Action Observation Based Rehabilitation of Children With Unilateral Cerebral Palsy

Recent evidence suggested that Action Observation Therapy (AOT), based on observation of actions followed by immediate reproduction, could be a useful rehabilitative strategy for promoting functional recovery of children affected by Unilateral Cerebral Palsy (UCP). The AOT is based on the discovery of mirror neurons, a class of visuomotor neurons that are activated when the individual performs a targeted action, both when observing the same action performed by another individual. An important assumption of AOT is that the mirror system, thanks to its visuomotor properties, is able to coordinate visual information with the observer's motor experience. Indeed, the actions outside the individual's behavioral repertoire are elaborated and categorized only on the basis of visual characteristics, without inducing any phenomenon of motor resonance in the observer's brain. Therefore, given the deficiency of their motor repertoire, children affected by UCP could have a reduced activation of the mirror system during the observation of actions performed by healthy subjects. Nevertheless, this activation could increase during the observation of the same actions performed by a subject with similar motor strategies, due to a similar form of hemiplegia. The present project is a randomized controlled clinical trial to verify the influence of the observed model on the effectiveness of AOT in the rehabilitation of the affected upper limb in children with UCP. In particular, the study will verify whether the rehabilitation through AOT based on a pathological model (improving the patient's current abilities) gives more results than AOT based on a typical (healthy) development model, as reported by all the documented researches in literature. Furthermore, to investigate the functional reorganization of the sensorimotor system after rehabilitative treatment, a subgroup of participants will be subjected to a fMRI session (Functional Magnetic Resonance), to verify functional changes,