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

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.

Inclusion criteria

• 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.

Exclusion criteria

• 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.