Data from: Cognitive approach to rehabilitation in children with hyperkinetic movement disorders post-DBS

Objective: This proof-of-concept feasibility trial examined the potential
of the Cognitive Orientation to daily Occupational Performance (CO-OP)
ApproachTM to augment deep brain stimulation (DBS) outcomes in
childhood-onset hyperkinetic movement disorders (HMD) including dystonia
and dyskinetic cerebral palsy. Methods: Single case experimental design
using multiple baseline as N-of-1 trial comprised of 10 intervention
sessions, with replications across participants (n=10). Treatment focused
on three participant-selected goals. Transfer was assessed on two
additional untreated goals. Individuals enrolled were 6-21 years of age,
had DBS in situ and sufficient manual ability. Primary outcome was
functional performance change on the Performance Quality Rating
Scale-Individualized (PQRS-i) measured before, during, post-treatment, and
at 3-months follow-up. Assessors of outcome were blinded to time of
assessment, number of intervention session and treatment allocation. To
measure effect size, a non-overlapping index, Tau-U, was used. Feasibility
parameters were captured. Results: One participant withdrew before
baseline assessment. Effect sizes of at least 0.66 were seen at both
post-treatment and follow-up with all participants showing improvements in
at least one trained goal in PQRS-i. Six participants improved on all
three goals and two improved on two trained goals. Two children showed
deterioration in one trained goal each. Transfer to untrained goals was
observed in three participants for a total of five goals. CO-OP was
feasible and acceptable to all participants. Conclusion: A
cognitive-based, task-oriented approach to support performance of
personally relevant functional skills enabling participation is acceptable
in childhood-onset HMD post-DBS. Further, preliminary efficacy to improve
outcomes and proof of concept with CO-OP has been established in this
population. Classification of Evidence: This study provides Class III
evidence that for children with hyperkinetic movement disorders who had
undergone DBS, CO-OP improves performance of personally relevant
functional skills.