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Cerebral Palsy (CP)NCT07612371

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

A study testing motor imagery, Action observation therapy and Conventional physiotherapy group in people with Cerebral Palsy (CP), run by Bahçeşehir University at 1 site in Turkey (Türkiye).

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The aim of this study is to evaluate the effects of action observation therapy and motor imagery methods, provided in addition to a conventional physiotherapy and rehabilitation program, on gross motor function, upper and lower extremity functional skills, and quality of life in children with cerebral palsy. Read more about this study

Who is it for?
Ages 7 to 16 years
Conditions the study is for
Cerebral Palsy (CP)
What is being tested?
motor imagery, Action observation therapy and Conventional physiotherapy group
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
1 siteTurkey (Türkiye)
Study dates
15 May 2026to Oct 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 7 to 16 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Being between 7 and 16 years of age
  • Having a diagnosis of unilateral cerebral palsy made by a pediatric neurologist
  • Being classified at levels I-II of the Gross Motor Function Classification System (GMFCS)
  • Scoring above 24 on the Mini-Mental State Examination for Children
  • Having no cognitive impairments (i.e., possessing an appropriate cognitive level to follow task instructions)
  • Willingness to participate in the study (child and family)
  • Being classified at levels I-III of the Manual Ability Classification System (MACS) -Being classified at levels I-III of the Communication Function Classification System (CFCS) -

Who cannot join

  • Children with uncontrolled seizures
  • Children who have received motor imagery training or action observation therapy within the last 6 months
  • Children with contractures
  • Children with severe visual and/or hearing impairments
  • Being classified at levels III, IV, or V according to the GMFCS
  • Scoring below 24 on the Mini-Mental State Examination for Children
  • Being classified at levels IV-V of the Manual Ability Classification System (MACS)
  • Having undergone orthopedic surgery or botulinum toxin (Botox) treatment within the last 6 months

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Turkey (Türkiye)1 site, 1 recruiting
  • Kurtkoy Ozel Egitim ve Rehabilitasyon Merkezi

    Istanbul

    Burak Yaşar, +905050181505, bynsunal@gmail.com

    Betul Unal, PhD (C)

    Recruiting

Other trials in Turkey (Türkiye)

About this study

Official title: Investigation of the Effects of Motor Imagery and Action Observation Therapy on Gross Motor Function, Upper Extremity Functional Skills, Activity, and Participation in Children With Unilateral Cerebral Palsy

The aim of this study is to evaluate the effects of action observation therapy and motor imagery methods, provided in addition to a conventional physiotherapy and rehabilitation program, on gross motor function, upper and lower extremity functional skills, and quality of life in children with cerebral palsy.

Read the detailed description

In children with unilateral cerebral palsy (CP), the ability to perform various hand activities is reduced. Sensory and motor impairments observed in the affected upper extremity are the main causes of functional limitations. These impairments restrict the ability to perform simple activities of daily living such as dressing, tooth brushing, hair combing, feeding, and playing, and also lead to limitations in activity and participation within a broader social context. Therefore, one of the primary goals of neurological rehabilitation in this population is to promote the effective use of the affected upper extremity in daily tasks by improving its capacity and performance, and to support the child's independence in daily living activities by enhancing skills and increasing participation in activities. However, approximately 75% of children with unilateral CP continue to demonstrate motor impairments in activities of daily living even when they participate in a comprehensive rehabilitation program including conventional physical therapy, orthotic use, and spasticity management. There is a need for new rehabilitation programs aimed at enhancing the effects of traditional treatments, which mainly involve motor interventions.

In CP rehabilitation, it is recommended to integrate motor training with environmental enrichment and to increase environmental stimuli in order to enhance task performance. These approaches are based on the implementation of real-life activity-based tasks through active movements, with high intensity and individualized goals. In this way, neuroplasticity is supported through attention, motivation, and intensive repetition. Furthermore, it is recommended that activity- and task-oriented motor training be complemented with cognitive interventions such as action observation therapy, motor imagery, and mirror therapy, which combine motor and cognitive rehabilitation approaches.

