Angela Mandich

Cognitive orientation to daily occupational performance (CO-OP): part II--the evidence.

CO-OP is a child-centred, cognitive based intervention, focused on enabling children to achieve their functional goals. It has been developed over the last nine years through a series of systematic studies that have specified the treatment protocol and evaluated its effect. Initially CO-OP was explored in two series of single case experimental studies. Subsequently, an informal follow-up study and a detailed analysis of the video-taped sessions of the approach were completed. Based on information from these studies, the approach was refined, key features elucidated and the protocol was specified. Next, a pilot randomized clinical trial was completed. The trial was conducted to determine how best to approach a full scale randomized clinical trial on the effectiveness of CO-OP, relative to the current therapeutic approach. Finally, a retrospective chart audit was carried out to examine the cumulative evidence on the effectiveness of CO-OP in improving the performance of children with DCD. This paper presents a detailed summary of these five studies and discusses the implications of the findings.

Cognitive orientation to daily occupational performance (CO-OP): part I--theoretical foundations

This paper is the first in a series of three papers that present the systematic development and evaluation of Cognitive Orientation to daily Occupational Performance (CO-OP). CO-OP is a cognitively based, child-centred intervention that enables children to achieve their functional goals. In Part I, the breadth of literature that provides the theoretical underpinnings for the approach is reviewed. Parts II and III provide a description of the approach and present the evidence to support its use with children with developmental coordination disorder.

Treatment of Children with Developmental Coordination Disorder: What Is the Evidence?

Summary Children with Developmental Coordination Disorder (DCD) experience significant difficulty performing everyday tasks and management of these children is a great source of debate. Because little is understood about the etiology of the disorder, treatment design has been driven by competing theories of motor development and motor skill acquisition. Traditional approaches to treatment have been based on neuromaturational, hierarchical theories and, consequently, therapies have focused on remeditating underlying deficits with the expectation of subsequent improvement in motor performance. Contemporary approaches, drawn from human movement science, propose that treatment methods be based on the assumption that skill acquisition emerges from the interaction of the child, the task and the environment. This paper provides a review of the treatment literature over the past 15 years, highlighting the fact that little evidence exists to suggest any one approach is better than another. Given current demands for evidence-based practice, and evolving concepts in skill acquisition, a movement toward interventions that are based on functional outcomes is recom-mended.

Cognitive orientation to daily occupational performance (CO-OP): part III--the protocol in brief.

Parts I and II of this series introduced the Cognitive Orientation to daily Occupational Performance (CO-OP), a new approach to intervention that is based on the premise that cognition plays an important role in the acquisition of occupational skills and the development of occupational competency. Developed for use with children who have occupational performance deficits, CO-OP is an individualized, client-centred approach focused on strategy-based skill acquisition. This third paper in this series presents a brief description of the actual CO-OP protocol including its objectives, prerequisites and key features.

Children with developmental coordination disorder (DCD) and their ability to disengage ongoing attentional focus: More on inhibitory function

Children with developmental coordination disorder (DCD), along with their Control counterparts, completed two endogenous, spatial precue tasks. When the precue arrow was informative (.80) with respect to target location, the spatial precue effect results demonstrated that children with DCD take significantly longer than Control individuals to volitionally disengage (inhibit) attention from an endogenously cued location (i.e., a disengagement inhibition deficit). When the precue was uninformative (.25), we found, contrary to a common assumption, that the precue arrow automatically moved attention in the direction of the arrow, and, in addition, that DCD children may also be less able to inhibit the precued-induced urge to move attention (i.e., an initiation inhibition deficit). This type of inhibitory difficulty was also indicated for manual response inclinations produced on catch trials. Overall, DCD children appeared to have an elevated difficulty suppressing the initiation of incorrect, stimulus-provoked movement urges, be they manual or attention in nature.

