Sensorimotor-assisted rehabilitation system

A vest, shorts, knee pieces and shoe attachments are linked by elastic cords whose tension the therapist sets joint by joint. The cords pull the body towards correct alignment and give the muscles that should be working something to work against — the same principle that was used to counter muscle loss in space.

In the suit, a child who habitually stands with bent knees and a rounded back is held closer to upright, and every step and reach practised in that posture is a repetition of the right pattern rather than of the compensation. The suit is worn during therapy, not all day.

Children with cerebral palsy first of all, and also developmental delay, brain injury, spina bifida and other neurological conditions in which weakness and poor alignment feed each other. Adults after stroke or brain injury are treated with it where the assessment finds the same pattern.

It requires the ability to tolerate the suit and to take part in a demanding session. Fixed contractures limit what the cords can align, which is one reason the assessment comes first.

The suit is used within an intensive block: several hours of therapy a day over a few weeks, combining suit work with exercise in the pulley-and-cage unit that lets a child move a single limb against resistance, and with the sensorimotor training on the rest of this site. Intensity is the mechanism, and it is why the programme is scheduled as a block rather than as weekly visits.

Strength, alignment and function are recorded at the start and end of the block with the same paediatric measures used elsewhere on this site, so the family leaves with a measured change rather than a description.

The published evidence for suit therapy shows small gains in gross motor function during intensive blocks, and it rests on a handful of small trials 1. It does not cure the underlying condition, and the gains have to be maintained with a home programme afterwards.

We say this before a family travels, because the intensive block is a considerable undertaking and it should be chosen with the realistic result in view.

Probably not much. A large systematic overview of cerebral palsy treatments concludes that adding a suit does not appear to bring benefit over and above the motor training it accompanies, and it does not recommend suit therapy as a first-line or stand-alone treatment 2. What reliably drives change is intensive, active practice of real tasks; for some families, the routine of the suit is what makes that practice happen 2.

In practice, the intensity of the block — how many hours of active practice a child can sustain — matters more than the equipment worn during it. A family choosing between a suit block and an equally intensive programme without a suit is choosing between two ways of delivering the same active practice.