Action Observation Versus Mirror Therapy in Children With Spastic Hemiplegic Cerebral Palsy

Overview

The goal of this clinical trial is to compare the effects of Action Observation therapy and Mirror therapy on hand grip strength and upper extremity function in children with hemiplegic cerebral palsy. Participants will be randomly assigned into two study groups of equal numbers: A group will receive traditional physical therapy program followed by mirror therapy protocol 3 times/ week for 12 weeks. Another group will receive the same traditional physical therapy program in addition exercises using action observation therapy, 3 times/week for 12 weeks. Then, the effect of both treatments will be compared between the two groups.

Hemiplegia is one of the most common movement disorders among children. It occurs in approximately 2.11 out of every 1000 live births. In hemiplegia, one side of the body is affected and the upper limb is usually more affected than the lower limb. Children with hemiplegic CP typically present with impaired selective motor control in the wrist, hand, and fingers. Common deformities include elbow and wrist flexion, thumb-in-palm deformity, and forearm pronation, which reduce the ability to reach, grasp, release, and manipulate objects. Many children compensate by relying on their non-affected hand, leading to developmental disregard of the weaker arm. Impaired upper limb (UL) function affects independence, participation, and quality of life and require effective rehabilitation. Innovative rehabilitation methods that harness neuroplasticity, such as Mirror Therapy (MT) and Action Observation Therapy (AOT), have been increasingly investigated. Both approaches are based on the activation of the mirror neuron system, which plays a key role in motor learning and motor recovery. Mirror Therapy, which is based on visual stimulation from the movements of unaffected limbs, has shown promising results for sensory and upper extremity motor performance of children with hemiplegic CP. Similarly, AOT, which involves observation of purposeful actions with the intention to imitate and then performing those actions, had a significant improvement on grip power, hand function, activities, and participation in activity of daily living in hemiplegic CP children. However, despite the evidence supporting both interventions individually, there is limited research directly comparing their relative effectiveness. Thus, a comparison of MT and AOT is important for a number of reasons. First, it could help clinicians prioritize therapy choices by clarifying whether one intervention results in better improvements in motor outcomes. Second, it will help develop a more sophisticated understanding of how to best utilize various mirror neuron system engagement modalities for pediatric neuro-rehabilitation. Findings may also help create accessible, affordable, and interesting treatment plans that can be incorporated into home-based rehabilitation programs and clinical settings, ultimately enhancing the lives of kids with cerebral palsy and their families.