RIABILITAZIONE DI BAMBINI EMIPLEGICI DA PARALISI CELEBRALE INFANTILE: Ruolo dell'esperienza motorie e dell'Action Observation Therapy nella rieducazione dell'arto superiore affetto

ABSTRACT Introduction Main topics of this thesis are mirror neurons and Cerebral Palsy. In order to highlight the importance of Cerebral Palsy and the research of an effective re-education treatment trough neuroscience developments, it is enough to remember its incidence: two out of one thousand new-borns in developed countries, that is a new affected child every five hours related to Italian population. Mirror neurons are specific types of brain cells that have the particularity of being active both when individuals perform a specific motor act and when they observe the same action performed by another subject. Mirror neurons system was originally detected in the premotor cortex and in the inferior parietal lobe of monkeys' brain, but later it was also seen in humans. The human mirror system is mainly involved in understanding other people's actions and their intentions behind them. This skill is fundamental during the child psychophysical development because it involves the mechanism of learning by imitation. In other words, children can learn a new motor ability just observing and repeating the observed action itself. As a consequence, to understand how the system works is crucial in rehabilitation. In fact, previous studies about children with hemiplegia (a type of Cerebral Palsy) have shown that a rehabilitation model based on the mechanism of learning by imitation is effective. However, it is also fundamental to understand which model the child (under study) has to follow. The aim of this study is to demonstrate that children who observe actions performed by other individuals, who might have the same motor impairment, have a higher activation of the mirror system rather than children who look at healthy models. Materials and Methods In this study, twenty-four children with hemiplegia have been recruited. They were chosen following some parameters, such as: †¢ Age (6-16); †¢ Motor impairment which was evaluated with House's classification (score between 4 and 7); †¢ Sufficient degree of collaboration assessed by the doctor / physiotherapist who is treating the child. After this evaluation, children were randomly assigned to an experimental or control group. Moreover, a subgroup of patients will be selected to perform further investigations via fRM. Patients were assessed at four different time: before the onset of the training (T0), after the onset of the training (T1), 8 to 12 weeks after the end of treatment (T2) and 24 to 28 weeks after the end of treatment (T3).