Hemiplegic Cerebral PalsyNCT07739069
Action Observation Versus Mirror Therapy in Children With Spastic Hemiplegic Cerebral Palsy
A study testing Mirror Therapy and Action Observation Therapy in people with Hemiplegic Cerebral Palsy, run by Cairo University at 1 site in Egypt.
Trial summary
The goal of this clinical trial is to compare the effects of Action Observation therapy and Mirror therapy on hand grip strength and upper extremity function in children with hemiplegic cerebral palsy. Read more about this study
- Who is it for?
- Ages 5 to 10 years
- Conditions the study is for
- Hemiplegic Cerebral Palsy
- What is being tested?
- Mirror Therapy and Action Observation Therapy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 36 participants
- Where
- 1 siteEgypt
- Study dates
- 1 Aug 2026to Nov 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 5 to 10 years
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- 1- Children diagnosed with spastic hemiplegic CP. 2- Their ages between 5-10 years. 3- Lack of use of the affected upper limb. 4- They will be at level II-III of the Manual Ability Classification System (MACS) 5- The will be at level I-II in the Gross Motor Function Classification System (GMFCS) 6- They will be graded 1 to 1+ in the affected U.L. on Modified Ashworth's Scale 7- The children should be capable of understanding and following instructions.
Who cannot join
- The children will be excluded if they have one of the following:
- Children with fixed contracture in the affected U.L.
- Injection of botulinum toxin into the upper limb muscles during the previous 6 months.
- Visual or Auditory disorders.
- Upper limb surgery in the last one year.
- Epilepsy.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Egypt1 site
outpatient clinic of Faculty of Physical Therapy, Cairo University & outpatient clinic of Faculty of Physical Therapy, Misr University for Science and Technology, Egypt
Giza, 12512
Nihal Emad, Demonstrator, 01148858954, nnihalns98@gmail.com
Nihal Abo-elenin, Demonstrator, +20 10 30512588, nihal.emad@must.edu.eg
About this study
Official title: ACTION OBSERVATION VERSUS MIRROR THERAPY ON UPPER EXTREMITY FUNCTIONS IN CHILDREN WITH SPASTIC HEMIPLEGIC CEREBRAL PALSY
The goal of this clinical trial is to compare the effects of Action Observation therapy and Mirror therapy on hand grip strength and upper extremity function in children with hemiplegic cerebral palsy.
Participants will be randomly assigned into two study groups of equal numbers:
A group will receive traditional physical therapy program followed by mirror therapy protocol 3 times/ week for 12 weeks.
Another group will receive the same traditional physical therapy program in addition exercises using action observation therapy, 3 times/week for 12 weeks.
Then, the effect of both treatments will be compared between the two groups.
Read the detailed description
Hemiplegia is one of the most common movement disorders among children. It occurs in approximately 2.11 out of every 1000 live births. In hemiplegia, one side of the body is affected and the upper limb is usually more affected than the lower limb. Children with hemiplegic CP typically present with impaired selective motor control in the wrist, hand, and fingers. Common deformities include elbow and wrist flexion, thumb-in-palm deformity, and forearm pronation, which reduce the ability to reach, grasp, release, and manipulate objects. Many children compensate by relying on their non-affected hand, leading to developmental disregard of the weaker arm. Impaired upper limb (UL) function affects independence, participation, and quality of life and require effective rehabilitation. Innovative rehabilitation methods that harness neuroplasticity, such as Mirror Therapy (MT) and Action Observation Therapy (AOT), have been increasingly investigated. Both approaches are based on the activation of the mirror neuron system, which plays a key role in motor learning and motor recovery. Mirror Therapy, which is based on visual stimulation from the movements of unaffected limbs, has shown promising results for sensory and upper extremity motor performance of children with hemiplegic CP. Similarly, AOT, which involves observation of purposeful actions with the intention to imitate and then performing those actions, had a significant improvement on grip power, hand function, activities, and participation in activity of daily living in hemiplegic CP children. However, despite the evidence supporting both interventions individually, there is limited research directly comparing their relative effectiveness. Thus, a comparison of MT and AOT is important for a number of reasons. First, it could help clinicians prioritize therapy choices by clarifying whether one intervention results in better improvements in motor outcomes. Second, it will help develop a more sophisticated understanding of how to best utilize various mirror neuron system engagement modalities for pediatric neuro-rehabilitation. Findings may also help create accessible, affordable, and interesting treatment plans that can be incorporated into home-based rehabilitation programs and clinical settings, ultimately enhancing the lives of kids with cerebral palsy and their families.
- Conditions
- Hemiplegic Cerebral Palsy
- Being tested
- Mirror Therapy, Action Observation Therapy
- Keywords
- Hemiplegic Cerebral Palsy, Mirror Therapy, Action Observation Therapy
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mirror TherapyBehavioural
Participants will receive 45-minute mirror therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During mirror therapy, the child will be seated with a mirror positioned in the midsagittal plane to reflect movements of the unaffected upper limb while concealing the affected upper limb, creating the visual illusion of normal movement in the affected limb. Children will observe the reflected movements while simultaneously attempting to perform the same functional tasks with the affected upper limb. The intervention includes task-oriented upper extremity activities such as object transfer, grasp and release, coin placement, ball gripping, card turning, circle drawing, block building, and water pouring.
