Effectiveness of CO-OP group intervention for children with developmental coordination disorder: single-case experimental design study protocol

INTRODUCTION

With the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, children with developmental coordination disorder learn to use a problem-solving strategy to deal with their motor difficulties and perform daily activities of their choice. Therapists use guided discovery to enable children to find their own solutions. Although CO-OP is recommended in a group setting, studies are needed to support its effectiveness.

METHODS AND ANALYSIS

A single-case study design with multiple baselines across participants and four systematic replications will be used. In each of the five groups, four children (aged 8-12 years) will be randomly included at the baseline. The baseline includes 5-8 measurements, and the CO-OP intervention stage is comprised of 10 sessions. The follow-up stage includes five measurements. Prior to baseline, each child in each of the five groups will choose five activities of which three will be carried out during the intervention sessions. Children's performance in each of these activities will be scored using the Performance Quality Rating Scale (PQRS) as the main measure. Three secondary measures will be collected: perceived activity performance using the Canadian Occupational Performance Measure, quality of life using the Kidscreen-27 and spontaneous motor rhythm using a computerised typing task. Graphed data will be analysed visually at the individual level with the Visual Aid Implying an Objective Rule (VAIOR) protocol which provides a colour code based on the level and trend of two consecutive phases, facilitating an objective visual analysis. Statistics will be performed for PQRS scores at the individual level and at the group level.

ETHICS AND DISSEMINATION

The protocol has been approved by the Comité de protection des personnes Sud-Est I (CPP 2021070) and the Comité d'éthique de la recherche avec les êtres humains de l'Université du Québec à Trois-Rivières (CER-22-294-07.03). Results will be published in a peer-reviewed scientific journal.

TRIAL REGISTRATION NUMBER

NCT05231486.

Psychomotor intervention to improve handwriting skills in children with ADHD: A single-case experimental design with direct inter-subject and systematic replications

Dysgraphia is highly prevalent in children with attention deficit hyperactivity disorder (ADHD) and adversely affects academic and developmental trajectories. To date, no study has rigorously examined the effects of a training program on handwriting quality in this specific population. Our objective was thus to develop an innovative program - we entitled PRO-PEN - and to evaluate its effects. We planned a multiple-baseline design across participants from grade 3-5, with direct inter-subject and systematic replications. Children of Group 1 (n = 4) were diagnosed with ADHD. Systematic replication was conducted in a second group of participants (Group 2, n = 4) with a diagnosis of developmental coordination disorder in addition to ADHD. The primary assessment focused on quality of handwriting. Generalization measures evaluated diverse neuropsychological and behavioural domains. In Group 1, effect sizes regarding handwriting quality were large (Taus > .60). Improvement was also observed for children of Group 2 (Taus > .50). Importantly, the positive effects persisted three months after the end of the training. Generalization effects extended beyond handwriting sphere. Therefore, PRO-PEN can be considered a promising training program for improving handwriting quality in ADHD, with a possible impact on wide cerebral regulation loops underpinning both handwriting and other neuropsychological and behavioural domains.

Effectiveness of CO-OP Approach for Children With Neurodevelopmental Disorders: A Systematic Review

Objective

To examine the scientific evidence regarding the effectiveness of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach for children with neurodevelopmental disorders (NDDs).

Data Sources

Selected articles published between January 2001 and September 2020 and listed in CINAHL, MEDLINE, and PsycINFO on the EBSCO platform, or found searching with Scopus, Google Scholar, OTseekern Central Register of Controlled Trials in the Cochrane Library, WHO International Clinical Trials Registry Platform, Turning Research into Practice, and ProQuest Dissertations and Theses. An update was performed in March 2022.

Study Selection

Eligibility criteria included studies that assessed the effectiveness of the CO-OP approach on children (0-18 years) with NDDs. Unpublished results were excluded, as well as research published in a language other than English or French.

Data Selection

The first 2 authors independently reviewed the titles, abstracts, and full texts. Discrepancies were discussed and resolved by consensus. Included studies were quality appraised using the PEDro-P scale or using the risk of bias scale in N-of-1 trials (RoBiNT) according to experimental design.

