The Effect of the CO-OP Approach for Children With Cerebral Palsy
Condition: Cerebral Palsy; Cognitive Orientation
MeSH terms: Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      In the literature, despite the reported positive findings of the Cognitive Orientation to
      daily Occupational Performance (CO-OP) approach, studies in this area have been limited and
      it is stated that studies involving more sample groups are needed (24-27). In addition, no
      studies investigating the effect of the CO-OP approach on functional status were found. The
      purpose of this study was to investigate the effects of CO-OP approach in terms of
      occupational performance and satisfaction also functional status in children with cerebral
      palsy (CP) and to determine parents' satisfaction level from CO-OP.

      The hypotheses of the study are: The CO-OP approach has no effect on occupational performance
      in children with CP. CO-OP approach has no effect on occupational satisfaction in children
      with CP. The CO-OP approach has no effect on the functional status of children with CP.
    

Detailed description: 
      Statistical analyses were performed using the Statistical Package for the Social Sciences
      (SPSS) version 22 (IBM SPSS Statistics; IBM Corporation, Armonk, NY). One sample
      Kolmogorov-Smirnov Test was used evaluate the distribution of variables prior to test
      selection. Group characteristics and outcome measures are described using mean and standard
      deviations for continuous variables and frequencies and proportions for categorical
      variables. Descriptive statistics were presented as median for the non-normally distributed
      quantitative and ordinal data and number (percentage) for the categorical variables.
      Differences in continuous variables (age, education, BMI, duration of diagnosis,) among
      groups were analyzed with the Mann Whitney U. Statistical differences in COPM and PEDI scores
      between baseline and post-treatment was analyzed with "Wilcoxon's signed-rank test" within
      groups. The z-score obtained from the Wilcoxon signed-rank test was reported to present a
      standardized measure of the difference between the mean ranks of the negative and positive
      groups. Comparison of changes between groups were analyzed with "Mann-Whitney U" test for
      COPM and PEDI scores. Statistical significance level was assumed at p<0.05.

      Clinical significance was calculated by using the Cohen d effect size index in independent
      groups. Clinical significance was determined according to Cohen's recommended limit values
      (0,2 small; 0,5 moderate and 0,8 large effect).
    

Intervention name(s): CO-OP approach; NDT
Intervention type(s): Other; Other
Intervention description(s): There are 3 stages in the CO-OP approach. Stage I, the Preparation Stage, is primarily concerned with establishing the "goal". Before the first interview, the child was contacted, the family and the child were informed, and it was checked whether they met the prerequisites. At this stage, 3 targets were selected and the basic performance level was determined. Stage II, the Acquisition Stage, is essentially the "plan" and "do" stage, in which the work of using strategies to acquire skills is done. This stage originally comprised 10 sessions. At this stage, the first session enabling principles were implemented and the global strategy "goal-plan-do-check" was introduced. The family attended this process with observation. Parents / caregivers were encouraged to make observations to generalize strategies. Stage III, the Verificatíon stage usually consists of only one session in which "control" is performed; the progress made was revised as learned strategies.; All participations received NDT for 45 minutes once daily, two times a week for period of 6 weeks by the same physiotherapist. The NDT protocol is improving muscular tone and movement patterns. Although the treatment activities varied for each CP participant, the overall goals (improved smoothness and efficiency of movement), which included improved trunk, hip, knee and ankle control, were the same for all CP participants. All sessions incorporated handling techniques that aimed to alter muscle tone during movement and to facilitate anti-gravity, weight-shifting and postural reactions.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study was a single blinded and randomized controlled trial. All children included in the study were evaluated by a single evaluator who was blind to therapy at baseline and at the end of treatment. The study was completed with a total of 30 individuals, 15 in the CO-OP+ neurodevelopmental therapy (NDT) and 15 in the NDT group. Both groups received NDT for 45 minutes once daily, two times a week for period of 6 weeks by the same physiotherapist. The NDT protocol is improving muscular tone and movement patterns. All sessions incorporated handling techniques that aimed to alter muscle tone during movement and to facilitate anti-gravity and postural reactions. All children who met the inclusion criteria using GMFCS and MACS were evaluated with sociodemographic data, activity daily log, COPM and PEDI. The CO-OP group received twelve sessions of intervention, with the baseline and end of treatment assessments, each lasting approximately one hour.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cerebral Palsy; Cognitive Orientation; occupations; functional status