Action Observation TherapyBehavioural
Participants will receive 45-minute action observation therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During each session, children will observe videos demonstrating goal-directed upper extremity activities matched to their functional level, followed by performance of the same activities using the affected upper limb under therapist supervision. The intervention includes task-oriented activities such as block transfer, line drawing, card turning, coin placement, cup stacking, ball squeezing, water pouring and drinking, and moving beverage cans. Video demonstrations are presented from multiple viewing angles to facilitate motor learning and action observation.
| Study group | Role | What they receive |
|---|---|---|
| Action Observation Therapy Group | Experimental | Participants will receive conventional physical therapy program for 45 minutes followed by 45 minutes of action observation therapy, three times per week for 12 weeks.. Receives: Behavioral: Action Observation Therapy |
| Mirror Therapy Group | Active comparator | Participants will receive the same conventional physical therapy program for 45 minutes followed by 45 minutes of mirror therapy, three times per week for 12 weeks. Receives: Behavioral: Mirror Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
gross manual dexterity
Hand dexterity will be assessed using the Box and Block Test by recording the number of blocks transferred from one compartment to the other within 60 seconds.
Measured: After 12 Weeks
Secondary outcomes (2)
Spontaneous Functional Analysis (SFA) of the Shriners Hospital Upper Extremity Evaluation (SHUEE)
The SFA evaluates the child's spontaneous use of the affected upper limb while performing standardized functional tasks, with higher scores indicating better spontaneous functional use.
Measured: After 12 weeks
Grip strength assessed using a hand dynamometer
Grip strength of the affected hand will be measured using a calibrated hand dynamometer. The maximum voluntary grip strength will be recorded in kilograms (kg), with higher values indicating greater grip strength.
Measured: After 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Jul 2026
- Study start1 Aug 2026 (estimated)
- Primary completion30 Sep 2026 (estimated)
- Study completionNov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Hemiplegic Cerebral PalsyStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Eligible participants will be randomly assigned in a 1:1 ratio to one of two intervention groups. The mirror therapy group will receive a conventional physical therapy program followed by 45 minutes of mirror therapy, while the action observation therapy group will receive the same conventional physical therapy program followed by 45 minutes of action observation therapy. Both groups will receive treatment three times per week for 12 weeks. Outcomes will be compared between the two groups to evaluate the effectiveness of the interventions in children with hemiplegic cerebral palsy.
- Masking
- None (open label)
- Enrolment
- 36 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Nihal Emad, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07739069
- Sponsor's protocol ID
- P.T.Rec/012/006210
- Status last verified
- Jul 2026
- First submitted
- 28 Jul 2026
- Last updated
- 31 Jul 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 31 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- ACTION OBSERVATION VERSUS MIRROR THERAPY ON UPPER EXTREMITY FUNCTIONS IN CHILDREN WITH SPASTIC HEMIPLEGIC CEREBRAL PALSY
- ClinicalTrials.gov ID
- NCT07739069
- Acronym / sponsor ID
- P.T.Rec/012/006210
- Conditions
- Hemiplegic Cerebral Palsy
- Keywords
- Hemiplegic Cerebral Palsy, Mirror Therapy, Action Observation Therapy
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 36 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 1 Aug 2026 (estimated)
- Primary completion
- 30 Sep 2026 (estimated)
- Study completion
- Nov 2026 (estimated)
- First posted
- 31 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to compare the effects of Action Observation therapy and Mirror therapy on hand grip strength and upper extremity function in children with hemiplegic cerebral palsy.
Participants will be randomly assigned into two study groups of equal numbers:
A group will receive traditional physical therapy program followed by mirror therapy protocol 3 times/ week for 12 weeks.
Another group will receive the same traditional physical therapy program in addition exercises using action observation therapy, 3 times/week for 12 weeks.
Then, the effect of both treatments will be compared between the two groups.
