Action observation training on functional performance in children with cerebral palsy

Aim: Cerebral palsy (CP), a prevalent pediatric neurological disorder, involves significant motor and sensory impairments requiring long-term, multifaceted management. Action observation therapy (AOT), a novel neurorehabilitation approach, activates the mirror neurons through task observation. Evidence for AOT remains inconclusive for CP despite promising results in other populations. The study aimed to investigate the effects of AOT on functional performance, specifically mobility and balance, in spastic CP. Methods: 28 spastic CP children, eligible based on the Gross Motor Function Classification System (GMFCS) and Modified Ashworth Scale (MAS), were randomly assigned to an experimental group receiving video-based AOT plus task-oriented physiotherapy or to a control group receiving the same task-oriented physiotherapy protocol with therapist demonstration but without video-based action observation. Both groups received an 8-week play-based, task-oriented physiotherapy program. The experimental group additionally received video-based AOT before performing the tasks, whereas the control group received therapist demonstration without video-based observation. Functional outcomes were assessed at baseline and after the intervention using the Pediatric Balance Scale (PBS) and the Gross Motor Function Measure-88 (GMFM-88). Within- and between-group differences were analyzed using the Wilcoxon Signed-Rank test and the Mann-Whitney U test, respectively. Results: Both groups showed significant within-group improvements in PBS and GMFM-88 scores after the intervention (p < 0.05). However, post-intervention comparisons did not show a significant difference between the experimental and control groups. The play-based format appeared to support engagement and functional gains in both groups. Conclusions: AOT led to clinical improvements without a statistically significant dominance over the conventional approach, suggesting AOT might be more beneficial with increased dosage or multimodal approaches (ClinicalTrials.gov identifier: NCT06672328).