Action Observation Based Rehabilitation of Children With Unilateral Cerebral Palsy

The study will compare two rehabilitation models through AOT to assess feasibility and effectiveness. In the preliminary phase of the study a single rehabilitation treatment protocol will be planned, based on the observation and execution of unimanual and bimanual actions integrated in activities that are significant for the subject's age group. The recorded actions will be performed by a child with typical development and by two hemiplegic children: 1. upper limb disability with grades between 4-5 according to House Functional Classification (HFC) system (corresponding to synergic hand of Ferrari and Cioni's Kinematic Hand Classification). 2. upper limb disability with grades between 6-7 according to HFC system (corresponding to subfunctional hand of Ferrari and Cioni's Kinematic Hand Classification). The participants (N. 26) randomly assigned to the experimental group will be subjected to the rehabilitation protocol through AOT based on the observation of the "Pathological Model". The model, while showing a manipulation strategy similar to that of the study participant, will show an improvement with respect to the patient's current abilities. The children randomly assigned to the control group will be subjected to the rehabilitation treatment protocol through AOT based on the "Typical developmental model". Both experimental and control treatment will consist of a minimum of 10 hours (min. 10, max 15) for a period of 15 consecutive working days (3 weeks). Each video sequence will show a specific action repeated several times for 3 minutes. Subsequently, participants will be asked to perform the action observed with their hemiplegic upper limb or with both upper limbs for a maximum of 3 repetitions. A subgroup of study participants (N. 8+8) from both groups will undergo two fMRI sessions, before and immediately after the AOT. The fMRI session consists of two experimental tasks: 1. action observation (functional session 1-2), in which patients will observe short videos in which actions are performed with the right hand from a subjective perspective. 2. motor task (session 3), in which actions consist in reaching-grasping an object (a cube, a sphere or a cylinder) and putting it into boxes, placed on the right and on the left of the object. The study consists of two experimental conditions: 1. Observation of the paretic hand, in which the actions will be performed by another patient with UCP. 2. Observation of the healthy hand, in which the action will be reproduced by a healthy model. The aim of the study is to investigate the functional reorganization of sensorimotor system comparing functional activation before and after rehabilitation with AOT.