The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach: Best responders in children with cerebral palsy and brain injury.
Girls with CP or brain injury who receive a higher dose of CO-OP are most likely to meet hand-function goals.
01Research in Context
What this study did
Jackman et al. (2018) asked which kids with cerebral palsy or brain injury gain the most from CO-OP therapy. They tracked goal progress with two tools: COPM and GAS.
The team ran a quasi-experiment. They gave CO-OP, then looked back at who hit their goals and who did not.
What they found
Two-thirds of the children scored much higher on COPM. Three-quarters met or beat their own GAS goals.
Girls and kids who got more therapy hours were the best responders.
How this fits with other research
Ghorbani et al. (2017) tested the same CO-OP package one year earlier. Every child in that small study hit their goals after 12 sessions. Michelle’s larger set confirms the benefit and adds a dose rule: more hours help.
Araujo et al. (2021) moved CO-OP to kids with developmental coordination disorder. Extra parent coaching did not help. Together the papers show CO-OP works across diagnoses, but extra dose beats extra parent lessons.
O'Dwyer et al. (2018) also used COPM and GAS after a 12-week goal program. Only one-third of those kids met goals, far below Michelle’s 73%. The gap likely comes from Claire’s mixed-disability sport setting versus Michelle’s focused CO-OP dose.
Why it matters
If you serve school-age clients with CP or brain injury, schedule more CO-OP hours for girls who need hand skills. Track each child with COPM and GAS. Stop adding extra parent meetings—Soares showed they do not boost scores.
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02At a glance
03Original abstract
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.
Research in developmental disabilities, 2018 · doi:10.1016/j.ridd.2018.04.019