Can robotic technology assist children with cerebral palsy after botulinum toxin injection?

Robotic enhanced therapy program (starting 1-2 weeks after lower limb botulinum toxin administration). Participants will undertake individual, one hour Physiotherapy-led sessions twice a week for six weeks (twelve sessions total). One session per week on the Lokomat® Pro Robotic Gait Orthosis (50% of program) face-to-face at the Hospital, and one session per week of land based therapy (50% of program) either face-to-face at the Hospital or, if required, through Telehealth. Telehealth will be provided as an option if 1. it is clinically safe and appropriate, 2. the participant can otherwise not attend the session and 3. it is <50% of their program. The participants will be provided with an information sheet which details the nature of the intervention - the specific components and requirements - and consent form. The Lokomat® Pro is a robotic gait orthosis to support a participant on a treadmill. The robotic exoskeleton provides specific guidance of the hip, knee and ankle movements to facilitate a physiological walking pattern. The device is completely programmable and can assist with tactile, visual and auditory feedback for the participant and allow for many repetitions of a typical gait pattern. Games enhance motivation and a visual display allows participants to track their progress. The aim of the Lokomat is to hit targets that are known to be critical elements of functional improvement. A typical Lokomat® session includes set up (10 minutes), facilitated walking for 30-45 minutes, with standing rest breaks as required. A child’s program will be individualised based on their objective measures, goals and functional level. Lokomat® sessions could include activities that target symmetrical step length, increased step height, reduced body weight support (increased load), movement control or increased pace. A typical land based session includes 45-60 minutes of activity based rehabilitation and is standard practice at the unit. The land based session is individualised and based on a child’s objective measures, goals and functional status. A typical session may include activities such as strengthening (lower limb and core), balance activities, gait re-education and practicing improved movement patterns (in walking, running or sports activities). Sessions will be overseen by a Physiotherapist to ensure all treatment sessions are clinically appropriate. Session attendance will be logged, and session notes maintained, as per usual Physiotherapy practice. There will be no botulinum toxin administration during the 6 week treatment period in accordance with our research questions and aim.