Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper

<p>Abstract</p> <p>Background</p> <p>Use of Botulinum toxin-A (BoNT-A) for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A.</p> <p>Methods/Design</p> <p>A randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental) or bimanual occupational therapy group (control). Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale.</p> <p>Discussion</p> <p>The aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy) versus bimanual occupational therapy (a bimanual therapy) on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following upper limb injection of BoNT-A. The paper outlines the background to the study, the study hypotheses, outcome measures and trial methodology. It also provides a comprehensive description of the interventions provided.</p> <p>Trial Registration</p> <p>ACTRN12605000002684</p

Energy-saving control of trams with DC series motors allowing for light signalling

Novelty of this paper consists in simultaneous analysis of the traffic of some tram vehicles taking into consideration the criterion of the electric energy consumption minimum. Problems of traffic disturbances have been also included. First of all the influence of the light signalling at the crossing has been analysed to reduce the energy use caused by long stops forcing necessity of quicker subsequent ride to liquidate delay in relation to the time-table. Within the elaborated methodology, the tram route is divided into parts in keeping with different motion resistances for individual route fragments. Such simulation is more real and precise for tram ride conditions in the city. The paper deals with modernized trams driven by DC series motors supplied from modern choppers. For the stage of the vehicle running with the constant speed, the best choice of the value of the field-weakening coefficient can increase the motor efficiency

Energy-optimum control of tram driving system with direct current motors at disturbances of vehicle traffic

The paper deals with problems of elaboration of an algorithm of the tram vehicle traffic with the object of achieving the minimum energy consumption. Except some specific, idealized situations, the frequent, dynamical changes of the tram traffic conditions occur. In particular, it's typical for the ride in the city centre. The various, unforeseeable disturbances of the traffic can appear. In this paper, within the framework of the original methodics three types of tram ride with traffic perturbations have been described: disturbances at the beginning of the ride, unplanned speed limitations during the vehicle run, unexpected disturbances inside the segment between the neighbouring stops. It was shown that the best determination of duration of the starting, the running with the constant speed, the coasting and braking made possible achieving the minimum of the electric-energy consumption. In the paper, calculations of the vehicle run according to the criterion of the minimum energy use have been connected with the procedure of liquidation of the delay

Problems of power losses of traction direct current motors at calculations of energy saving traffic of tram vehicles

The suitable control of the tram vehicle at various disturbances of the city traffic can ensure the electric energy savings equal to even 30 %. The author of this work continues with elaboration of computer software making possible realization of the tram vehicle run according to the criterion of the minimum energy use. In literature, the problem of the energy saving ride was solved for the tram vehicle only at the assumption that the running of the tram is realized without the traffic disturbances, for the separated, straight and horizontal tracks. Computer software for these idealized run conditions couldn't applied in real routs and literature methods weren't introduced to the energy saving control of tram vehicles. Within the original methodics of the author, the following new phenomena are taken into consideration: an influence of traffic disturbances, changes of motion resistances, interaction of different vehicles. In the typical, dynamical ride of a tram, great changes of values of motor losses occur within resistance, iron and mechanical losses. This effect has been here analysed and taken into account for algorithm of an energy saving traffic of a tram

Software for computer system of coordinated organization of energy-saving traffic of tram vehicles

The paper deals with the coordinated organization of ride of some tram vehicles running through the same crossing with the traffic lights. For every tram and in accordance with the criterion of the minimum electrical energy use, the best time of the starting, time of the running with the constant speed, time of the coasting and braking have been calculated. Within the framework of examples relating to traffic of four tram vehicles there was shown the variant when it was possible to ensure the ride of every tram free from collisions (at green light). Additionally two other examples have been given when trams have stopped at the red light and were in expectation of the green light. In connection with the special city conditions consisting in dynamically changing ride parameters, different traffic disturbances can appear. By way of example, it can be unexpected speed limitation or change of the voltage value of the traction network. In the case of greater time lags of the traffic, the ride delay must be liquidated during the quicker run between some succeeding stops. Also in such case, the best control strategy can ensure the electrical energy savings.W artykule omówiono skoordynowaną organizację ruchu kilku pojazdów tramwajowych, które przejeżdżają przez to samo skrzyżowanie z sygnalizacją świetlną. Dla każdego z tramwajów obliczano takie czasy jazdy dla etapu rozruchu, czasy jazdy ze stałą prędkością, czasy trwania fazy wybiegu oraz etapu hamowania, dla których otrzymuje się minimalne zużycie pobieranej z sieci energii elektrycznej. W ramach przykładów dotyczących ruchu czterech tramwajów pokazano wariant, gdy dla każdego z tramwajów udało się zapewnić bezkolizyjny - przy zielonym świetle – przejazd przez to samo skrzyżowanie. Zamieszczono też takie dwa przykłady, gdy niektóre tramwaje musiały przy czerwonym świetle oczekiwać na skrzyżowaniu na możliwość dalszej jazdy. W ramach dynamicznej jazdy tramwaju w warunkach miejskich formułowanie algorytmów jazdy pojazdu przy minimalnym zużyciu energii komplikuje potrzeba uwzględniania różnych możliwych zakłóceń ruchu, np. występowanie nieplanowych ograniczeń prędkości, zmian wartości napięcia sieci trakcyjnej. Przy długich postojach w oczekiwaniu na zielone światło zlikwidowanie powstałego opóźnienia w ruchu może wymagać zaplanowania przyspieszonej jazdy na kilku kolejnych odcinkach

