Occupational Performance Approach Research Articles

Research on the Cognitive Orientation to daily Occupational Performance Approach: A Bibliometric Review.

The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. However, how the research literature on this topic is patterned is still unknown, so it is difficult to identify potential areas for research and clinical interest. To analyze the literature published on the CO-OP approach to provide a detailed and structured analysis of the publication patterns. All literature related to CO-OP included in the Web of Science database through June 15, 2024. All published studies related to CO-OP were included in the bibliometric analysis, which was conducted on the raw data retrieved from the Web of Science database using the Bibliometrix R package. The annual growth rate in CO-OP research has been 0.8%, significantly increasing from 2015 onward. Most of the research has been published in occupational therapy and rehabilitation journals by English-speaking research teams, and its scope has expanded from developmental coordination disorder to a wide range of health conditions. In addition, two main lines of research have emerged: one focusing on understanding the underlying cognitive processes involved in CO-OP and the other focusing on its clinical effectiveness. Research on CO-OP has significantly increased over the past decade, and it currently encompasses a wide range of areas. This analysis may facilitate the advancement of research on and the clinical practical application of CO-OP. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. Occupational therapists use it to improve the occupational performance of both children and adults with movement difficulties. However, it is unknown how the research literature on this topic is patterned, so it is difficult to identify potential areas for research and clinical interest. This study found that scientific literature on CO-OP has significantly increased in the past decade and that its scope has expanded from developmental coordination disorder to a wider range of health conditions, such as cerebral palsy. Moreover, research is now focused on two main questions: What are the underlying cognitive processes involved during intervention, and how effective is the CO-OP approach? These findings can be used to further improve occupational performance and participation among occupational therapy clients who struggle with motor performance and planning.

I didn’t know I had executive dysfunction, now I can do something about it: perspectives about CO-OP from people with Parkinson’s disease

Purposes People with Parkinson’s disease (PD) experience increasing disability across their lifespan. Holistic rehabilitation approaches are needed to maximize their daily functioning and quality of life (QoL). The Cognitive Orientation to daily Occupational Performance (CO-OP) approach targets daily functioning, with established efficacy in other neurological populations. This study is part of a larger trial of CO-OP with people with PD, describing the perspectives of people with PD who received CO-OP about its effect on their lives. Methods People with PD participating in a randomized controlled trial (RCT) were interviewed following the CO-OP programme. Views about the feasibility, acceptability, and experiences of CO-OP were explored. Inductive thematic analysis was used to interpret the findings. Results Analysis of interviews (n = 20) identified that CO-OP drove positive change in participants’ daily lives. Participants reported transfer and generalization of learned strategies, suggesting effective use of skills learned in CO-OP. Conclusions Addressing a critical gap in PD management, findings suggest that CO-OP was perceived as effective in addressing a broad scope of PD-related issues. Findings hold particular significance for individuals experiencing long-term PD consequences, potentially offering a viable option to enhance participation and QoL. Findings support CO-OP as an implementable, acceptable, and potentially beneficial intervention in PD. Further research is warranted to establish efficacy.

CO-OP Approach With Children and Youth With Executive Function Deficits After Acquired Brain Injury: A Qualitative Study of Care Partners' Involvement.

