Effects of Motor Imagery and Action Observation on Motor Function in Unilateral Cerebral Palsy

NCT07612371 | Recruiting

• 1 other identifier: E-78097791-020-5100
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of this study is to evaluate the effects of action observation therapy and motor imagery methods, provided in addition to a conventional physiotherapy and rehabilitation program, on gross motor function, upper and lower extremity functional skills, and quality of life in children with cerebral palsy.

Conditions

Cerebral Palsy (CP)

Keywords

motor imagery; Mirror Neurons; quality of life; Cognitive Training

Outcome Measures

Primary Outcomes (1)

• ABILHAND-Kids

  Manual ability in daily activities assessed using the ABILHAND-Kids questionnaire for children with cerebral palsy (measured as logit score using Rasch analysis). ABILHAND-Kids evaluates the child's perceived difficulty in performing daily bimanual activities, such as dressing (buttons, zippers), eating with utensils, using scissors or pencils, opening containers, handling small objects. Contains a list of everyday manual tasks Each item is rated based on difficulty: Impossible, difficult, easy. Higher scores indicate better manual ability. Time Frame: 8 weeks

  0th week; 8th week

Secondary Outcomes (6)

• Pediatric Quality of Life Inventory (PedsQL)

  0th week; 8th week

• Jebsen-Taylor Hand Function Test

  0th week; 8th week

• The Child and Adolescent Scale of Participation (CASP)

  0th week; 8th week

• Gross Motor Function Measure (GMFM)

  0th week; 8th week

• Timed Up and Go Test

  0th week; 8th week

Study Arms (3)

Motor Imagery Group

ACTIVE COMPARATOR

Mental imagery practice will be applied in addition to conventional physiotherapy. A total of 10 movements supporting activities of daily living, including unimanual and bimanual upper extremity activities, walking, and balance activities, will be practiced from both first-person and third-person perspectives. The intervention will be administered for 50 minutes per session, twice a week, for 8 weeks. The intervention protocol will consist of 20 minutes of conventional physiotherapy followed by 30 minutes of motor imagery practice.

Other: motor imagery

Action Observation Therapy Group:

ACTIVE COMPARATOR

Action observation therapy will be applied in adition to conventional physiotherapy. A total of 10 movements supporting activities of daily living, including unimanual and bimanual upper extremity activities, walking, and balance activities, will be practiced. In action observation therapy, after participants observe the movement (observation phase), they will be asked to imitate the observed movement (execution phase). The intervention will be administered for 50 minutes per session, twice a week, for 8 weeks. The intervention protocol will consist of 20 minutes of conventional physiotherapy followed by 30 minutes of action observation therapy.

Other: Action observation therapy

Conventional physiotherapy group

ACTIVE COMPARATOR

Conventional physiotherapy training will be structured according to the child's symptoms and needs, and will consist of stretching, strengthening, normal walking training, postural control training, and weight-bearing training in different positions (sitting, standing, side-lying, prone).

Other: Conventional physiotherapy group

Interventions

motor imagery OTHER

Participants will receive treatment for 16 sessions in total, with 2 sessions per week for 8 weeks. Each session will last 50 minutes. The motor imagery practice will consist of a total of 10 movements including unimanual and bimanual, walking and balance activities, and will be performed by participants from both first-person and third-person perspectives. Balance activities: * Single-leg standing balance * Sit and stand up with your arms crossed in front of you while sitting in the chair. Walking activities: * The child gets up from the chair without support, walks 3 meters, then returns and sits back down in the chair * Walking sideways and backward on different surfaces Bimauel upper extremity activities * Putting on a blouse * Putting on and zipping up/down a dress with a front zipper. * Putting on shoes and tying the laces. Unimanual upper extremity activities * Taking food from the plate with a spoon and putting it in the mouth * Combing hair * Holding the doorknob and opening

Motor Imagery Group

Action observation therapy OTHER

Participants will receive treatment for 16 sessions in total, with 2 sessions per week for 8 weeks. Each session will last 50 minutes. Action observation therapy will consist of a total of 10 movements including unimanual and bimanual, walking and balance activities. After participants observe the movement (observation phase), they are asked to imitate the movement they observed (execution phase). Balance activities: * Single-leg standing balance * Sit and stand up with your arms crossed in front of you while sitting in the chair. Walking activities: * The child gets up from the chair without support, walks 3 meters, then returns and sits back down in the chair * Walking sideways and backward on different surfaces Bimauel upper extremity activities * Putting on a blouse * Putting on and zipping up/down a dress with a front zipper. * Putting on shoes and tying the laces. Unimanual upper extremity activities * Taking food from the plate with a spoon and putting it in the mouth

Action Observation Therapy Group:

Conventional physiotherapy group OTHER

Participants will receive treatment for 16 sessions in total, with 2 sessions per week for 8 weeks. Each session will last 50 minutes. Conventional physiotherapy training will be structured according to the child's symptoms and needs, and will consist of stretching, strengthening, normal walking training, postural control training, and weight-bearing training in different positions (sitting, standing, side-lying, prone).

