1
|
Pellichero A, Best KL, Sorita É, Archambault PS, Demers L, Rouault L, Routhier F. Feasibility and clinical applicability of a novel power wheelchair training approach. Disabil Rehabil Assist Technol 2024; 19:516-524. [PMID: 35895011 DOI: 10.1080/17483107.2022.2103189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the feasibility and the clinical applicability of administering the COMET (cognition, occupation, mobility, evaluation and training) intervention. MATERIALS AND METHODS A pilot research was conducted with adults who were being considered for power wheelchair (PWC) provision, or who were recently provided a PWC, and who had been identified to benefit from a PWC training. The COMET intervention applies a goal directed, client-centred and occupation-based approach. Feasibility and applicability indicators were collected for: process, resources, management and treatment. Indicators were evaluated as "successful/unsuccessful". Clinical outcomes included the Goal Attainment Scale (GAS), the Canadian Occupational Performance Measure (COPM), the Power mobility Indoor Driving Assessment (PIDA) and the Wheelchair Skills Test (WST). RESULTS Four females (62.5 ± 3.5 years) with cognitive impairment participated in the study. Among the 13 indicators, 10 were successfully achieved. Indicators that did not meet the criteria for success were adherence rate, safety and treatment for the PIDA. Two adverse events were reported, with one minor injury. Participants demonstrated better than expected results on the GAS, the COPM scores and the WST. However, only two reported an improvement beyond 4% of the PIDA. CONCLUSIONS With few modifications, the COMET intervention and the study protocol will be feasible and applicable in clinical practice. Individuals with complex cognitive and mobility impairment demonstrated abilities to learn PWC use. Further investigation of the COMET intervention is required to evaluate its efficacy.Implications for rehabilitationA novel power wheelchair (PWC) training approach adapted to individual with complex mobility and cognitive impairments was developed: the COMET (cognition, occupation, mobility, evaluation and training) intervention.The COMET intervention applies a goal directed, client-centred and occupation-based approach.With minor modifications, the COMET intervention may be feasible and clinically applicable to train individuals with complex motor and cognitive impairments how to use a PWC.Further evaluation of the COMET intervention and lager control trialsare suggested.
Collapse
Affiliation(s)
- Alice Pellichero
- Department of Rehabilitation, Université Laval, Québec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Québec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Éric Sorita
- Université de Bordeaux - Handicap Activité Cognition Santé (EA 4136 HACS), Bordeaux, France
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada
| | - Louise Demers
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Canada
| | - Lucas Rouault
- Dispositif d'expertise et de la liaison pour les troubles d'apprentissage - ADIMC, La Couronne, France
- Association Nationale Française des Ergothérapeutes, Paris, France
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| |
Collapse
|
2
|
Hoare B, Ditchfield M, Thorley M, Wallen M, Bracken J, Harvey A, Elliott C, Novak I, Crichton A. Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study. BMC Neurol 2018; 18:63. [PMID: 29739443 PMCID: PMC5938804 DOI: 10.1186/s12883-018-1070-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 05/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child’s ability to use their two hands to perform bimanual tasks. Methods/Design This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6–12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain – lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive – standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location. Discussion This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both cognitive and motor outcomes in children with unilateral cerebral palsy. Trial registration ACTRN12614000631606; Date of retrospective registration 29/05/2014.
Collapse
Affiliation(s)
- Brian Hoare
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia. .,School of Occupational Therapy, La Trobe University, Bundoora, VIC, 3168, Australia. .,Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.