Care partners' involvement is a key feature of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach that can enhance rehabilitation outcomes and promote the generalization and transfer of strategies and skills to everyday life. Gaining insight into care partners' experience with their child's CO-OP intervention is critical to understanding how to enhance care partners' involvement. To gain insight into the experience of care partners whose child with acquired brain injury (ABI) participated in CO-OP intervention. A qualitative descriptive research design was used. Semistructured interviews were conducted at three time points (immediate postintervention and at 2 and 6 mo postintervention). Two rehabilitation centers. Thirteen care partners of 12 children or youth with severe ABI. Three themes emerged from the analysis of 33 interviews: (1) The child is an active agent in their therapy, (2) the care partner is the keystone who helps solidify the elements of CO-OP, and (3) CO-OP mastery requires time and practice, and its use evolves over time. These themes highlight the progressive nature of proficiency in CO-OP for both care partners and children. This was evident not only in the children's improvement in task performance, but also in their ability to problem solve. Care partners' role in supporting the CO-OP approach also unfolds over time as their confidence in their child's problem-solving abilities, and in their own ability to adequately provide guidance, increases. Engagement seems to be central in facilitating this progression for both children and their care partners. Plain-Language Summary: This is the first study to provide insights into the involvement of care partners in the Cognitive Orientation to daily Occupational Performance (CO-OP) approach for children and youth with executive function deficits after acquired brain injury. This is also the first study to explore the evolution of care partners' experiences over time. Involving care partners is a key feature of the CO-OP. Understanding care partners' experiences with their child's CO-OP intervention can improve a child's rehabilitation outcomes. The study found that care partners' role in supporting their child's CO-OP approach improved over time as their confidence in their child's problem-solving abilities increased. The care partners' own ability to adequately provide guidance to their child also increased over time. Engagement seems to be central in facilitating this progression for both children and their care partners. It is hoped that occupational therapists will consider the findings of this study to better support care partners in implementing the CO-OP approach with their child in their real-life context.

Supporting Functional Goals in Spinal Muscular Atrophy: A Case Report of The Cognitive Orientation to Daily Occupational Performance (CO-OP) Approach

Supporting Functional Goals in Spinal Muscular Atrophy: A Case Report of The Cognitive Orientation to Daily Occupational Performance (CO-OP) Approach

Effectiveness of CO-OP group intervention for children with developmental coordination disorder: single-case experimental design study protocol

IntroductionWith the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, children with developmental coordination disorder learn to use a problem-solving strategy to deal with their motor difficulties and perform daily...

Cognitive Orientation to daily Occupational Performance to improve occupational performance goals for children with executive function deficits after acquired brain injury.

To determine the effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach in improving the occupational performance goals of children and young people with executive function deficits after acquired brain injury (ABI) (e.g. etiologies such as stroke, encephalitis, brain tumor, and traumatic brain injury). A replicated single-case experimental study using a randomized multiple baseline design across participants and goals was used. Three clusters of four participants (12 participants, nine males and three females, aged 8-16 years) were included. The intervention consisted of 14 individual CO-OP sessions. Each participant chose four goals; three goals were trained during the intervention sessions and a fourth goal served as the control. The Goal Attainment Scale (GAS) was used as a repeated measure to determine goal achievement while the Canadian Occupational Performance Measure (COPM) was used to identify the perceived goal achievement of children, young people, and their parents. For 26 of the 35 trained goals, the intervention led to statistically significant improvements in the GAS. Perceived occupational performance and satisfaction improved significantly for the trained goals (30 out of 35 goals for the COPM performance and satisfaction of participants; 26 out 31 goals for the COPM performance of parents; 24 out of 31 goals for the COPM satisfaction of parents) and were maintained at the follow-up. Almost all COPM control goal results were significant, but these changes were not supported by the GAS measures or the statistical analysis. The generally positive results of this study provide evidence of the benefits of using the CO-OP approach with this population.

Feasibility of using the Cognitive Orientation to daily Occupational Performance in a population of Danish stroke survivors: Adaptation and study protocol

Background A need was identified for an occupational therapy intervention for stroke survivors in a Danish municipal healthcare setting with emphasis on its ability to transfer and generalise what is learned in occupational therapy to everyday life post therapy. Being a possible candidate, the Cognitive Orientation to daily Occupational Performance (CO-OP) approach needed to be adapted to the target group and context, and its feasibility needed examination regarding reach, dose, intervention components, fidelity, perceived value, benefits, harms, and potential outcomes. Aim To adapt the CO-OP to a Danish healthcare setting and present a protocol for examining its feasibility. Material and methods The Adapting interventions to new contexts (ADAPT) guidance was followed to (1) Assess the rationale for intervention and consider intervention-context fit, (2) Plan and undertake adaptations, and (3) Plan a feasibility study. Results Intervention materials and procedures were translated and adapted for home-based occupational therapy with people in the subacute phase of stroke. A protocol was developed to examine feasibility aspects. Quantitative and qualitative evaluations were planned and measurements chosen. Conclusions and significance The planned feasibility study will contribute to further developing and refining the intervention before performing a possible large-scale effectiveness study.

