromyography was introduced in modern
experimental studies [30, 31] to detect muscular contraction
forces of the limbs during playing movements [20, 32–35].
Several studies have investigated fingertip force or pressure
on piano keys using piezoelectric force transducers, pres-
sure sensors, and strain-gauge-type miniature force trans-
ducers [36–41]. However, these studies measured the force
exerted on the sensor on one key or the sensor be applied
in the key-bed. These methods have limited ability in pre-
cisely estimating the actual finger striking force exerted on
piano keys while playing the piano. Without this informa-
tion, the relationships between the striking force, movement
mechanism, and disease pathogenesis might be difficult to
determine objectively. Thus, it is essential to develop appro-
priate quantitative methods for directly measuring the strik-
ing force from the digits to clarify the mechanism of play-
ing performance and analyze the relationship between digit
coordination and playing-related injuries. In addition, piano
playing is a bimanual finger movement affected by tempo;
therefore, it is necessary to investigate the digit coordination
and control mechanisms of both hands under various tempi.
Investigations based on kinetic measures are critical
for examining the mechanism of playing performance and
revealing the relationship between digit coordination and
playing-related injuries to thoroughly understand the digit
coordination of fundamental movements during piano play-
ing. To the best of our knowledge, suitable apparatuses
for measuring the finger-striking forces during piano per-
formances are limited. Therefore, this study attempted to
investigate the complexity of digit coordination based on an
elaborately designed device by embedding force transducers
in regular upright piano keys. A novel force-detection sys-
tem for piano keys that could record the striking force imme-
diately while preserving most of the original piano features
was established. Psychometric properties of the system, such
as validity and reliability tests, were conducted to measure
the applicability of this novel system. In addition, the vari-
ability of the acquired kinetic information was determined.
Furthermore, this study aimed to investigate the differences
in digit coordination and kinetic performance between pro-
fessional pianists and non-musicians while performing basic
piano fingerings using this force detection system.
2 Methods
2.1 Development ofSensor‑Embedded Kinetic
Assessment Piano System (SeKAPS)
2.1.1 Hardware andSoftware Establishment ofSeKAPS
For the standard piano fingering, twelve subminiature load
cells (SLB-25, 6.35 mm height, 9.53 mm diameter, Trans-
ducer Techniques, CA, USA) were embedded in the middle
of the 12 corresponding keys of an upright piano (Fig.1).
Each load cell was held between two linear bearings to
ensure stability (Fig.1C). Twelve white keys (C2, C3-G3,
C4-G4, and C5) were modified (Fig.1E). The white key
without a keytop was refitted from being embedded in the
load cell. The key step was milling to embed the load cell,
wires, and linear bearings. An aluminum pad was designed
to transduce the strike force to the load cell. The sticks and
bearings were used to ensure the vertical movement of the
aluminum pad. To maintain the original physical features
of these modified keys, a trimmed front white keytop was
attached to the aluminum pad, and the weight was added
with lead at the end of the white key.
Analog force data were obtained from a customized
amplifier connected to a NIDAQ device (PCI-6723, National
Instruments Corp., USA). The sampling rate was 1000 Hz.
The load cells embedded in the keys were calibrated with
standard weights using regression analysis. Weight calibra-
tion was performed using standard weights of 50, 100, 200,
300, 600, 800, 1100, 1300, and 1600 g. Each sample was
weighed three times with each standard weight.
2.1.2 Validity ofSeKAPS
A customized calibrated system with a load cell (MDB-50,
Transducer Techniques, CA, USA) was fixed to a pneumatic
linear actuator with a height-adjustable frame to establish
the criterion-related validity of the load cells embedded in
the modified piano keys. During calibration with a load cell,
the fixture with the MDB-50 load cell rapidly moved down-
ward to exert a downward force on each load cell of SLB-25
embedded in the piano keys (Fig.2) to simulate key striking
during piano playing. The force outputs from the load cell
of SLB-25 and the calibrated reference with a load cell were
collected simultaneously. The force data from the SLB-25
load cell were obtained using a calibrated reference with a
load cell.
