Can robotic-assisted therapy help children with acquired brain injury?

INTERVENTION: Robotic assisted therapy intervention arm. Approx 1‐1.5 hour individual therapy sessions, 3x week over a 5 week period. Treatments alternate between conventional therapy and robotic therapy during this period (15 sessions in total ‐ 8 robotics and 7 conventional). During robotic therapy sessions two robotic devices, the Armeo and Lokomat will be used. Armeo is designed to improve arm function and Lokomat to improve walking. These sessions will be administered by a senior physiotherapist who is an expert with the robotic devices. There will be 30‐40 minutes of Lokomat and 20‐30 minuntes of Armeo per session. They will be conducted at the Little Heroes Foundation Centre for Robotics and Innovation located in the Women's and Children's Hospital in Adelaide, South Australia. Participants will receive guidance and encouragement from therapists and get visual biofeedback from the devices and play virtual reality games. Conventional sessions will consist of current standard‐practice manual exercises overseen by a clinical expert paediatric physiotherapist for improving gait, balance and functional abilities. They will be one on one sessions of 30‐45 minute duration. Exercises will be goal directed and chosen at the discretion of the treating physiotherapist from intervention areas including functional strengthening, isolated strengthening, gait training, cardio‐respiratory training, balance/core exercises and motor skill learning. Exercises will progress in difficultly to remain challenging for each client and reviewed at the end of each week. Participants will receive encouragement from therapists and general verbal performance feedback in order to engage participants as much as possible and to increase their active participation and motivation. There is a 6 week washout period between interventions. CONDITION: Acquired brain injury PRIMARY OUTCOME: Canadian Occupational Performance Measure (COPM) SECONDARY OUTCOME: 10 metre walk test 2 minute walk test Box and block test. Functional mobility scale Gross motor function classification system (GMFCS). Hip torque in Newton Metre assessed by Lokomat force sensors Knee torque in Newton Metre assessed by Lokomat force sensors Overall perception of exertion ‐ measured using Borgs Rating. Pediatric Quality of Life inventory. Questionnaire ‐ specifically written by study authors about perceived benefits and barriers of the treatment. Range of motion of lower limbs ‐ straight leg raise, Thomas test, dorsiflexion. Measured in supine with a goniometer. Resting blood pressure by oximeter. Resting heart rate by oximeter. INCLUSION CRITERIA: ‐ Limitations in gross motor functioning resulting from an acquired brain injury (ABI) ‐ Diagnosis of ABI in paediatric age and adolescence (4‐18 years) ‐ Had sustained the ABI 12 months prior to recruitment. ‐ Participant has both upper and lower limb functional goals ‐ Femur length greater than 21cm and upper arm greater than 16cm ‐ Able to fit to both arm and leg orthosis ‐ Able to comprehend and follow instructions for robotic therapy ‐ Ability to signal pain/fear/discomfort to therapist