Cognitive orientation to daily occupational performance approach in people with multiple sclerosis: A pilot study.

Multiple sclerosis is the most important cause of non-injury-related disability in young adults. The disease has unknown causes and distresses and affects daily activities. While therapeutic interventions mainly focus on body function and structure to reduce impairment, Cognitive Orientation to Daily Occupational Performance (CO-OP) is a cognitive approach that provides intervention at the level of activity and participation. We aim to examine the effects of CO-OP approach on fatigue, quality of life, occupational performance, and satisfaction in people living with multiple sclerosis; and to examine whether they could transfer strategies and skills learned during CO-OP to untrained goals. A pre-post design was used. Assessment tools included Montreal Cognitive Assessment, Multiple Sclerosis Impact Scale, Fatigue Impact Scale and the Canadian Occupational Performance Measure. Six individuals living with multiple sclerosis participated in 10 CO-OP sessions twice a week. The sessions were held in an environment of the participants' choice, along with an extra session added to determine the goals. The study was registered in the ethics committee of University of Social Welfare and Rehabilitation Sciences (IR.USWR.REC.1399.089). The performance improved (2-point positive change) in 12 out of 18 trained goals and in three out of six untrained goals (self-report). The improvement was maintained at a 3-month follow-up assessment. There was a statistically significant difference in Canadian Occupational Performance Measure (χ2 = 11.565, p= 0.003 same for performance and satisfaction scores), Fatigue Impact Scale (χ2 =7.000, p= 0.030), and Multiple Sclerosis Impact Scale scores over time (χ2 =9.478, p= 0.009) respectively. The CO-OP approach has the potential to improve daily activity performance, reduce pain, and improve the quality of life for people living with multiple sclerosis. A definitive randomised controlled trial is required.

Intervention with the CO-OP Approach leads to a transfer effect over time to untrained goals for children with cerebral palsy or spina bifida

Purpose This study aims to investigate whether the treatment effects, in terms of goal attainment, transfer effects and impact on executive functions, of an intervention in children with cerebral palsy or spina bifida using the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach are maintained over time, from immediately after the intervention to three months afterwards. Method A three-month follow-up study, from an intervention using CO-OP. Thirty-four children (7–16 years) each identified four goals (one untrained to examine transfer) and participated in an eleven-session intervention. Assessments were performed at baseline, immediately after the intervention and at a three-month follow-up using the Canadian Occupational Performance Measure and the Performance Quality Rating Scale. Executive function and self-rated competence were assessed at the same timepoints. Results Statistically significant and clinically relevant improvements in goal achievement were demonstrated for both trained and untrained goals after the intervention and were maintained at follow-up. The clinically relevant improvement in untrained goals continued to increase until follow-up. Self-rated competence increased after the intervention and was maintained at follow-up. Conclusion The CO-OP intervention was effective in achieving and maintaining the children’s own goals over time. The transfer effect was confirmed by higher goal attainment for the untrained goals.

Cognitive Orientation to Daily Occupational Performance: A Randomized Controlled Trial Examining Intervention Effects on Children with Developmental Coordination Disorder Traits.

Children with traits of developmental coordination disorder (DCD-t) may experience occupational performance problems that go unrecognized and therefore may not be adequately supported. The cognitive orientation to daily occupational performance (CO-OP) approach has been effective in interventions for developmental coordination disorder (DCD). Based on an open-label, randomized controlled trial design, this study evaluated the effects of CO-OP on the occupational performance and motor skills of older kindergarten children with DCD-t using the School Assessment of Motor and Process Skills (S-AMPS) and the Movement Assessment Battery for Children, Second Edition. Children with a total DCDQ score of less than 40 or M-ABC2 scores in the 5th to 16th percentile were considered to have DCD-t. Furthermore, children with DCD-t and S-AMPS process skills less than 0.7 were considered to have DAMP (Deficits in Attention, Motor control and Perception)-t. After 3 months of CO-OP intervention, the performance and motor skills of children with DCD-t improved significantly. However, there were no significant changes noted in the motor skills of children with DAMP-t, although their occupational performance improved. These results suggest that CO-OP is effective even for older kindergarten children with DCD-t. However, further improvement of the CO-OP approach or a different strategy is required for children with ADHD comorbidity.

