Effectiveness of functional hand splinting and the cognitive orientation to occupational performance (CO-OP) approach in children with cerebral palsy and brain injury: two randomised controlled trial protocols

Pediatric Patients With Hemiplegia: A Systematic Review of a Randomized Controlled Trial

Hemiplegia is the medical term for paralysis of one side of the body. It results in muscular wasting on the affected side, impairs gait, reduces motor abilities, and causes instability and a loss of grasping capacity. The patient's quality of life is impacted by hemiplegia because it impairs brain and spinal cord functions. Consequently, a range of therapeutic options, including physical therapy, medical health management, and other multidisciplinary care, are accessible. The effects of treatments on juvenile patients with hemiplegia who are participating in a randomized controlled trial (RCT) are examined in this systematic review. Using the Boolean operator "AND," the research process entailed searching for keywords like "Hemiplegia" and "Pediatrics." Based on the inclusion and exclusion criteria, a total of six RCTs were included in the study. According to the study's findings, hemiplegic patients benefited from Kinesio taping (KT), botulinum toxin type-A (BoNT-A), hyaluronic acid injections, and bimanual treatment.

Effect of the cognitive orientation to daily occupational performance (CO-OP) approach for children with cerebral palsy: A randomized controlled trial

PURPOSE

The study aimed to examine the effects of "Cognitive Orientation to daily Occupational Performance" (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents' satisfaction level.

METHODS

Thirty-two children with CP were randomized to experimental (n = 16) or control (n = 16) groups, with n = 2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT.

RESULTS

No baseline differences existed, except for years of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (p < 0.05).

CONCLUSION

CO-OP is expected to be beneficial if incorporated into CP rehabilitation.

The Effectiveness of Robot- vs. Virtual Reality-Based Gait Rehabilitation: A Propensity Score Matched Cohort

Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.

Effects of transcranial direct current stimulation combined with cognitive orientation to daily occupational performance in children with cerebral palsy: a protocol for a randomised controlled trial

Background/Aims

Children with hemiplegic cerebral palsy have limitations in activities requiring reach and manipulation of objects with their affected upper extremity. Transcranial direct current stimulation and the cognitive orientation to occupational performance approach are relatively new interventions that may lead to promising results for these children. This article describes the method of a randomised clinical trial that will compare the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with transcranial direct current stimulation and neurodevelopmental treatment.

Methods

A four-armed clinical trial with a sample size of 36 participants will be performed in Tehran. Participants will be randomly divided into four groups. Group A will receive neuro-developmental treatment with sham transcranial direct current stimulation, group B will receive neurodevelopmental treatment with transcranial direct current stimulation, group C will receive cognitive orientation to daily occupational performance with sham transcranial direct current stimulation, and group D will receive cognitive orientation to daily occupational performance with transcranial direct current stimulation. The examiner will be blind to the study and assessments will be done at baseline, after the end of the intervention and 1 month after the completion of the intervention (as follow up). Data analysis will be as repeated measure analysis of variance and intention to treat.

Conclusions

This article describes the protocol of a clinical trial that compares the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with the combination of transcranial direct current stimulation and neurodevelopmental treatment on upper extremity goals and functions of children with hemiplegic cerebral palsy.

Documenting change with the Canadian Occupational Performance Measure for children with cerebral palsy

AIM

To assess the Canadian Occupational Performance Measure's (COPM) ability to document change over 3 years in children with cerebral palsy (CP).

METHOD

This was a prospective study with ambulatory children with CP, aged 2 to 6 years. Caregivers set one to three COPM goals which were rescored annually over 3 years. A ceiling effect for performance goals was operationalized as a score of 8. A Wald χ² generalized estimating equations model adjusted for age, sex, and Gross Motor Function Classification System (GMFCS) level, evaluated change over time.

