Action observation as a motor rehabilitation in children with cerebral palsy

Alsamour, Marie [UCL] Gilliaux, Maxime [UCL] Renders, Anne [UCL] Stoquart, Gaëtan [UCL] Lejeune, Thierry [UCL] Edwards, Martin [UCL]

INTRODUCTION: The aim of the study was to evaluate whether action observation could be used to rehabilitate action in children with cerebral palsy. Cerebral palsy is the most common cause of physical disability in children. Action Observation Therapy (AOT) has been developed from mirror neuron system theory and proposes that the observation of action could improve both the planning and execution of motor actions through common neural processes. METHOD: Seven children with hemiplegic congenital cerebral palsy aged between 7 and 12 years participated in the study. We evaluated motor actions using measures of force, fine and gross manual dexterity, range and quality of movement through the REAplan robotic device, activity limitation and participation restriction measures. A double blind cross over design was used. The experimental condition consisted of viewing a DVD with seven videos of approximately ten minutes showing a first person perspective of a child’s daily living action activities with a narrative. The control condition consisted of normal therapy. The statistical analyses compared the single case results with the confidence interval norms. RESULTS: The results showed significant action improvements for four of the seven children (two in particular with very strong improvements). The improvements were to the measures of force, fine and gross manual dexterity and the quality of movements. Participation restriction and quality of shaped movements measured by the robot did not show significant improvements. The level of action ability explained the difference between the patients (responders versus none responders). DISCUSSION: This study was the first to adapt AOT for children with cerebral palsy and measure action using a robot device. We showed evidence that the therapy worked for children with good manual abilities. We propose that the level of manual ability and the functions of the mirror neuron system are likely matched, and that children with poor manual ability may have reduced mirror neuron system capacity, explaining the reduced rehabilitation effect for these children. We propose that this hypothesis requires further testing.