Hand function in hemiplegia

Effect of parent-delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial
by Emma Kirkpatrick, Janice Pearse, Peter James and Anna Basu

Unilateral cerebral palsy (hemiplegia) is the commonest form of cerebral palsy. It affects thousands of children in the UK. As there is currently no cure, improving hand function through therapy is important.

Recently there has been much interest in a brain network called the “mirror neuron system”. You activate this when moving but also when watching the same movement performed by others. We know that careful watching and copying are an important way of learning new activities.

We wanted to see whether adding “watching and copying” into therapy would improve hand function more than repeated practice of movements alone. We also wanted to develop a play-based therapy that parents/carers could use at home.

What did we do?

We developed a series of play activities useful for children with hemiplegia. For each game or toy, one set of instructions focused on watching and copying a parent’s moves. The other set focused on repeated independent practice, with the parent supporting rather than repeating the activity.
70 children aged 3 to 10 years took part in the trial in two random groups. Everyone followed a therapy programme for 3 months. This consisted of 15 minute sessions, 5 days a week. All children took part in the same range of assessments.

What did we find?

At 3 months, there was no difference in the improvement of hand function between the two groups.

What does it mean?

Watching movements before copying them does not seem to create better results than repeated practice at home with parents. However, play activities with parents, which focus on particular hand movements, do lead to small but significant improvements in hand function.

What next?

We are working on a website of games and activities for parents or therapists to use. We hope you will find the suggestions useful.
Mac Keith Press publishes two series of books: the Clinics in Developmental Medicine and the International Reviews of Child Neurology Series for the International Child Neurology Association.