Effects of Action Observation Therapy and Video-Based Play Therapy on Children With Unilateral Cerebral Palsy

Effects of Action Observation Therapy and Video-Based Play Therapy on the Upper Extremity and Trunk in Children With Unilateral Cerebral Palsy in the Framework of the International Classification of Functioning, Disability, and Health

Cerebral Palsy (CP) defines a group of permanent disorders in the development of movement and posture, which occur in the developing fetal and newborn brain, due to non-progressive disorders, leading to activity limitations. In addition to the traditional rehabilitation interventions used in upper extremity rehabilitation, a new treatment method, Action Observation Therapy (AOT), has been added recently with the discovery of the Mirror Neuron System. AOT; By watching the videos prepared, mirror neurons are activated and these activities are learned through imitation. Activation of mirror neurons strengthens voluntary motor movement by strengthening the affected nerve pathways or by creating alternative pathways. AOT is an easily applicable method as telerehabilitation because it is based on watching and replaying video recordings. Virtual Rehabilitation (VR); It is another treatment approach applied to improve the motor functions of children with CP and created with the contribution of developing technology. It has been reported that activities have a positive effect on motor learning due to their intense, task-oriented, active participation and high motivation. Within the scope of this thesis, the effect of AOT and VR to be applied at home, which has been on the agenda for upper extremity, on the trunk and upper extremity will be examined in detail and a contribution will be made to the literature.

Cerebral Palsy (CP) defines a group of permanent disorders in the development of movement and posture that occur in the developing fetal and newborn brain, due to non-progressive disorders, leading to activity limitations. Unilateral CP (uCP) accounts for 38% of cases. These children complain of motor and sensory disorders that are more prominent on one side of the body, usually in the upper extremity (UE). These sensorimotor disorders typically limit their ability to perform activities of daily living, negatively affecting participation and quality of life. Therefore, in the last ten years, research on UE interventions for children with uCP has been focused on; While trying to develop existing methods, new treatment methods are tried to be created. There are various treatment modalities that aim to relieve UE function disorders and reduce activity limitations. It is very important to determine the most effective treatment method. However, there are few randomized controlled studies measuring clinical outcomes in children with uCP. New intervention strategies based on sound methodological and scientific foundations are needed.

It has been reported that motor learning is the basis of UE treatments applied in CP and reported to be effective. Based on neurophysiological findings, there are studies suggesting that AOT and VR treatment approaches accelerate the motor learning process. AOT; It includes observing selected UE actions and actively imitating the observed action. AOT has been previously used in the treatment of upper extremity in patients with chronic stroke, recovery of frostbite phenomenon in Parkinson's disease, treatment of lower and upper extremities in pediatric rehabilitation, and recovery of limb function after orthopedic surgery and has been reported in studies. Recent studies, especially in children with uCP, have reported promising results. In general, telerehabilitation is an effective, flexible, personalized and relatively cost-effective intervention, which strengthens the hypothesis that home rehabilitation services are a viable alternative to routine care. AOT can be easily performed at home as it is an approach based on careful observation and active imitation of actions. approach has been reported. Studies have reported that VR improves posture, balance, upper extremity function, and trunk control. There is no study in the literature examining the effects of motor learning-based AOT and VR applied at home on UE and body within the framework of international functionality, disability and health classification. Within the scope of the study, a contribution will be made to the literature, which has been reported to be insufficient in studies on UE treatments.

Inclusion Criteria:

• The clinical type is spastic hemiparetic CP.
• Upper extremity spasticity value between 0 and 3 according to Modified Ashworth.
• To have the cognitive level to understand simple instructions.
• It is largely the absence of auditory and visual loss.

Exclusion Criteria:

• Not volunteering to participate in the study.