Data Synthesis

Results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eighteen studies were initially included, with 2 additional studies added in the update. Three reached evidence level III (15%), 10 reached level IV (70%), and 5 reached level V (15%). All data collected on the activity-participation domain showed a significant improvement. Group therapy sessions show promising results for the improvement of activities or participation, as well as psychosocial dimensions such as self-esteem.

Conclusions

The scientific evidence analyzed shows that the CO-OP approach has a positive effect on children with NDDs, particularly in regard to their activities and participation. Future experimental studies should be designed in ways that allow determining effect sizes. Group therapy sessions appear relevant but require further research.

Making all the right moves: Clinician-led development and pilot of an evaluative toolkit for a community-based school readiness group program

Introduction

Children often present to occupational therapy with delays in pre-school occupations, with underlying skill deficits. If unaddressed, deficits may affect adjustment to school, jeopardising educational progress. Although evidence supports group-based interventions, evaluation can be time-intensive and expensive. We developed and piloted an evaluative toolkit to measure and report outcomes for short school readiness groups.

Method

We sought measures that were inexpensive, reliable and responsive to change in key domains. Skills and pre-school occupations were measured in children [ n = 58; mean = 5 years] before and after our school starters group program. Parents rated their children’s skills, school readiness and level of school-related anxiety.

Results

Our resource-efficient, multi-measure, skills-based evaluative toolkit reliably recorded changes in children’s performance in our school readiness program. Measures were adapted for groups. Children demonstrated improvements in skills important for successful school transition pre-post program; including static and dynamic balance, pencil grasp/control, pre-writing/drawing skills and name writing. Parents’ confidence in their child’s readiness for school increased, while school-related-anxiety decreased.

Conclusion

The evaluative toolkit proved responsive to change and showed excellent inter-rater reliability. Measures were practicable for groups, easy to administer and score, and engaged parents in their child’s progress. In our six-session School Starters group, important pre-school skills were improved in participating children.

Benefits of an Intensive Individual CO-OP Intervention in a Group Setting for Children with DCD

Purpose

The present study focused on the impact of an adapted Cognitive Orientation to daily Occupational Performance (CO-OP) five-day intervention program for children with developmental coordination disorder (DCD). Important adaptations were the new combination of individual CO-OP sessions and group activities, the short and intensive program that was followed by a training and coaching trajectory, and the use of video logs.

Materials and Methods

Eighteen children with DCD (aged 8-16 years) participated in the five-day intervention during which they worked on three intervention goals. After the intervention, during an eight-week training and coaching trajectory for parents and children, children worked on a transfer goal. Assessment took place at four moments in time: two pretest measures, a posttest measure, and a 3-month follow-up measure. Primary outcome measures focused on changes in performance and satisfaction of self-chosen intervention and transfer goals. The secondary outcome measure explored changes in children's attitude, motivation, and confidence in relation to motor skill activities, social skills, and level of participation.

Results

Significant improvements were found with regard to the performance and satisfaction of intervention goals. For the transfer goal, only parents reported significant improvements. Finally, parents indicated potential improvements with regard to the attitude, motivation, and confidence of their children, but not for their social skills or level of participation.

Conclusion

The findings are promising with regard to the efficacy of this adapted CO-OP intervention for improving intervention goals, but less effective for transfer of learned skills to other goals after the intervention. Future research should focus on how postintervention parental coaching can be improved in order to increase generalization and transfer.

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

Background: Cognitive orientation to daily occupational performance (CO-OP) is a client-centered treatment approach that was developed in the 1990s by occupational therapists. Purpose: Exploring current evidence about the effectiveness of CO-OP on children with cerebral palsy (CP). Method: Major electronic databases were searched. A narrative synthesis of current literature and meta-analyses on randomized control trials (RCTs) were conducted on changes in occupational performance. Findings: Seven studies with 103 participants were included. Four studies were RCTs with moderate levels of evidence, and three studies had single-subject designs. Although beneficial effects of CO-OP on goal achievement and transferring learned skills were reported, meta-analyses showed that CO-OP had no significant effect on the performance (WMD = 1.52, 95% CI = -1.58 to 4.63, P = .33) and satisfaction domains (WMD = 1.71, 95% CI = -1.14 to 4.57, P = .24) of Canadian Occupational Performance Measure scores compared to alternative interventions. Implications: CO-OP improves occupational performance but not more than alternative interventions. Results are inconclusive due to small sample sizes and heterogeneity of alternative interventions and participants. Therefore, research with a larger number of participants with sound RCT methods is needed.

