The Cognitive Orientation to Daily Occupational Performance Approach and Transfer: A Scoping Review.

Transferring learning from therapy to everyday life skills is a necessary step for successful therapy outcomes, yet rarely addressed and achieved. However, a cognitive approach to skill acquisition, and the Cognitive Orientation to daily Occupational Performance (CO-OP), explicitly identifies transfer as an objective and incorporates elements into the intervention to support transfer. A scoping review was undertaken to explore the nature and extent of the research regarding CO-OP and transfer. An online search of 10 databases was conducted to identify and examine research studies reporting on CO-OP and transfer. The search yielded 25 documents that addressed CO-OP and transfer. The studies used a variety of approaches to evaluate transfer; all reported transfer on at least one and, in many cases, multiple transfer outcome variables. The CO-OP literature addresses transfer across a variety of populations and settings using a variety of approaches. Further work is required to establish a common approach to examining transfer in the CO-OP literature and the literature in general.

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.

Limited interlimb transfer of locomotor adaptations to a velocity-dependent force field during unipedal walking.

Several studies have demonstrated that motor adaptations to a novel task environment can be transferred between limbs. Such interlimb transfer of motor commands is consistent with the notion of centrally driven strategies that can be generalized across different frames of reference. So far, studies of interlimb transfer of locomotor adaptations have yielded disparate results. Here we sought to determine whether locomotor adaptations in one (trained) leg show transfer to the other (test) leg during a unipedal walking task. We hypothesized that adaptation in the test leg to a velocity-dependent force field previously experienced by the trained leg will be faster, as revealed by faster recovery of kinematic errors and earlier onset of aftereffects. Twenty able-bodied adults walked unipedally in the Lokomat robotic gait orthosis, which applied velocity-dependent resistance to the legs. The amount of resistance was scaled to 10% of each individual's maximum voluntary contraction of the hip flexors. Electromyography and kinematics of the lower limb were recorded. All subjects were right-leg dominant and were tested for transfer of motor adaptations from the right leg to the left leg. Catch trials, consisting of unexpected removal of resistance, were presented after the first step with resistance and after a period of adaptation to test for aftereffects. We found no significant differences in the sizes of the aftereffects between the two legs, except for peak hip flexion during swing, or in the rate at which peak hip flexion adapted during steps against resistance between the two legs. Our results indicate that interlimb transfer of these types of locomotor adaptation is not a robust phenomenon. These findings add to our current understanding of motor adaptations and provide further evidence that generalization of adaptations may be dependent on the movement task.

Locomotor adaptations and aftereffects to resistance during walking in individuals with spinal cord injury.

Muscle activity during the swing phase of walking is influenced by proprioceptive feedback pathways. Previous studies have shown that feedback and anticipatory motor commands contribute to locomotor adaptive strategies to prolonged exposure to a resistance against leg movements during walking. The purpose of this study was to determine whether people with motor-incomplete spinal cord injuries (SCI) modulate flexor muscle activity in response to different levels of resistance in a similar way as uninjured controls. A second purpose was to determine whether people with motor-incomplete SCI have the capacity to form anticipatory motor commands following exposure to resistance. Subjects walked on a treadmill with the Lokomat robotic gait orthosis. The Lokomat applied different levels of a velocity-dependent resistance, normalized to each subject's maximum voluntary contraction of the hip flexors. Each condition consisted of 20 steps against resistance followed by 20 steps without. Electromyography and kinematics of the lower limb were recorded. Although both groups responded to the resistance with an overall increase in rectus femoris activity during swing, the SCI group showed weak modulation of muscle activity to different levels of resistance. Following removal of the resistance, both groups showed aftereffects, but they were manifested differently. Controls responded to the removal of resistance with a high step, whereas the SCI subjects exhibited increased step length. The size of the aftereffect was related to the amount of added resistance. In addition, the SCI group showed a negative relationship between the size of the aftereffect and locomotor function.

Treadmill-based locomotor training with leg weights to enhance functional ambulation in people with chronic stroke: a pilot study.

BACKGROUND AND PURPOSE: Novel locomotor training strategies for individuals with disorders of the central nervous system have been associated with improved locomotor function. The purpose of this study was to investigate the effects of treadmill-based locomotor training combined with leg weights on functional ambulation in individuals with chronic stroke. We assessed functional ambulation and muscle activity in ambulatory individuals with chronic stroke. METHODS: We used a pre/posttest design. Six individuals with chronic stroke who were community ambulators were recruited. Participants underwent a 30-minute treadmill-based locomotor training sessions three times per week for four to 12 weeks. The training program involved treadmill walking for 30 minutes with partial body weight support as needed. Leg weights, equivalent to 5% of body weight, were affixed around the paretic leg. Outcome measures consisted of the 10-m walk test, the modified Emory Functional Ambulation Profile, and temporal gait parameters. RESULTS: Improvements were observed in functional ambulation measures, particularly the stairs subscore of the modified Emory Functional Ambulation Profile. Participants also exhibited an increase in the proportion of time the paretic leg spent in swing. No significant improvements were observed in the 10-m walk test. CONCLUSIONS: This pilot study demonstrates that the combination of leg weights and treadmill training is a feasible approach, that is well tolerated by participants. This approach may have the potential to improve some aspects of functional ambulation and the performance of activities requiring hip and knee flexion.