The Effect Of Action Observation Therapy On Balance And Lower Extremity Function In Children With Hemiparetic Cerebral Palsy

Purpose: Action Observation Therapy (AOT) supports motor learning by engaging the mirror neuron system and has shown promising results in improving upper extremity functions in children with cerebral palsy. However, its effects on balance and lower extremity functions in children with hemiparetic cerebral palsy have not been sufficiently investigated. The aim of this study was to evaluate the effectiveness of AOT, when applied in addition to conventional physiotherapy, on improving balance, lower extremity functions, and gait performance in children with hemiparetic cerebral palsy. Methods: Twenty children with hemiparetic cerebral palsy (GMFCS levels I–II) (mean age: 9.60 ± 2.19 years) were randomly assigned to either the experimental group (conventional physiotherapy + AOT) or the control group (conventional physiotherapy only). The intervention lasted 6 weeks; both groups participated in 12 physiotherapy sessions, while the experimental group additionally received AOT sessions twice weekly for 30 minutes. Outcome measures included the Timed Up and Go (TUG) test, the Pediatric Balance Scale, the Five Times Stair Ascending/Descending Test, and the 6-Minute Walk Test (6MWT). Results: Following the intervention, the experimental group demonstrated significantly greater improvements in TUG performance, dynamic balance (particularly in the 360° turning and forward reach tasks), and stair climbing ability compared to the control group. Although both groups showed significant improvements in the 6MWT, no significant between-group difference was observed for this outcome. In addition, moderate to strong correlations were found between physical growth parameters and motor performance outcomes. Conclusion: AOT combined with conventional physiotherapy significantly enhances balance and lower extremity functions in children with hemiparetic cerebral palsy. These findings support the integration of AOT into rehabilitation programs to improve dynamic balance and functional mobility. Further studies with larger sample sizes and longer follow-up periods are recommended to confirm these results and to investigate the long-term effects of AOT.