Conventional physiotherapy group

Eligibility Criteria

• Age: 7 Years - 16 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Being between 7 and 16 years of age
• Having a diagnosis of unilateral cerebral palsy made by a pediatric neurologist
• Being classified at levels I-II of the Gross Motor Function Classification System (GMFCS)
• Scoring above 24 on the Mini-Mental State Examination for Children
• Having no cognitive impairments (i.e., possessing an appropriate cognitive level to follow task instructions)
• Willingness to participate in the study (child and family)
• Being classified at levels I-III of the Manual Ability Classification System (MACS) -Being classified at levels I-III of the Communication Function Classification System (CFCS) -

You may not qualify if:

• Children with uncontrolled seizures
• Children who have received motor imagery training or action observation therapy within the last 6 months
• Children with contractures
• Children with severe visual and/or hearing impairments
• Being classified at levels III, IV, or V according to the GMFCS
• Scoring below 24 on the Mini-Mental State Examination for Children
• Being classified at levels IV-V of the Manual Ability Classification System (MACS)
• Having undergone orthopedic surgery or botulinum toxin (Botox) treatment within the last 6 months

Sponsors & Collaborators

• Bahçeşehir University: lead

Study Sites (1)

Kurtkoy Ozel Egitim ve Rehabilitasyon Merkezi

Istanbul, Turkey (Türkiye)

RECRUITING

Related Publications (6)

• Steenbergen B, Jongbloed-Pereboom M, Spruijt S, Gordon AM. Impaired motor planning and motor imagery in children with unilateral spastic cerebral palsy: challenges for the future of pediatric rehabilitation. Dev Med Child Neurol. 2013 Nov;55 Suppl 4:43-6. doi: 10.1111/dmcn.12306.

  PMID: 24237279 BACKGROUND

• Sgandurra G, Ferrari A, Cossu G, Guzzetta A, Fogassi L, Cioni G. Randomized trial of observation and execution of upper extremity actions versus action alone in children with unilateral cerebral palsy. Neurorehabil Neural Repair. 2013 Nov-Dec;27(9):808-15. doi: 10.1177/1545968313497101. Epub 2013 Jul 25.

  PMID: 23886886 BACKGROUND

• Alamer A, Melese H, Adugna B. Effectiveness of Action Observation Training on Upper Limb Motor Function in Children with Hemiplegic Cerebral Palsy: A Systematic Review of Randomized Controlled Trials. Pediatric Health Med Ther. 2020 Sep 15;11:335-346. doi: 10.2147/PHMT.S266720. eCollection 2020.

  PMID: 32982541 BACKGROUND

• Demeco A, Molinaro A, Ambroggi M, Frizziero A, Fazzi E, Costantino C, Buccino G. Cognitive approaches in the rehabilitation of upper limbs function in children with cerebral palsy: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2024 Jun;60(3):445-457. doi: 10.23736/S1973-9087.24.08288-1. Epub 2024 Mar 21.

  PMID: 38512713 BACKGROUND

• Shin YK, Lee DR, Hwang HJ, You SJ, Im CH. A novel EEG-based brain mapping to determine cortical activation patterns in normal children and children with cerebral palsy during motor imagery tasks. NeuroRehabilitation. 2012;31(4):349-55. doi: 10.3233/NRE-2012-00803.

  PMID: 23232157 BACKGROUND

• Buccino G, Molinaro A, Ambrosi C, Arisi D, Mascaro L, Pinardi C, Rossi A, Gasparotti R, Fazzi E, Galli J. Action Observation Treatment Improves Upper Limb Motor Functions in Children with Cerebral Palsy: A Combined Clinical and Brain Imaging Study. Neural Plast. 2018 Jul 4;2018:4843985. doi: 10.1155/2018/4843985. eCollection 2018.

  PMID: 30123250 BACKGROUND

MeSH Terms

Conditions

Cerebral Palsy

Condition Hierarchy (Ancestors)

Brain Damage, Chronic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases

Study Officials

• Hasan K. Alptekin, Prof. Dr.

  Bahçeşehir University

  STUDY CHAIR

• Pelin Pisirici, Assoc. Prof.

  Bahçeşehir University

  STUDY DIRECTOR

Central Study Contacts

Betul Unal

CONTACT

+905314070105; betul.unal1@bahcesehir.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Three groups with a conventional therapy control group

Study Record Dates

• First Submitted: May 15, 2026
• First Posted: May 28, 2026
• Study Start: May 15, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): October 1, 2026
• Last Updated: May 28, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: After publication of the study results
• Access Criteria: De-identified individual participant data will be available upon reasonable request. Requests will be reviewed and approved by the principal investigator for non-commercial academic research purposes only.

Locations

TU (1)