The aim of this randomized controlled trial was to assess whether action observation treatment may improve upper limb motor functions in children with cerebral palsy (CP). All children with CP admitted to our unit for rehabilitation from May 2009 to May 2010 were eligible. Inclusion criteria were age between 6 years and 11 years, an IQ of at least 70, and no major visual and/or auditory deficits. Fifteen children were enrolled and randomly assigned to either a case group (n=8; four males, four females; median age 7 y 6 mo) or control group (n=7; five males, two females; median age 8 y). Six participants had left-sided hemiplegia, six right-sided hemiplegia, and three had tetraplegia; 10 were independent walkers. Those in the case group were asked to observe video clips showing daily age-appropriate actions, and afterwards to imitate them. Participants in the control group were asked to observe video clips with no motor content and afterwards to execute the same actions as cases. The primary outcome measure was the Melbourne Assessment Scale. Children were scored twice at baseline (2 wks apart), and at the end of treatment, by a physician blind to group assignment. At baseline groups did not differ on functional evaluation. After treatment, the functional score gain (Δ) was significantly different in the case and control groups (p=0.026). The present results support the notion that action observation treatment can be an effective part of the rehabilitation programme in children with CP. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.