TY - JOUR
T1 - Cognitive Strategy Training in Childhood-Onset Movement Disorders
T2 - Replication Across Therapists
AU - Gimeno, Hortensia
AU - Polatajko, Helene J.
AU - Lin, Jean Pierre
AU - Cornelius, Victoria
AU - Brown, Richard G.
N1 - Funding Information:
We would like to thank the children, young people, and their families that participated in the study. We would also like to thank the occupational therapists who delivered the intervention. Funding. HG was funded by a National Institute for Health Research (NIHR/HEE Clinical Doctoral Research Fellowship, CDRF-2013-04-039). This paper represents independent research partly funded by the National Institute for Health Research (NIHR) (HG) and the NIHR Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King's College London (RB). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. J-PL has received grants from the Guy's and St Thomas' Charity G060708 to set up the Complex Motor Disorders Service Multidisciplinary Team for Deep Brain Stimulation and Intrathecal Baclofen Service, the Dystonia Society UK Grant 01/2011 and 07/2013, and Action Medical Research GN2097.
Publisher Copyright:
© Copyright © 2021 Gimeno, Polatajko, Lin, Cornelius and Brown.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1/21
Y1 - 2021/1/21
N2 - Objective: To explore preliminary effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach in improving outcomes in childhood-onset hyperkinetic movement disorders (HMDs) including dyskinetic cerebral palsy following deep brain stimulation (DBS) across UK clinical occupational therapists. Methods: Randomized, multiple-baseline, Single Case Experimental Design N-of-1 trial with replications across participants. Five self-selected goals were identified: three goals were worked on during CO-OP and two goals were left untreated and used to assess skills transfer. Participants were between 6 and 21 years and had received DBS surgery with baseline Manual Ability Classification System (MACS) levels I–IV. Participants were randomized to typical or extended baseline (2 vs. 6 weeks), followed by 10 weekly individual CO-OP sessions. The primary outcome was functional performance measured by the Performance Quality Rating Scale-Individualized (PQRS-I), assessed before, during, and following treatment. Outcome assessors were blinded to baseline allocation, session number, and assessment time. A non-overlapping index, Tau-U, was used to measure effect size. Results: Of the 12 participants recruited, 10 commenced and completed treatment. In total, 63% of trained goals improved with effect sizes 0.66–1.00 (“moderate” to “large” effect), seen for all children in at least one goal. Skills transfer was found in 37% of the untrained goals in six participants. Conclusions: Cognitive strategy use improved participant-selected functional goals in childhood-onset HMD, more than just practice during baseline. Preliminary effectiveness is shown when the intervention is delivered in clinical practice by different therapists in routine clinical settings.
AB - Objective: To explore preliminary effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach in improving outcomes in childhood-onset hyperkinetic movement disorders (HMDs) including dyskinetic cerebral palsy following deep brain stimulation (DBS) across UK clinical occupational therapists. Methods: Randomized, multiple-baseline, Single Case Experimental Design N-of-1 trial with replications across participants. Five self-selected goals were identified: three goals were worked on during CO-OP and two goals were left untreated and used to assess skills transfer. Participants were between 6 and 21 years and had received DBS surgery with baseline Manual Ability Classification System (MACS) levels I–IV. Participants were randomized to typical or extended baseline (2 vs. 6 weeks), followed by 10 weekly individual CO-OP sessions. The primary outcome was functional performance measured by the Performance Quality Rating Scale-Individualized (PQRS-I), assessed before, during, and following treatment. Outcome assessors were blinded to baseline allocation, session number, and assessment time. A non-overlapping index, Tau-U, was used to measure effect size. Results: Of the 12 participants recruited, 10 commenced and completed treatment. In total, 63% of trained goals improved with effect sizes 0.66–1.00 (“moderate” to “large” effect), seen for all children in at least one goal. Skills transfer was found in 37% of the untrained goals in six participants. Conclusions: Cognitive strategy use improved participant-selected functional goals in childhood-onset HMD, more than just practice during baseline. Preliminary effectiveness is shown when the intervention is delivered in clinical practice by different therapists in routine clinical settings.
KW - cerebral palsy
KW - dystonia
KW - participation
KW - rehabilitation
KW - single case experimental design
UR - http://www.scopus.com/inward/record.url?scp=85100583762&partnerID=8YFLogxK
U2 - 10.3389/fped.2020.600337
DO - 10.3389/fped.2020.600337
M3 - Article
AN - SCOPUS:85100583762
SN - 2296-2360
VL - 8
JO - Frontiers in Pediatrics
JF - Frontiers in Pediatrics
M1 - 600337
ER -