Hortensia Gimeno1,2, Helene J Polatajko3, Jean-Pierre Lin1, Victoria Cornelius4, Richard G Brown2,5. 1. Complex Motor Disorders Service, Paediatric Neurosciences, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. 2. Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom. 3. Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada. 4. Imperial Clinical Trials Unit, Imperial College London, School of Public Health, London, United Kingdom. 5. South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Abstract
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.
RCT Entities:
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.
Authors: Anne Koy; Martin Hellmich; K Amande M Pauls; Warren Marks; Jean-Pierre Lin; Oliver Fricke; Lars Timmermann Journal: Mov Disord Date: 2013-02-13 Impact factor: 10.338
Authors: Hortensia Gimeno; Helene J Polatajko; Victoria Cornelius; Jean-Pierre Lin; Richard G Brown Journal: Can J Occup Ther Date: 2018-06 Impact factor: 1.614
Authors: Verity M McClelland; Doreen Fialho; Denise Flexney-Briscoe; Graham E Holder; Markus C Elze; Hortensia Gimeno; Ata Siddiqui; Kerry Mills; Richard Selway; Jean-Pierre Lin Journal: Clin Neurophysiol Date: 2017-11-24 Impact factor: 3.708
Authors: Hortensia Gimeno; Richard G Brown; Jean-Pierre Lin; Victoria Cornelius; Helene J Polatajko Journal: Neurology Date: 2019-02-22 Impact factor: 9.910
Authors: Daniel E Lumsden; Hortensia Gimeno; Markus Elze; Kylee Tustin; Margaret Kaminska; Jean-Pierre Lin Journal: Eur J Paediatr Neurol Date: 2016-02-19 Impact factor: 3.140