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

Официальное название

ACTION OBSERVATION VERSUS MIRROR THERAPY ON UPPER EXTREMITY FUNCTIONS IN CHILDREN WITH SPASTIC HEMIPLEGIC CEREBRAL PALSY

Обзор

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.

Подробное описание

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.

Вмешательства

• Поведенческое Mirror Therapy
  Participants will receive 45-minute mirror therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During mirror therapy, the child will be seated with a mirror positioned in the midsagittal plane to reflect movements of the unaffected upper limb while concealing the affected upper limb, creating the visual illusion of normal movement in the affected limb. Children will observe the reflected movements while simultaneously attemp
• Поведенческое Action Observation Therapy
  Participants will receive 45-minute action observation therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During each session, children will observe videos demonstrating goal-directed upper extremity activities matched to their functional level, followed by performance of the same activities using the affected upper limb under therapist supervision. The intervention includes task-oriented activities such as block transfer,

Первичные конечные точки

• gross manual dexterity [Срок оценки: After 12 Weeks]

Вторичные конечные точки (2)

• Spontaneous Functional Analysis (SFA) of the Shriners Hospital Upper Extremity Evaluation (SHUEE) [Срок оценки: After 12 weeks]
• Grip strength assessed using a hand dynamometer [Срок оценки: After 12 weeks]

Критерии участия

Критерии включения

• 1- Children diagnosed with spastic hemiplegic CP. 2- Their ages between 5-10 years. 3- Lack of use of the affected upper limb. 4- They will be at level II-III of the Manual Ability Classification System (MACS) 5- The will be at level I-II in the Gross Motor Function Classification System (GMFCS) 6- They will be graded 1 to 1+ in the affected U.L. on Modified Ashworth's Scale 7- The children should be capable of understanding and following instructions.

Критерии исключения

• The children will be excluded if they have one of the following:
• Children with fixed contracture in the affected U.L.
• Injection of botulinum toxin into the upper limb muscles during the previous 6 months.
• Visual or Auditory disorders.
• Upper limb surgery in the last one year.
• Epilepsy.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Египет · 1 центр

• outpatient clinic of Faculty of Physical Therapy, Cairo University & outpatient clinic of — Giza

Идентификаторы

NCT: NCT07739069 · P.T.Rec/012/006210

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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