RESULTS

In total, 124 children (47 [37.9%] females, 77 [62.1%] males; mean age 3y 11mo [SD 1y 1mo]; GMFCS level I [n=78, 62.9%], II [n=21, 16.9%], and III [n=25, 20.2%]) were set 345 COPM goals at baseline. By Year 3, 106 participants (85.5%) rescored 287 of the goals (83.2%). Performance scores increased between baseline mean (SD) 2.93 (0.56), Year 1 5.98 (0.58) with 34.8% at ceiling; Year 2 6.74 (0.60) 48.3% at ceiling; and Year 3 7.37 (0.60) 59.6% at ceiling (Wald χ² [3]=607.18, p<0.001). Satisfaction scores increased between baseline 4.42 (0.59), Year 1 6.82 (0.60) with 48% at ceiling; Year 2 7.53 (0.60) with 62.2% at ceiling (Wald χ² [3]=208.48, p<0.001); with no significant increase by Year 3 7.82 (0.62) with 66.9% at ceiling.

INTERPRETATION

COPM performance scores increased steadily over 3 years. By Year 2, a ceiling effect was seen in about half of the goals. The COPM may have utility to measure change over 3 years; periodic resetting of the descriptors of goal success are required to minimize ceiling.

Effects of a Cognitive-Functional Intervention Method on Improving Executive Function and Self-Directed Learning in School-Aged Children with Attention Deficit Hyperactivity Disorder: A Single-Subject Design Study

Background

School-aged children with attention deficit hyperactivity disorder (ADHD) face many difficulties with self-directed learning because of their poor executive function. This leads to secondary problems such as learning disabilities and depression, so the role of intervention to improve executive function in school-aged children with ADHD is important.

Objective

The present study is aimed to investigate how cognitive-functional (Cog-Fun) intervention affected executive function of school-aged children with ADHD and the sustainability of these effects. To investigate the effects of changes in the executive function of school-aged children with ADHD through Cog-Fun intervention in self-directed learning.

Method

A single-subject A-B-A research design was employed in this study. Three children aged 9-10 years who were diagnosed with ADHD were selected. A total of 17 experimental sessions were conducted. The Cog-Fun intervention program was implemented during the intervention phase. To measure dependent variables, Behavior Rating Inventory of Executive Function (BRIEF) and Homework Problems Checklist (HPC) were used. Significant changes in executive function assessed by the Children's Color Trails Test (CCTT) and Stroop test were analyzed through two-standard deviation band analysis. Additionally, video clips of task performance were analyzed to examine qualitative performance changes in self-directed learning.

Result

All three participants presented statistically significant changes with a number of near-misses of CCTT and color words score of Stroop test during the intervention. T-scores of the Global Executive Composite (GEC) decreased after the intervention, indicating improvement in executive function. The follow-up period revealed retention of the improved executive function. Additionally, self-directed learning improved in all participants after the implementation Cog-Fun intervention.

Conclusion

The study supports the effectiveness of Cog-Fun intervention in improving executive function in school-aged children with ADHD and confirmed that the improvement of executive function ultimately leads to the improvement of self-directed learning performance.

Minimum Clinically Important Difference of Gross Motor Function and Gait Endurance in Children with Motor Impairment: A Comparison of Distribution-Based Approaches

Objective

The minimum clinically important difference (MCID) is a standard way of measuring clinical relevance. The objective of this work was to establish the MCID for the 6-minute walking test (6minWT) and the Gross Motor Function Measure (GMFM-88) in pediatric gait disorders.

Methods

A cohort, pretest-posttest study was conducted in a hospitalized care setting. A total of 182 patients with acquired brain injury (ABI) or cerebral palsy (CP) performed 20 robot-assisted gait training sessions complemented with 20 sessions of physical therapy over 4 weeks. Separate MCIDs were calculated using 5 distribution-based approaches, complemented with an anonymized survey completed by clinical professionals.

Results

The MCID range for the 6minWT was 20-38 m in the ABI cohort, with subgroup ranges of 20-36 m for GMFCS I-II, 23-46 m for GMFCS III, and 24-46 m for GMFCS IV. MCIDs for the CP population were 6-23 m, with subgroup ranges of 4-28 m for GMFCS I-II, 9-19 m for GMFCS III, and 10-27 m for GMFCS IV. For GMFM-88 total score, MCID values were 1.1%-5.3% for the ABI cohort and 0.1%-3.0% for the CP population. For dimension “D” of the GMFM, MCID ranges were 2.3%-6.5% and 0.8%-5.2% for ABI and CP populations, respectively. For dimension “E,” MCID ranges were 2.8%-6.5% and 0.3%-4.9% for ABI and CP cohorts, respectively. The survey showed a large interquartile range, but the results well mimicked the distribution-based methods.

