Effect of parent‐delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial

Aim To determine whether home‐based, parent‐delivered therapy comprising action observation ( AO ) and repeated practice ( RP ) improves upper limb function more than RP alone in children with unilateral cerebral palsy ( UCP ). Method Design: single‐blinded parallel‐group randomized controlled trial with 1:1 allocation comparing AO + RP (intervention) with RP alone (control). Randomization: computer‐generated, with allocation concealment by opaque sequentially‐numbered envelopes. Setting: northern England, August 2011 to September 2013. Participants: 70 children with UCP ; mean age 5.6 years ( SD 2.1), 31 female. Intervention: home‐based activities were provided, tailored to interests and abilities. Duration: 15 minutes/day, 5 days/week for 3 months. Assessments: Assisting Hand Assessment ( AHA ; primary outcome measure), Melbourne Assessment 2 ( MA 2), and ABILHAND ‐Kids at baseline, 3 months, and 6 months. Results Outcome data was available at 3 months for 28 children in the AO + RP group and 31 controls, and at 6 months for 26 and 28 children respectively. There were no between‐group differences in AHA , MA 2, or ABILHAND ‐Kids at 3 or 6 months versus baseline (all p >0.05). Combined‐group improvements ( p <0.001), observed in AHA and MA 2 at 3 months, were maintained at 6 months. ABILHAND ‐Kids also showed improvement at 3 months ( p =0.003), maintained at 6 months. Interpretation Parent‐delivered RP (with or without AO ) improves upper limb function and could supplement therapist input.