Paediatric intensive rehabilitation

Intensive blocks of two to four weeks, repeated two or three times a year, concentrate practice into set periods, although in most controlled studies of young children, intensive and conventional therapy have produced similar improvements 2. The block establishes new ability; the home programme between blocks is what holds it.

This is why the parent trains alongside the child throughout, rather than waiting outside. What happens between blocks determines whether the block was worth it.

Three to four sessions daily, structured as play. Gross motor work matched to the child's current level rather than their age, hand function, robotic gait training scaled to a child's body, game-based virtual reality, hydrotherapy, and speech or occupational therapy where indicated.

Session length is set by attention rather than by protocol. A twenty-minute session a child engages with is worth more than a forty-minute session they resist.

Cerebral palsy, acquired brain injury, spinal cord injury, neuromuscular conditions, developmental motor delay, and brachial plexus injury. Age from around two years, though the specific technologies have their own size requirements.

Assessment before travel establishes which components are appropriate. Robotic gait training, for instance, depends on leg length and hip stability rather than on age.

What we think is achievable in the next twelve months, based on the assessment rather than on what you would like to hear — and when we think a block will not add enough to justify the travel and the cost.

Rehabilitation improves function. It does not remove cerebral palsy, and any programme that implies otherwise is selling something.

A child spends a few weeks here and the rest of the year at home. What the parent can do — handling, positioning, the home programme, how to make therapy part of daily routine — determines what the block is worth.

Parents attend the sessions that teach these things and practise them under supervision. This is the part of the programme most likely to be skipped elsewhere and most likely to determine the result.

An intensive block interrupts school and separates families, and that cost is real. We plan blocks around school holidays where possible and we are honest when the timing of a block matters less than its content.

Where a family cannot manage repeated blocks, we say what a single block can and cannot achieve rather than encouraging a schedule they cannot sustain.

An international clinical practice guideline on improving physical function in cerebral palsy draws on three systematic reviews, 30 randomised trials and five before-after studies 1. To reach functional goals, it recommends four ingredients: goals chosen by the child and family, practice of whole tasks in real-life settings, support that empowers the family, and a team approach 1.

Evidence on intensity itself is less clear-cut. A systematic review of 38 controlled studies in young children found that in most of them, intensive training produced improvements similar to conventional therapy or to another intensive approach, while pooled analyses supported constraint-induced movement therapy for hand function 2. That puts the weight on what is practised and whether it continues at home, rather than on hours alone.