Action observation motor rehabilitation in children with hemiplegiccerebral palsy : a pilot study

BACKGROUND: Cerebral palsy (CP) is the most common cause of physical disability in children. Action Observation Therapy (AOT) has been developed from mirror neuron system (MNS) theory and proposes that the observation of action could improve both the planning and execution of motor actions through common neural processes. The purpose of this study was to adapt this therapy to children with CP in order to rehabilitate their upper limb movement ability. METHOD: Seven children with hemiplegic congenital CP have participated to the study. Assessment included impairment (force, fine and gross manual dexterity and quality of movement through a robotic device), activity limitation and participation restriction measures. A single blind cross over design has been used. The experimental condition consisted of viewing videos showing a first person perspective of a child’s daily living activities with a narrative. Statistical analysis used was single cases through confidence interval. RESULTS: The results showed significant action improvements for four of the seven children. The improvements were to the measures of force, fine and gross manual dexterity and the quality of rectilinear movements. Participation restriction and quality of shaped movements did not show significant improvements. The initial level of action ability explained the difference between the patients. DISCUSSION: This study was one the first to adapt AOT to children with CP and to assess the three dimensions of handicap including kinematics measures. It seems that the level of manual ability and the functions of the MNS are likely matched: children with poor manual ability may have reduced MNS capacity, explaining the reduced rehabilitation effect. Although additional studies have to be led, AOT provides a recent and promising rehabilitative tool for action in children with CP