Conclusions

This study identified for the first time MCID ranges for 6minWT and GMFM-88 in pediatric patients with neurological impairments, offering useful insights for clinicians to evaluate the impact of treatments. Distribution-based methods should be used with caution: methods based on pre-post correlation may underestimate MCID when applied to patients with small improvements over the treatment period. Our results should be complemented with estimates obtained using consensus- and anchor-based approaches.

Immediate effect of a functional wrist orthosis for children with cerebral palsy or brain injury: A randomized controlled trial

STUDY DESIGN

Two-group randomized controlled trial.

INTRODUCTION

Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence.

PURPOSE OF THE STUDY

The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury.

METHODS

A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group.

RESULTS

After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13; standard deviation, 11.476) and the no orthotic group (mean, 14.07; standard deviation, 11.106; t[28], -0.954; P = .348; and 95% confidence interval, -12.380 to 4.513).

DISCUSSION

In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a 'typical' position, may not lead to an immediate improvement in hand function.

CONCLUSIONS

Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term.

Motor Improvement in Adolescents Affected by Ataxia Secondary to Acquired Brain Injury: A Pilot Study

Aim

To assess changes in locomotion and balance in adolescents affected by ataxia secondary to acquired brain injury after a rehabilitation treatment with physiotherapy and the Gait Real-time Analysis Interactive Lab (GRAIL), an immersive virtual reality platform.

Methods

11 ataxic adolescents (16(5) years old, 4.7(6.7) years from injury) underwent 20 45-minute sessions with GRAIL plus 20 45-minute sessions of physiotherapy in one month. Patients were assessed before and after rehabilitation with functional scales and three-dimensional multiple-step gait analysis.

Results

Results showed significant improvements in ataxia score assessed by the Scale for the Assessment and Rating of Ataxia, in dimension D and E of Gross Motor Function Measure, in walking endurance and in balance abilities. Moreover, the training fostered significant changes at hip, knee, and ankle joints, and the decrease of gait variability, toward healthy references.

Interpretation

In spite of the pilot nature of the study, data suggest that training with immersive virtual reality and physiotherapy is a promising approach for ataxic gait rehabilitation, even in chronic conditions.

Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury

OBJECTIVE

To evaluate retrospectively the effect of robotic rehabilitation in a large group of children with motor impairment; an additional goal was to identify the effects in children with cerebral palsy (CP) and acquired brain injury (ABI) and with different levels of motor impairment according to the Gross Motor Function Classification System. Finally, we examined the effect of time elapsed from injury on children's functions.

DESIGN

A cohort, pretest-posttest retrospective study was conducted.

SETTING

Hospitalized care.

PARTICIPANTS

A total of 182 children, 110 with ABI and 72 with CP and with Gross Motor Function Classification System (GMFCS) levels I-IV, were evaluated retrospectively.

INTERVENTIONS

Patients underwent a combined treatment of robot-assisted gait training and physical therapy.

MAIN OUTCOME MEASURES

All the patients were evaluated before and after the training using the 6-minute walk test and the Gross Motor Function Measure. A linear mixed model with 3 fixed factors and 1 random factor was used to evaluate improvements.

RESULTS

The 6-minute walk test showed improvement in the whole group and in both ABI and CP. The Gross Motor Function Measure showed improvement in the whole group and in the patients with ABI but not in children with CP. The GMFCS analysis showed that all outcomes improved significantly in all classes within the ABI subgroup, whereas improvements were significant only for GMFCS III in children with CP.

CONCLUSIONS

Children with motor impairment can benefit from a combination of robotic rehabilitation and physical therapy. Our data suggest positive results for the whole group and substantial differences between ABI and CP subgroups, with better results for children with ABI, that seem to be consistently related to time elapsed from injury.