Efficacy and Feasibility of the CO-OP Approach in Parkinson's Disease: RCT Study Protocol.

Background. Parkinson's disease (PD) leads to cognitive dysfunction which limits participation and occupational performance. Cognitive Orientation to Daily Occupational Performance (CO-OP) approach is effective in other adult neurological populations and warrants investigation in PD. Purpose. To describe a study protocol evaluating the preliminary efficacy and feasibility of CO-OP approach in PD. Method. A randomised controlled trial (RCT) with adults with PD was assigned to either: CO-OP training-intensive (CO-OP-I, 20 sessions) or waitlist control (WLC) followed by CO-OP-standard (CO-OP-S, 10 sessions). Outcomes. Occupational performance and satisfaction of adults with PD in chosen goals. Measures will be obtained at baseline, post-intervention, and 3-month follow-up. Implications. As the first RCT focused on CO-OP in PD, this trial will provide evidence for the potential of this approach in PD and lay the groundwork for future large-scale trials. Trial Registration. New Zealand Clinical Trials Registry, ACTRN12621001483842. Registered November 1, 2021; retrospectively registered 3 months after commencement.

Terapia motora cognitiva: descrição e análise clínica de crianças com Transtorno do Desenvolvimento da Coordenação (TDC),

Abstract Introduction It is estimated that 6% of school-age children have Developmental Coordination Disorder (DCD), characterized by motor difficulties that restrict participation at home, in the community and at school. The Cognitive Orientation to Daily Occupational Performance Approach (CO-OP) is effective in improving the functional performance of these children, but there is little clinical data on variations in the response to the intervention. Objective To identify and describe the most relevant characteristics of children with DCD that influence their response to CO-OP. Method Case study conducted with four children with DCD who underwent CO-OP: the two who had the highest gain and the two who had the lowest gain with the intervention. The data obtained in this study were categorized and synthesized to compose a clinical description of the participants’ characteristics. Results Parents of children with better performance showed better parenting style. Unstructured observation of the researchers during the collections showed that the families of the children with greater progress attended the collections more often and were more engaged. Greater family support seems to provide children with more confidence, as well as increase motivation to achieve goals in therapy. Conclusion The support offered by parents is a relevant factor for the good performance of children with DCD in the intervention using the CO-OP. The clinical description of children with DCD assists in the reasoning during professional practice because it identifies characteristics that can influence progress in the intervention.

Combining elements of the CO-OP Approach™ with education to promote healthy eating among older adults: A pilot study.

This paper describes an exploratory study developing the Baycrest Brain-healthy Eating Approach (BBEA). Poor diet is a modifiable risk factor for many health problems including dementia. Mediterranean type diets, high in plant-based foods, rich in poly- and mono- unsaturated fatty acids with minimal consumption of saturated fat, red meat, and processed foods, are considered brain healthful. While several dementia prevention trials randomized controlled trials have included nutritional counselling in favor of these diets as one component of their interventions, the extent to which dietary change occurred is not known. Based on observations that a strategy training approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach, was beneficial for promoting lifestyle changes in older adults with complaints of cognitive changes, we undertook to develop the BBEA combining elements of CO-OP with didactic nutrition education. This exploratory, descriptive study assesses the feasibility and acceptability of the BBEA. Healthy community dwelling older adults (n = 5) were recruited using convenience sampling. Participants received five, 2 h, group sessions. During these sessions participants were supported in adopting dietary practices consistent with brain healthy eating. Each participant set specific dietary goals important to them. Feasibility of the intervention was demonstrated through high levels of attendance and by the findings that at each session, all participants set personally meaningful goals and received education on selected brain healthy eating topics. Acceptability was demonstrated through participants' positive reports of their experiences and perspectives obtained via semi-structured interviews. Thus, the BBEA appears to be feasible and acceptable.

