A Collaborative and Cognitive-based Intervention for Young People with Cerebral Palsy

Abstract

Background. Evidence-based approaches to improve function in individuals with cerebral palsy are needed. Purpose. To investigate the effectiveness of the Cognitive Orientation to daily Occupational Performance approach™ (CO-OP) to improve performance on self-chosen, functional goals as compared to traditional occupational therapy for cerebral palsy. Method. Crossover design with 12 participants, aged 6–15 years, randomly assigned to CO-OP and traditional intervention groups, followed by crossover and a 3-month follow-up. The participants identified three occupation-based goals for CO-OP and each group received ten 45-minutes intervention twice weekly in clinical context. Occupational performance, manual dexterity and Gross Motor Function Measures were analysed using generalized estimating equations. Findings. There were clinical and statistically significant improvements in functional goals following CO-OP and not traditional therapy. There were gains in dexterity but not in gross motor skills. Implications. CO-OP was effective to improve functional performance in young people with cerebral palsy and should be more utilized.

Cognitive Orientation to Daily Occupational Performance (CO-OP) in Children with Cerebral Palsy: A Systematic Review with Meta-analysis

“…Included studies employed different measures to determine performance changes including the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS), the Performance Quality Rating Scale (PQRS), and the Activity Scale for Kids (ASK). The COPM was used in five of them (Cameron et al, 2017;Ghorbani et al, 2017;Jackman et al, 2018aJackman et al, , 2018bSousa et al, 2020); three studies used the GAS (Ghorbani et al, 2017;Jackman et al, 2018aJackman et al, , 2018b; four studies used the PQRS (Cameron et al, 2017;Gimeno et al, 2019Gimeno et al, , 2021Sousa et al, 2020); and one study used ASK (Cameron et al, 2017). A good inter-rater reliability and the construct/criterion validity of COPM have been described for children with CP (Verkerk et al, 2006).…”

“…Interventions were implemented by qualified occupational therapists in the participants' home (Cameron et al, 2017;Gimeno et al, 2019Gimeno et al, , 2021 or in a clinical setting (Jackman et al, 2018a(Jackman et al, , 2018bSousa et al, 2020). Three of the included studies videotaped a part of the CO-OP sessions to determine therapists' fidelity and showed that therapists' fidelity ranged from 38% to 91% in Gimeno et al (2021), 100% in Cameron et al (2017), and 83% in Sousa et al (2020); Jackman et al (2018aJackman et al ( , 2018b) used CO-OP in small groups with a supplementary daily home self-practice program, and other studies implemented the CO-OP programs face to face and individually. Six studies applied CO-OP intervention between 10 and 12 sessions and 45-60 min duration for each session.…”

“…Of the seven included studies, four studies had a randomized controlled trial (RCT) design (Cameron et al, 2017;Jackman et al, 2018aJackman et al, , 2018bSousa et al, 2020) with a level III of OCEBM level of evidence. Other studies were single-case experimental design (Ghorbani et al, 2017;Gimeno et al, 2019Gimeno et al, , 2021 with levels I and II of SSRD's level of evidence.…”

“…Other studies were single-case experimental design (Ghorbani et al, 2017;Gimeno et al, 2019Gimeno et al, , 2021 with levels I and II of SSRD's level of evidence. According to MMAT, three studies were determined as "High" (Cameron et al, 2017;Ghorbani et al, 2017;Sousa et al, 2020) and four studies were determined as having "moderate" methodological quality (Gimeno et al, 2019(Gimeno et al, ,2021Jackman et al, 2018aJackman et al, , 2018b. In two studies, topographical distribution of participants varied significantly in the baseline and approximately 27% of participants did not complete the assigned intervention (Jackman et al, 2018a(Jackman et al, , 2018b.…”

“…In the RCT studies, the risk of selection bias was low since those studies used a computer-generated random number generator and include methods to randomize participants to the trial or control groups (Cameron et al, 2017;Jackman et al, 2018aJackman et al, , 2018bSousa et al, 2020). The risk of assignment bias and adhering to intervention bias was high in three studies because participants and therapists were aware of the protocols and goals of intervention (Jackman et al, 2018a(Jackman et al, , 2018bSousa et al, 2020) and also participants in one study crossed over to the comparator intervention (Sousa et al, 2020). Additionally, as the COPM, the GAS, and other client-centered outcome measures were selfreport, outcomes were influenced by knowledge of interventions received.…”