Cognitive strategy on upper extremity function for stroke: A randomized controlled trials

BACKGROUND

Cognitive orientation to daily occupational performance (CO-OP) is a task-specific training applied using a cognitive behavioral approach to improve performance in daily activities and to enable the patient to overcome limitations related to them.

OBJECTIVES

The purpose of this study was to investigate the effects of the CO-OP approach in comparison with task-specific upper extremity training (TUET) on performance related to daily and functional activities in individuals with chronic hemiparetic stroke.

METHODS

Forty-nine participants diagnosed with stroke for the first time underwent 30 minutes of either the CO-OP approach or TUET 5 days a week for 4 weeks. We evaluated their performance on the box-and-block test (BBT), Canadian occupational performance measure (COPM), and community integration questionnaire (CIQ) and Wolf motor function test-functional score (WMFT-F) before and after the training.

RESULTS

Our results show a significantly improvement in the WMFT-F, COPM-P, COPM-S, BBT, and CIQ scores after training in the CO-OP group, but only COPM-S score was significantly improvement after training in TUET group (p <  0.05). This study also found higher increases in the mean WMFT-F, COPM-P, COPM-S and BBT scores in the CO-OP group than in the TUET group, but CIQ score did not have a significantly higher increase between-group after training.

CONCLUSIONS

The results of this study suggest that the CO-OP approach resulted in a positive therapeutic effect on self-selected occupational performance and daily and functional activities in individuals with chronic hemiparetic stroke.

Effectiveness of Cognitive Orientation to daily Occupational Performance over and above functional hand splints for children with cerebral palsy or brain injury: a randomized controlled trial

Background

Functional hand splinting is a common therapeutic intervention for children with neurological conditions. The aim of this study was to investigate the effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach over and above conventional functional hand splinting, and in combination with splinting, for children with cerebral palsy or brain injury.

Methods

A multisite, assessor-blinded, parallel, randomized controlled trial was conducted in Australia. Participants (n = 45) were randomly allocated to one of three groups; (1) splint only (n = 15); (2) CO-OP only (n = 15); (3) CO-OP + splint (n = 15). Inclusion: age 4–15 years; diagnosis of cerebral palsy or brain injury; Manual Ability Classification System I–IV; hand function goals; sufficient language, cognitive and behavioral ability. Primary outcome measures were the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS). Treatment duration for all groups was 2 weeks. CO-OP was provided in a group format, 1 h per day for 10 consecutive weekdays, with parents actively involved in the group. Hand splints were wrist cock-up splints that were worn during task practice. Three individual goals were set and all participants were encouraged to complete a daily home program of practicing goals for 1 h. Analyses were conducted on an intention to treat basis.

Results

The COPM showed that all three groups improved from baseline to immediately post-treatment. GAS showed a statistically significant difference immediately post-intervention between the splint only and CO-OP only groups p = 0.034), and the splint only and CO-OP + splint group (p = 0.047) favoring CO-OP after controlling for baseline.

Conclusions

The CO-OP Approach™ appeared to enhance goal achievement over and above a functional hand splint alone. There was no added benefit of using hand splints in conjunction with CO-OP, compared to CO-OP alone. Hand splints were not well tolerated in this population. Practice of functional goals, through CO-OP or practice at home, leads to goal achievement for children with cerebral palsy or brain injury.

Trial registration

Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000690752) on 24/06/2013.

Electronic supplementary material

The online version of this article (10.1186/s12887-018-1213-9) contains supplementary material, which is available to authorized users.

