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Introduction

Cognitive Orientation to Daily Occupational Performance (CO-OP) is an intervention approach which focuses on utilizing skill acquisition, cognitive strategy development, and generalization to remediate occupational performance issues (Polatajko et. al, 2001). The goal of the CO-OP approach is to use cognition, via problem solving, to drive successful occupational performance through the development of new skills or improvement of existing skills. CO-OP may be a beneficial intervention approach for individuals with obesity. Specifically, by introducing the acquisition of healthy eating and exercise skills, by developing cognitive strategies and problem solving skills to maintain a healthy lifestyle, and by increasing the generalization of healthy habits, CO-OP will increase the ability to engage in successful occupational performance and support healthy eating and exercise habits in individuals with obesity (Polatajko et. al, 2001).

Theory

Cognitive orientation to daily occupational performance (CO-OP) is “a client-centred, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery” (Mandich & Polatajko, 2004). This intervention targets metacognition to promote self-evaluation of our thought process to complete tasks (Dawson et al., 2009).

Case Study

This client came for a third session occupational therapy session using CO-OP as an intervention approach. Rosa is a 52-year-old woman with an intellectual disability who weighs 265 lbs. She states that she has difficulty preparing meals and maintaining a healthy weight.  Rosa only eats frozen meals and fatty and sugary snacks because she doesn’t know how to prepare a healthy meal and she believes that is the reason why she is overweight.  (Cypress, 1999).

Evidence

The success of the CO-OP approach with children with developmental disorders has allowed it to spread as an approach to treat clients with stroke (Huijbregts, McEwen, Polatajko & Ryan, 2010), showing use in functional groups (Chambers, Green & Sugden, 2008), and has applications in health-delivery systems like telecare (Dawson, Hunt, Marziali, Ng & Polatajko, 2013). A scoping review of over 27 studies identified CO-OP as an effective intervention in the populations it was used in, and also as a widely known approach used and discussed within the scope of occupational therapy (Bates, Houldin, Polatajko & Scammell, 2016). Despite this body of evidence, there is a gap in the body of research about the effectiveness of the CO-OP approach in driving positive outcomes in populations of people with obesity.

Intervention Plan

Problem Statement

• Client has difficulty with meal preparation and health management secondary to poor problem solving skills

Long Term Goals

• Ct will successfully complete a meal preparation task independently within 20 weeks in order to improve performance in IADLs.
• Ct will successfully complete a health management task independently within 20 weeks in order to improve performance in IADLs.
• Ct will independently demonstrate CO-OP problem-solving strategies when competing an untrained task in order to improve problem solving skills for IADLs in 20 weeks.

Short Term Goals

• Ct will verbalize 4/4 CO-OP steps independently within 5 weeks in order to improve problem solving skills needed for successful IADL performance.
• Ct will use the CO-OP strategy to complete a health management task with verbal cues in order to improve performance in IADLs in 5 weeks.
• Ct will successfully adapt plan in response to error independently in 5 weeks in order to improve problem solving skills needed for successful IADL performance.

Intervention format: Individual

Setting: Outpatient setting

Supplies: Grocery store sale ad

Agenda:

• Ask the client about any new developments in her health, and overall well being.

• Have the describe how she has used the CO OP strategy since the last session

• Have the client use CO-OP to complete a trained task (have client identify a healthy snack from several unhealthy ones)

Documentation

S: Client said, “ I find myself losing control of my eating habits daily because I begin to snack on high calorie foods and then start to lose discipline for all my meals there after.”

O: The client participated in her third one hour session of occupational therapy working on CO-OP problem solving. Ct was unable to successfully verbalize the 4 steps for CO-OP.  Client reported not using the CO-OP since her last session because she lost the instructions.The client participated in a task that required her to identify healthy/ unhealthy snack choices in a supermarket catalog using the CO-OP strategy. She identified one healthy snack when doing the task independently. However, she was able to identify 5 healthy snacks when the therapist provided verbal cues and reminded her of the co-op strategy. At the end of the session client was given the written CO-OP steps in a lanyard to facilitate its use problem solving.

A: The client seemed to be discouraged in her progress when asked about her use of the Co-op since last session. She is currently not implementing and generalizing Co-op strategies into her meal prep and health management occupations. She demonstrates difficulty identifying healthy snack options independently because she could not recall the steps to implement co-op to the activity presented in therapy. The client was successful at identifying healthy options when she was reminded of the co-op strategy through verbal cues from the therapist. The client would benefit from visual cue that can help her remember the steps when she is on her own.

P: Next therapy session will continue working on implementation of the Co-op strategy to improve problem solving in meal prep and health management tasks. The client will benefit from continued engagement in trained task activities that require use of co-op to make better health choices.

References

Bates, S. V., Houldin, A., & Polatajko, H. J, Scammell, E. M., . (2016). The cognitive orientation   to daily occupational performance (CO-OP): A scoping review. The Canadian   Journal of Occupational Therapy, 83(4), 216-225. http://dx.doi.org.ezproxy.fiu.edu/10.1177/0008417416651277

Chambers, M. E., Green, D., Sugden, D. A., (2008). Does subtype of developmental   coordination disorder count: Is there a differential effect on outcome following  intervention? Human Movement Science, 27, 363-382, oi:10.1016/j.humov.2008.02.009

Cypress, M. (1999). Case study: A 52-year-old woman with obesity, poorly controlled type 2 diabetes, and symptoms of depression. Clinical Diabetes, 17(3), 143.

Dawson, D. R., Hunt, A., Marziali, E. Ng, E., Polatajko, H. J. (2013). Telerehabilitation for addressing executive dysfunction after traumatic brain injury. Brain Injury, 27, 548-564,   doi:10.3109/02699052.2013.766927.

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. Revue Canadienne D’ergotherapie, 76(2), 115-127.

Huijbregts, M. P. J., McEwen, S. E., Polatajko, H. J., Ryan, J. D. (2010). Inter-task transfer of  meaningful, functional skills following a cognitive-based treatment: Results of three    multiple baseline design experiments in adults with chronic stroke. Neuropsychological Rehabilitation, 20, 541-561, doi:10.1080/09602011003638194.

Mandich, A. & Polatajko, H. (2004). Enabling occupation in children: The cognitive orientation to daily occupational performance (CO-OP) approach. Ottawa, ON: CAOT Publications

Polatajko, H. J., Mandich, A. D., Missiuna, C., Miller, L. T., Macnab, J. J., Malloy-Miller, T., & Kinsella, E. A. (2001). Cognitive orientation to daily occupational performance (CO-OP): Part III–the protocol in brief. Physical & Occupational Therapy in Pediatrics, 20(2-3), 107-123. doi:10.1080/J006v20n02_07