The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach is superior to ordinary treatment for achievement of goals and transfer effects in children with cerebral palsy and spina bifida – a randomized controlled trial

Purpose Children with cerebral palsy (CP) or spina bifida (SB) often have executive dysfunction affecting activity performance. With the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach, children find their own way to perform activities, using problem-solving strategies and meta-cognitive thinking. The present study aimed to investigate the effectiveness of the CO-OP Approach in children with CP or SB, compared with conventional rehabilitation, in achieving self-identified activity goals, and to explore any generalization and transfer effects. Method Randomized controlled trial, CO-OP versus treatment as usual, 38 children (7–16 years) participated. Each child identified four goals (to study generalization and transfer, one remained untrained). Primary outcomes: Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Secondary outcomes assessed executive functions and self-rated everyday-life competence. Results Self-rated goal attainment (COPM) was significantly greater for both trained and untrained goals in the CO-OP group compared with the control group. The rating of observed performance (PQRS) was significantly higher for trained goals in the CO-OP group. The CO-OP group experienced fewer problems in everyday life after treatment. Executive functions did not differ significantly between groups. Conclusion CO-OP is more effective than ordinary treatment in achieving both trained and untrained goals. IMPLICATIONS FOR REHABILITATION CO-OP enables children with CP (MACS levels I–III) or SB without intellectual disabilities to reach self-identified goals. CO-OP shows transfer effects to new activities and situations, which may enhance children’s self-efficacy. CO-OP is an important complement to conventional rehabilitation services for children with CP and SB.

A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study.

This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability.

The Cognitive Orientation to daily Occupational Performance (CO-OP) approach for a client with stroke and cognitive impairment

The Cognitive Orientation to daily Occupational Performance (CO-OP) approach for a client with stroke and cognitive impairment

Mothers’ experience of being involved with the transfer of the CO-OP approach: A qualitative study

Introduction Since mothers are the best persons to facilitate transfer in their children, it is important to understand their experience with implementing the cognitive orientation to daily occupational performance approach at home. Therefore, this study aims to explore mothers’ experiences in facilitating transfer during implementing cognitive orientation to daily occupational performance approach at the home in children with specific learning disorder. Method A semi-structured interview was applied for mothers of children receiving cognitive orientation to daily occupational performance. The interviews were transcribed verbatim and the data were analyzed using a continuous comparison technique and inductive content analysis. Results Five themes emerged which described the mothers’ experiences of being involved with the transfer of cognitive orientation to daily occupational performance approach at home including (1) mothers’ feelings toward themselves; (2) supportive therapist; (3) supportive social settings; (4) multidimensional educational content; and (5) educational methods. Conclusion Mothers expressed that cognitive orientation to daily occupational performance approach was simple, but they needed deeper information and skills. They provided suggestions for increasing the involvement during cognitive orientation to daily occupational performance intervention to increase transfer.

Clinician perspectives on implementing a team-based metacognitive strategy training approach to stroke rehabilitation.

The objective of this research study was to explore site and clinician specific experiences, successes and challenges in implementing a complex intervention (cognitive orientation to daily occupational performance approach) to enhance stroke team's ability to address cognitive impairments as part of comprehensive stroke rehabilitation. A focus group was held with clinicians from five study sites, all rehabilitation stroke hospitals in a large urban setting, to discuss implementation experiences. Participants were clinicians (site champions) from each of the five participating stroke program study sites and included four occupational therapists, three physiotherapists and one speech-language pathologist. Thematic analysis was used to identify themes that represented clinicians' perspectives. Implementing this complex team-based intervention was influenced by three themes-organizational support, experiential evidence, and clinicians' perspectives. Continued implementation of the intervention following the withdrawal of study support was represented on a continuum that ranged from not using the approach at all to implementing it with all patients. Sites where managers encouraged and supported use of the intervention within teams (organization support), continued to use it after the study support period as did clinicians who were willing to try new interventions (clinicians' perspectives). Development of iterative conclusions through implementation or attempts to implement the intervention had both positive and negative effects on continued implementation (experiential evidence). Strategies that reinforce development of positive experiential evidence and building organizational support for innovative practice were found to be useful adjuncts in facilitating implementation of complex interprofessional interventions.

