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

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).

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.