Practically Feasible Sensor-Embedded Kinetic Assessment Piano System for Quantifying Striking Force of Digits During Piano Playing
1 3
2.1.3 Reliability ofSeKAPS
The reliability of the 12 modified keys were determined by
22 healthy young volunteers (3 males, 19 females, mean
age ± SD: 26.59 ± 3.55 years) with an average of 6.23 ± 3.24
years of piano-learning experience. All the participants were
right-handed and had no history of a hand injury, surgery,
or neurological deficits. All the participants were informed
about the purpose of the study, and a signed, informed con-
sent form approved by the Institutional Review Board of
the National Cheng Kung University Hospital was obtained
from each participant prior to the experiment.
Before the measurements, each participant sat upright on
an adjustable piano bench in front of the modified piano
keys. Each participant was requested to demonstrate the fol-
lowing types of basic piano skills: (1) scale, a set of musical
notes ordered by an ascending pitch and a descending pitch;
(2) octave, eight intervals between two music pitches (C4
and C5) for five cycles (Fig.3). Each piano skill was per-
formed using the right hand, followed by the left hand. Each
skill performance was repeated three times in an interval of
5 s with a rest period of approximately 30 s. All the partici-
pants were evaluated on three testing days, with a one-week
interval between the testing days. The striking forces on the
Fig. 1 A The sideview of
SeKAPS. B The structure of the
modified key. C The exploded
view of force detecting part that
containing load cell, linear bear-
ings and aluminum pad. D The
sideview of the force detect-
ing part. E Each load cell was
embedded in 12 white keys (C2,
C3-G3, C4-G4, and C5)
K.-Y. Lai etal.
1 3
modified keys were recorded during piano playing to exam-
ine the reproducibility of the 12 modified piano keys.
2.1.4 Variability ofSeKAPS
Variability is used to estimate measurement error or stability.
Variability is quantified as the coefficient of variance (CV),
defined as the ratio of the standard deviation to the mean,
and expressed as a percentage. A low CV indicates consist-
ent responses from the measurements.
2.2 Human InVivo Experiments forSeKAPS
Ten professional pianists and ten non-musicians were
recruited for this study. The following inclusion criteria for
professional pianists were applied: (a) students majoring
in piano at the College of Music, (b) self-employed piano
teachers with a college degree in music, (c) participants with
more than 10 years of piano-playing experience, and (d) par-
ticipants with no neurological deficit, hand musculoskeletal
diseases, nor history of hand surgery. The exclusion criteria
for the non-musicians included participants with experience
in playing any musical instrument and non-musicians with
neurological deficit, hand musculoskeletal diseases, or his-
tory of hand surgery.
The participants were instructed to sit on a chair facing
the modified piano. Prior to the testing session, each partici-
pant was assigned to perform two piano skills: the octave
(fingering 1r5r-1r5r-1r5r-1r5r-1r5r; 1l5l-1l5l-1l5l-1l5l-1l5l)
and chord (fingering 1r3r5r-1r3r5r-1r3r5r-1r3r5r-1r3r5r;
1l3l5l-1l3l5l-1l3l5l-1l3l5l-1l3l5l) (Fig.4).
Each skill was performed first with the right hand and
then with the left hand. The participants practiced for
approximately 15 min. This study employed a metronome
to cue the tempo during each trial. The skills were performed
at T140 (140 beats/min) on a quarter note. The participants
were instructed to play synchronously with the beat of the
metronome. In addition, the target loudness of the tone was
set to approximately 95 dB using a sound level meter to con-
trol the force applied uniformly by all participants. All skills
were exhibited with a Legato touch. The striking forces of
the digits acting on each modified key were continuously
recorded for each skill. For the between-group analysis, the
obtained peak force was calculated as the mean value and
CV within one trial.
2.3 Statistical Analysis
Statistical analyses were conducted using SPSS 17.0 soft-
ware (SPSS Inc., Chicago, Illinois, USA). Descriptive
statistics were used to calculate the mean and standard
deviation (SD) values of demographic data. Regression
analysis was used for the validity test. The intraclass
Fig. 2 Customized calibrated system with load cell of MDB-50
Fig. 3 Two basic skills used
in reliability test: A chord, B
octave
Practically Feasible Sensor-Embedded Kinetic Assessment Piano System for Quantifying Striking Force of Digits During Piano Playing
1 3
correlation coefficient (ICC) was used to test the reli-
ability of the striking force. The ICC was calculated using
variance estimates obtained via the analysis of variance
from all trials during the three visits. Variability can be
used to estimate measurement errors. Variability was
quantified as the CV, defined as the ratio of the stand-
ard deviation to the mean, and expressed as a percent-
age. A lower CV indicated consistent responses from the
measurements. Therefore, CV can be used to assess the
response stability across repeated trials for each modi-
fied key. The Mann–Whitney U-test was used to assess
between-group differences. The level of statistical signifi-
cance was set at p < 0.05.
