Comparison of Synchronous and Asynchronous Action Observation Therapy in Children With Cerebral Palsy

NCT ID: NCT07114731

Last Updated: 2025-08-14

Basic Information

• Recruitment Status: ENROLLING_BY_INVITATION
• Clinical Phase: NA
• Total Enrollment: 26 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-05-26
• Study Completion Date: 2025-09-20

Brief Summary

The aim of this study is to compare the effects of synchronous and asynchronous action observation therapy (AOT) on balance, gait, and functional capacity in children with cerebral palsy (CP). CP is a neurodevelopmental disorder characterized by impairments in motor skills, particularly motor control and postural balance. By examining the contributions of synchronous (real-time) and asynchronous (delayed) AOT methods to motor performance, this study seeks to identify the most effective therapeutic approach for this population.

Detailed Description

Cerebral palsy (CP) is defined as a non-progressive neurological disorder that arises during fetal development, the neonatal period, or early childhood and results in permanent motor impairments. Lesions in the central nervous system of children with CP lead to a range of musculoskeletal, neuromuscular, and sensory system problems, causing postural abnormalities, balance and coordination deficits, and limitations in mobility. These impairments significantly reduce independence in activities of daily living.

Various therapeutic approaches are utilized in the rehabilitation process to improve the functional independence of children with CP. According to the International Classification of Functioning, Disability and Health (ICF), rehabilitation interventions should be grounded in neuroplasticity-based principles to maximize functional outcomes. One such neuroplasticity-based approach that has gained increasing attention in recent years is Action Observation Therapy (AOT).

AOT is based on the mirror neuron theory, which posits that observing an action activates similar neural regions in the cerebral cortex as performing the action itself. This simultaneous activation facilitates action understanding, imitation, and motor learning, suggesting that AOT may be an effective intervention to enhance motor function in individuals with CP. Improving motor functions in children with CP is crucial to enhancing their participation in daily life activities and overall quality of life. In addition to conventional physiotherapy interventions, AOT has emerged in recent years as an effective rehabilitation strategy that supports neuroplasticity. AOT facilitates motor learning and skill acquisition by targeting the brain's mirror neuron system.

Although there is substantial evidence in the literature demonstrating that AOT improves upper extremity functions, studies systematically comparing its effects on balance, gait, and general functional capacity remain limited. In particular, the differential effects of synchronous and asynchronous AOT applications on various motor outcomes have not yet been thoroughly investigated. Understanding the mechanisms of action of these two approaches may contribute to the development of more individualized and tailored treatment programs for children with CP.

Moreover, the low cost and easy applicability of AOT increase its potential for clinical use. Therefore, the findings of this study could enhance the effectiveness of rehabilitation programs, offering more accessible treatment alternatives for both healthcare professionals and families. To address this gap in the literature, the present study aims to comprehensively investigate the effects of synchronous and asynchronous AOT on motor functions in children with CP.

In this study, both groups will receive neurodevelopmental treatment (NDT) for 20 minutes as part of their intervention program. In addition, participants in the synchronous AOT group will observe exercise videos divided into four components (1. Sitting posture and sit-to-stand exercises; 2. Weight-shifting exercises; 3. Balance exercises; 4. Gait exercises) and perform the observed movements simultaneously in real time. Conversely, the asynchronous AOT group will first observe each of these video segments for 3 minutes and then perform the corresponding exercises sequentially after observation. Each session will last 45 minutes, conducted twice a week for 8 weeks.

The exercise videos were developed to include 12 task-oriented exercises tailored to the GMFCS level and extremity involvement of the children. The exercises are designed with varying levels of difficulty to enhance functional skills and lower extremity performance.

Conditions

Cerebral Palsy (CP); Spastic Diplegia Cerebral Palsy; Spastic Hemiplegic Cerebral Palsy; Neurodevelopmental Disorder (Diagnosis); Action Observation; Action Observation Therapy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Neurodevelopmental treatment (NDT) + Synchronous Action Observation Therapy (AOT) Group

Participants in this group will receive a 20-minute Neurodevelopmental Training (NDT) session followed by synchronous Action Observation Therapy (AOT). The AOT component consists of four video modules:

1. Sitting position + Sit-to-Stand exercises

2. Weight-shifting exercises

3. Balance exercises

4. Walking exercises

Participants will observe the videos in real-time and perform the movements simultaneously. The intervention will last for 8 weeks, with sessions conducted twice weekly for 45 minutes each.

Group Type: EXPERIMENTAL

Synchronous Action Observation Therapy

Intervention Type: OTHER

Real-time observation and execution of motor tasks through structured video modules designed based on participants' GMFCS level and extremity involvement.

Neurodevelopmental treatment (NDT) + Asynchronous Action Observation Therapy (AOT) Group

Participants in this group will receive the same 20-minute NDT session followed by asynchronous Action Observation Therapy (AOT). In this group, participants will first watch each of the four video modules, then perform the exercises afterward (i.e., not in real time).

The intervention will last for 8 weeks, with sessions conducted twice weekly for 45 minutes each.

Group Type: EXPERIMENTAL

Asynchronous Action Observation Therapy

Intervention Type: OTHER

Observation of structured motor task videos followed by delayed execution, adapted to individual GMFCS levels and extremity involvement patterns.

Interventions

Synchronous Action Observation Therapy

Real-time observation and execution of motor tasks through structured video modules designed based on participants' GMFCS level and extremity involvement.

Intervention Type: OTHER

Asynchronous Action Observation Therapy

Observation of structured motor task videos followed by delayed execution, adapted to individual GMFCS levels and extremity involvement patterns.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Voluntary participation of both the child and their family in the study
• Diagnosis of cerebral palsy with spastic clinical type, including hemiparetic and diparetic distribution
• Age between 6 and 18 years
• Classified as Level I or II according to the Gross Motor Function Classification System (GMFCS)
• Ability to comply with exercise interventions (based on medical report indicating normal mental level or "mild mental retardation")
• Ability to understand and speak Turkish

Exclusion Criteria

• Presence of spasticity ≥3 in lower extremity muscle groups as measured by the Modified Ashworth Scale
• Inability to cooperate with verbal commands
• Presence of visual or hearing impairments
• Diagnosis of epilepsy or current use of antiepileptic medications
• Presence of joint contractures
• Botulinum toxin injection to the lower extremities within the past 6 months
• Undergoing orthopedic surgery within the past 6 months
• Presence of any additional systemic or neurological diseases
• Missing three consecutive rehabilitation sessions

• Minimum Eligible Age: 6 Years
• Maximum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Istanbul University - Cerrahpasa

OTHER

Sponsor Role: lead

Responsible Party

Iremnur Gunhan

Physiotherapist

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Istanbul Unıversıty-Cerrahpasa

Istanbul, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

Other Identifiers

IstanbulUC_IG

Identifier Type: -

Identifier Source: org_study_id