Robotically-driven orthoses exert proximal-to-distal differential recovery on the lower limbs in children with hemiplegia, early after acquired brain injury

Robotically-driven orthoses (RDO) are promising for treating gait impairment in children with hemiplegia after acquired brain injury (ABI). Despite this, existing literature on the employment of RDO in ABI is scanty, and cohorts' age spans throughout the adult age, with no specific focus on the developmental age. We aim to compare a treatment solely based on conventional physiotherapy (CP) with a program combining RDO training with CP, and to examine the effect of time following ABI on recovery. A prospective two-cohorts study was conducted in a rehabilitation hospital. Post-acute and chronic children with hemiplegia due to ABI underwent either: (i) 20 sessions of RDO plus 20 sessions of CP (n = 29), or (ii) 40 of CP (n = 12). Gross Motor Function Measures (GMFM), Functional Assessment Questionnaire (FAQ), 6 Minutes Walk Test and gait analysis (GA) parameters were recorded before and after training. Over all the patients in RDO + CP group, all GMFM domains and FAQ improved after RDO training (p < 0.05). The unaffected limb showed significantly decreased stance, increased step length and reduced anteroposterior center of pressure oscillation; the affected side increased the stride length. ROM hip and knee flex-extension increased bilaterally (p < 0.05 for all). RDO training during the acute/subacute post-injury phase increased motor functional abilities, cadence and velocity of gait (p < 0.05). We conclude that RDO imposes a proximal-to-distal differential effect on the lower limbs, with the hip joint being the most stimulated. RDO training fostered recovery, increasing the quality of gait on the unaffected side. Planning RDO early in the rehabilitation course of pediatric ABI is advantageous. RDO + CP may extend rehabilitation efficacy to the proximal segment of leg and to gait velocity.

The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach: Best responders in children with cerebral palsy and brain injury

BACKGROUND

Identifying the characteristics of individuals who are most likely to respond to a certain rehabilitation intervention is advantageous for the child, family, clinicians and the healthcare system.

AIM

To investigate the individual characteristics of children with cerebral palsy or brain injury who responded best to the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach.

METHODS

Post hoc analyses were conducted on 30 participants who participated in CO-OP within a larger randomized controlled trial. Inclusion: cerebral palsy or brain injury; age 4-15 years; Manual Abilities Classification System (MACS) I-IV; goals related to hand function; sufficient cognitive, language and behavioral ability to undertake CO-OP. Outcome measures were the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) collected immediately following the two week intervention period.

RESULTS

Following CO-OP, 67% (n = 20) of participants showed a statistically significant response on the COPM, and 73%(n = 22) on the GAS. Nine participants were classified as best responders. When compared to non-responders, best responders were more likely to be female (p = .025) and to have received a higher dose of CO-OP (p = .028). Neither age nor MACS were predictors of response.

CONCLUSION

To be successful in CO-OP, children should meet the prerequisites of CO-OP, particularly the language and cognitive ability to set goals and communicate effectively with the therapist. In this small sample, children with comorbidities were less likely to achieve goals, females were more likely to respond and dose of therapy was important to success.

Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study

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.

Characteristics associated with physical activity capacity and performance in children and adolescents with an acquired brain injury

AIM

To examine characteristics associated with physical activity capacity and performance in children with acquired brain injury (ABI).

METHODS

58 children (32 men; age 11 years 11 months ± 2 years 6 months; Gross motor function classification system [GMFCS] equivalent I = 29, II = 29) >12 months post ABI were recruited. Physical activity capacity measures included: (i) combined score of three 30-second repetition maximum functional strength exercises; (ii) timed up and go; (iii) 6-minute walk test and (iv) high-level mobility assessment tool (HiMAT). Physical activity performance determined time spent in sedentary, light and moderate to vigorous physical activity (MVPA). Full scale intelligence quotient (FSIQ) was assessed using the Wechsler intelligence scale for Children-IV. Regression models were constructed with functional strength score (n = 56), activity counts/minutes and time spent in MVPA and sedentary (n = 37).

RESULTS

The HiMAT and FSIQ explained 69% of the variance in functional strength. Age explained 12% of the variance in counts/min and 14% of the variance in time spent sedentary. GMFCS explained 10% of the variance in time spent in MVPA.

CONCLUSIONS

The ability to perform functional strength exercises is associated with mobility beyond independence and adequate intellectual ability for children with ABI. Age was the most significant factor associated with physical activity performance, and interventions should target adolescents with ABI.

The Cognitive Orientation to daily Occupational Performance (CO-OP): A scoping review

Background.

