Cognitive orientation to daily occupational performance approach in people with multiple sclerosis: A pilot study

BACKGROUND

Multiple sclerosis is the most important cause of non-injury-related disability in young adults. The disease has unknown causes and distresses and affects daily activities. While therapeutic interventions mainly focus on body function and structure to reduce impairment, Cognitive Orientation to Daily Occupational Performance (CO-OP) is a cognitive approach that provides intervention at the level of activity and participation.

PURPOSE

We aim to examine the effects of CO-OP approach on fatigue, quality of life, occupational performance, and satisfaction in people living with multiple sclerosis; and to examine whether they could transfer strategies and skills learned during CO-OP to untrained goals.

METHODS

A pre-post design was used. Assessment tools included Montreal Cognitive Assessment, Multiple Sclerosis Impact Scale, Fatigue Impact Scale and the Canadian Occupational Performance Measure. Six individuals living with multiple sclerosis participated in 10 CO-OP sessions twice a week. The sessions were held in an environment of the participants' choice, along with an extra session added to determine the goals. The study was registered in the ethics committee of University of Social Welfare and Rehabilitation Sciences (IR.USWR.REC.1399.089).

RESULTS

The performance improved (2-point positive change) in 12 out of 18 trained goals and in three out of six untrained goals (self-report). The improvement was maintained at a 3-month follow-up assessment. There was a statistically significant difference in Canadian Occupational Performance Measure (χ2  = 11.565, p = 0.003 same for performance and satisfaction scores), Fatigue Impact Scale (χ2  = 7.000, p = 0.030), and Multiple Sclerosis Impact Scale scores over time (χ2  = 9.478, p = 0.009) respectively.

CONCLUSION

The CO-OP approach has the potential to improve daily activity performance, reduce pain, and improve the quality of life for people living with multiple sclerosis. A definitive randomised controlled trial is required.

Feasibility of using the Cognitive Orientation to daily Occupational Performance in a population of Danish stroke survivors: Adaptation and study protocol

BACKGROUND

A need was identified for an occupational therapy intervention for stroke survivors in a Danish municipal healthcare setting with emphasis on its ability to transfer and generalise what is learned in occupational therapy to everyday life post therapy. Being a possible candidate, the Cognitive Orientation to daily Occupational Performance (CO-OP) approach needed to be adapted to the target group and context, and its feasibility needed examination regarding reach, dose, intervention components, fidelity, perceived value, benefits, harms, and potential outcomes.

AIM

To adapt the CO-OP to a Danish healthcare setting and present a protocol for examining its feasibility.

MATERIAL AND METHODS

The Adapting interventions to new contexts (ADAPT) guidance was followed to (1) Assess the rationale for intervention and consider intervention-context fit, (2) Plan and undertake adaptations, and (3) Plan a feasibility study.

RESULTS

Intervention materials and procedures were translated and adapted for home-based occupational therapy with people in the subacute phase of stroke. A protocol was developed to examine feasibility aspects. Quantitative and qualitative evaluations were planned and measurements chosen.

CONCLUSIONS AND SIGNIFICANCE

The planned feasibility study will contribute to further developing and refining the intervention before performing a possible large-scale effectiveness study.

White Matter Changes With Rehabilitation in Children With Developmental Coordination Disorder: A Randomized Controlled Trial

Background and Objectives: Children with developmental coordination disorder (DCD) have difficulty learning motor skills, which can affect their participation in activities of daily living and psychosocial well-being. Over 50% of children with DCD also have attention deficit hyperactivity disorder (ADHD), which further exacerbates their motor problems and impact on quality of life. A rehabilitation approach known as Cognitive Orientation to Occupational Performance uses problem-solving strategies to help children learn motor skills they wish to achieve. While this cognitive approach has been effective for children with DCD, few studies have examined the effectiveness of this approach for children with co-occurring ADHD. Further, the underlying mechanism and neural basis of this intervention are largely unknown.

Methods: In this randomized waitlist-controlled trial, we used MRI to examine white matter microstructure after intervention in 8–12-year-old children with DCD (n = 28) and with DCD and co-occurring ADHD (n = 25). Children in both groups were randomized to either a treatment group or waitlist group at their first MRI. The treatment group began the intervention after their MRI scan and returned for a post-treatment scan at 3 months, and follow-up scan at 6 months; the waitlist group waited 3 months before their second MRI, received the intervention, and then had a post-treatment scan. Each child received intervention once weekly for 10 weeks. Diffusion tensor imaging was used to acquire white matter diffusion parameters and was analyzed using tract-based spatial statistics (TBSS).

