CO-OP Approach in Occupational Therapy

Definition:
“CO-OP is a client-centred, performance-based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery”
 
Motor learning has 3 distinct phases

  1. Cognitive phase: marked by disjointed movements.  It is necessary to pause and think about each movement before attempting it.   
  2. Associative phase: Less thought is required to carry out individual steps, however the overall task it is not yet fluid.
  3. Autonomic phase: no longer need to think about the movement and it gets more and more refined with practice.
 
Key features of CO-OP
  • Client directed motivating goal
  • Dynamic Performance Analysis
  • Cognitive Strategy Use
  • Guided Discovery
 
Dynamic Performance Analysis
  • Identifying performance problems or break downs in the task
  • Identify potential strategies to enable performance
  • This can relate to the person, the environment or the task
 
For example:
Task: To put on a pair of shorts
Performance problems:
  • Person: both legs going into one side, right hand letting go of the pants, not bending body forward to hold pants open etc.
  • Task: entire sequence for lower body dressing very complex
  • Environment: difficult to balance and complete in standing position
 
Potential Strategies:
  • Person: prompt to hold onto pants with both hands, touch cue to facilitate bending
  • Task: Start at point of being handed the pants in correct orientation. Use elastic loose shorts which are easier
  • Environment: Complete sitting down
 
Skill Acquisition through strategy use:
A cognitive strategy is a tool put in place to help learn, memorize and problem solve.
 
Global problem solving strategy in CO-OP is Goal, Plan, Do, Check:
  • Goal: What do I want to do?
  • Plan: How am I going to do it?
  • Do: Do it (carry out the plan)
  • Check: How well did the plan work?
Specific strategies for different stages: 
If the person can’t come up with a specific goal or plan:
  • Supplementing task knowledge
  • Verbal motor mnemonic to assist in remembering the plan
  • Specify the exact task to be completed
  • Demonstrate the task
 
If the person has trouble executing the movement:
  • Feeling the movement
  • Body Position
  • Attention to task
  • Task modification
 
If the person can do the movement but needs verbal guidance:
  • Verbal guidance
  • Verbal self-guidance
  • Verbal rote script
  • Complete the routine exactly the same way each time
 
Guided Discovery:
  • Everyone learns best if given the opportunity to problem solve situations and come up with solutions themselves.
  • Ask lots of questions, comment on performance and give feedback
 
For example:
  • That step seems hard?
  • It seems that ________ is happening when we get to that part?
  • Why do you think it isn’t working?
  • Demonstrate what is happening to highlight breakdown and encourage problem solving.
  • Which way do you think works better?
  • I wonder what we could do differently?
  • I wonder if this would work?

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