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

Abstract 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 functio...

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Main Authors: Michelle Jackman, Iona Novak, Natasha Lannin, Elspeth Froude, Laura Miller, Claire Galea
Format: Article
Language:English
Published: BMC 2018-07-01
Series:BMC Pediatrics
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12887-018-1213-9
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spelling doaj-461343af0cce434cbcee653aca28075d2020-11-25T02:11:16ZengBMCBMC Pediatrics1471-24312018-07-0118111210.1186/s12887-018-1213-9Effectiveness of Cognitive Orientation to daily Occupational Performance over and above functional hand splints for children with cerebral palsy or brain injury: a randomized controlled trialMichelle Jackman0Iona Novak1Natasha Lannin2Elspeth Froude3Laura Miller4Claire Galea5School of Child and Adolescent Medicine, The University of SydneySchool of Child and Adolescent Medicine, The University of SydneyAlfred Health, La Trobe UniversitySchool of Health Science, Australian Catholic UniversitySchool of Health Science, Australian Catholic UniversityCerebral Palsy Alliance Research Institute, The University of SydneyAbstract 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.http://link.springer.com/article/10.1186/s12887-018-1213-9Upper limbTask-specific trainingMotor trainingCognitionOrthosesGoal-directed
collection DOAJ
language English
format Article
sources DOAJ
author Michelle Jackman
Iona Novak
Natasha Lannin
Elspeth Froude
Laura Miller
Claire Galea
spellingShingle Michelle Jackman
Iona Novak
Natasha Lannin
Elspeth Froude
Laura Miller
Claire Galea
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
BMC Pediatrics
Upper limb
Task-specific training
Motor training
Cognition
Orthoses
Goal-directed
author_facet Michelle Jackman
Iona Novak
Natasha Lannin
Elspeth Froude
Laura Miller
Claire Galea
author_sort Michelle Jackman
title 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
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
publisher BMC
series BMC Pediatrics
issn 1471-2431
publishDate 2018-07-01
description Abstract 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.
topic Upper limb
Task-specific training
Motor training
Cognition
Orthoses
Goal-directed
url http://link.springer.com/article/10.1186/s12887-018-1213-9
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