Rehabilitation in childhood-onset hyperkinetic movement disorders including dystonia: Treatment change in outcomes across the ICF and feasibility of outcomes for full trial evaluation.

Childhood-onset hyperkinetic movement disorders (HMD), including dystonia are notoriously difficult to treat and there are limited studies showing successful medical, surgical or non-pharmacological interventions. This prospective study used grouped data (n=22) from two studies of the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach for patient-selected goals. Eligibility included aged 6-21 years, deep brain stimulation in place, with manual ability classification system level I-IV. Outcome was assessed on a range of patient-reported and clinician-rated measures across the International Classification of Function at end-treatment (10 weekly sessions) (series 1 and 2) and 3-month follow-up (series 1). Feasibility of outcomes to be used in a full trial were explored. Nineteen participants completed the intervention and were included in the analysis. Of the primary outcome measures, the self-reported Canadian Occupational Performance Measure showed improvement in goal performance (mean change 4.08, 95% CI [3.37,4.79] post-; 4.18 [5.10,5.26] follow-up), and satisfaction (4.03 [3.04,5.03) post-; 4.44 [3.07,5.82] follow-up]. The Assessment of Motor and Process Skills showed improved motor score (0.52 [0.01,1.03] at follow-up only, while the process score did not change. Objective blind-rated pooled data using the Performance Quality Rating Scale-individualized indicated significant change for trained goals (3.79 [3.37,4.21] post-; (4.01,5.10) follow-up] and untrained goals (1.90 [1.24,2.55] post 1.91 [0.23,3.60] follow-up]. Motor impairment assessed by the Burke-Fahn Motor Disability Rating Scale was unchanged (-3.26 [-6.62,0.09] post-;-1.11 [-8.05,5.82] follow-up). Improvement was also observed in self-efficacy (0.97 [0.47,1.47] post-; 1.37 [1.91-0.83] follow-up) and Quality of Life (0.12 [0.03-0.22] follow-up). Goal improvement; self-efficacy and quality of life captured significant change post-intervention. This improvement was shown despite no change on impairment-related measures and were shown to be feasible measures to use in a larger study of CO-OP for this population.

Brain functional connectivity in children with developmental coordination disorder following rehabilitation intervention

BackgroundChildren with developmental coordination disorder (DCD) show improved motor function after Cognitive Orientation to Occupational Performance (CO-OP) intervention; however, the neural basis for these improvements is unknown.MethodsIn this randomized waitlist-controlled trial, 78 children with DCD (with/without ADHD) were randomly assigned to either a treatment or waitlist group and underwent three resting-state MRI scans over six months. The treatment group received intervention between the first and second scan; the waitlist group received intervention between the second and third scan.ResultsAfter CO-OP intervention, children with DCD [13 male, 8 female; mean (SD) age: 10.0 (1.7) years] showed increased functional connectivity between the default mode network and right anterior cingulate gyrus (p < 0.01). Additional gains were noted at follow-up three months after the intervention, with greater functional connectivity between the dorsal attention network and precentral gyrus (p < 0.02). However, children with DCD + ADHD [18 male, 1 female; mean (SD) age: 10.0 (1.14) years] did not show brain changes following CO-OP.ConclusionFor children with DCD, increased functional connectivity in networks associated with self-, emotion-, and attention-regulation may underlie motor skill improvements observed after CO-OP intervention. Modifications to the CO-OP protocol may be required to induce similar brain changes in children with DCD + ADHD.ImpactThis study provides neuroscientific evidence for the Cognitive Orientation to Occupational Performance (CO-OP) approach as an effective rehabilitation intervention to induce brain and behavioral changes in children with DCD.While children with DCD ± ADHD showed improved motor function after CO-OP, only children with DCD showed brain changes after intervention.Children with DCD showed increased functional connectivity in networks associated with self-, emotion-, and attention-regulation after the intervention.Treatment modifications may be required to induce similar brain changes in children with DCD + ADHD.Pediatricians are encouraged to refer children with DCD with and without ADHD for CO-OP intervention to improve their motor skills.