Combined Cognitive-Strategy and Task-Specific Training Affects Cognition and Upper-Extremity Function in Subacute Stroke: An Exploratory Randomized Controlled Trial.

The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO-OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis-Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO-OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO-OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial.

Incorporating a Cognitive Strategy Approach into an Outpatient Stroke Physiotherapy Programme: Case Report.

Purpose: Cognitive Orientation to daily Occupational Performance (CO-OP) has demonstrated an effect on skill performance, compared with the usual outpatient rehabilitation, in people living with stroke when implemented by occupational therapists. This study explored refining CO-OP for delivery by both occupational therapists and physiotherapists. Client Description: Two cases were recruited and treated using the CO-OP approach, which augments task-specific training with cognitive strategies and guided discovery. Intervention: Case 1 was a 79-year-old woman, 31 days after parietal stroke, and Case 2 was a 45-year-old man, 62 days after bilateral brain stem stroke. Case 1 withdrew from the study for medical reasons. Outcome measures applied were the Canadian Occupational Performance Measure, the Stroke Impact Scale (SIS), the Self-Efficacy Gauge, the Berg Balance Scale, the Box and Block Test, and the 2-minute walk test. Measures and Outcomes: After 10 sessions, Case 2 made gains in most measures, including a 22-point gain in the SIS mobility domain. Implications: The therapists reported that the combined delivery required additional communication with the patients but was feasible. Case 2 reported physical and mobility gains larger than the mean changes seen in past CO-OP research. Although these results cannot be generalized, findings suggest that the inter-professional application of CO-OP warrants further investigation.

Objectif : appliquée par des ergothérapeutes, l'approche CO-OP (Cognitive Orientation to daily Occupational Performance) est plus efficace que la réadaptation habituelle en milieu ambulatoire pour améliorer la fonction des personnes ayant subi un accident vasculaire crébral (AVC). Cette étude porte sur l'amélioration de l'approche CO-OP exécutée en parallèle par des ergothérapeutes et des physiothérapeutes. Description du client : nous avons recruté deux personnes que nous avons traitées à l'aide de l'approche CO-OP, qui complète les exercices traditionnels par des stratégies cognitives et de découverte guidée. Intervention : le premier cas était celui d'une femme âgée de 79 ans victime d'un AVC au lobe pariétal 31 jours auparavant, et le deuxième cas, celui d'un homme âgé de 45 ans victime d'un AVC bilatéral du tronc cérébral 62 jours auparavant. Le premier cas s'est retiré de l'étude pour des raisons médicales. Nous avons mesuré les résultats à l'aide de la mesure canadienne du rendement occupationnel (COPM), de l'échelle d'évaluation de l'impact de l'AVC (SIS), de l'échelle d'évaluation du sentiment d'efficacité personnelle (Self-efficacy Scale), de l'échelle de l'équilibire de Berg, du test « Boîte et blocs ¼ et du test de marche de 2 minutes. Mesures et résultats : après 10 séances, le deuxième cas avait réalisé des gains dans la plupart des mesures, dont un gain de 22 points à l'échelle SIS pour la mobilité. Implications : les thérapeutes ont indiqué que la prestation en parallèle nécessitait davantage de communication avec le patient, mais était faisable. Les gains physiques et de mobilité chez le deuxième cas sont supérieurs aux changements moyens observés lors d'études antérieures sur l'approche CO-OP. Même si on ne peut généraliser les résultats, l'application interprofessionnelle de l'approche CO-OP mérite davantage de recherche.

Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke: An Exploratory Randomized Controlled Trial.

PURPOSE: The purpose of this study was to estimate the effect of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach compared with usual outpatient rehabilitation on activity and participation in people <3 months poststroke. METHODS: An exploratory, single-blind, randomized controlled trial, with a usual-care control arm, was conducted. Participants referred to 2 stroke rehabilitation outpatient programs were randomized to receive either usual care or CO-OP. The primary outcome was actual performance of trained and untrained self-selected activities, measured using the Performance Quality Rating Scale (PQRS). Additional outcomes included the Canadian Occupational Performance Measure (COPM), the Stroke Impact Scale Participation Domain, the Community Participation Index, and the Self-Efficacy Gauge. RESULTS: A total of 35 eligible participants were randomized; 26 completed the intervention. Post intervention, PQRS change scores demonstrated that CO-OP had a medium effect over usual care on trained self-selected activities (d = 0.5) and a large effect on untrained activities (d = 1.2). At a 3-month follow-up, PQRS change scores indicated a large effect of CO-OP on both trained (d = 1.6) and untrained activities (d = 1.1). CO-OP had a small effect on COPM and a medium effect on the Community Participation Index perceived control and on the Self-Efficacy Gauge. CONCLUSION: CO-OP was associated with a large treatment effect on follow-up performances of self-selected activities and demonstrated transfer to untrained activities. A larger trial is warranted.