{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:06:37Z","timestamp":1784264797061,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> To explore preliminary effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach in improving outcomes in childhood-onset hyperkinetic movement disorders (HMDs) including dyskinetic cerebral palsy following deep brain stimulation (DBS) across UK clinical occupational therapists.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Randomized, multiple-baseline, Single Case Experimental Design N-of-1 trial with replications across participants. Five self-selected goals were identified: three goals were worked on during CO-OP and two goals were left untreated and used to assess skills transfer. Participants were between 6 and 21 years and had received DBS surgery with baseline Manual Ability Classification System (MACS) levels I\u2013IV. Participants were randomized to typical or extended baseline (2 vs. 6 weeks), followed by 10 weekly individual CO-OP sessions. The primary outcome was functional performance measured by the Performance Quality Rating Scale-Individualized (PQRS-I), assessed before, during, and following treatment. Outcome assessors were blinded to baseline allocation, session number, and assessment time. A non-overlapping index, Tau-<jats:italic>U<\/jats:italic>, was used to measure effect size.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Of the 12 participants recruited, 10 commenced and completed treatment. In total, 63% of trained goals improved with effect sizes 0.66\u20131.00 (\u201cmoderate\u201d to \u201clarge\u201d effect), seen for all children in at least one goal. Skills transfer was found in 37% of the untrained goals in six participants.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Cognitive strategy use improved participant-selected functional goals in childhood-onset HMD, more than just practice during baseline. Preliminary effectiveness is shown when the intervention is delivered in clinical practice by different therapists in routine clinical settings.<\/jats:p>","DOI":"10.3389\/fped.2020.600337","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T15:14:25Z","timestamp":1611242065000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Cognitive Strategy Training in Childhood-Onset Movement Disorders: Replication Across Therapists"],"prefix":"10.3389","volume":"8","author":[{"given":"Hortensia","family":"Gimeno","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene J.","family":"Polatajko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pierre","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Cornelius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1111\/ene.13255","article-title":"Efficacy of pallidal stimulation in isolated dystonia: a systematic review and meta-analysis","volume":"24","author":"Moro","year":"2017","journal-title":"Eur J Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1002\/mds.25339","article-title":"Effects of deep brain stimulation in dyskinetic cerebral palsy: a meta-analysis","volume":"28","author":"Koy","year":"2013","journal-title":"Mov Disord."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1111\/dmcn.12997","article-title":"Functional outcomes using the assessment of motor and process skills following deep brain stimulation","volume":"58","author":"Gimeno","year":"2016","journal-title":"Dev Med Child Neurol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11910-020-1022-z","article-title":"State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy","volume":"20","author":"Novak","year":"2020","journal-title":"Curr Neurol Neurosci Rep."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1016\/j.apmr.2019.01.013","article-title":"Long-term specialized physical therapy in cervical dystonia: outcomes of a randomized controlled trial","volume":"100","author":"van den Dool","year":"2019","journal-title":"Arch Phys Med Rehabil."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1007\/s00415-013-7220-8","article-title":"The effectiveness of physiotherapy for cervical dystonia: a systematic literature review","volume":"261","author":"de Pauw","year":"2014","journal-title":"J Neurol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e1212","DOI":"10.1212\/WNL.0000000000007092","article-title":"Cognitive approach to rehabilitation in children with hyperkinetic movement disorders post-DBS","volume":"92","author":"Gimeno","year":"2019","journal-title":"Neurology."},{"key":"B8","volume-title":"Enabling Occupation in Children: The Cognitive Orientation to Daily Occupational Performance (CO-OP) Approach","author":"Polatajko","year":"2004"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1002\/jclp.20272","article-title":"An analysis of therapist treatment effects: toward providing feedback to individual therapists on their clients' psychotherapy outcome","volume":"62","author":"Okiishi","year":"2006","journal-title":"J Clin Psychol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1017\/S1352465815000065","article-title":"My therapist is a student? 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