Effects of Motor Imagery and Action Observation on Motor Function in Unilateral Cerebral Palsy

Mental imagery practice will be applied in addition to conventional physiotherapy. A total of 10 movements supporting activities of daily living, including unimanual and bimanual upper extremity activities, walking, and balance activities, will be practiced from both first-person and third-person perspectives.

The intervention will be administered for 50 minutes per session, twice a week, for 8 weeks. The intervention protocol will consist of 20 minutes of conventional physiotherapy followed by 30 minutes of motor imagery practice.

Participants will receive treatment for 16 sessions in total, with 2 sessions per week for 8 weeks. Each session will last 50 minutes.

The motor imagery practice will consist of a total of 10 movements including unimanual and bimanual, walking and balance activities, and will be performed by participants from both first-person and third-person perspectives.

Balance activities:

• Single-leg standing balance
• Sit and stand up with your arms crossed in front of you while sitting in the chair.

Walking activities:

• The child gets up from the chair without support, walks 3 meters, then returns and sits back down in the chair
• Walking sideways and backward on different surfaces

Bimauel upper extremity activities

• Putting on a blouse
• Putting on and zipping up/down a dress with a front zipper.
• Putting on shoes and tying the laces. Unimanual upper extremity activities
• Taking food from the plate with a spoon and putting it in the mouth
• Combing hair
• Holding the doorknob and opening

Participants will receive treatment for 16 sessions in total, with 2 sessions per week for 8 weeks. Each session will last 50 minutes.

Action observation therapy will consist of a total of 10 movements including unimanual and bimanual, walking and balance activities. After participants observe the movement (observation phase), they are asked to imitate the movement they observed (execution phase).

Balance activities:

• Single-leg standing balance
• Sit and stand up with your arms crossed in front of you while sitting in the chair.

Walking activities:

• The child gets up from the chair without support, walks 3 meters, then returns and sits back down in the chair
• Walking sideways and backward on different surfaces

Bimauel upper extremity activities

• Putting on a blouse
• Putting on and zipping up/down a dress with a front zipper.
• Putting on shoes and tying the laces. Unimanual upper extremity activities
• Taking food from the plate with a spoon and putting it in the mouth

Manual ability in daily activities assessed using the ABILHAND-Kids questionnaire for children with cerebral palsy (measured as logit score using Rasch analysis). ABILHAND-Kids evaluates the child's perceived difficulty in performing daily bimanual activities, such as dressing (buttons, zippers), eating with utensils, using scissors or pencils, opening containers, handling small objects. Contains a list of everyday manual tasks Each item is rated based on difficulty: Impossible, difficult, easy. Higher scores indicate better manual ability.

Time Frame: 8 weeks

Hand function assessed using the Jebsen-Taylor Hand Function Test (JTHFT), a standardized measure of fine and gross motor hand function during simulated activities of daily living. The test consists of seven subtests, including writing, page turning, lifting small objects, simulated feeding, stacking, and lifting light and heavy objects. Performance is measured as completion time in seconds for each subtest and total test time using a stopwatch. Measurement method: Each task is performed as quickly as possible. Time is measured in seconds with a stopwatch. Each task is recorded separately. Scoring system: Time elapsed for each subtest (in seconds) is used. Total score: sum of subtest times or total time separately for each hand.

Lower completion time indicates better hand function.