Cognitive Orientation to daily Occupational Performance Approach for Iranian Elderly without Cognitive Impairments: A Single Subject Study

Purposes: The elderly population in Iran is growing. Aging is a natural phenomenon that causes changes in brain structures, including the frontal lobe and its connections, which are responsible for the executive functions of the brain. These structural changes lead to problems in cognitive and physical functioning and the elderly face problems such as decreased performance in daily activities of life and participation in social activities. In Cognitive Orientation to daily Occupational Performance Approach, participants learn to improve their motor performance using cognitive strategies. The effectiveness of this approach has been reported in stroke, TBI and some childhood disorders. The purpose of this study was to investigate the feasibility of this approach and its effect on Iranian elderly without cognitive problems. Methods: A single subject study A-B design with follow-up conducted. Participants were two elderly people referred to Ramsar Health Center. Prior to the intervention, in order to examine the participants’ cognitive status Digit Span Forward were used to measure attention and Digit Span Backwards and Digit Symbol were used to measure working memory. Participantschr('39') executive function was also assessed by the Wisconsin Card Sorting Test and Independence in ADL with FIM. Each participant selected three functional goals by Canadian Occupational Performance Measure (COPM) for the focus of the CO-OP intervention. After 2 weeks of evaluating participantschr('39') performance on selected goals using the Performance Quality Rating Scale (PQRS) to determine baseline performance, the intervention period began. During this period, a total of 8 to 10 sessions were held for each participant. During these sessions, participants were first taught global problem-solving strategies (Goal, Plan, Do, Check), and participants were introduced to domain-specific strategies and their importance in executing activities, and then through guided discovery during implementation, then they were guided to use these strategies in their execution by guided discovery. During this period, participantschr('39') performance on the selected goals was assessed 5 times by the PQRS. At the end of the intervention, to evaluate the long-term impact of the intervention, the participantschr('39') performance on the selected goals was re-evaluated by the PQRS at three times. Results: The results of the PQRS showed that the performance of the first participant in each of the 3 selected activities improved. The results of the PQRS for the second participant showed a significant improvement in performance on the 2 selected goals, however one of the selected goals did not show a significant change, which may be related to the nature of the this goal. Participantschr('39') net scores in FIM and COPM showed improvement in performance and satisfaction on selective goals, and performance independence remained constant. Conclusion: Cognitive Orientation to daily Occupational Performance Approach (CO-OP) is feasible in the Iranian elderly population and the preliminary results indicate the positive impact of this approach on improving the performance in the trained goals. However, given the limitations of this study in interpreting the results, it is recommended that future studies with a higher sample size be conducted to evaluate the effectiveness and efficacy of this approach. It is also recommended to use alternative tools instead of PQRS to evaluate the results, given the different cultural contexts.