The Cognitive Orientation to daily Occupational Performance (CO-OP) approach—now trademarked as the CO-OPApproach—was introduced in the literature in 2001 as an intervention to improve real-world performance in children with developmental coordination disorder. CO-OP has since appeared in numerous publications and has seen adoption with various populations. No compilation of the CO-OP literature is available.

Purpose.

The purpose of this scoping review was to examine the extent (number) and nature (features and characteristics) of the literature on CO-OP.

Method.

Using the scoping review methodology outlined by Arksey and O’Malley, 10 online databases were searched for materials discussing CO-OP. Materials found were reviewed by two reviewers, independently. Articles were categorized according to identified study characteristics.

Findings.

In all, 94 documents were found, including 27 research articles examining application and adaptations of CO-OP with eight populations. In all cases, the approach was deemed useful; however, in many cases, adaptations to the CO-OP protocol were recommended.

Implications.

CO-OP has been applied with a number of populations. There is now sufficient research to warrant a systematic review of the research literature.

Parents' experience of undertaking an intensive cognitive orientation to daily occupational performance (CO-OP) group for children with cerebral palsy

PURPOSE

The purpose of this study was to explore the experience of parents of children with cerebral palsy (CP) who participated in an intensive cognitive orientation to daily occupational performance (CO-OP) group program addressing child chosen goals.

METHOD

Participants were six parents of children with CP who participated in a CO-OP upper limb task-specific training program. Parents participated in semi-structured interviews conducted via phone. A grounded theory approach was used. Interviews were transcribed verbatim and coded to identify categories and overarching themes of the parent experience of CO-OP.

RESULTS

The theory of CO-OP for children with CP was one of offering a unique and motivating learning experience for both the child and the parent, differing from other therapeutic approaches that families had previously been involved in. Five categories were identified: the unique benefits of CO-OP; the importance of intensity; the child's motivation; challenging the parent role; and the benefits and challenges of therapy within a group context.

CONCLUSION

Parents felt that CO-OP was a worthwhile intervention that leads to achievement of goals involving upper limb function and had the capacity to be transferred to future goals. Intensity of therapy and a child's motivation were identified as important factors in improvements. Further studies using quantitative research methods are warranted to investigate the benefits of CO-OP for children with neurological conditions. Implications for rehabilitation The cognitive orientation to daily occupational performance (CO-OP) is a promising upper limb cognitive motor training intervention for children with cerebral palsy. In a small sample, parents perceived that CO-OP leads to achievement of upper limb goals. Intensity of therapy, the child's motivation and the parents' ability to "step-back" were identified as important to the success of CO-OP.

Early intervention to improve hand function in hemiplegic cerebral palsy

Children with hemiplegic cerebral palsy often have marked hand involvement with excessive thumb adduction and flexion and limited active wrist extension from infancy. Post-lesional aberrant plasticity can lead to progressive abnormalities of the developing motor system. Disturbances of somatosensory and visual function and developmental disregard contribute to difficulties with hand use. Progressive soft tissue and bony changes may occur, leading to contractures, which further limit function in a vicious cycle. Early intervention might help to break this cycle, however, the precise nature and appropriateness of the intervention must be carefully considered. Traditional approaches to the hemiplegic upper limb include medications and botulinum toxin injections to manage abnormalities of tone, and surgical interventions. Therapist input, including provision of orthoses, remains a mainstay although many therapies have not been well evaluated. There has been a recent increase in interventions for the hemiplegic upper limb, mostly aimed outside the period of infancy. These include trials of constraint-induced movement therapy (CIMT) and bimanual therapy as well as the use of virtual reality and robot-assisted therapy. In future, non-invasive brain stimulation may be combined with therapy. Interventions under investigation in the infant age group include modified CIMT and action observation therapy. A further approach which may be suited to the infant with thumb-in-palm deformity, but which requires evaluation, is the use of elastic taping. Enhanced cutaneous feedback through mechanical stimulation to the skin provided by the tape during movement has been postulated to modulate ongoing muscle activity. If effective, this would represent a low-cost, safe, widely applicable early intervention.