{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:02Z","timestamp":1760060702851,"version":"build-2065373602"},"reference-count":56,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["RC2025","RF-2019-12370746"],"award-info":[{"award-number":["RC2025","RF-2019-12370746"]}]},{"name":"Cerebral Palsy Alliance","award":["RC2025","RF-2019-12370746"],"award-info":[{"award-number":["RC2025","RF-2019-12370746"]}]},{"name":"Pedal with Pete Foundation","award":["RC2025","RF-2019-12370746"],"award-info":[{"award-number":["RC2025","RF-2019-12370746"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Children with diplegic Cerebral Palsy often exhibit upper-limb (UL) motor impairments compounded by deficits in visuospatial, sensory, and executive functions. Despite this, research has primarily focused on lower-limb rehabilitation, leaving the treatment of UL function in diplegic Cerebral Palsy underexplored. Action Observation Therapy (AOT), based on Mirror Neuron System activation, has shown promise in promoting motor recovery, but evidence specific to this population is limited. This exploratory randomized controlled trial (RCT) aims to assess the feasibility and effectiveness of a home-based AOT program\u2014ACT ON DIP\u2014for improving upper-limb function in children and adolescents with diplegic Cerebral Palsy. Methods: Fifty-four participants with spastic diplegic Cerebral Palsy (MACS and GMFCS levels I\u2013III, aged 5\u201316 years) will be randomly assigned to an experimental group (receiving an 8-week home-based AOT program) or a control group (receiving standard care). The ACT ON DIP system includes an ad hoc software, kits of objects for daily tasks, and wearable sensors. The system allows for delivering structured uni- and bimanual AOT activities tailored to the child\u2019s profile. Primary outcome is the Both Hands Assessment (BoHA); secondary outcomes include motor (MA-2, BBT, ABILHAND), neuropsychological (NEPSY-II, Corsi Test, BRIEF), and participation measures (COPM, PEM-CY, CP-QOL). A subgroup will undergo fMRI to explore neural correlates of training-related changes. Results: Feasibility, compliance, and user experience with the home-based system will be assessed. This study will evaluate short-, medium-, and long-term changes in UL performance and related neuropsychological functions. Conclusions: ACT ON DIP represents a novel, personalized, and accessible tele-rehabilitation intervention for children with diplegic Cerebral Palsy. If effective, it could expand treatment opportunities for UL rehabilitation in this population and support broader implementation of home-based AOT.<\/jats:p>","DOI":"10.3390\/children12091229","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T07:56:51Z","timestamp":1757923011000},"page":"1229","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["ACT-ON-DIP: Study Protocol of a Randomized Controlled Trial of a Home-Based ACTion Observation Tele-RehabilitatioN for Upper Limb in Children with DIPlegic Cerebral Palsy"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6931-7813","authenticated-orcid":false,"given":"Elena","family":"Beani","sequence":"first","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"},{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Matteucci","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Sicola","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giada","family":"Martini","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3874-3611","authenticated-orcid":false,"given":"Maria Chiara","family":"Di Lieto","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"Bombonato","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Menici","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annalisa","family":"Cotardo","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6358-5649","authenticated-orcid":false,"given":"Silvia","family":"Filogna","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6629-4852","authenticated-orcid":false,"given":"Federica","family":"Camuncoli","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2159-439X","authenticated-orcid":false,"given":"Laura","family":"Biagi","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris Foundation, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Cioni","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Fedeli","sequence":"additional","affiliation":[{"name":"FightTheStroke Foundation, 20125 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Gelmini","sequence":"additional","affiliation":[{"name":"Child and Adolescence Neuropsychiatry Unit, AUSL IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Neviani","sequence":"additional","affiliation":[{"name":"Children Rehabilitation Unit, Azienda Unit\u00e0 Sanitaria Locale IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Vecchi","sequence":"additional","affiliation":[{"name":"Children Rehabilitation Unit, Azienda Unit\u00e0 Sanitaria Locale IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Perazza","sequence":"additional","affiliation":[{"name":"Children Rehabilitation Unit, Azienda Unit\u00e0 Sanitaria Locale IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0170-3766","authenticated-orcid":false,"given":"Silvia","family":"Faccioli","sequence":"additional","affiliation":[{"name":"Children Rehabilitation Unit, Azienda Unit\u00e0 Sanitaria Locale IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0138-6369","authenticated-orcid":false,"given":"Antonino","family":"Errante","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, 43100 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Piras","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, 43100 Parma, 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