Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol

Abstract

The movements of the affected upper limb in infantile hemiplegia are slower and clumsy. This leads to a decrease in the use of the affected hand. The visual effect obtained using the mirror box and the observation of actions in another individual can activate the same structural neuronal cells responsible for the execution of these actions. This research will study the affected upper limb functionality in hemiplegia infantile from 6 to 12 years old after the application of two intervention protocols: observation action therapy and mirror therapy combined with observation action therapy. Children with a diagnose of congenital infantile hemiplegia will be recruited to participate in a randomized controlled trial with two intervention protocols during four weeks (1 h per/day; 5 sessions per/week): Mirror Therapy Action Observation (MTAO) or Action Observation Therapy (AOT). The study variables will be: spontaneous use, measured with the Assisting Hand Assessment (AHA); manual ability measured with the Jebsen Taylor Hand Function Test (JTHFT); surface electromyography of the flexors and extensors muscles of the wrist and grasp strength through a grip dynamometer. Four assessments will be performed: At baseline situation, at the end of treatment, 3 and 6 months after treatment (follow-up assessments). This study will study the effects of these therapies on the use of the affected upper limb in children with hemiplegia.

Effectiveness of a Telecare Physical Therapy Program in Improving Functionality in Children and Adolescents with Cerebral Palsy: A Cases Study

“…In addition, the videos used in the studies have selected actions that were attractive and adapted to the age of the participants, divided into simple motor tasks ordered according to their complexity and visualized in different perspectives: 1st person, 3rd person and from a lateral plane [ 15 , 16 , 18 , 20 ]. In the present study, the duration of the videos was 3 min, and the execution of each action was carried out from the lateral plane [ 15 , 16 , 18 , 20 , 36 ]. Each action was carried out three times without interruption, with each participant being asked to repeat the actions visualized in the videos 3–5 times between sessions.…”

“…In the literature consulted about AOT in Cerebral Palsy, Buccino [ 16 ] conducted a 3-week study, applying one session per day for 5 days a week, as did the research of Sgandurra [ 37 ], who also conducted an intervention of 15 consecutive sessions, performing five sessions per week. On the other hand, the study by Simon-Martinez [ 36 ] lasted 9 days with a total of 54 h of therapy. In another study conducted by Kirkpatrick [ 21 ], the AOT Therapy was not carried out by watching a video, but parents acted as models for their children and performed the different motor acts.…”

“…In another study conducted by Kirkpatrick [ 21 ], the AOT Therapy was not carried out by watching a video, but parents acted as models for their children and performed the different motor acts. Finally, some of these studies combined OAT with other therapies, such as Constraint Induced Movement Therapy using a splint on the less affected upper limb [ 36 ] and Mirror Therapy [ 38 ].…”

“…The results of the current study are consistent with previously conducted studies that confirm that an intervention using AOT is effective for the improvement of gross motor function, balance and walking performance in Cerebral Palsy. The content of the program was quite novel, as it combined AOT activities [ 36 , 37 , 38 ] that have already shown benefits in the motor area, especially in upper limb function [ 36 , 38 ], adapted to the age and specific conditions of the participants and objectives of the study, with family-centered practices [ 39 , 40 , 41 , 42 , 43 ]. Each part of the intervention was focused on the improvement of the variables of the study (balance, walking endurance, walking speed and dimensions related to the walking ability of the GMFT), with positive results.…”

The Effectiveness of Mirror Therapy in Stroke Patients: A Systematic Review

“…No conclusions can be drawn to support effectiveness MT for patients in the acute and sub-acute stages. Seven studies (Hung et al 2022); (Wei et al 2022); (Miclaus et al 2021);(Palomo-Carrión et al 2021) (Noureen et al 2022) (Hsieh et al 2020) (Gandhi et al 2020) in this review have included participants in the chronic stage and acute but the majority of them consisted of one lowquality RCT (Wei et al 2022) and 3 experimental studies (Miclaus et al 2021);(Palomo-Carrión et al 2021) (Noureen et al 2022) and two high-quality RCTs (Hung et al 2022) and (Gandhi et al 2020) and 1 high-quality experimental study (Hsieh et al 2020), Furthermore, all case studies used a combination of interventions. Remember the lack of high-quality evidence, it is difficult to conclude that the chronic stage is the optimal time to use this approach.…”