Results and Conclusion: Children with DCD showed significant improvement in white matter microstructure in the bilateral anterior thalamic radiation, bilateral sensorimotor tract, bilateral cingulum, fornix, splenium and body of corpus callosum, right inferior fronto-occipital fasciculus, and white matter pathways to bilateral inferior gyri, right middle frontal gyrus, frontal medial cortex, and left cuneus. We suggest that these rehabilitation-induced neural changes in children with DCD occurred in regions associated with attention, self-regulation, motor planning, and inter-hemispheric communication, which positively affected brain connectivity and motor function. In contrast, children with DCD and co-occurring ADHD did not show any brain changes following the intervention. Modifications to the treatment protocol might help address the attentional and self-regulatory needs of children with a dual diagnosis.

Clinical Trial Registration: ClinicalTrials.gov ID: NCT02597751.

CO-OP for Children with DCD: Goals Addressed and Strategies Used

INTRODUCTION.

Developmental coordination disorder (DCD) is a neurodevelopmental disorder that impacts motor coordination and interferes with participation in everyday activities. Cognitive Orientation to Occupational Performance (CO-OP) is a client-centered treatment approach that focuses on skill acquisition through cognitive strategy use.

OBJECTIVES.

To determine which types of goals a sample of children with DCD choose most frequently and which domain-specific strategies were most commonly used to address these goals.

METHODS.

Retrospective chart review of 50 children (8-12 years) with DCD who completed CO-OP intervention was conducted to identify goal types and strategy use.

RESULTS.

Leisure was the most common goal type. Supplementing task knowledge, body position, and task modification were the most frequently used strategies.

CONCLUSIONS.

Results confirm the types of goals that are commonly selected by children with DCD and highlight commonly used strategies used to meet these goals. Findings will help guide occupational therapists in selecting appropriate strategies to meet children's goals.

Feasibility of an iterative rehabilitation intervention for stroke delivered remotely using mobile health technology

Background: Telehealth affords rehabilitation professionals opportunities to expand access to intervention for people in rural areas. Complex interventions have not been adapted for remote delivery using mobile health technologies. Strategy training is a complex intervention that teaches clients skills for identifying barriers and solutions to engagement in meaningful activities. Our goal was to adapt the delivery of strategy training for remote delivery using mobile health technology.Methods: We conducted a sequential descriptive case series study (n = 5) in which community-dwelling participants with chronic stroke and prior exposure to strategy training used the iADAPTS mobile health application for 5 weeks. Expert practitioners advised revisions to the intervention process. Safety was assessed via monitoring occurrence of adverse events and risk for adverse events. Acceptability was assessed via the Client Satisfaction Questionnaire-8 (CSQ-8) and the Patient-Provider Connection Short Form of the Healing Encounters and Attitudes Lists (HEAL PPC).Results: Revisions to the intervention process supported the delivery of strategy training using mobile health technology after stroke. No adverse events occurred and risk for adverse events was managed through the intervention process. Acceptability was high (CSQ-8, 25 to 32; HEAL PPC, 59.9 to 72.5).Conclusions: Strategy training can be adapted for delivery using mobile health technology, with careful consideration to methods for training participants on new technology and the intervention delivery. Future research should establish the efficacy and effectiveness of integrating mobile health in delivery of interventions that promote engagement in client-selected activities and community participation.Implications for rehabilitationTranslating the strategy training intervention from face-to-face to remote delivery required thoughtful adaptation of the intervention protocol.Strategies for training clients to use mobile health technology during intervention may be important when designing remotely delivered mHealth intervention protocols.Client safety should be considered within the design of the intervention protocol for a complex intervention designed to be delivered remotely.Future studies should examine the efficacy of complex rehabilitation interventions such as strategy training on clinical outcomes (e.g., community participation).

