Cerebrovascular Accident
Conditions
Keywords
CO-OP, executive functions, stroke, single-case experimental designs, transfer of knowledge, sens of self efficacy
Brief summary
The research focuses on top-down intervention approaches and more specifically on the Cognitive Orientation to daily Occupational Performance (CO-OP) method in the rehabilitation of executive function disorders in adult post-stroke subjects in chronic phase. The main objective of this study is therefore to improve performance in significant activities of daily living for people with chronic post-stroke dysexecutive disorders.
Detailed description
Today, approaches to intervention with adults after stroke can be categorized into two groups: bottom-up approaches (neurodevelopmental, sensory integration, mental imagery, cognitive stimulation, perceptual-motor/kinesthetic training...) and top-down approaches (task-oriented approach, neuromotor task training, occupational performance coaching, the CO-OP approach). Although bottom-up intervention approaches have existed for several years longer than top-down approaches, in general, top-down intervention approaches have shown better results. In the latest work with post-stroke adults with objective cognitive impairment, the data indicate the relevance of CO-OP in improving performance and satisfaction, attention, inhibition and flexibility or apathy. This study aims to demonstrate the effectiveness of the CO-OP approach in adult post-stroke patients in chronic phase, specifically on planning function, through the Single Case Experimental Design methodology by randomized intervention (3 patients) over 6 weeks of treatment and 10 weeks of evaluation.
Interventions
OTHERCo-OP treatment
The Cognitive Orientation to daily Occupational Performance (CO-OP) approach is described as a patient-centred, performance-oriented approach to activities and problem solving that allows skills to be acquired through a process of strategy use and guided discovery. The CO-OP protocol is composed of seven key characteristics: i) the goals chosen by the patient, ii) dynamic performance analysis, iii) the use of cognitive strategies, iv) guided discovery, v) the principles of empowerment, vi) the involvement of a relative, vii) the structure of the intervention (Polatajko and Mandich, 2004/2017). CO-OP is an evidence-based approach to intervention, including evidence of its effectiveness on a physical, cognitive and emotional dimension in adults with stroke
Sponsors
University Hospital, Toulouse
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Stroke responsible for a dysexecutive syndrome authenticated by the GREFEX battery * Stroke more than 6 months old (chronic phase) * Social security affiliation * Signing of a free and informed consent following clear and detailed information.
Exclusion criteria
* Disorder of comprehension objectified by the - LAnguage Screening Test (LAST) (minimum score 4/8 in expression and 6/7 in comprehension) * Significant anosognosia of dysexecutive syndrome * Pregnant women * Neurological condition other than stroke or psychiatric disorder * Patient following a rehabilitation with a liberal therapist targeting executive functions during the period of participation in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improved performance in significant activities of daily living | 10 weeks | Improved performance in significant activities of daily living will be measured bi-weekly by the Canadian Occupational Performance Measurement. The score is between 1 to 10 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| improvement in the sense of personal effectiveness | 10 weeks | The improvement in the sense of personal effectiveness will be measured by New General Self-Efficacy Scale (8 questions with response to 1 for strongly disagree to 5 for strongly agree) |
| Analytically measure of executive functions | 10 weeks | The analytical improvement of executive functions will be measured by the Trail Making Tes |
Countries
France
Outcome results
None listed