Established care
Technology-assisted rehabilitation
Robotic gait training, body-weight supported treadmill, FES, virtual reality
Useful mainly as a way of delivering more practice, not as a treatment in its own right — and that distinction decides whether it is worth the money.
Randomised or controlled trials in children are under way or completed, but the result is not yet settled enough for routine care. Taking part in a registered trial is reasonable; paying for it as an established treatment is not.
Where it stands, condition by condition
The same therapy can be well supported for one problem and completely untested for another. This is the single most common place families are misled.
| Condition | Evidence | What that means here |
|---|---|---|
| Robotic gait training / treadmill with body-weight support | In clinical trials | Can deliver high repetition. Evidence of advantage over equally intensive conventional training is not established. |
| Functional electrical stimulation | In clinical trials | Used for foot drop and to assist grasp; benefit reported, best evidence when combined with active practice. |
| Virtual reality and active video games | In clinical trials | Improves engagement and can increase practice volume. Effects on function are modest. |
| Exoskeletons for home use | Early research only | Marketed ahead of the evidence in children. |
What it is
A group of devices that assist, resist or motivate movement: treadmills with partial body-weight support, robotic gait trainers, electrical stimulation of weak muscles, and game-based systems.
They are often presented to families as a different kind of treatment. They are better understood as delivery mechanisms for practice — the same active principle, packaged.
How it is meant to work
Each device solves a practical limit: a treadmill lets a child take hundreds of steps they could not take unsupported; a game holds attention long enough for repetitions to accumulate; stimulation makes a movement possible so it can be practised.
The risk sits in the same place. If the device does the movement for the child, the active practice that drives change may be removed rather than enabled.
What has actually been tested
- Studies consistently show these systems can deliver high repetition counts safely, and children usually enjoy them.
- What is far less clear is whether they beat the same amount of well-delivered conventional therapy. Most trials that control for intensity find the advantage shrinks or disappears.
- That is not an argument against them — a child who will do 500 steps in a game and 80 in a corridor is better off in the game. It is an argument against paying a premium for the technology itself.
What we still do not know
- Which children benefit most, and at what stage.
- Whether gains persist after access to the device ends.
- Cost-effectiveness against simply funding more therapist time.
Risks and costs
- Skin pressure, discomfort and fatigue with harnesses and robotic frames.
- Passive dependence if assistance is not reduced as the child improves.
- Financial: these are the treatments most often sold as expensive intensive packages abroad.
Questions to ask before you agree
A centre that is doing good work will welcome these questions and answer them in writing.
- How many active repetitions will my child actually perform, and how is assistance reduced over time?
- Would the same hours of conventional therapy cost less and achieve the same?
- What happens when the block ends?
More in this section
Early detection and early intervention
The single highest-value thing in this whole field, and the one least often discussed in clinics selling treatment. Cerebral palsy can be identified in the first months of life, and that is when therapy does the most.
Established careGoal-directed, task-specific training
Not a brand of therapy but the principle underneath the ones that work: the child practises the actual task they are trying to learn, with enough repetition to matter.
Established careConstraint-induced therapy and bimanual training
For a child who uses one hand much more than the other, these are among the best-evidenced interventions in paediatric neurology — and both work, for different things.
Established carePhysiotherapy and strength training
Well supported when it is built around function and genuinely loaded — much weaker when it is passive stretching and generic exercise.
Established careOccupational therapy
The discipline that works on what the child actually does all day — dressing, eating, writing, playing, getting through a school morning.
Established careSpeech, language and communication
For a child who cannot speak clearly, giving them a way to communicate is among the most consequential interventions available — and the fear that it will stop them talking is unfounded.
Established careSpasticity and tone management
Medical and surgical treatment of tone, which works best when it is tied to a functional goal rather than to a number on a tone scale.
In clinical trialsNamed physiotherapy approaches
Families are usually asked to choose between brands. The evidence says the brand matters far less than whether the session is active, goal-directed and repeated often enough.
In clinical trialsSensory therapies
Two things are sold under one word. Manualised Ayres Sensory Integration has been tested in trials; the sensory add-ons sold around it mostly have not.
Established careVision and cerebral visual impairment
The most commonly missed problem in children with brain injury. A child who cannot interpret what they see is often described as inattentive, uncooperative or more delayed than they are.