Detailed description
Hemiplegia is one of the most common movement disorders among children. It occurs in approximately 2.11 out of every 1000 live births. In hemiplegia, one side of the body is affected and the upper limb is usually more affected than the lower limb. Children with hemiplegic CP typically present with impaired selective motor control in the wrist, hand, and fingers. Common deformities include elbow and wrist flexion, thumb-in-palm deformity, and forearm pronation, which reduce the ability to reach, grasp, release, and manipulate objects. Many children compensate by relying on their non-affected hand, leading to developmental disregard of the weaker arm. Impaired upper limb (UL) function affects independence, participation, and quality of life and require effective rehabilitation. Innovative rehabilitation methods that harness neuroplasticity, such as Mirror Therapy (MT) and Action Observation Therapy (AOT), have been increasingly investigated. Both approaches are based on the activation of the mirror neuron system, which plays a key role in motor learning and motor recovery. Mirror Therapy, which is based on visual stimulation from the movements of unaffected limbs, has shown promising results for sensory and upper extremity motor performance of children with hemiplegic CP. Similarly, AOT, which involves observation of purposeful actions with the intention to imitate and then performing those actions, had a significant improvement on grip power, hand function, activities, and participation in activity of daily living in hemiplegic CP children. However, despite the evidence supporting both interventions individually, there is limited research directly comparing their relative effectiveness. Thus, a comparison of MT and AOT is important for a number of reasons. First, it could help clinicians prioritize therapy choices by clarifying whether one intervention results in better improvements in motor outcomes. Second, it will help develop a more sophisticated understanding of how to best utilize various mirror neuron system engagement modalities for pediatric neuro-rehabilitation. Findings may also help create accessible, affordable, and interesting treatment plans that can be incorporated into home-based rehabilitation programs and clinical settings, ultimately enhancing the lives of kids with cerebral palsy and their families.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Eligible participants will be randomly assigned in a 1:1 ratio to one of two intervention groups. The mirror therapy group will receive a conventional physical therapy program followed by 45 minutes of mirror therapy, while the action observation therapy group will receive the same conventional physical therapy program followed by 45 minutes of action observation therapy. Both groups will receive treatment three times per week for 12 weeks. Outcomes will be compared between the two groups to evaluate the effectiveness of the interventions in children with hemiplegic cerebral palsy.
| Arm | Type | Receives |
|---|---|---|
| Action Observation Therapy Group | Experimental | Behavioral: Action Observation TherapyParticipants will receive conventional physical therapy program for 45 minutes followed by 45 minutes of action observation therapy, three times per week for 12 weeks.. |
| Mirror Therapy Group | Active comparator | Behavioral: Mirror TherapyParticipants will receive the same conventional physical therapy program for 45 minutes followed by 45 minutes of mirror therapy, three times per week for 12 weeks. |
Who may qualify
- Ages
- 5 to 10 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (1 listed)
- 1- Children diagnosed with spastic hemiplegic CP. 2- Their ages between 5-10 years. 3- Lack of use of the affected upper limb. 4- They will be at level II-III of the Manual Ability Classification System (MACS) 5- The will be at level I-II in the Gross Motor Function Classification System (GMFCS) 6- They will be graded 1 to 1+ in the affected U.L. on Modified Ashworth's Scale 7- The children should be capable of understanding and following instructions.
Key exclusion criteria (6 listed)
- The children will be excluded if they have one of the following:
- Children with fixed contracture in the affected U.L.
- Injection of botulinum toxin into the upper limb muscles during the previous 6 months.
- Visual or Auditory disorders.
- Upper limb surgery in the last one year.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mirror TherapyParticipants will receive 45-minute mirror therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During mirror therapy, the child will be seated with a mirror positioned in the midsagittal plane to reflect movements of the unaffected upper limb while concealing the affected upper limb, creating the visual illusion of normal movement in the affected limb. Children will observe the reflected movements while simultaneously attempting to perform the same functional tasks with the affected upper limb. The intervention includes task-oriented upper extremity activities such as object transfer, grasp and release, coin placement, ball gripping, card turning, circle drawing, block building, and water pouring. | Behavioural | Mirror Therapy Group |
| Action Observation TherapyParticipants will receive 45-minute action observation therapy sessions in addition to the traditional physical therapy program, three sessions per week for 12 consecutive weeks. During each session, children will observe videos demonstrating goal-directed upper extremity activities matched to their functional level, followed by performance of the same activities using the affected upper limb under therapist supervision. The intervention includes task-oriented activities such as block transfer, line drawing, card turning, coin placement, cup stacking, ball squeezing, water pouring and drinking, and moving beverage cans. Video demonstrations are presented from multiple viewing angles to facilitate motor learning and action observation. | Behavioural | Action Observation Therapy Group |
Primary outcome
gross manual dexterity
Time frame: After 12 Weeks
Hand dexterity will be assessed using the Box and Block Test by recording the number of blocks transferred from one compartment to the other within 60 seconds.
2 secondary outcomes
Spontaneous Functional Analysis (SFA) of the Shriners Hospital Upper Extremity Evaluation (SHUEE)
Time frame: After 12 weeks
Grip strength assessed using a hand dynamometer
Time frame: After 12 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 31 Jul 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
outpatient clinic of Faculty of Physical Therapy, Cairo University & outpatient clinic of Faculty of Physical Therapy, Misr University for Science and Technology, Egypt
Giza, Egypt
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mirror Therapy and Action Observation Therapy in people with Hemiplegic Cerebral Palsy, run by Cairo University at 1 site in Egypt.
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 1 inclusion and 6 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: opening soon, as of the sponsor's last update on 31 Jul 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 Egypt. 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?
Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
gross manual dexterity (time frame: After 12 Weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 31 Jul 2026.