3 Results
3.1 Validity, Reliability, andVariability ofSeKAPS
The R2 values of the regression analyses for the 12 load
cells were 0.993–0.999 (p < 0.001), indicating high valid-
ity of the SeKAPS. The ICC values of the 12 modified
keys were 0.82–0.93 (Table1), indicating the high reli-
ability of the SeKAPS.
For the variability test, the mean CV of all participants
among the three trials ranged from 13 to 24% while play-
ing the scale, and from 5 to 24% while playing the octave.
The results showed that the repeated measurement varia-
tions were within the satisfactory range. In other words,
the stability of the responses measured from the 12 modi-
fied keys was acceptable.
3.2 Human InVivo Experiments forSeKAPS
Twenty right-handed female participants were recruited
for this study. The mean age of the professional pianist
group was 20.3 ± 1.6 years, with an average piano-learning
experience of 13.7 ± 2.2 years. The mean age of the non-
musician group was 22.4 ± 2.3 years.
Fig. 4 Name of fingering on
bilateral hands
Table 1 ICC value and 95% C.I. of each modified key while playing
scale and octave on one-week-interval repeated measures
C3, D3, E3, F3, G3, C4, D4, E4, F4, and G4 are the scale keys
C2, C3, C4, and C5 are the octave keys
ICC intraclass correlation coefficient
C.I. confidence interval
Modified keys Basic piano skills
Scale Octave
ICC 95% C.I. ICC 95% C.I.
C2 0.904 0.805–0.957
C3 0.864 0.724–0.939 0.903 0.803–0.957
D3 0.929 0.856–0.939
E3 0.912 0.820–0.961
F3 0.902 0.801–0.956
G3 0.862 0.720–0.939
C4 0.819 0.632–0.919 0.931 0.860–0.969
D4 0.876 0.749–0.945
E4 0.880 0.756–0.946
F4 0.908 0.814–0.959
G4 0.869 0.734–0.941
C5 0.915 0.828–0.962
K.-Y. Lai etal.
1 3
Significant differences in the mean peak force of the right
and left little fingers between the non-musician and pro-
fessional pianist groups were observed while playing the
chords. There was a significant difference in the mean CV of
the peak force of the right and left middle and little fingers
between the two groups. In addition, the results showed a
significant difference in the mean CVs of the peak force
of the left thumb and little finger between the two groups
(Table2).
4 Discussion
Pianists perform repetitive multifinger force production
movements while playing the piano. Pianists typically use
their both hands to play complex melodies and perform
faster repetitive finger movements and more forceful striking
of keys while playing piano. A pianist aims to achieve good
control of each digit on the key with appropriate striking
force and fewer playing mistakes. Therefore, finger coor-
dination plays a critical role in playing the piano. Thus, an
adequate apparatus is required to objectively and precisely
measure the forces acting on piano keys. The SeKAPS was
designed and established to measure the striking force of a
pianist’s digits when playing the piano.
It is crucial to determine the reliability of a newly
designed apparatus and validate the data acquisition accu-
racy. The force generated by a fixture with a calibrated refer-
ence load cell was used to verify the validity of SeKAPS.
The results showed high R2 values (> 0.99), indicating that
the 12 load cells embedded in the modified piano keys of the
upright piano accurately recorded the actual striking force.
Thus, the striking forces of the digits applied to the load cells
embedded in the modified keys were recorded precisely. For
the reliability test, the ICC results showed good repeatabil-
ity of measurements on the one-week-interval testing days.
The mean CV values for all the participants in the three
trials were stable, with slight variability in the measured
responses. This indicates consistency in the striking force
for repeated SeKAPS trials during piano playing.
