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.
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
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
Parallel
motor imagery
Other interventionParticipants 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
Action observation therapy
Other interventionParticipants 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
Conventional physiotherapy group
Other interventionParticipants 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).
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
Pediatric Quality of Life Inventory (PedsQL)
Quality of life assessed using the Pediatric Quality of Life Inventory (PedsQL) 3.0 Cerebral Palsy Module Child and Parent Reports. The 35-item questionnaire evaluates daily activities, school activities, movement and balance, pain, fatigue, eating activities, and speech and communication in children with cerebral palsy. Items are scored on a 5-point Likert scale and transformed to a 0-100 scale. Higher scores indicate better quality of life.
Jebsen-Taylor Hand Function Test
Hand function assessed using the Jebsen-Taylor Hand Function Test (JTHFT), a standardized measure of fine and gross motor hand function during simulated activities of daily living. The test consists of seven subtests, including writing, page turning, lifting small objects, simulated feeding, stacking, and lifting light and heavy objects. Performance is measured as completion time in seconds for each subtest and total test time using a stopwatch. Measurement method: Each task is performed as quickly as possible. Time is measured in seconds with a stopwatch. Each task is recorded separately. Scoring system: Time elapsed for each subtest (in seconds) is used. Total score: sum of subtest times or total time separately for each hand. Lower completion time indicates better hand function.
The Child and Adolescent Scale of Participation (CASP)
The CASP questionnaire assesses an individual's community participation in home, school, and neighborhood settings. It consists of 20 questions in total, with 4 sub-sections: Home participation (6 questions), neighborhood and community participation (4 questions), school Participation (5 questions), and home and community activities (5 questions). Scoring system: 4 = expected for their age (full participation), 3= somewhat limited, very limited, 2=unable, and 1=not applicable. Total and/or domain scores are calculated, and scores transformed to a standardized 0-100 scale. Higher scores indicate better levels of participation in daily life activities.
Gross Motor Function Measure (GMFM)
Gross motor function assessed using the Gross Motor Function Measure (GMFM-88), a standardized assessment tool for children with cerebral palsy. The scale consists of 88 items across five domains: lying and rolling, sitting, crawling and kneeling, standing, and walking/running/jumping. Items are scored on a 4-point Likert scale according to the child's level of performance. Total scores range from 0 to 264, with higher scores indicating better gross motor function.
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