The comparison of “Cognitive Orientation to daily Occupational Performance (CO-OP)” with Current Treatment Approach (CTA) on motivation and participation of 8-12 years old children with cerebral palsy

The comparison of “cognitive orientation to daily occupational performance (CO-OP)” with current treatment approach (CTA) on motivation and participation of 8-12 years old children with cerebral palsy

Clinical, Randomized, Tripple-blind trial with two parallel group

After approval of the proposal, the ethical code is drawn up. Iran univercity of medical science introduce the researcher to exceptional education organization for recieving license to enter to schools. We will communicate with the families and invite them to examine the child condition and inclusion criteria by Gross motor function classification system (GMFCS), The Manual Ability Classification System (MACS) and colored Raven intelligence scale. we randomize children to groups of A & B (A: CO-OP and B: CTA). people in group A, will choose three intervention goal with parent and child by using Candian Occupational Performance Model (COPM) and will receive twelve 45-minute sessions of intervention on average twice per week. In group B, children recieve 12 sessions of traditional treatment of occupational therapy. To assess volition, we will use "pediatric volitional questionnaire 2.1" that is an observational questionnaire, will fill by a blinded assessor in Pre and post treatment & session 6. This assessor will observe child behavior in the film recorded. The "Pediatric motivation" (PMOT) scale, assesses motivation from children perspective during therapy session. The questionnaire will be filled by the child in sessions 1, 3,7,11 and 12. "Dimensions of mastery questionnaire(DMQ) parent proxy-report" and "Life habit questionnaire" (LIFE_H) for 5-13-years children with cerebral palsy to assess participation will fill at pre and post session by parents.

Inclusion criteria: age 8 and 12 years of age at the time of intake; diagnosis of cerebral palsy that is determined by neurologist; level 1, 2, or 3 on the Gross Motor Function Classification Scale (GMFCS); level 1, 2 or 3 on The Manual Ability Classification System (MACS); normal intelligence that is determined by Raven test; normal or corrected to normal, hearing and vision; sufficient language ability to communicate with and beunderstood during treatment. Exclusion criteria: dissuasion of parents in making response to questions of measurements or bringing students to the intervention sessions; dissuasion of students in making response to questions of measurements or coming to the intervention sessions; child had previously received, or were presently receiving, a cognitive treatment.

Cognitive orientation to daily occupational performance (CO-OP): is a well-explicated top-down, problem solving approach that has been shown to support skill acquisition and a client-centered approach. The CO-OP approach differ from traditional bottom-up interventions in that it is situated in a learning paradigm and use cognitive strategies to facilitate skill acquisition at the ICF activity rather than structure and function level, and draw on motor learning principle to help children discover how to perform everyday activities. The main objective of CO-OP are skill acquisition, the learning of global problem solving strategy (goal, plan, do, check) and the identification of domain-specific strategies to support generalization to the other environment and transfer to other motor-based tasks. CO-OP can be used to enable the achievement of occupation-based goal while simultaneously promoting self-efficacy. “9 child with inclusion criteria will enter to CO-OP group., Each sample will receive the intervention two days a week and 2 hours in every day. Each sample will receive 12 hours treatment. Current approach for children with cerebral palsy: this treatment typically focus on remediation or bottom-up approaches. Many of this therapeutic approaches to managing cerebral palsy are based on neuromaturational models of motor development which focus on improving motor movement (bottom-up approaches) and do not emphasize performance in every day activities. Other approaches implementing these bottom-up strategies, such as casting and positioning techniques, can be effective in achieving in anatomical goals such as increase range of motion and enhancing postural tone. Little evidence exists that achieving these anatomical goals translates into improved task performance or motor-based skill acquisition among children with cp.

Participation; Mastery motivation; Volition; Motivation during therapy

Participants will select by covenience sampling. Randomizing participants in CO-OP & CTA groups will done with randomization digits table by a blind person to the study.

Participants will not aware of the group that are randomized. In this study the assesments will performed by parent, the child and trained assessor who are blind to the study. The data will enter in SPSS and statistically analysis by a blind statistician.

Article puplished

March 2019

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