The SeKAPS investigated the digit force of 10 profes-
sional pianists and 10 non-musicians while playing chords
and octaves to detect the actual finger force during piano
playing.
The results of the invivo test showed that the little finger
striking force of professional pianists exceeded that of the
non-musicians. Because the little finger plays a supportive
role in grasping and manipulating movements, the little-
finger striking force of the non-musicians was weak.
However, professional pianists may enhance the force
and coordination of their little fingers through finger exer-
cises while playing the piano. Therefore, the difference in
the mean peak force of the little finger between the two
groups indicates superior finger motor control in profes-
sional pianists.
In addition, the discrepancy in the finger-stroke charac-
teristics during piano playing between professional pianists
and non-musicians was examined using the CV value. The
CV results showed that the finger-stroke stability of the pro-
fessional pianist group during piano playing was better than
that of the non-musician group, particularly the middle fin-
ger and little finger of the bilateral hands during chord play
and the thumb and little finger during octave play. During
piano training, professional pianists may perform different
dynamics written on musical sheets, such as pianissimo (pp)
or fortissimo (ff). pp indicates that the pianists should play
Table 2 Results of Mann–
Whitney U-test between pianists
and non-musicians while
playing chord and octave
Unit: Newton
C.V. coefficient of variance, NS nonmusicians, PS professional pianists, R right, L left
Significance: *p < 0.05 (two-tailed), **p < 0.01 (two-tailed)
Peak mean Peak C.V.
NS (n = 10) PS (n = 10) p-value NS (n = 10) PS (n = 10) p-value
Chord
R_thumb 3.68 ± 1.66 4.02 ± 1.35 0.43 0.13 ± 0.03 0.09 ± 0.04 0.09
R_middle finger 4.34 ± 1.51 4.70 ± 2.08 0.57 0.12 ± 0.05 0.07 ± 0.04 0.02*
R_little finger 2.79 ± 0.89 4.19 ± 1.46 0.01*0.21 ± 0.10 0.08 ± 0.03 0.00**
L_thumb 3.49 ± 1.15 4.24 ± 1.50 0.19 0.11 ± 0.08 0.09 ± 0.03 0.21
L_middle finger 5.82 ± 2.03 5.15 ± 1.45 0.68 0.15 ± 0.07 0.10 ± 0.04 0.01*
L_little finger 2.60 ± 1.14 3.71 ± 1.04 0.01*0.21 ± 0.13 0.10 ± 0.04 0.03*
Octave
R_thumb 4.47 ± 1.11 5.49 ± 2.15 0.47 0.13 ± 0.04 0.09 ± 0.05 0.14
R_little finger 4.16 ± 1.44 5.08 ± 1.61 0.16 0.09 ± 0.05 0.07 ± 0.04 0.14
L_thumb 5.19 ± 1.62 6.67 ± 2.65 0.27 0.11 ± 0.06 0.09 ± 0.04 0.05*
L_little finger 5.28 ± 1.57 5.89 ± 1.54 0.73 0.11 ± 0.05 0.06 ± 0.02 0.02*
Practically Feasible Sensor-Embedded Kinetic Assessment Piano System for Quantifying Striking Force of Digits During Piano Playing
1 3
very quietly, whereas ff time indicates that they should play
very loudly. Therefore, professional pianists usually have
better force control of each finger during piano playing than
non-musicians. Through SeKAPS measurements, this study
highlighted the differences in finger motor control between
professional pianists and non-musicians.
Fernandes and Barros investigated finger coordination
based on a gross-grip task using a kinematic analysis and
observed that pianists exhibited better motor control than
non-musicians [42]. Oku and Furuya examined the dif-
ference in key force between classical pianists and musi-
cally untrained individuals using a strain-gauge miniature
uniaxial-force transducer at the distal end of one key. The
results showed that pianists had better finger-stroke stabil-
ity than non-musicians at slow tempi. However, their study
only measured a single finger force once [39]. In our study,
the SeKAPS with 12 load cells could measure the finger
force of 12 keys simultaneously while demonstrating differ-
ent piano skills. Therefore, compared with previous studies,
the SeKAPS in this study is a comprehensive representation
of the actual force of each finger during piano playing. It also
demonstrates the performance of motor control for different
piano skills.
