24

Introduction

This chapter is based on teaching the client to use compensatory thinking strategies. The CO-OP is a therapy technique that works on the cognitive orientation to daily occupational performance and creating problem solving strategies. The steps include creating a goal, where the client identifies what they want to do. Then creating a plan where they write down how they will go about doing it. Next the client does the plan and last, they learn how to check their performance. During the last step the client reflects on if their plan originally worked or if things need to be modified. Therapists guide the session with questions in order assist them in reflecting and being able to generalize what they learn to other settings (Dawson, 2009).

Theory

CO-OP is a cognitive approach that helps one solve problems with occupational performance problems. CO-OP in relation to MOHO helps the client improve their cognition and skill acquisition to improve ones occupational performance. By identifying tasks that are important to the client, the client is motivated to work on problem-solving to complete these meaningful tasks so that he can better perform according to the duties to fulfill his role as a father (Brown, 2011).

Evidence

Upon reviewing the evidence there were no particular articles that applied to our specific population; however, we found an article that described the use of the intervention and how it can be useful. According to the article, CO-OP can be used to achieve daily occupational performance and has been developed over the last nine years through systematic studies that have evaluated its effect. A pilot randomized clinical trial by Polatajko, Mandich, Miller, and Macnab (2001) determined the effectiveness of CO-OP. Although this evidence demonstrates the effectiveness of CO-OP in improving the performance of children with DCD, it can still be used to achieve one’s functional goals. The same steps (goal-plan-do-check) can be used to help adults overcome obstacles just like children, and provides them with a useful technique. Individuals that are unable to participate in everyday activities due to a hindering disorder such as anxiety, would also benefit from this technique in order to visualize and verbalize the necessary steps to solve their problem.Through the use of a therapist’s guidance and the steps our client can draw out a plan and follow the steps to increase participation in their occupational performance.

Case Study

Clint is a 25 year old male who goaltends for the Florida Panthers hockey team. About a month ago, his neck was slashed with another player’s skate during a game, almost killing him. Following this incident, he is plagued by PTSD, alcoholism, OCD, and has made a suicide attempt. Previously, playing hockey gave Clint a feeling of purpose; however, now he no longer believes that he is capable of returning to work. Clint has begun to have difficulties completing household management. He has difficulty trimming his hedges due to his traumatic experiences with blades. He has participated in multiple OT sessions but is now being educated on CO-OP strategies to better problem-solve to overcome the anxiety that is hindering his performance.

Intervention Plan

Problem statement:

• Client is unable to participate in household management tasks due to symptoms of anxiety.

2 long term goals:

• LTG: Client will be able to trim his hedges independently within 20 weeks for increased independence in household management.
• LTG: Client will demonstrate independence in completing household management tasks as shown by a 10/10 in the COPM for productivity after 15 weeks of treatment.

3 short term goals:

• STG: Client will practice deep breathing exercises before preparing to use kitchens shears for household management within 2 weeks.
• STG: Client will verbalize 3/3 CO-OP strategies independently within 3 weeks to improve ability to apply CO-OP strategy and increase independence in household management tasks.
• STG: Client will demonstrate appropriate use of CO-OP strategies with minimal verbal cues within 8 weeks to improve independence in complex IADL’s.

Intervention format

• CO-OP

Description of setting

• Self-pay Outpatient clinic.

Supplies

• Kitchen shears, Bonsai plant

Agenda

-Empower client to choose 3 personal goals (10 minutes)

-Teach client and spouse the CO-OP process (Goal-Plan-Do-Check) (20 minutes)

-Have client verbalize and practice CO-OP strategies while trimming a small Bonsai plant (25 minutes)

-Assign homework for client to complete prior to next week’s session (5 minutes)

Documentation

S: Client stated that he would like to get back to trimming his hedges and mowing the lawn but the blades give him anxiety and remind him of his accident.

O: Client engaged in a 1 hour session using CO-OP strategies to be able to overcome his anxiety when completing certain household tasks. Client identified 3 goals he’d like to work on with his main priority being trimming his hedges at home independently. Client and spouse were educated on the CO-OP process. Client and spouse repeated the Goal-Plan-Do-Check steps back without any errors or cueing from therapist. Client completed plant trimming task using kitchen shears with moderate verbal cues from therapist.

A: Client demonstrated persistent deficits managing anxiety as evidenced by hyperventilation and diaphoresis. Despite persistent deficits, client shows potential for continued improvement in managing symptoms of anxiety. Client demonstrated improved knowledge in CO-OP process as evidenced by his ability to verbalize all the steps of the CO-OP without error.

P: Client with implement Goal-Plan-Do-Check problem solving strategies at home for homework. Client would benefit from at least 15 more OT sessions in order to create a problem solving technique to overcome his fear of using a hedge trimmer in order to generalize and eventually be able to do all outdoor chores without anxiety.

References

Brown, C. (2011). Cognitive Skills, in Occupational Therapy in Mental Health: A Vision for Participation. Brown, Stoffel, Editors. FA Davis: Philadelphia.

Dawson, D. R., Gaya, A., Hunt, A., Levine, B., Lemsky, C., & Polatajko, H. J. (2009). Using the cognitive orientation to occupational performance (CO-OP) with adults with executive dysfunction following traumatic brain injury. Canadian Journal of Occupational Therapy, 76(2), 115-127.

Polatajko, H. J., Mandich, A. D., Miller, L. T., & Macnab, J. J. (2001). Cognitive Orientation to Daily Occupational Performance (CO-OP) Part II The Evidence. Physical & Occupational Therapy in Pediatrics, 20(2-3), 83-106.