Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy

Abstract

Aim The aim of this randomized controlled trial was to assess whether action observation treatment may improve upper limb motor functions in children with cerebral palsy (CP). Method All children with CP admitted to our unit for rehabilitation from May 2009 to May 2010 were eligible. Inclusion criteria were age between 6 years and 11 years, an IQ of at least 70, and no major visual and/or auditory deficits. Fifteen children were enrolled and randomly assigned to either a case group (n=8; four males, four females; median age 7y 6mo) or control group (n=7; five males, two females; median age 8y). Six participants had left‐sided hemiplegia, six right‐sided hemiplegia, and three had tetraplegia; 10 were independent walkers. Those in the case group were asked to observe video clips showing daily age‐appropriate actions, and afterwards to imitate them. Participants in the control group were asked to observe video clips with no motor content and afterwards to execute the same actions as cases. The primary outcome measure was the Melbourne Assessment Scale. Children were scored twice at baseline (2wks apart), and at the end of treatment, by a physician blind to group assignment. Results At baseline groups did not differ on functional evaluation. After treatment, the functional score gain (Δ) was significantly different in the case and control groups (p=0.026). Interpretation The present results support the notion that action observation treatment can be an effective part of the rehabilitation programme in children with CP.

Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis

“…54,56 Mirror therapy creates a visual illusion of a functional impaired arm using a mirror reflection of the unimpaired arm. Movements of the unimpaired limb are performed while watching its reflection in a mirror that shows the image of the unimpaired limb superimposed over the impaired limb.…”

“…56 A number of studies reported different domains of outcome (eg, activity, participation) 25,33,36 or different times for follow-up 34,39,43 in separate papers. Details of each intervention and duration, frequency, and intensity of intervention for control and comparison groups are summarized in Table 2.…”

“…Twelve studies were of very high methodologic quality, scoring $8 on the PEDro scale. 10 Fourteen studies were of poor methodologic quality, scoring ,6 on the PEDro scale (BoNT-A, [21][22][23] cCIMT, 6,25,26 mCIMT, 7,29,30,38,44 forced-use therapy, 48 and other UL interventions 50,54,56 ). Twenty-six studies (57%) did not report concealed allocation.…”

“…Data from 6 studies (9 publications) were not included in meta-analyses. One study reported median scores, 15 6 did not present summary statistics of central tendency and variability, 21,22,25,28,38,56 and 2 reported change scores with or without SDs. 41,55 For quantitative comparison of outcomes, data were available to pool across trials and 2 main comparisons were performed: (1) BoNT-A and OT versus OTalone and (2) cCIMT or mCIMT versus (a) a control group or therapy group receiving a lesser dosage of therapy or (b) a comparison group receiving an equivalent dosage of an alternative intervention.…”

Effect of parent‐delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial

“…6 Results in stroke were encouraging, 4,7,8 but few studies have assessed AO therapy in children with CP. Buccino et al 9 undertook a pilot study of 15 children aged 6 to 11 years with hemiplegia or tetraplegia. Children attended 15 physiotherapist-led rehabilitation sessions at a clinical centre.…”