| | - Michael Ditchfield
- Department of Diagnostic Imaging, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Margaret Wallen
- School of Allied Health, Australian Catholic University, North Sydney, NSW, 2060, Australia
| | - Jenny Bracken
- Department of Diagnostic Imaging, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia
| | - Adrienne Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Bentley, 6102, Western Australia, Australia.,Department of Paediatric Rehabilitation, Princess Margaret Hospital, Washington, WA, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, PO Box 6427, Frenchs Forest, NSW, 2086, Australia
| | - Ali Crichton
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia
| |
Collapse
|
3
|
Hoare B, Greaves S. Unimanual versus bimanual therapy in children with unilateral cerebral palsy: Same, same, but different. J Pediatr Rehabil Med 2017; 10:47-59. [PMID: 28339410 DOI: 10.3233/prm-170410] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. AIM AND METHODS Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy. DISCUSSION The current emphasis on total dosage of practice for achieving positive outcomes fails to recognise the influence of other critical concepts within motor learning. Limitations exist in the application of motor learning principles using CIMT due to its unimanual nature. CIMT is effective for development of unimanual actions brought about by implicit learning, however it is difficult to target explicit learning that is required for learning how to use two hands together. Using bimanual therapy, object properties can be adapted to trigger goal-related perceptual and cognitive processes required for children to learn to recognise when two hands are required for task completion. CONCLUSION CIMT and bimanual should be viewed as complementary. CIMT could be used to target unimanual actions. Once these actions are established, bimanual therapy could be used for children to learn how to use these actions for bimanual skill development.
Collapse
Affiliation(s)
- Brian Hoare
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,CPtherapy, Australian Catholic University, Victoria, Australia
| | - Susan Greaves
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Occupational Therapy Department, The Royal Children's Hospital, Victoria, Australia
| |
Collapse
|
4
|
Missiuna C, DeMatteo C, Hanna S, Mandich A, Law M, Mahoney W, Scott L. Exploring the use of cognitive intervention for children with acquired brain injury. Phys Occup Ther Pediatr 2010; 30:205-19. [PMID: 20608858 DOI: 10.3109/01942631003761554] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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 child's 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.
Collapse
Affiliation(s)
- Cheryl Missiuna
- CanChild Centre for Childhood Disability Research and the School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
5
|
The application of motor learning strategies within functionally based interventions for children with neuromotor conditions. Pediatr Phys Ther 2009; 21:345-55. [PMID: 19923975 DOI: 10.1097/pep.0b013e3181beb09d] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify and describe the application of 3 motor learning strategies (verbal instructions, practice, and verbal feedback) within 4 intervention approaches (cognitive orientation to daily occupational performance, neuromotor task training, family-centered functional therapy, and activity-focused motor interventions). METHODS A scoping review of the literature was conducted. Two themes characterizing the application of motor learning strategies within the approaches are identified and described. RESULTS Application of a motor learning strategy can be a defining component of the intervention or a means of enhancing generalization and transfer of learning beyond the intervention. Often, insufficient information limits full understanding of strategy application within the approach. CONCLUSIONS A greater understanding of the application, and perceived nonapplication, of motor learning strategies within intervention approaches has important clinical and research implications.
Collapse
|
6
|
Rodger S, Liu S. Cognitive Orientation to (Daily) Occupational Performance: Changes in Strategy and Session Time Use over the Course of Intervention. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2008. [DOI: 10.3928/15394492-20080901-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cognitive Orientation to (daily) Occupational Performance (CO-OP) is a cognitive intervention that was developed to assist children with developmental coordination disorder (DCD) enhance their motor performance in everyday activities. Using a computer-based analysis of 10 videotaped treatment sessions for each of four boys with DCD who were 6 to 9 years of age, this study investigated changes in cognitive strategy use and session time use over the course of intervention. Cognitive strategy use focused on the child's use of global and domain-specific strategies during intervention. Session time use referred to the duration of Talking About Task (describing the task or plans that will be executed), Practicing Task (actually doing the task or activity), and Dual Tasking (both talking and doing) coded during video segments observations. Trends in strategy and session time use over 10 sessions appeared to be child- and goal-specific, with few systematic patterns observed. This article discusses the use of specific strategies over time both within and across the four participants. Individual results were varied and highlight the unique child—task—environment interactions that occur during intervention, reinforcing the individualized and client-centered focus of the CO-OP.
Collapse
|