Cognitive Strategies and Motor Performance in Children with Developmental Coordination Disorder

Recently, researchers in occupational therapy have investigated the use of a cognitive or “top down” approach to improving the occupational performance of children with developmental coordination disorder. A cognitive approach is multifaceted in nature and one essential component of such an approach is the use of cognitive strategies. Although strategy use has a long history within the education and psychology literature, little discussion within the pediatric therapy literature has occurred. This paper reports the results of an in-depth videotape analysis of therapists using cognitive strategies during occupational therapy intervention. Eight domain specific strategies were identified and elucidated. This research will be beneficial to therapists who wish to incorporate a cognitive approach into their clinical practice.

On the ability of children with developmental coordination disorder (DCD) to inhibit response initiation: The simon effect

The ability of children with developmental coordination disorder (DCD) to inhibit the initiation of an incorrect manual response urge was examined using a typical Simon task. While the size of the Simon effect was the same for both DCD (N = 20) and Control (N = 20) groups of children, showing no difference with respect to the time needed to complete the inhibition an unwanted response, children with DCD produced significantly more errors of the type which reflected a reduced ability to successfully effect the inhibition operation when it was required. This result is consistent with some earlier findings pointing to an inhibitory deficit for children with DCD (Wilson & Maruff, 1999).

Cognitive strategy generation in children with developmental coordination disorder.

Background. Developmental coordination disorder (DCD) is a condition of impaired quality of movement and occupational performance. It has been hypothesized that the difficulties experienced by children with DCD may in part be due to an impaired ability to use cognitive strategies to solve occupational performance problems. Cognitive Orientation to daily Occupational Performance (CO-OP) is a verbally-based approach to helping children remediate this difficulty. The current pilot study investigated the use of cognitive strategies in children with DCD to determine whether cognitive strategy use is improved by CO-OP. Methods. Observations of video-recorded sessions of 18 school-aged children were scored for frequency and type of cognitive strategies used. Results. Differences within and between groups revealed changes in the types and frequency of cognitive strategies. Clinical Implications. The results of the present study support the use of a cognitively-based approach such as CO-OP in assisting children with DCD in developing cognitive strategies when solving occupational performance problems. However, further research using a larger sample is necessary to fully explore the impact of CO-OP on the strategy use of children with DCD.

School-based occupational therapy for children with fine motor difficulties: evaluating functional outcomes and fidelity of services.

Consultative occupational therapy services are becoming widely used in the school environment. However, few studies have evaluated the utility of and the process by which these services are delivered. This study examined whether the written communication and fine motor skills of 23 children with fine motor difficulties improved after receiving school-based occupational therapy from a program whose mandate was to deliver services according to a consultation model of service delivery. In addition, the study assessed the process of service delivery, including treatment fidelity, or the extent to which consultation services were implemented as intended. Statistically significant and practically meaningful improvement was found in written communication on the Vineland Adaptive Behavior Scales-Classroom Edition (VABS-C) and School Functional Assessment-Version 3.0 (SFA), and in fine motor skills on the SFA, but not on the VABS-C. An examination of the service delivery process revealed that therapists deviated from a purely consultative model, with 86% providing some direct therapy to children. Parents were mostly satisfied with services received, whereas teachers were indifferent or somewhat dissatisfied. Treatment fidelity is taken into consideration when discussing study findings. Recommendations to enhance school-based occupational therapy services delivered according to a primarily consultative model, and suggestions for future research, are provided.

Exploring the Use of Cognitive Intervention for Children with Acquired Brain Injury

ABSTRACT Introduction: Children with acquired brain injury (ABI) often experience cognitive, motor, and psychosocial deficits that affect participation in everyday activities. Cognitive Orientation to Daily Occupational Performance (CO-OP) is an individualized treatment that teaches cognitive strategies necessary to support successful performance. Objective: This study explores the use of CO-OP with children with ABI. Method: Children with ABI, experiencing school and self-care difficulties, were identified from a previous study. Six children, aged 6–15 years, completed 10 weekly intervention sessions with occupational therapists. Children and parents rated the childs performance of challenging everyday tasks and their satisfaction with this performance. Task performance was also evaluated objectively through videotape analysis. Results: Participants showed significant improvement in their ability to perform child-chosen tasks and maintained this performance 4 months later. However, they had difficulty applying the executive problem-solving strategy and discovering cognitive strategies on their own. Issues related to the use of CO-OP with this population are discussed.