Effects of hand arm bimanual intensive therapy with and without action observation training on upper extremity motor functions in children with spastic hemiplegic cerebral palsy

To compare the effects of hand arm bimanual intensive therapy with and without action observation training on upper extremity motor functions in children with unilateral spastic cerebral palsy.

community based, Double blinded, Randomized control trial

Trial will be conducted at Ghurki Trust teaching hospital, Patients and assessor will be blinded through concealment of assignment.

Inclusion criteria:  Spastic hemiplegic Cerebral Palsy diagnosed by Neurophysician.  Aged 5-12 years  Male and female  Mini-mental state examination ≥24  Spasticity of grade ≤2 on Modified Ashworth scale  Gross motor functional classification scale (GMFCS) III-IV  Manual Ability Classification System (MACS) III- IV  Sufficient cooperation and cognitive understanding to participate in the activities.  No sensory impairments.  No history of seizures  Parents able to commit to an intensive therapy program. Exclusion criteria:  Children with visual impairments  Aphasic children  Uncontrolled seizures  Previous orthopedic surgery of upper limb.  Severe spasticity and contractures that requires orthotic management.  BoNT-A injection in the UL within 6 months prior to study entry.

HABIT will be given for total 60 hours, 3 hour a day (1 hour home practice), 5 times per week for 4 weeks. AOT will be carried out for 30 minutes each day, 5 days a week, for 4 weeks. The total number of training sessions was 20 per subject.

Upper Extremity motor functions was assessed using Abilhand kids and Jebson taylor hand function Test.

The basic strategy used for randomization will be the development of an ordered list with group assignments made in advance using random number table. As participants enter the study, they will be given consecutive numbers and assigned to the group indicated for each number.

Patients will be blinded for their group allocation. They will receive their allocated treatment without the knowledge of weather they belong to the control group or interventional group. The duration on treatment session will be same for both groups. The assessor will be physical Therapist who will have no role in the treatment of the patients. The collected data will be analyzed by biostatistician who will be unaware of the group specification of data.