Mirror Therapy in Children With Hemiparetic Cerebral Palsy

Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder resulting from injury to the developing brain and is characterized by impairments in movement, posture, and motor function. Children with hemiparetic CP commonly experience unilateral upper extremity weakness, impaired selective motor control, reduced hand function, decreased grip strength, and limitations in activities of daily living. These impairments negatively affect functional independence and quality of life.

Mirror therapy is a low-cost, non-invasive rehabilitation approach based on the principles of neuroplasticity and motor learning. By creating the visual illusion that the affected upper limb is moving normally through the reflection of the unaffected limb, mirror therapy is thought to enhance cortical activation and facilitate motor recovery. Although originally developed for phantom limb pain, mirror therapy has been increasingly applied in neurological rehabilitation and has demonstrated promising effects on upper extremity function.

Several studies have investigated mirror therapy in children with cerebral palsy and reported improvements in hand function and motor performance. However, considerable variation exists in treatment protocols, including intervention duration, exercise content, and comparison groups, limiting the generalizability of the findings. In addition, few studies have incorporated a sham-controlled design, making it difficult to distinguish the specific therapeutic effects of mirror therapy from nonspecific treatment effects.

The present randomized, sham-controlled clinical trial aims to evaluate the effectiveness of mirror therapy combined with conventional physiotherapy in children with hemiparetic CP. Participants will be randomly assigned to either an experimental group receiving mirror therapy in addition to conventional physiotherapy or a control group receiving sham mirror therapy together with the same conventional physiotherapy program.

Upper extremity outcomes will be evaluated before and after an 8-week intervention period using validated assessment tools, including the Selective Control of the Upper Extremity Scale (SCUES), ABILHAND-Kids questionnaire, hand grip strength measured with a Jamar dynamometer, and manual dexterity assessed with the Nine-Hole Peg Test. Baseline motor ability and muscle tone will be documented using the Manual Ability Classification System (MACS) and the Modified Ashworth Scale.

This study is expected to provide higher-quality evidence regarding the effectiveness of mirror therapy by using a standardized intervention protocol and a sham-controlled design. The findings may contribute to the development of evidence-based rehabilitation strategies aimed at improving upper extremity motor control, hand function, and functional independence in children with hemiparetic CP.