Action Observation Therapy in Children With Spastic Diplegia (AOT/CP)

Effect of Live Versus Video Action Observation Training on Balance and Gait in Children With Spastic Diplegia

The aim of this study is to compare the effect of live versus video action observation training (AOT) on balance and gait in children with spastic diplegia.

Study Overview

• Status: Not yet recruiting
• Conditions: Spastic Diplegia
• Intervention / Treatment: Other: A selected physical therapy program; Other: Live action observation training (AOT); Other: Video action observation training (AOT)

Detailed Description

Children with spastic diplegic often face difficulties with balance and walking, affecting their independence and quality of life. Because of the impact of reduced gait speed and other gait abnormalities on their participation and quality of life, the main focus of physical therapy interventions is to improve balance and gait of children with cerebral palsy (CP).

Action observation training is a developing rehabilitation based on mirror neurons that activate when one performs movements or observes the movements of others. It is applied to improve motor skills and learning in athletes, healthy people, and patients with motor disorders.

Although many studies have focused on the application of action observation training (AOT), especially in improving upper limb function in individuals with stroke or children with CP, there is still a lack of sufficient research examining its effects on spasticity, gross motor abilities, balance, and gait in children with CP.

There is one study comparing the effects of live and video forms of AOT on upper limb function in children with hemiparetic CP. The researchers found that live AOT was more effective than video AOT in improving upper limb performance.

To our knowledge, there are no previous studies that compare the effect of live and video forms of AOT on balance and gait in children with spastic diplegia. Addressing this gap may provide valuable insights into the optimal mode of AOT delivery for enhancing balance and gait.

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Esraa Elsayed Ali Elkiky, M.Sc; Phone Number: +20 10 92002696; Email: esraa.elkiky@gmail.com
• Study Contact Backup: Name: Mai Elsayed Abbass, PhD

Study Locations

• Egypt
  • Giza, Egypt, 12511
    • Outpatient clinic of the Faculty of physical therapy, Cairo University
    • Contact: Esraa Elsayed Ali Elkiky, M.Sc; Phone Number: +20 10 92002696; Email: esraa.elkiky@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Children of diplegia who walk by a crouch gait.
• The age of the selected children will range from 4 to 7 years old.
• Degree of spasticity will range from 1 to 1+, according to modified Ashworth scale (MAS).
• They will be selected as Level II according to Gross motor function classification system (GMFCS).
• They will be able to understand the tasks and researchers' instructions.
• Their heights are not less than 1 meter to be able to see the screen of the Biodex balance system.

Exclusion Criteria:

• Visual or auditory impairments.
• Vestibular impairments.
• Fixed deformities of the upper, lower limbs, and the spine.
• Botulinum toxin (Botox) injection for the last six months.
• Orthopedic surgeries in the last six months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: A selected physical therapy program; Fifteen children will receive one hour of a selected physical therapy program, three times per week for 3 months.	Other: A selected physical therapy program; Participants will receive a conventional physical therapy program, 3 sessions per week for 3 months. The program will include approximation exercises, balance training, functional activities (sit-to-stand, squatting, stair climbing), gait training with obstacles, walking exercises on different surfaces, and stretching exercises for the upper and lower limbs. The intervention aims to improve balance, mobility, coordination, and functional performance.
Experimental: A selected physical therapy program + Live action observation training (AOT); Fifteen children will receive 30 minutes of the same selected physical therapy program plus 30 minutes of live AOT, three times per week for 3 months.	Other: A selected physical therapy program; Participants will receive a conventional physical therapy program, 3 sessions per week for 3 months. The program will include approximation exercises, balance training, functional activities (sit-to-stand, squatting, stair climbing), gait training with obstacles, walking exercises on different surfaces, and stretching exercises for the upper and lower limbs. The intervention aims to improve balance, mobility, coordination, and functional performance.; Other: Live action observation training (AOT); Participants will receive live AOT for 30 minutes, 3 times per week, for 3 months. Each task will involve 3 minutes of observing the therapist performing the activity, followed by 3 minutes of verbal guidance and 3 minutes of task execution by the child. A 1-minute rest period will be provided between tasks.
Experimental: A selected physical therapy program + Video action observation training (AOT); Fifteen children will receive 30 minutes of the same selected physical therapy program plus 30 minutes of video AOT, three times per week for 3 months.	Other: A selected physical therapy program; Participants will receive a conventional physical therapy program, 3 sessions per week for 3 months. The program will include approximation exercises, balance training, functional activities (sit-to-stand, squatting, stair climbing), gait training with obstacles, walking exercises on different surfaces, and stretching exercises for the upper and lower limbs. The intervention aims to improve balance, mobility, coordination, and functional performance.; Other: Video action observation training (AOT); Participants will receive video-based AOT for 30 minutes, 3 times per week, for 3 months. They will observe task demonstrations presented on a computer screen from multiple viewing angles, followed by guided practice and task performance, similar to the live AOT protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Stability Index (OSI)	It will be assessed using the Biodex Balance System. Participants will stand on a dynamic platform at stability level 5 for three 30-second trials. The Overall Stability Index (OSI) will be recorded as a measure of postural stability in all directions. Lower OSI values indicate better balance control and greater postural stability.	3 months
Anteroposterior Stability Index (APSI)	It will be measured using the Biodex Balance System during dynamic balance testing. APSI reflects the participant's ability to maintain balance in the forward and backward directions. Lower APSI scores indicate improved anteroposterior postural control.	3 months
Mediolateral Stability Index (MLSI)	It will be assessed using the Biodex Balance System. MLSI evaluates the participant's ability to control balance in the side-to-side direction during dynamic standing. Lower MLSI values indicate better mediolateral stability and balance performance.	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hip Flexion Angle	It will be assessed using Kinovea motion analysis software during gait. Reflective markers will be placed on anatomical landmarks, and participants will walk at a self-selected speed while being recorded with a high-definition camera. Hip flexion will be measured during the late swing phase, corresponding to peak hip flexion. Greater hip flexion angles toward normative values will indicate improved gait kinematics.	3 months
Knee Flexion Angle	It will be evaluated using Kinovea software from recorded gait videos. Anatomical markers will be positioned on the greater trochanter, lateral femoral condyle, and lateral malleolus. Knee flexion will be measured during the terminal stance phase. Changes toward normal knee kinematics will be considered indicative of gait improvement.	3 months
Ankle Dorsiflexion Angle	It will be measured using Kinovea software during gait analysis. Reflective markers placed on the lower limb and foot will be used to calculate ankle joint kinematics. Ankle dorsiflexion will be assessed at initial contact. Increased dorsiflexion toward normal gait values will indicate improved gait performance.	3 months

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Chair: Eman Ibrahem El-Hadidy, PhD, Professor, Cairo university; Study Director: Mai Elsayed Abbass, PhD, Ass. Professor, Cairo university

Study record dates

Study Major Dates

• Study Start (Estimated): June 20, 2026
• Primary Completion (Estimated): September 20, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: June 11, 2026
• First Submitted That Met QC Criteria: June 11, 2026
• First Posted (Actual): June 16, 2026

Study Record Updates

• Last Update Posted (Actual): June 16, 2026
• Last Update Submitted That Met QC Criteria: June 11, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy
• Other Study ID Numbers: P.T.REC/012/006208

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No