The literature reveals that piano-related hand injuries
include tendonitis, de Quervain’s disease, 2nd–5th flexor
tenosynovitis, as well as various peripheral nerve entrap-
ment syndromes such as carpal tunnel syndrome and ulnar
neuropathy [25]. In order to obtain a comprehensive under-
standing of the injury mechanism and disease pathogenesis,
it is imperative to investigate the impact of finger reaction
forces while striking the piano keys. The clinical importance
of this study is to build an evaluation tool, SeKAPS, which
can demonstrate the force control of each digit of pianists.
Furthermore, pianists can adjust the digit movement strate-
gies via SeKAPS to prevent playing-related hand injuries.
The limitation of the SeKAPS design is that the load
cells embedded in the key only measure the finger-striking
force in the normal direction without considering playing-
related shear forces. In addition, SeKAPS has a non-portable
design; therefore, it may not be used at all times and places
without modifying the piano. Moreover, only 10 professional
pianists and 10 non-musicians were examined in the invivo
test of this study. The limited number of participants might
have been insufficient to comprehensively represent the fea-
tures of these two populations. More participants should be
included in future studies. Furthermore, only female par-
ticipants were recruited in the part of human invivo experi-
ments for SeKAPS in this study, resulting in a lack of data
on the playing performance of male participants. In future
studies, the number of modified keys with load cells should
be increased to obtain more concrete evidence related to fin-
ger control while playing piano pieces. Furthermore, future
studies should adopt time-related variables of key striking.
Previous research did not empirically describe the com-
plex mechanics of piano playing; thus, it failed to represent
the finger stroke characteristics among all digits during piano
playing, including the actual striking force of each digit. In
this study, the customized SeKAPS system embedded with
12 load cells enabled the accurate measurement of the finger-
striking force during piano playing. This system can also rep-
resent the finger coordination when exhibiting different piano
skills. SeKAPS data directly provide motor control strate-
gies, enhancing the effectiveness of piano training protocols
for pianists. Moreover, it can serve as an evaluation tool for
clinicians and therapists in understanding the mechanics of
playing-related musculoskeletal injuries in pianists.
Acknowledgements This study was funded by the National Sci-
ence and Technology Council (NSTC) of TAIWAN (Grant No.
98-2320-B-006-003-MY3). This work was also partially supported
by the Medical Device Innovation Center, National Cheng Kung Uni-
versity, from the Featured Areas Research Center Program within the
framework of the Higher Education Sprout Project of the Ministry of
Education (MOE) in Taiwan. The authors would also like to thank
Mr. Cheng-Chun Chen for his kind assistance with several technical
aspects of this study.
Author Contributions KYL, LCK, and FCS were the principal con-
tributors to the study design, data collection, and assessment. KYL,
YCL, CHH, CFL, LCK, and FCS performed technical problem-solving
in the experiments. KYL, CFL, and CHT participated in the registration
and clinical examinations of the participants. KYL, YCL, CHH, LCK,
and FCS participated in the data analysis and interpretation. KYL,
YCL, CHH, and LCK drafted the manuscript. All the authors read and
approved the content and format of the final manuscript.
Funding We certify that no party with a direct interest in the results
of this study has or will confer a benefit on us or any organization with
which we are associated. We also certify that all financial and material
support for this research (for example, governmental grants) and work
are clearly identified on the title page of the manuscript.
Data Availability IRB No. B-ER-104-160 - approved by the Institu-
tional Review Board of the National Cheng Kung University Hospi-
tal. The datasets analyzed during the current study are not publicly
available due to data protection requirements, but anonymous data or
files could be available from the corresponding author upon reason-
able request.
Declarations
Conflict ofinterest The authors declare no potential conflicts of in-
terest with respect to the research design, experiments, authorship, or
publication of this article.
Ethical Approval All procedures involving human participants in this
study were performed in accordance with the ethical standards of the
institutional and/or national research committee and with the 1964
Helsinki Declaration and its later amendments or comparable ethical
standards. The procedures and consent forms used in this study were
reviewed and approved by the Institutional Review Board of National
Cheng Kung University Hospital in Taiwan.
Informed Consent Informed consent was obtained from all the partici-
pants recruited in this study.
K.-Y. Lai etal.
1 3
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