Investigation of Motor Imaging Skills in Children With Spastic Cerebral Palsy

The aim of this study was to investigate implicit and explicit motor imagery skills in children with spastic cerebral palsy and typically developing children. The main questions it aims to answer are:

* There is a difference between the implicit motor imagery skills of children with bilateral and unilateral CP.
* There is a difference between the explicit motor imagery skills of children with bilateral and unilateral CP.
* There is a difference between the implicit motor imagery skills of children with cerebral palsy and typically developing children.
* There is a difference between the explicit motor imagery skills of children with cerebral palsy and typically developing children.

Cerebral Palsy (CP) is a group of permanent disorders in activity limitation, motor and posture development due to non-progressive damage to the developing fetus or infant brain. Motor disorders in CP are often accompanied by sensory, perception, cognitive, communication, language and speech disorders, behavioral disorders, epilepsy, vision, hearing, endocrine, urogenital and secondary musculoskeletal system problems.

To date, CP has been classified by many researchers. The most recently used classification is the classification made by the Surveillance of Cerebral Palsy in Europe (SCPE) in 2000. According to this classification, SP; They are divided into 3 groups: spastic, dyskinetic and ataxic types. In spastic type CP, abnormal posture and movement patterns, increased muscle tone, pathological reflexes (Babinski, clonus, etc.) are dominant. The most common type of CP is spastic type CP. Spastic type CP is divided into bilateral and unilateral CP. Involvement in spastic bilateral CP, bilaterally in 4 extremities; In spastic unilateral CP, involvement occurs unilaterally in one half of the body. Dyskinetic type SP; It is characterized by abnormal posture and movement patterns, involuntary, uncontrollable, often stereotypic movements. It is divided into two groups: dystonic and choreoathetoid CP. While hypokinesia and hypertonus predominate in dystonic type CP, hyperkinesia and hypotonus predominate in choreoathetoid type CP. Ataxic type CP is characterized by coordination disorder in target-directed movements, gait and trunk control deficiencies, intention tremor, and speech disorder.

Recent studies indicate that motor disorders in children with CP are not only related to movement execution, but also to impairments in cognitive process, motor planning including motor control, and motor imagery ability.

Motor imagery refers to a mental process in which the individual mentally imagines a movement without actually performing an active movement. Studies have shown that similar brain regions are activated during movement performance and movement visualization. Motor imagined movements and actively performed motor movements occur in the premotor and parietal areas, basal ganglia and cerebellum. Based on this, motor imagery allows identifying the cognitive and cerebral properties of movement representation independently of motor output and sensory feedback.

Imagination is divided into two: express and implicit motor imagery. During express motor imagery, the person simulates a specific motor movement, that is, the individual is aware that he is visualizing the movement. Implicit motor imagery is the ability to engage with the projection and manipulation of the body schema from a first-person perspective. In implicit motor imagery, the movement is visualized unconsciously.

Implicit motor imagery skills will be evaluated Hand Laterality Task, Explicit motor imagery skills will be evaluated with Movement Imagery Questionnaire for Children (MIQ-C), mental chronometry and box block test. All assessments will be evaluated and recorded separately in the dominant and nondominant upper extremities as actual performance and imaged performance.

All evaluations will be made in between the ages of 6-18 typically developing children and children with unilateral and bilateral cerebral palsy with level 1 or 2 according to the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS).

Eligibility Criteria:
Inclusion Criteria:

* Diagnosed with spastic type CP between the ages of 6-18
* Gross Motor Function Classification System (GMFSS) level 1- 2
* Manual Dexterity Classification System (EBSS) level 1-2
* Having at least 24 points from the Mini-Mental test for children,
* Having an IQ \> 70,
* To be able to understand the instructions of the study.

Exclusion Criteria:

* Having severe vision, hearing or attention problems,
* Having advanced cardiovascular or cognitive problems,
* Not being able to follow work instructions,
* Having had upper extremity surgery within the last 6 months,
* Having received MI training in the last 6 months.