This study will evaluate whether an intensive day camp that combines somatosensory and motor training for the affected upper limb improves hand function and participation in children with unilateral cerebral palsy more than an intensive motor-only camp of equal duration and intensity. Children aged 5 to 15 years with unilateral spastic cerebral palsy and Manual Ability Classification System (MACS) levels I-III will be randomly assigned to one of two intervention groups. The experimental group will receive an 8-day, 40-hour camp including structured tactile, proprioceptive and vestibular stimulation integrated into meaningful functional tasks for the upper limb. The control group will receive an 8-day, 40-hour camp focused exclusively on intensive motor training without specific somatosensory stimulation.
The primary outcome is the change in spontaneous bimanual performance of the affected hand, measured with the Assisting Hand Assessment (AHA). Secondary outcomes include measures of unilateral upper limb function, somatosensory function, hand grip strength, gross motor function, balance, trunk control, participation in daily activities and objective upper limb activity measured with wrist-worn accelerometers. Outcomes will be assessed at baseline, immediately after the intervention, and at follow-up visits approximately 2 and 3 months after the camp.
diagnosis of spastic CP
aged between 5 and 15 years of age
able to follow simple verbal instructions and complete all the necessary tests according to their ages
MACS level I-III
uncontrolled epilepsy episodes in the 6 months prior to the start of the study
botulinum toxin in the last 6 months
orthopedic or neurological surgery in the 12 months prior to the start of the study or scheduled during the intervention development period
visual or cognitive disabilities that interfere with treatment
Parallel
Somatosensory-Motor Intensive Camp
BehavioralStructured 8-day intensive rehabilitation camp (40 hours total, 5 hours/day) for children with unilateral cerebral palsy. Integrates somatosensory stimulation (tactile massage, texture discrimination, vibration therapy, proprioceptive exercises, vestibular/balance activities) within functional upper limb motor tasks, play-based workshops, and bimanual activities targeting spontaneous hand use and participation in daily activities.
Motor-Only Intensive Camp
BehavioralStructured 8-day intensive rehabilitation camp (40 hours total, 5 hours/day) focused exclusively on upper limb motor training for children with unilateral cerebral palsy. Includes active range of motion exercises, grip strength training, fine motor coordination tasks (grasping, threading, block manipulation), reaching/coordination circuits without structured somatosensory stimulation.
Assisting Hand Assessment (AHA)
Change in spontaneous bimanual hand use of the affected upper limb in children with unilateral cerebral palsy, measured by the Assisting Hand Assessment (AHA). The AHA is a video-based, criterion-referenced measure of how effectively a child with a unilateral hand impairment spontaneously uses their affected hand during bimanual play activities. Scores range from 0-100 (higher scores indicate better bimanual performance).
Melbourne Assessment of Unilateral Upper Limb Function Version 2 (MA-2)
Quality of unilateral upper limb movement (range of motion, accuracy, dexterity, fluency) in children with unilateral cerebral palsy, measured by video analysis using MA-2 standardized criteria.
Somatosensory Function (SWM, 2PD, Stereognosis)
Tactile discrimination and somatosensory function of the affected hand measured by Semmes-Weinstein Monofilaments (SWM) for touch threshold, two-point discrimination (static/dynamic), localization, double simultaneous stimulation, and stereognosis (object recognition by touch).
Hand Grip Strength (Jamar Dynamometer)
Maximum cylindrical grip strength (kg) of affected and non-affected hands, measured in standardized sitting position with 3 trials per hand using Jamar hydraulic dynamometer.
Upper Limb Activity (Wrist Accelerometry)
Objective measurement of spontaneous upper limb movement quantity and intensity using wrist-worn accelerometers on both wrists during AHA assessment and daily life outside camp.
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