Effectiveness of Cognitive Orientation to dailyĞOccupational Performance over and above functional hand splints for children with cerebral palsy or brain injury: A randomized controlled trial

Michelle Jackman, Iona Novak, Natasha Lannin, Elspeth Froude, Laura Miller, Claire Galea

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9 Citations (Scopus)


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 theĞCognitive 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 (nĞ=45) were randomly allocated to one of three groups; (1) splint only (nĞ=15); (2) CO-OP only (nĞ=15); (3) CO-OP + splint (nĞ=15). Inclusion: age 4-15Ğyears; 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 MeasureĞ(COPM) and Goal Attainment Scale (GAS). Treatment duration for all groups was 2Ğweeks. CO-OP was provided in a group format, 1Ğh 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 pĞ=0.034), and the splint only and CO-OP + splint group (pĞ=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.

Original languageEnglish
Article number248
Number of pages12
JournalBMC Pediatrics
Issue number1
Publication statusPublished - 31 Jul 2018
Externally publishedYes


  • Cognition
  • Goal-directed
  • Motor training
  • Occupational therapy
  • Orthoses
  • Task-specific training
  • Upper limb

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