Effectiveness of mirror therapy in improving bimanual performance, somatosensory function of the upper limb and quality of life in children with unilateral spastic cerebral palsy: Randomized Clinical Trial
Unilateral spastic cerebral palsy (CPUE) is the result of a lesion in a cerebral hemisphere in the immature brain, which involves the involvement of the opposite hemicos, especially in the upper extremity. The alterations are mostly motor, although deficits in somatosensory function are also present, and are closely related to the functionality of the hand. Evidence suggests mirror therapy as a therapy with potential effects on bimanual performance and somatosensory function, which could substantially impact quality of life.
Project definition
Executive Summary
A single-blind randomized clinical trial is proposed, the sample size of which will be 11 subjects per group. The experimental group will perform a program of bimanual motor exercises in the family environment for 5 weeks, 30 minutes a day, 5 days a week with mirror therapy, while the control group will do it without a mirror. The effects on bimanual performance, somatosensory function and self-perceived quality of life will be evaluated pre-treatment, post-treatment and at the end of the month.
Context and Justification
Favorable results in this study would imply the implementation of a low-cost therapy, adaptable to the natural environment of children with PCUE and without contraindications, with the potential to improve bimanual performance, somatosensory function and quality of life. In addition, the creation of an adaptable therapy at home would increase the family involvement and empowerment of the parents of these children, increasing their confidence and accompanying them in the disability process.
General Objective
L’objectiu del present estudi és demostrar l’eficàcia d’un programa d’exercicis motors amb teràpia mirall en nens amb PCUE de 8-12 anys classificats en els dos primers nivells de «Manual Ability Classification System» en la millora de l’acompliment bimanual, la funció somatosensorial i la qualitat de vida.
Specific Objectives
- To study the effectiveness of a program of bimanual motor exercises with mirror therapy in the upper limbs carried out in the family environment compared to the same program without mirror therapy to improve the somatosensory function of the affected hand in children with PCUE aged 8-12 years classified in MACS levels I and II.
- To evaluate the increase in the quality of life of children with PCUE between 8 and 12 years classified in MACS I and II through the application of a bimanual program of mirror therapy.
- To verify that the effects of the bimanual motor exercise program with mirror therapy in the upper limbs on somatosensory function and bimanual performance are maintained 1 month after implementation.
Approach and Strategies
Study design
The present study is a single-blind randomized clinical trial. The random assignment will be carried out through simple randomization with the Epidat 4.2 program.
Attendees
The study population will be children with PCUE between 8 and 12 years classified in levels I and II in MACS.
Anticipated benefits
The results obtained in the present study are expected to be favorable to the application of TE as a treatment on bimanual performance, somatosensory function and the quality of life of these children, as the first investigations in it suggest.
It would be the first study in the Spanish population based on those exercises applicable to TE that have obtained potentially beneficial results, providing a sufficient and representative sample size of the population and creating a methodology based on evidence, adapted to be carried out in the ' natural environment with the collaboration of the main caregivers and in which the follow-up and compliance of the therapy throughout the study is controlled quite thoroughly
Positive Effects in the Community or Sector Beneficiated
Mainly, this study could serve to continue the current research on the adaptation of mirror therapy in children with PCUE, and thus be able to expand the field of treatments for motor function that exist today.
In addition, it is intended to contribute to the emphasis of practice centered on the family and the adaptation of treatments within the natural environment of children with the aim of creating therapies focused on functionality that are much more enriching and motivating, taking into account the child's environment, as a way to improve the activity and participation of children with PCUE within their environment, that is, to improve their independence and autonomy.
Likewise, it is intended to emphasize the need for the importance of sensory function in the overall development of the child with or without pathology, and to reinforce the importance of its correct assessment, given the importance it has in complete and overall development.
On the other hand, this project is in line with previous studies, deepening the search for low-cost therapies with high effectiveness. The proposed intervention develops others that already exist and aims to approach a possible protocolization of mirror therapy, which would lead to the creation of a very low-cost therapy, without side effects and without apparent contraindications, which it could be another therapy to consider in the treatment of this population. The realization of this project would mean a social change in the involvement of families with children with PCUE in addressing their limitations, offering a therapy designed to be able to adapt to the maximum
to their needs and requirements, being able to do it from home and empowering them and accompanying them in the disability process.
Likewise, the present project would have a very important impact on physiotherapy. According to the research team's knowledge, this would be the first randomized clinical trial to consider mirror therapy as a therapy for children with PCUE, highlighting the need to consider sensory limitations within motor impairment, with the aim of improving performance of activities of daily living and quality of life.
