Using the cognitive orientation to occupational performance (CO-OP) with adults with executive dysfunction following traumatic brain injury.

Background: Meta-cognitive strategies have a positive effect on the rehabilitation of executive dysfunction. However, achieving generalization to daily life remains a challenge. We believe that providing rehabilitation in the person's own physical environment and using self-identified tasks will enhance the benefits of meta-cognitive training and promote generalization.

Purpose: This pilot study tested the applicability of the Cognitive Orientation to Occupational Performance (CO-OP) approach for use with adults with executive dysfunction arising from traumatic brain injury (TBI).

Methods: A single-case design was used with 3 adults, 5 to 20 years post-TBI and their self-identified significant others. Assessments included neuropsychological tests and the Canadian Occupational Performance Measure. The intervention entailed guiding participants to use a meta-cognitive problem-solving strategy to perform self-identified daily tasks that they needed and wanted to do and with which they were having difficulties. The intervention occurred over 20 one-hour sessions in participants' environments.

Findings: Performance improved to criterion (2-point positive change) on 7 of 9 trained goals and on 4 of 7 untrained goals (self-report). Improvement was maintained at a 3-month follow-up assessment.

Implications: The CO-OP approach has the potential to improve performance in daily functioning for adults with executive dysfunction following TBI.