Effect of parent‐delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial

Abstract

Aim To determine whether home‐based, parent‐delivered therapy comprising action observation (AO) and repeated practice (RP) improves upper limb function more than RP alone in children with unilateral cerebral palsy (UCP). Method Design: single‐blinded parallel‐group randomized controlled trial with 1:1 allocation comparing AO+RP (intervention) with RP alone (control). Randomization: computer‐generated, with allocation concealment by opaque sequentially‐numbered envelopes. Setting: northern England, August 2011 to September 2013. Participants: 70 children with UCP; mean age 5.6 years (SD 2.1), 31 female. Intervention: home‐based activities were provided, tailored to interests and abilities. Duration: 15 minutes/day, 5 days/week for 3 months. Assessments: Assisting Hand Assessment (AHA; primary outcome measure), Melbourne Assessment 2 (MA2), and ABILHAND‐Kids at baseline, 3 months, and 6 months. Results Outcome data was available at 3 months for 28 children in the AO+RP group and 31 controls, and at 6 months for 26 and 28 children respectively. There were no between‐group differences in AHA, MA2, or ABILHAND‐Kids at 3 or 6 months versus baseline (all p>0.05). Combined‐group improvements (p<0.001), observed in AHA and MA2 at 3 months, were maintained at 6 months. ABILHAND‐Kids also showed improvement at 3 months (p=0.003), maintained at 6 months. Interpretation Parent‐delivered RP (with or without AO) improves upper limb function and could supplement therapist input.

Determinants of parent‐delivered therapy interventions in children with cerebral palsy: A qualitative synthesis and checklist

“…For preschool and primary school age children with unilateral CP, parent‐delivered therapy was shown to lead to improvements in upper limb function (Ferre et al, ; Kirkpatrick, Pearse, James, & Basu, ). Such programmes require intensive parental support.…”

“…Such programmes require intensive parental support. As an example (Kirkpatrick et al, ), parents of 70 children aged 3–10 years with unilateral CP were supported in providing home‐based activities, personalized to the child's own interests, abilities, and level of hand function. Support included training, provision of written instructions, home visits, and regular telephone contact, plus contact for troubleshooting.…”

ABILHAND‐Kids questionnaire: responsive to change or room for change?

“…They used the measure with an exclusively unilateral spastic cerebral palsy (USCP) cohort, as did we in an earlier paper. 3 The questionnaire is validated for children with all types of CP between the ages of 6 years and 15 years, and when used exclusively with children with USCP the item hierarchies may be altered. 4 While item hierarchy was found to be invariant across CP subtypes in the study, 1 British and American versions of the questionnaire have not been Rasch analysed following translation from the original French.…”

Action observation therapy: handle with caution?

“…There is increasing evidence for the efficacy of this method in adults with hemiplegia during the subacute and chronic phases of stroke. 2 In their trial, which addresses the efficacy of action observation therapy in children with unilateral cerebral palsy (CP), Kirkpatrick et al 3 demonstrate that there is no added-value of action observation over repetitive motor training, in a home-based, parent-delivered variant of the approach. This contrasts with a previous randomized trial in children with unilateral CP by Sgandurra et al, 4 which had shown significant improvements in bimanual function following more intensive, therapist-delivered, action observation therapy.…”

“…It also reduces nutrient intakes in a group with already severe nutritional issues. 3 Singular diseases such as ataxia telangiectasia should not be judged by the same standards as more common events. The strengths of this study include the absence of invasive techniques, which in this group is preferred in terms of gaining agreement and compliance (even though invasive techniques might be preferred in other groups).…”