How Does Mirror Visual Feedback Therapy Effectively Reduce Behavioral Problems in Children with Unilateral Spastic Cerebral Palsy?

Background: Unilateral spastic cerebral palsy (USCP), which is caused by an early brain injury, primarily affects one side of the body and is associated with sensory-motor deficits and spasticity. Cerebral palsy can also lead to cognitive, sensory, communicative, perceptual, and behavioral disorders, as well as seizures. Objectives: The present study investigated the effects of mirror visual feedback therapy (MVFT) on behavioral problems in children with USCP. Methods: Using a pretest-posttest experimental design, 14 children (aged 6 - 12 years) with hemiplegic CP were randomly assigned to either an experimental group (n = 7) that performed movements in front of a mirror or a control group (n = 7) that performed the same movements without a mirror. The Strengths and Difficulties Questionnaire (SDQ) was administered to assess behavioral problems at baseline and after 16 sessions of 30 minutes each. The experimental group performed finger, wrist, and elbow flexion/extension; forearm rotation; finger stretching; and making a fist with their unaffected hand in front of a mirror, while the control group performed identical exercises without a mirror. Data normality was confirmed using the Shapiro-Wilk test, and the data were analyzed using two-way repeated-measures ANOVA. Results: Posttest results showed a significant reduction in total difficulties (TD; P < 0.05) and a significant increase in prosocial behaviors (PB; P < 0.05) in the experimental group compared to the control group. Conclusions: The MVFT effectively reduced behavioral problems, suggesting that motor training in front of a mirror can be beneficial for children with USCP.