Physical Therapy Management of Children With Developmental Coordination Disorder: An Evidence-Based Clinical Practice Guideline From the Academy of Pediatric Physical Therapy of the American Physical Therapy Association

BACKGROUND

Developmental coordination disorder (DCD), classified as a neurodevelopmental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), affects approximately 5% to 6% of school-aged children. Characteristics of DCD include poor motor coordination and delayed development of motor skills, not explained by other conditions. Motor deficits negatively affect school productivity, performance in activities of daily living, and recreation participation. Children with coordination problems, at risk for or diagnosed with DCD, should be evaluated by a team of professionals, including a physical therapist (PT).

PURPOSE

This clinical practice guideline (CPG) provides management strategies for PTs and informs clinicians and families about DCD. It links 13 action statements with specific levels of evidence through critical appraisal of the literature and provides recommendations for implementation.

RESULTS/CONCLUSIONS

The DCD CPG addresses examination, referral, first choice and supplemental interventions, discharge, compliance audits, implementation, and research recommendations. Supplemental tools are provided to support PT management.

Practitioner Review: Effective management of functional difficulties associated with sensory symptoms in children and adolescents

BACKGROUND

Sensory symptoms are defined as atypical behavioral responses to daily sensory stimuli that impact on the performance of everyday routines. Sensory symptoms have been observed in young people with and without developmental concerns. There is uncertainty, however, regarding the best way to identify and manage sensory symptoms. The aim of this paper is  to provide a review of current best evidence regarding measurement of and interventions for sensory symptoms.

METHODS

A narrative review methodology is adopted to address the aims of this paper. First, sensory symptoms are defined, and then, an overview of the evidence for the relationship between sensory symptoms and childhood function is provided. Second, commonly used sensory assessment tools are summarized and evaluated. Finally, an overview and critique of the evidence for sensory and nonsensory-based interventions addressing sensory symptoms are given.

RESULTS

The terminology used to describe sensory symptoms varies by discipline, and several conceptual taxonomies including sensory subtypes have been proposed. There is ample evidence to support the association of sensory symptoms with childhood function including social engagement, repetitive behaviors, anxiety, and participation in self-care routines. Measurement of sensory symptoms is dominated by proxy-report instruments, and few single instruments assess the entire domain of sensory symptomatology. The evidence for interventions for sensory symptoms is emerging but still limited by low quantity and methodological concerns.

CONCLUSIONS

Effective management of sensory symptoms may mitigate the burden of neurodevelopmental disability and mental illness in young people. Identification of sensory symptoms should be conducted by a skilled practitioner utilizing multiple measurement methods. Intervention protocols for sensory symptoms should be informed by current best evidence which is strongest for Ayres Sensory Integration^® , Qigong massage, the Alert Program^® , and Social Stories. To make significant progress in this field, however, new intervention studies must address the question of 'what intervention works for whom?'.

Is Motor Impairment in Autism Spectrum Disorder Distinct From Developmental Coordination Disorder? A Report From the SPARK Study

BACKGROUND

Motor impairments are pervasive in Autism Spectrum Disorder (ASD); however, children with ASD rarely receive a dual diagnosis of Developmental Coordination Disorder (DCD). The Simons Foundation SPARK study engaged families affected by ASD through an online study.

OBJECTIVES

The DCD parent questionnaire (DCDQ) was used to assess the prevalence of a risk for motor impairment or DCD in children with ASD between 5 and 15 years of age.

DESIGN

This study utilizes parent reports from a large database of children with ASD.

METHODS

A total of 16,705 parents of children with ASD completed the DCDQ. We obtained our final SPARK dataset (n = 11,814) after filtering out invalid data, using stronger cut-offs to confirm ASD traits, and excluding children with general neuromotor impairments/intellectual delays. We compared DCDQ total and subscale scores from the SPARK dataset with published norms for each age between 5 and 15 years.

RESULTS

The proportion of children with ASD at risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services.

LIMITATIONS

Our analysis of a large database of parent-reported outcomes using the DCDQ did not involve follow-up clinical assessments.