Motor imagery is the mental simulation of movement without any overt motor action and refers to the capacity to generate kinesthetic representations of motor actions. Motor imagery selectively stimulates the cognitive aspect of motor behavior and is considered a prerequisite for motor planning processes. Recent studies have shown that despite motor deficits related to movement execution in children with CP, the ability to imagine movements may remain preserved. Therefore, interventions focusing on motor planning and imagery have emerged as potential treatment options for CP. However, the number of studies investigating the effectiveness of motor imagery in the CP population is quite limited, and well-designed studies examining the effectiveness of motor imagery training in individuals with CP are needed.

Action Observation Therapy (AOT) is known to be a cognitive intervention used to improve various motor skills in patients with motor impairments. From a rehabilitation perspective, the mirror neuron system plays a major role in the human capacity to learn through imitation. Based on the mirror neuron system, action observation consists of systematically and repeatedly observing actions followed by the reproduction of the observed actions. Findings from studies using AOT have indicated that AOT improves activities of daily living and has been proposed as a novel neurophysiological approach focused on motor learning in CP rehabilitation. Nevertheless, well-designed studies investigating the effectiveness of action observation training in individuals with CP are still needed.

The aim of this study is to evaluate the effects of Action Observation Therapy and motor imagery methods, provided in addition to conventional rehabilitation, on gross motor function, upper and lower extremity functional skills, and quality of life in children with CP.

Being tested
motor imagery, Action observation therapy, Conventional physiotherapy group
Keywords
motor imagery, Mirror Neurons, quality of life, Cognitive Training
Medical subject headings
Cerebral Palsy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • motor imageryOther

    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
  • Action observation therapyOther

    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
  • Conventional physiotherapy groupOther

    Participants will receive treatment for 16 sessions in total, with 2 sessions per week for 8 weeks. Each session will last 50 minutes. Conventional physiotherapy training will be structured according to the child's symptoms and needs, and will consist of stretching, strengthening, normal walking training, postural control training, and weight-bearing training in different positions (sitting, standing, side-lying, prone).

Study groups in NCT07612371
Study groupRoleWhat they receive
Motor Imagery GroupActive comparatorMental 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.
Receives: Other: motor imagery
Action Observation Therapy Group:Active comparatorAction observation therapy will be applied in adition 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. In action observation therapy, after participants observe the movement (observation phase), they will be asked to imitate the observed movement (execution phase). 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 action observation therapy.
Receives: Other: Action observation therapy
Conventional physiotherapy groupActive comparatorConventional physiotherapy training will be structured according to the child's symptoms and needs, and will consist of stretching, strengthening, normal walking training, postural control training, and weight-bearing training in different positions (sitting, standing, side-lying, prone).
Receives: Other: Conventional physiotherapy group

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. ABILHAND-Kids

    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

    Measured: 0th week; 8th week

Secondary outcomes (6)
  1. Pediatric Quality of Life Inventory (PedsQL)

    Quality of life assessed using the Pediatric Quality of Life Inventory (PedsQL) 3.0 Cerebral Palsy Module Child and Parent Reports. The 35-item questionnaire evaluates daily activities, school activities, movement and balance, pain, fatigue, eating activities, and speech and communication in children with cerebral palsy. Items are scored on a 5-point Likert scale and transformed to a 0-100 scale. Higher scores indicate better quality of life.

    Measured: 0th week; 8th week

  2. Jebsen-Taylor Hand Function Test

    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.

    Measured: 0th week; 8th week

  3. The Child and Adolescent Scale of Participation (CASP)

    The CASP questionnaire assesses an individual's community participation in home, school, and neighborhood settings. It consists of 20 questions in total, with 4 sub-sections: Home participation (6 questions), neighborhood and community participation (4 questions), school Participation (5 questions), and home and community activities (5 questions). Scoring system: 4 = expected for their age (full participation), 3= somewhat limited, very limited, 2=unable, and 1=not applicable. Total and/or domain scores are calculated, and scores transformed to a standardized 0-100 scale. Higher scores indicate better levels of participation in daily life activities.

    Measured: 0th week; 8th week

  4. Gross Motor Function Measure (GMFM)

    Gross motor function assessed using the Gross Motor Function Measure (GMFM-88), a standardized assessment tool for children with cerebral palsy. The scale consists of 88 items across five domains: lying and rolling, sitting, crawling and kneeling, standing, and walking/running/jumping. Items are scored on a 4-point Likert scale according to the child's level of performance. Total scores range from 0 to 264, with higher scores indicating better gross motor function.