Modern system of control of tram vehicle at minimum electric energy consumption

The paper deals with the tram vehicle control according to the criterion of the minimum use of the electric energy. The calculations and investigations show that for the given interstop distance and the ride time (the given time-table, the same average speed), the different types of the tram traffic are possible. The optimization of the tram vehicle run consists in determination of duration of the starting phase, the running with the constant speed, the coasting stage and the braking phase in order to attain the minimum electric energy use. Within the framework of the tram traffic in the city conditions, various disturbances can appear. In this paper, the influence of the local and global limitations of the vehicle speed on the values of the energy consumption is analysed. The local velocity reductions can appear both in the initial part of the ride and inside the interstop traffic. An application of power electronics devices makes possible the realization of the recuperation of the electric energy during the tram vehicle braking. The paper deals also with comparison of the values of the energy consumption at various disturbances of the tram traffic and for two different cases, when the energy recovery during the braking exists or doesn't occur. For every type of the tram ride, the duration of the individual phases of the traffic is calculated with the aim of achievement the minimum electric energy use. The suitable energy optimum control of the tram vehicle at various perturbations of the city traffic can ensure the electric energy savings equal to even 30 %

Energy-saving control of tram driving motors taking into account light signalling disturbing smoothness of vehicle traffic

The paper deals with problems of the tram vehicle control in accordance with the criterion of the minimum electrical energy consumption. In this elaboration, the energy-saving control of the tram driving electric motors takes also into consideration the influence of cross-roads light signalling disturbing the smoothness of the vehicle traffic. In general, the light change during the tram running is here treated as the ride perturbation. Relations describing the tram traffic contain nonlinearities as a result of properties of motion resistances and owing to the magnetic circuit saturation in the motors. Determination of the run algorithm ensuring minimization of the electric energy consumption has been realized by application of the numerical method of differential equations solving and by using the optimization procedure. Calculation process takes many constraints into account, for example the adhesion effect connected with existence of a limiting force acting in the wheel circumference. Within perturbations caused by light signalling, computations of the tram energy-saving run were connected with the algorithm of the delay liquidation. In the case of greater time lags of the traffic, the ride delay must be liquidated during the run between some succeeding stops. Also here the best control strategy can ensure the electrical energy saving

Energy-saving coordination of traffic of some trams driven by induction motors

The paper deals with new software ensuring the ride of some interdependent tram vehicles in accordance with the criterion of the minimum energy consumption. All trams have been driven by vectorially controlled and field oriented three-phase induction motors supplied from the modern inverters. First of all, the influence of light signalling on the coordinated energy-saving traffic of trams has been taken into consideration. In one example there was shown the possible case for three trams ride free from the possibility of collisions. Here the energy savings were the biggest. Every time it is very difficult to ensure the green light for every tram vehicle at the same crossing. There were analysed two variants of disturbances caused by the light signalling: additional short and long tram stop. In the instance of large time lags of the traffic, the ride delay must be liquidated during the run between some succeeding stops

Choice of optimum condenser capacitance at single - phase operation of induction motor with three - phase stator winding

The paper deals with problems connected with the single-phase operation of an induction motor possessing a three-phase winding in the stator and an additional condenser. Simulation calculations have been realized and they have shown that the pulsating torques of great amplitudes have appeared during the single-phase work of the induction motor. The mechanical pulsations generate vibration and noise. The new conception of the choice of the optimum value of the condenser capacitance has been presented. The condenser ought to ensure both the great mechanical power of the motor and decrease of vibration and noise. Besides the mechanical power and amplitude of the pulsation torque, values of many other, important electrical parameters have been simultaneously analysed, for example: power losses in windings resistances, the constant component of the motor torque, the power factor, the efficiency, currents and voltages connected with the phase windings, the electric active and reactive power, the supply current flowing from the single-phase feeding network, the voltage and the current of the condenser