The goal of this clinical trial is to compare the effects of Action Observation therapy and Mirror therapy on hand grip strength and upper extremity function in children with hemiplegic cerebral palsy.
Participants will be randomly assigned into two study groups of equal numbers:
A group will receive traditional physical therapy program followed by mirror therapy protocol 3 times/ week for 12 weeks.
Another group will receive the same traditional physical therapy program in addition exercises using action observation therapy, 3 times/week for 12 weeks.
Then, the effect of both treatments will be compared between the two groups.
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.
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.
Parallel
Mirror Therapy
BehavioralParticipants will receive 45-minute mirror therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During mirror therapy, the child will be seated with a mirror positioned in the midsagittal plane to reflect movements of the unaffected upper limb while concealing the affected upper limb, creating the visual illusion of normal movement in the affected limb. Children will observe the reflected movements while simultaneously attempting to perform the same functional tasks with the affected upper limb. The intervention includes task-oriented upper extremity activities such as object transfer, grasp and release, coin placement, ball gripping, card turning, circle drawing, block building, and water pouring.
Action Observation Therapy
BehavioralParticipants will receive 45-minute action observation therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During each session, children will observe videos demonstrating goal-directed upper extremity activities matched to their functional level, followed by performance of the same activities using the affected upper limb under therapist supervision. The intervention includes task-oriented activities such as block transfer, line drawing, card turning, coin placement, cup stacking, ball squeezing, water pouring and drinking, and moving beverage cans. Video demonstrations are presented from multiple viewing angles to facilitate motor learning and action observation.
gross manual dexterity
Hand dexterity will be assessed using the Box and Block Test by recording the number of blocks transferred from one compartment to the other within 60 seconds.
Spontaneous Functional Analysis (SFA) of the Shriners Hospital Upper Extremity Evaluation (SHUEE)
The SFA evaluates the child's spontaneous use of the affected upper limb while performing standardized functional tasks, with higher scores indicating better spontaneous functional use.
Grip strength assessed using a hand dynamometer
Grip strength of the affected hand will be measured using a calibrated hand dynamometer. The maximum voluntary grip strength will be recorded in kilograms (kg), with higher values indicating greater grip strength.
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