    Measured: 0th week; 8th week

  5. Timed Up and Go Test

    Functional mobility assessed using the Timed Up and Go Test (TUG). Participants are instructed to stand up from a chair, walk 3 meters, turn around, return to the chair, and sit down. Completion time is measured in seconds using a stopwatch. Lower completion times indicate better functional mobility.

    Measured: 0th week; 8th week

  6. Five Times Sit-to-Stand Test

    Lower extremity functional strength assessed using the Five Times Sit-to-Stand Test (5xSTS). Participants are instructed to stand up and sit down five times as quickly as possible from a standard chair without using upper extremity support. Completion time is measured in seconds using a stopwatch. Lower completion times indicate better functional performance.

    Measured: 0th week; 8th week

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 May 2026
  2. Study start15 May 2026
  3. Primary completionOct 2026 (estimated)
  4. Study completionOct 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Three groups with a conventional therapy control group
Masking
None (open label)
Enrolment
48 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07612371
Sponsor's protocol ID
E-78097791-020-5100
Status last verified
May 2026
First submitted
15 May 2026
Last updated
28 May 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: IPD will be made available upon reasonable request after publication of the study results. Requests will be evaluated and approved by the principal investigator to ensure that the proposed use is methodologically sound and in accordance with ethical and institutional regulations. Data will be shared for academic and non-commercial research purposes only.

Publications

  • Steenbergen B, Jongbloed-Pereboom M, Spruijt S, Gordon AM. Impaired motor planning and motor imagery in children with unilateral spastic cerebral palsy: challenges for the future of pediatric rehabilitation. Dev Med Child Neurol. 2013 Nov;55 Suppl 4:43-6. doi: 10.1111/dmcn.12306.

    PubMed 24237279
  • Sgandurra G, Ferrari A, Cossu G, Guzzetta A, Fogassi L, Cioni G. Randomized trial of observation and execution of upper extremity actions versus action alone in children with unilateral cerebral palsy. Neurorehabil Neural Repair. 2013 Nov-Dec;27(9):808-15. doi: 10.1177/1545968313497101. Epub 2013 Jul 25.

    PubMed 23886886
  • Alamer A, Melese H, Adugna B. Effectiveness of Action Observation Training on Upper Limb Motor Function in Children with Hemiplegic Cerebral Palsy: A Systematic Review of Randomized Controlled Trials. Pediatric Health Med Ther. 2020 Sep 15;11:335-346. doi: 10.2147/PHMT.S266720. eCollection 2020.

    PubMed 32982541
  • Demeco A, Molinaro A, Ambroggi M, Frizziero A, Fazzi E, Costantino C, Buccino G. Cognitive approaches in the rehabilitation of upper limbs function in children with cerebral palsy: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2024 Jun;60(3):445-457. doi: 10.23736/S1973-9087.24.08288-1. Epub 2024 Mar 21.

    PubMed 38512713
  • Shin YK, Lee DR, Hwang HJ, You SJ, Im CH. A novel EEG-based brain mapping to determine cortical activation patterns in normal children and children with cerebral palsy during motor imagery tasks. NeuroRehabilitation. 2012;31(4):349-55. doi: 10.3233/NRE-2012-00803.

    PubMed 23232157
  • Buccino G, Molinaro A, Ambrosi C, Arisi D, Mascaro L, Pinardi C, Rossi A, Gasparotti R, Fazzi E, Galli J. Action Observation Treatment Improves Upper Limb Motor Functions in Children with Cerebral Palsy: A Combined Clinical and Brain Imaging Study. Neural Plast. 2018 Jul 4;2018:4843985. doi: 10.1155/2018/4843985. eCollection 2018.

    PubMed 30123250

Questions about this trial

What is this clinical trial studying?

A study testing motor imagery, Action observation therapy and Conventional physiotherapy group in people with Cerebral Palsy (CP), run by Bahçeşehir University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 28 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Betul Unal (+905314070105, betul.unal1@bahcesehir.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

ABILHAND-Kids (time frame: 0th week; 8th week). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07612371, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 May 2026.

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