The Effect of Upper Extremity Mirror Therapy on Cerebral Re-organization, Functional Motor Skills, Daily Life Activities and Health Related Quality of Life in Children With Spastic Hemiplegic Cerebral Palsy

The Effect of Mirror Therapy on Cerebral Re-organization, Functional Motor Skills, and Quality of Life in Hemiplegic Cerebral Palsy

Sponsors

Lead sponsor: Hacettepe University

Source Hacettepe University
Brief Summary

The purpose of this study is to investigate brain reorganization, functional motor development, level of daily living activity and quality of life of upper extremity mirror therapy in children with spastic hemiplegic cerebral palsy. Several studies have reported increased use of the affected arm following rearrangement of cerebral re-organization with mirror therapy. The investigator's study is the first of its kind and was planned to evaluate the effectiveness of upper extremity mirror therapy in cerebral reorganization and functional motor skills in children with spastic hemiplegic cerebral palsy. Hypothesis of this study is that mirror therapy improves brain re-organisation, functional motor skills and daily living activities in unilateral spastic CP.

Detailed Description

Cerebral palsy (CP) is the most common neurodisability in children. It has been defined as a disorder of movement and posture due to a defect or lesion of the immature brain and as a group of non-progressive, but often changing motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development.

Characteristically, children with unilateral cerebral palsy (CP) have one well-functioning hand and one impaired hand.Common features of the hemiplegic hand are slowness, abnormal muscle tone, decreased strength, and coordination difficulties, which occur to a varying extent in children independently of age. Many children also have impaired sensibility and mirror movements. Perhaps most importantly, children with unilateral CP hav e varying degrees of limitation in their ability to handle objects in daily life. This limitation is most obvious insituations where two hands are needed. However, knowledge about bimanual ability in chil dren with unilateral CP and its development over time is scarce at present.

To improve upper extremity function in children with unilateral CP, the mirror therapy is a promising approach. Mirror therapy for the first time, Ramachandran et al. has described for the treatment of phantom pain in amputee. Also in unilateral spastic CP mirror therapy have indicated that visual illusion of functional limb provided by mirror can support healing. By means of visual feedback, modified vision and perception is stimulated plasticity the premotor cortex and developed re-organization. In the current studies, mirror therapy in hemiplegic patients, have been shown that improve the function and reduce the sensitivity of the hemi neglect. Gygax et al. have investigated the effects of mirror therapy on upper extremity function 10 children with unilateral spastic CP between 6-14 years. Consequently, the spontaneous use affected hand, the maximum grip force increase of 15% and is demonstrated that improve the upper extremity motor function.

Overall Status Completed
Start Date January 12, 2015
Completion Date March 13, 2017
Primary Completion Date December 19, 2016
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Functional Magnetic Resonance Imaging (fMRI) change from baseline brain reorganization at 8 weeks
Quality of upper extremity skills assessment (QUEST) change from baseline upper extremity skills at 8 weeks
Secondary Outcome
Measure Time Frame
Functional independence measure (WeeFIM) change from baseline functional independence at 8 weeks
Child Health Questionnaire Parent Form 50 Questions (CHQ-PF50) change from baseline quality of life at 8 weeks
Enrollment 10
Condition
Intervention

Intervention type: Other

Intervention name: control group

Description: Children continued their traditional physiotherapy including upper limb exercises in three times a week for 8 week.

Arm group label: control group

Other name: traditional physiotherapy

Intervention type: Other

Intervention name: intervention group

Description: Participants allocated to the experimental group completed three times a week, 8-week mirror therapy in addition to traditional physiotherapy . This protocol consisted of mirror therapy with a mirror box.

Arm group label: intervention group

Other name: mirror therapy in addition to traditional physiotherapy

Eligibility

Criteria:

Inclusion Criteria:

- Congenital spastic hemiplegic cerebral palsy,

- Between the ages of 4-18,

- Continuing physiotherapy and rehabilitation program throughout the study.

Exclusion Criteria:

- Upper extremity fracture or muscle-tendon and bone operation shortly before 6 months,

- Any pharmacologic agent that will inhibit spasticity within 6 months,

- Visual function disorder except eye fracture defect

Gender: All

Minimum age: 4 Years

Maximum age: 18 Years

Healthy volunteers: No

Overall Official
Last Name Role Affiliation
Duygu Korkem, PhD Study Director Uskudar University
Location
facility
Hacettepe University
Location Countries

Turkey

Verification Date

August 2018

Responsible Party

Responsible party type: Principal Investigator

Investigator affiliation: Hacettepe University

Investigator full name: Duygu Korkem

Investigator title: Researcher

Keywords
Has Expanded Access No
Condition Browse
Number Of Arms 2
Arm Group

Arm group label: control group

Arm group type: Other

Description: Children continued their traditional physiotherapy

Arm group label: intervention group

Arm group type: Active Comparator

Description: We applied mirror therapy in addition to traditional physiotherapy

Patient Data No
Study Design Info

Allocation: Non-Randomized

Intervention model: Parallel Assignment

Intervention model description: In this type of controlled clinical trials, the same subjects are used as experimental and control groups, ie both the new treatment method and the classical method or the placebo method are applied to the same subjects. The efficacy is applied to the new treatment method and on the other hand the classical method is applied on the same subjects at different times and the results are compared.

Primary purpose: Treatment

Masking: None (Open Label)

Source: ClinicalTrials.gov