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NCT Number: NCT07651111

Action Observation Therapy in Children With Spastic Diplegia

The aim of this study is to compare the effect of live versus video action observation training (AOT) on balance and gait in children with spastic diplegia.

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Key information

Conditions

Spastic Diplegia Brain Damage, Chronic Brain Diseases Central Nervous System Diseases Cerebral Palsy Nervous System Diseases

Age range

4 year–7 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Outpatient clinic of the Faculty of physical therapy, Cairo University

Giza, 12511, Egypt

Location contact

Esraa Elsayed Ali Elkiky, M.Sc

CONTACT

[email protected]

+20 10 92002696

About this study

Children with spastic diplegic often face difficulties with balance and walking, affecting their independence and quality of life. Because of the impact of reduced gait speed and other gait abnormalities on their participation and quality of life, the main focus of physical therapy interventions is to improve balance and gait of children with cerebral palsy (CP).

Action observation training is a developing rehabilitation based on mirror neurons that activate when one performs movements or observes the movements of others. It is applied to improve motor skills and learning in athletes, healthy people, and patients with motor disorders.

Although many studies have focused on the application of action observation training (AOT), especially in improving upper limb function in individuals with stroke or children with CP, there is still a lack of sufficient research examining its effects on spasticity, gross motor abilities, balance, and gait in children with CP.

There is one study comparing the effects of live and video forms of AOT on upper limb function in children with hemiparetic CP. The researchers found that live AOT was more effective than video AOT in improving upper limb performance.

To our knowledge, there are no previous studies that compare the effect of live and video forms of AOT on balance and gait in children with spastic diplegia. Addressing this gap may provide valuable insights into the optimal mode of AOT delivery for enhancing balance and gait.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Children of diplegia who walk by a crouch gait.
  • The age of the selected children will range from 4 to 7 years old.
  • Degree of spasticity will range from 1 to 1+, according to modified Ashworth scale (MAS).
  • They will be selected as Level II according to Gross motor function classification system (GMFCS).
  • They will be able to understand the tasks and researchers' instructions.
  • Their heights are not less than 1 meter to be able to see the screen of the Biodex balance system.

Exclusion criteria

  • Visual or auditory impairments.
  • Vestibular impairments.
  • Fixed deformities of the upper, lower limbs, and the spine.
  • Botulinum toxin (Botox) injection for the last six months.
  • Orthopedic surgeries in the last six months.

Treatment and study plan

A selected physical therapy program

Other

Participants will receive a conventional physical therapy program, 3 sessions per week for 3 months. The program will include approximation exercises, balance training, functional activities (sit-to-stand, squatting, stair climbing), gait training with obstacles, walking exercises on different surfaces, and stretching exercises for the upper and lower limbs. The intervention aims to improve balance, mobility, coordination, and functional performance.

Live action observation training (AOT)

Other

Participants will receive live AOT for 30 minutes, 3 times per week, for 3 months. Each task will involve 3 minutes of observing the therapist performing the activity, followed by 3 minutes of verbal guidance and 3 minutes of task execution by the child. A 1-minute rest period will be provided between tasks.

Video action observation training (AOT)

Other

Participants will receive video-based AOT for 30 minutes, 3 times per week, for 3 months. They will observe task demonstrations presented on a computer screen from multiple viewing angles, followed by guided practice and task performance, similar to the live AOT protocol.

Primary outcomes

  1. Overall Stability Index (OSI)

    Time frame: 3 months

    It will be assessed using the Biodex Balance System. Participants will stand on a dynamic platform at stability level 5 for three 30-second trials. The Overall Stability Index (OSI) will be recorded as a measure of postural stability in all directions. Lower OSI values indicate better balance control and greater postural stability.

  2. Anteroposterior Stability Index (APSI)

    Time frame: 3 months

    It will be measured using the Biodex Balance System during dynamic balance testing. APSI reflects the participant's ability to maintain balance in the forward and backward directions. Lower APSI scores indicate improved anteroposterior postural control.

  3. Mediolateral Stability Index (MLSI)

    Time frame: 3 months

    It will be assessed using the Biodex Balance System. MLSI evaluates the participant's ability to control balance in the side-to-side direction during dynamic standing. Lower MLSI values indicate better mediolateral stability and balance performance.

Secondary outcomes

  1. Hip Flexion Angle

    Time frame: 3 months

    It will be assessed using Kinovea motion analysis software during gait. Reflective markers will be placed on anatomical landmarks, and participants will walk at a self-selected speed while being recorded with a high-definition camera. Hip flexion will be measured during the late swing phase, corresponding to peak hip flexion. Greater hip flexion angles toward normative values will indicate improved gait kinematics.

  2. Knee Flexion Angle

    Time frame: 3 months

    It will be evaluated using Kinovea software from recorded gait videos. Anatomical markers will be positioned on the greater trochanter, lateral femoral condyle, and lateral malleolus. Knee flexion will be measured during the terminal stance phase. Changes toward normal knee kinematics will be considered indicative of gait improvement.

  3. Ankle Dorsiflexion Angle

    Time frame: 3 months

    It will be measured using Kinovea software during gait analysis. Reflective markers placed on the lower limb and foot will be used to calculate ankle joint kinematics. Ankle dorsiflexion will be assessed at initial contact. Increased dorsiflexion toward normal gait values will indicate improved gait performance.

Study contacts

Contact information is provided by the study sponsor or research team.

Esraa Elsayed Ali Elkiky, M.Sc

CONTACT

[email protected]

+20 10 92002696

Mai Elsayed Abbass, PhD

CONTACT

Sponsors and collaborators

Lead sponsor

Cairo University

Other

Registry information

Official study title

Effect of Live Versus Video Action Observation Training on Balance and Gait in Children With Spastic Diplegia

Acronym: AOT/CP

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jun 16, 2026
Registry last updated
Jun 16, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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