GR IN: Evaluation of Group versus Individual Models of Physiotherapy for Children and Adolescents with Cerebral Palsy following Lower Limb Botulinum Toxin A injections.

For a given recruitment period, eligible subjects will be assessed at baseline 0-2 weeks prior to receiving lower limb Botulinum Toxin A (BoNTA) injections. All subjects will then receive lower limb BoNTA as per present QCPHS protocol. Muscles to be injected will be selected by the Clinic Rehabilitation Consultant and physiotherapist according to assessment findings and clinical indications. Muscles selected will accordingly vary between subjects but must be in the lower limb as stated in the inclusion criteria. In the ambulant population, common muscles injected include medial hamstrings, gastrocnemius, soleus and tibialis posterior. Dose is different for all children but is according to recommendations based on the consensus opinion of the 'We Move' Spasticity Study Group (2002). This is worked out on a dose/kilo/muscle ratio which calculates a total dose/kilo. The maximum dose allowed is 16 units/kilo or to a total adult dose of 400 units. 2-3 weeks post BoNTA injections, all subjects will commence their rehabilitation. Subjects will not be re-injected with BoNTA until completion of the rehabilitation and 6 month post BoNTA assessments (final assessment point and exit from study). The Children allocated to the group-based intervention will receive physiotherapy together in a small group (3 or more children) with a physiotherapist and assistant. The format will consist of: 5 minutes warm up (group activity); 10 minutes of lower limb stretching (as a group); 4x5 minute circuit stations (group, paired or individual) addressing 1. Functional Strengthening 2. Balance 3. Targeted Motor Control 4. Fitness/Agility; 5 minutes warm down (group activity). Dose will consist of 6 sessions of physiotherapy provided in 1 hour sessions over 6 weeks. A standardised, individualised (3 activities related to individual goals to be completed 3 times a week) Home Exercise Programme will also be given to each participant and progressed each week as appropriate.