Effect Of Parent-Delivered Action Observation Therapy On Upper Limb Function In Unilateral Cerebral Palsy: A Randomized Controlled Trial

AimTo 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).MethodDesign: 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.ResultsOutcome 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.InterpretationParent-delivered RP (with or without AO) improves upper limb function and could supplement therapist input.