CONCLUSIONS

Using a large sample of children with ASD, this study shows that a risk for motor impairment or DCD was present in most children with ASD and persists into adolescence; however, only a small proportion of children with ASD were receiving physical therapist interventions. A diagnosis of ASD must trigger motor screening, evaluations, and appropriate interventions by physical and occupational therapists to address the functional impairments of children with ASD while also positively impacting their social communication, cognition, and behavior. Using valid motor measures, future research must determine if motor impairment is a fundamental feature of ASD.

Exploration of the Influential Factors on Adherence to Occupational Therapy in Parents of Children with Cerebral Palsy: A Qualitative Study

BACKGROUND

Cerebral palsy (CP) is the leading cause of permanent disability in children. Occupational therapists serve a primary role in the rehabilitation of children with CP. Poor adherence to treatment is common. The aim of this study is to explore the viewpoint of occupational therapists on factors which impact adherence to occupational therapy (OT) interventions among parents of children with CP.

MATERIAL AND METHODS

A qualitative approach using semi-structured interviews were employed. Our participants were recruited by purposive sampling among occupational therapists who were working in Kermanshah province, western Iran. The interviews were taped and transcribed. Content analysis using constant comparison was performed.

RESULTS

The mean age of our participants was 34.23±7.50. Four main categories with specific subcategories emerged as important in affecting adherence. The first category of child and family-related factors described factors such as the clinical status of the child and family composition. These factors had the potential for both improving and reducing adherence to treatment. The second category of therapist-related factors described the effect of appropriate professional skills of the therapist on improving adherence and included clinical competency, communication skills, and job satisfaction. The third category of environmental factors addressed factors such as cultural views of child disability and access to OT interventions. The category mostly emphasized environmental barriers to adherence to treatment. The fourth category of therapy-related factors described barriers such as the type of therapy, and the length of treatment.

CONCLUSION

Adherence to OT interventions in parents of children with CP can be influenced by several factors. These factors range from child and family-related factors to therapy-related factors and have the potential for both positively and negatively affecting adherence. Programs to improve adherence should address these factors together.

Participation of children with developmental coordination disorder

Children with developmental coordination disorder (DCD) participate less frequently and in less diverse activities compared to typically-developing children. Participation restrictions have been attributed to poor motor skills, but no studies have examined the influence of the environment on participation of children with DCD. This study examined participation in children with DCD at home, school and in the community, considering both personal and environmental factors. Eighty-one parents of 4- to 12-year-old children with DCD (M = 8.3, SD = 2.1) completed the Participation and Environment Measure-Child and Youth (PEM-CY). Our data were compared to previously published data on typically-developing children. Children with DCD participated less frequently than typically-developing children in school and community settings and had less overall environmental support in all three settings. Regarding improvement in participation, children with DCD would benefit from motor interventions that also focus on modification of the environment to support their participation in home, school, and community settings.

Evaluating the evidence for motor-based interventions in developmental coordination disorder: A systematic review and meta-analysis

BACKGROUND

As part of the process of creating an update of the clinical practice guidelines for developmental coordination disorder (DCD) (Blank, Smits-Engelsman, Polatajko, & Wilson, 2012), a systematic review of intervention studies, published since the last guidelines statement was conducted.

AIM

The aim of this study was to 1) systematically review the evidence published from January 2012 to February 2017 regarding the effectiveness of motor based interventions in individuals with DCD, 2) quantify treatment effects using a meta-analysis, 3) examine the available information on different aspects of delivery including use of group intervention, duration and frequency of therapy, and 4) identify gaps in the literature and make recommendations for future intervention research.

METHOD

An electronic search of 5 databases (PubMed, Embase, Pedro, Scopus and Cochrane) was conducted for studies that evaluated motor-based interventions to improve performance for individuals with DCD.

RESULTS

Thirty studies covering 25 datasets were included, 19 of which provided outcomes on standardized measures of motor performance. The overall effect size (Cohen's d) across intervention studies was large (1.06), but the range was wide: for 11 interventions, the observed effect was large (>0.80), in eight studies moderate (>0.50), and in five it was small or negligible (<0.50). Positive benefits were evident for activity-oriented approaches, body function-oriented combined with activities, active video games, and small group programs.

CONCLUSION

Results showed that activity-oriented and body function oriented interventions can have a positive effect on motor function and skills. However, given the varied methodological quality and the large confidence intervals of some studies, the results should be interpreted with caution.