Therapists' experience of the cognitive orientation to daily occupational performance (CO-OP) approach: Shifting from conventional practice

Background: The CO-OP Approach^TM has been increasingly used in research and practice, yet its critical elements and implementation challenges are largely undescribed. Obtaining therapists' perspectives on CO-OP may reveal insights into potential critical and mediating factors.Aim/Objective: To explore the experiences of CO-OP therapists by understanding their perceptions on the approach compared with conventional practice, and by identifying mediating factors in its implementation.Material and Method: This exploratory study utilized a qualitative descriptive design. A purposive sample of occupational therapists (n = 3) was interviewed. Data were analyzed using thematic analysis and themes were validated within a focus group.Results/Findings: Three themes were identified: 'CO-OP works,' 'CO-OP delivery is mediated by contextual factors,' and 'CO-OP shifts the therapeutic approach.' Therapists perceived CO-OP to be efficacious for client-centred goal attainment. Guided discovery and the problem-solving strategy were identified as unique and challenging CO-OP elements. Mediating factors such as level of cognitive impairment and quality of family member involvement may affect CO-OP efficacy.Conclusions: Therapists found CO-OP to be efficacious and adopted unique elements into their professional approaches.Significance: This is the first study to investigate CO-OP therapists' experiences. Future research is recommended to enhance training of therapists in key CO-OP features.

Feasibility of Motor Imagery Training for Children with Developmental Coordination Disorder - A Pilot Study

Children with Developmental Coordination Disorder (DCD) experience movement difficulties that may be linked to processes involved in motor imagery (MI). This paper discusses recent advances in theory that underpin the use of MI training for children with DCD. This knowledge is translated in a new MI training protocol which is compared with the cognitive orientation to daily occupational performance (CO-OP). Children meeting DSM-5 criteria for DCD were assigned to MI (n = 4) or CO-OP (n = 4) interventions and completed nine treatment sessions, including homework exercises. Results were positive, with two children in the MI group and three in the CO-OP group improving their m-ABC-2 score by ≥ 2 standard scores, interpreted as a clinically meaningful change. Moreover, all children and parents noticed improvements in motor skills after training. This is the first study to demonstrate the feasibility of a theoretically principled treatment protocol for MI training in children with DCD, and extends earlier work.

Trial registration: The complete trial is registered at the Dutch trial register, www.trialregister.nl (NTR5471). http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5471

Effectiveness of a summer camp intervention for children with developmental coordination disorder

BACKGROUND

Developmental coordination disorder (DCD) significantly affects a child's motor abilities and negatively impacts their self-efficacy and participation in physical activity. Using a task-specific approach and cognitive strategies in a group setting, we designed a summer camp intervention for children with DCD.

AIMS

Our purpose was to examine the effectiveness of the summer camp in meeting child-chosen functional motor goals and increasing self-efficacy and participation.

METHODS

This mixed methods study examined performance and satisfaction of child-chosen goals, self-efficacy, and participation of 11 children before and after the camp. Survey and interview data from three children and nine parents were collected to supplement quantitative findings.

RESULTS

Statistically significant improvement in performance and satisfaction of child-chosen goals was noted. While no measureable changes in self-efficacy and participation were observed, parents and children reported positive benefits to camp participation, including the confidence to try new activities, being with other children with DCD, and learning more about the disorder.

CONCLUSION

The intensive, group-based summer camp may offer a valuable alternative to improve the functional skills of children with DCD, while providing other notable benefits.

Occupation-based strategy training for adults with traumatic brain injury: a pilot study

OBJECTIVE

To evaluate, before undertaking a larger trial, feasibility of the study processes to determine the effectiveness of occupation-based strategy training for producing changes on trained real-world behaviors, and to determine whether far transfer of training effects to measures of real-world impact, including participation in everyday life, could be achieved.

DESIGN

Partially randomized controlled trial with pre- and postintervention assessments done by assessors masked to the treatment arm.

SETTING

Testing occurred at a research institute, interventions at participants' homes.

PARTICIPANTS

People (N=13) with chronic traumatic brain injury (TBI), 7 in the experimental group (mean age, 42.6y; mean time post-TBI, 9.8y; 4 men) and 6 in the control arm (mean age, 40.5y; mean time post-TBI, 10.8y; 3 men), were assessed immediately before and after the intervention phase.

INTERVENTION

Occupation-based strategy training, an adapted version of the Cognitive Orientation to daily Occupational Performance (CO-OP), was provided in two 1-hour sessions per week for 10 weeks.

MAIN OUTCOME MEASURES

Canadian Occupational Performance Measure, Dysexecutive Questionnaire, Mayo-Portland Adaptability Inventory-4 Participation Index, and Assessment of Motor and Process Skills.

RESULTS

The study processes (testing and intervention) were acceptable to all participants. Evidence of far transfer was found as the experimental group improved significantly more than the control group on performance and satisfaction with performance ratings on untrained goals (P<.05), and reported increased levels of participation (P<.01).

CONCLUSIONS

Findings must be interpreted with caution since the sample is small and comparisons are made with a no-treatment control. Nevertheless, they suggest that the training is feasible and a larger trial warranted.