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

Journal article


Jackman, Michelle, Novak, Iona, Lannin, Natasha, Froude, Elspeth, Miller, Laura and Galea, Claire. (2018). 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. 18(1), pp. 1 - 12. https://doi.org/10.1186/s12887-018-1213-9
AuthorsJackman, Michelle, Novak, Iona, Lannin, Natasha, Froude, Elspeth, Miller, Laura and Galea, Claire
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.

Keywordsupper limb; task-specific training; motor training; cognition; orthoses; goal-directed; occupational therapy
Year2018
JournalBMC Pediatrics
Journal citation18 (1), pp. 1 - 12
PublisherBioMed Central
ISSN1471-2431
Digital Object Identifier (DOI)https://doi.org/10.1186/s12887-018-1213-9
Scopus EID2-s2.0-85050737853
Open accessOpen access
Page range1 - 12
Research GroupSchool of Allied Health
Publisher's version
License
Place of publicationUnited Kingdom
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Therapeutic practice resulted in moderate improvement in handwriting ability for children with poor handwriting when compared with sensorimotor intervention, but not when compared with a control group
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