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Introduction

Cognitive Orientation to Daily Occupational Performance (CO-OP) is an intervention approach used for individuals with deficits in metacognition. CO-OP takes a cognitive approach in developing skills to combat with daily occupational performance problems. CO-OP is very client centered, involves those close to the client, and allows them to set their own goals and strategies to reach those goals. Clients that demonstrate deficits in executive functions, such as those with a traumatic brain injury (TBI), can benefit from a CO-OP based intervention (Dawson et al., 2009; Polatajko, Mandich, Miller, & Macnab, 2001)

Theory

Metacognitive strategies are believed to have a positive effect on the rehabilitation of executive dysfunction. Having the client practice self-identified tasks in their own physical environment promotes generalization and enhances the benefits of metacognitive training. The Cognitive Orientation to Occupational Performance (CO-OP) approach has the potential to improve performance in daily tasks in individuals with executive dysfunction (Dawson et al., 2009)

Evidence

A single case study conducted by Dawson, Gaya, and Levine (2009) explored the benefits of metacognitive strategies on the executive functioning of adults with TBI. The study’s participants included three adults who experienced a TBI 5-20 years prior, as well as their self-identified significant others. The assessments included neuropsychological tests and the Canadian Occupational Performance Measure (COPM). The intervention included  guiding participants in self-identified daily tasks that they needed and wanted to do, but had difficulty completing. The intervention occurred over 20 one-hour sessions in the participants individual environments. The study concluded that the CO-OP approach has the potential to improve the daily functioning of adults with a TBI.

Case Study

Gloria came to the United States 15 years ago to live with her daughter after escaping the cartel. Since she has moved here, her daughter states she has jumped head first into helping out with tasks around the house and taking care of the children. Yolanda, her daughter, says that she wouldn’t be able to get by for long without her mother’s help. While getting ready to take her grandchildren to school a month ago, Gloria fell down the stairs and suffered a TBI. Although she is home now, the injury has caused Gloria to have issues with memory and completing every day tasks. Prior to her injury, Gloria fixed meals for her family, cleaned the home, washed clothes, and took the children to school. Since her TBI, Gloria has forgotten how to pay for groceries, the steps for washing and drying laundry, and has been unable to cook full meals.

Intervention Plan

Problem Statement

Client’s memory impairments are impeding her ability to complete ADL’s independently.

Short Term Goals

1. Client will demonstrate CO-OP strategies for completing laundry tasks using verbal cues  in 5 weeks.
2. Client will demonstrate CO-OP strategies for planning a meal using verbal cues in 5 weeks.
3. Client will verbalize the steps for cooking a simple meal with verbal cues in 10 weeks.

Long Term Goals

1. Client will implement CO-OP strategies independently to complete laundry tasks in 20 weeks.
2. Client will independently demonstrate CO-OP strategies for untrained tasks in 20 weeks
3. Client will independently prepare a family meal using CO-OP for meal prep in 20 weeks.

Intervention Format

Individual

Setting

Gloria will meet with the occupational therapist at her home for 1 hour, 2x/week for 20 weeks.

Supplies

None

Agenda

• Meet Gloria and develop rapport to establish trust (2 mins)
• Administer the COPM to identify what occupational skills Gloria is struggling with and what she would like to focus on (25 mins)
  • Discuss the occupations she finds most important and how she believes she can improve those skills (15 mins)
  • Have Gloria complete a simple cooking task (10 mins)
• Provide a summary of the discussion (6 mins)

Documentation

S: Client states that she would like to be able to get back to cooking for her family the way she used to.

O: Client participated in a one hour session in which she identified occupations which she found the most important. Client identified her three most important occupations as laundry, cooking and grocery shopping. On a scale from 1-10 (10=most important, 1=least important) client rated the importance of the following tasks: grocery shopping=10, cooking=9, and laundry=9. Client then rated her performance level on the following tasks (10=very good performance, 1=poor performance): grocery shopping= 2, cooking=1, and laundry=1. Client then rated her satisfaction level on the following tasks (10=highly satisfied, 1=poorly satisfied): grocery shopping=1, cooking=1, and laundry=1. Client completed simple microwave cooking activity with skilled observation. Client skipped putting water in the oatmeal before placing in microwave.

A: Client demonstrated deficits in executive functioning, resulting in client’s inability to complete preferred  IADL’s.  Client would benefit from further occupational therapy to increase cognitive skills needed to complete complex IADL’s. Client is motivated to improve IADL’s and to increase  her family dynamics. Client would be a good candidate for CO-OP  intervention to improve executive functioning.

P: Client will continue with OT sessions for 1 hour, 2x/week for 20 weeks focusing on CO-OP strategies to increase her participation in cooking, laundry, and grocery shopping.

References

Brown, C., Stoffel, V., & Munoz, J. P. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F.A. Davis

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