Exploring the Use of the Cognitive Orientation to Daily Occupational Performance Approach (CO-OP) With Children, Teenagers and Young Adults With Executive Functions Deficits Following Severe Acquired Brain Injury
Condition: Acquired Brain Injury
MeSH terms: Brain Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      Acquired brain injury (ABI) in childhood are the cause of disabling motor, cognitive and
      behavioural disorders, with severe consequences on the later development of autonomy and
      learning, with long-term repercussions on independence for activities of daily living, and
      social and professional integration.

      Among cognitive disorders, executive function (EF) deficits are among the most frequent and
      disabling, with major consequences on the development of autonomy and the course of schooling
      and learning.

      The Cognitive Orientation to daily Occupational Performance (CO-OP) could be an interesting
      approach for the rehabilitation of these consequences. CO-OP is a performance-based treatment
      approach for children and adults who experience difficulties performing the skills they want
      to, need to or are expected to perform. CO-OP is a specifically tailored, active
      client-centered approach that engages the individual at the meta-cognitive level to solve
      performance problems. Focused on enabling success, the CO-OP approach employs collaborative
      goal setting, dynamic performance analysis, cognitive strategy use, guided discovery, and
      enabling principles.

      It has been shown to be effective in a variety of populations, but has been little explored
      in children with ABI. The hypothesis that CO-OP is effective in improving the occupational
      performance and executive functioning of these children on a daily basis is emerging, but
      needs to be confirmed. This study falls within this framework.

      Primary objective:

        1. To measure the distance maintenance of the knowledge acquired through rehabilitation, as
           well as the generalization and transfer into everyday life.

             1. Maintenance of acquired knowledge

             2. Generalization and transfer

             3. Impact of a consolidation session on generalization and transfer

           Secondary objectives:

        2. Gather the experience of family members/caregivers in accompanying their child in the
           CO-OP process outside of rehabilitation sessions.

        3. Establish the parental educational style and identify whether there is a link between
           the parental educational style and the commitment of the family members/caregivers.
    

Detailed description: 
      Twelve participants will be included (aged 8 to 21 years old). Participants will have
      different assessment times, before, during and after the CO-OP intervention (immediate
      post-intervention, 2, 4 and 6-months post-intervention). Parents will be asked to answer
      questionnaires and interview and to participate in certain CO-OP sessions, if they can.

      They will choose four objectives (problematic everyday life activities they want to improve).
      Three will be worked on in CO-OP sessions, the fourth will be the control objective.

      The duration of the baseline, as well as the order of introduction of the objectives and the
      starting point of the objectives, are randomized.

      Participants will have 14 sessions of rehabilitation with the CO-OP approach (2 sessions per
      week for 7 weeks).
    

Intervention name(s): CO-OP intervention
Intervention type(s): Other
Intervention description(s): The general structure of the intervention will follow the original key principles of CO-OP, with some adjustments to adapt it to the specificities of the ABI population (14 CO-OP sessions vs 10 in the original protocol).
The global strategy will be taught to the participant at the first session. The following sessions will be consisted of an process of implementation of the global strategy in the context of guided discovery to identify domain specific strategies to overcome performance ''breakdowns" the participant will be experiencing when performing the self-selected tasks. In addition, "homework" will be assigned to encourage the application and practice of the cognitive strategies discovered during the intervention sessions. Parents will be invited to attend the sessions if it will be possible for them. In any case, the global strategy, as well as the progress of the child, will be explained to the parents.
Intervention model: Single Group Assignment
Intervention model description: Single case experimental study design with multiple baselines across individuals and behaviors.
Randomization:
Which patient starts when the COOP sessions?
What are the possible starting points for the 3 goals to be worked on?
Which of the 4 goals ABCD is assigned to which goal number? The most important goal (A) will necessarily be worked on first. We will draw lots to determine the order in which the goals will be worked on and which goal will be designated as the control goal.
Masking: None (Open Label)
Primary purpose: Other
Keywords: Cognitive Orientation to daily Occupational Performance; rehabilitation; executive functions; child acquired brain injury; teenagers; young adults; acquired brain injury