The Effect of Upper Extremity Mirror Therapy on Cerebral Re-organization, Functional Motor Skills, Daily Life Activities and Health Related Quality of Life in Children With Spastic Hemiplegic Cerebral Palsy
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Spastic Hemiplegic Cerebral Palsy
- Sponsor
- Hacettepe University
- Enrollment
- 10
- Locations
- 1
- Primary Endpoint
- Functional Magnetic Resonance Imaging (fMRI)
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
The purpose of this study is to investigate brain reorganization, functional motor development, level of daily living activity and quality of life of upper extremity mirror therapy in children with spastic hemiplegic cerebral palsy. Several studies have reported increased use of the affected arm following rearrangement of cerebral re-organization with mirror therapy. The investigator's study is the first of its kind and was planned to evaluate the effectiveness of upper extremity mirror therapy in cerebral reorganization and functional motor skills in children with spastic hemiplegic cerebral palsy. Hypothesis of this study is that mirror therapy improves brain re-organisation, functional motor skills and daily living activities in unilateral spastic CP.
Detailed Description
Cerebral palsy (CP) is the most common neurodisability in children. It has been defined as a disorder of movement and posture due to a defect or lesion of the immature brain and as a group of non-progressive, but often changing motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development. Characteristically, children with unilateral cerebral palsy (CP) have one well-functioning hand and one impaired hand.Common features of the hemiplegic hand are slowness, abnormal muscle tone, decreased strength, and coordination difficulties, which occur to a varying extent in children independently of age. Many children also have impaired sensibility and mirror movements. Perhaps most importantly, children with unilateral CP hav e varying degrees of limitation in their ability to handle objects in daily life. This limitation is most obvious insituations where two hands are needed. However, knowledge about bimanual ability in chil dren with unilateral CP and its development over time is scarce at present. To improve upper extremity function in children with unilateral CP, the mirror therapy is a promising approach. Mirror therapy for the first time, Ramachandran et al. has described for the treatment of phantom pain in amputee. Also in unilateral spastic CP mirror therapy have indicated that visual illusion of functional limb provided by mirror can support healing. By means of visual feedback, modified vision and perception is stimulated plasticity the premotor cortex and developed re-organization. In the current studies, mirror therapy in hemiplegic patients, have been shown that improve the function and reduce the sensitivity of the hemi neglect. Gygax et al. have investigated the effects of mirror therapy on upper extremity function 10 children with unilateral spastic CP between 6-14 years. Consequently, the spontaneous use affected hand, the maximum grip force increase of 15% and is demonstrated that improve the upper extremity motor function.
Investigators
Duygu Korkem
Researcher
Hacettepe University
Eligibility Criteria
Inclusion Criteria
- •Congenital spastic hemiplegic cerebral palsy,
- •Between the ages of 4-18,
- •Continuing physiotherapy and rehabilitation program throughout the study.
Exclusion Criteria
- •Upper extremity fracture or muscle-tendon and bone operation shortly before 6 months,
- •Any pharmacologic agent that will inhibit spasticity within 6 months,
- •Visual function disorder except eye fracture defect
Outcomes
Primary Outcomes
Functional Magnetic Resonance Imaging (fMRI)
Time Frame: change from baseline brain reorganization at 8 weeks
Brain reorganization was assessed by functional magnetic resonance imaging (fMRI).Being a non-invasive method, FMRI is nowadays the most common method used to map the neural activity of the human brain. fMRI is also used to describe patterns of cortical activation in children and adults with brain lesions
Quality of upper extremity skills assessment (QUEST)
Time Frame: change from baseline upper extremity skills at 8 weeks
Quality of upper extremity skills assessment was be assessed by Quality of Upper Extremity Skills Test (QUEST). The test evaluates that handcraft and the quality of the movement in children with CP.This is an objective standardized measure evaluating the quality of upper extremity function in 4 domains: dissociated movement, grasp, protective extension, and weight bearing. Scores for the QUEST are calculated as percentages with a maximum score of 100.
Secondary Outcomes
- Functional independence measure (WeeFIM)(change from baseline functional independence at 8 weeks)
- Child Health Questionnaire Parent Form 50 Questions (CHQ-PF50)(change from baseline quality of life at 8 weeks)