|Year : 2018 | Volume
| Issue : 3 | Page : 92-97
Effectiveness of cognitive orientation to daily occupational performance to improve shopping skills in children with learning disability
Madhumala Karunakaran1, S Sugi2, K Rajendran3
1 Occupational Therapist Consultant, Columbia Asia Referral Hospital, Banglaore, Karnataka, India
2 Professor, Department of Occupational Therapy, KMCH College of Occupational Therapy, Coimbatore, Tamil Nadu, India
3 Associate Professor, KMCH Institue of Health Science & Research, Coimbatore, Tamil Nadu, India
|Date of Web Publication||9-Nov-2018|
Dr. Madhumala Karunakaran
No. 19/11, 4th Street, Sriramapuram, Ambur, Vellore - 635 802, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Studies reports that children with learning disability were more dependent in shopping skills than typical children, and studies reports that shopping experience will promote cognitive and social development and understanding the sequences of events involved in shopping is clearly one of the most important aspects of transaction knowledge, there are many approaches to improve shopping skills. Hence, till date, the cognitive orientation to daily occupational performance (COOP) approach is not done in learning disability to improve shopping skills. Objectives: The aim and objectives of this study are to find out the effectiveness of COOP to improve the shopping skills in children with learning disability. Study Design: Two group pre- and post-test quasi-experimental design. Methods: Totally 30 children diagnosed with learning disability based on inclusion and exclusion criteria were included in this study and children were divided into two groups 15 in experimental group and 15 in control group. Assessment tools such as Test of grocery shopping skills (TOGSS), Canadian occupational performance measure (COPM), and Performance quality rating scale (PQRS) were used as outcome measures. Experimental group underwent regular occupational therapy and COOP intervention and control group underwent regular occupational therapy and money handling skills training for 36 sessions within 12 weeks. Scores obtained were subjected to statistical analysis. Results: Statistical analysis using independent t-test of pre- and post-test scores of TOGSS where P = 0.001 (<0.05), COPM and PQRS where P = 0.001 (<0.05) shows significant improvement in shopping skills in learning disability children, Effect size of TOGSS, COPM, and PQRS were greater in the experimental group. Thus, finding of this study indicated that there was a significant improvement in experimental group when compared to control group. Conclusion: COOP approach showed significant improvement in shopping skills for learning disability children and children were satisfied with their performance. Thus, COOP approach is effective in improving shopping skills for learning disability children.
Keywords: Cognitive Orientation to Daily Occupational Performance, Learning Disability, Shopping
|How to cite this article:|
Karunakaran M, Sugi S, Rajendran K. Effectiveness of cognitive orientation to daily occupational performance to improve shopping skills in children with learning disability. Indian J Occup Ther 2018;50:92-7
|How to cite this URL:|
Karunakaran M, Sugi S, Rajendran K. Effectiveness of cognitive orientation to daily occupational performance to improve shopping skills in children with learning disability. Indian J Occup Ther [serial online] 2018 [cited 2020 Oct 28];50:92-7. Available from: http://www.ijotonweb.org/text.asp?2018/50/3/92/244551
| Introduction|| |
Occupation has been defined as “daily activities that reflect cultural values, provides structure to living and meaning to individuals; these activities meet human needs for self-care, enjoyment, and participation in society.”
Occupational therapy practitioners consider the many types of occupations in which clients might engage. The broad range of activities or occupations are sorted into categories called “areas of occupation”, they are activities of daily living (ADL), instrumental ADL (IADL), rest and sleep, education, work, play, leisure, and social participation.
AOTA defines IADLs as “activities that are oriented toward interacting with environment and that are often complex in nature.”
Children with learning disability may have difficulty in some or all of the activities of reading, writing, and arithmetic. This can present them with numerous obstacles in the area of IADL. For example, if clients have difficulty with writing or arithmetic, they may have difficulty with financial management (not able to write what they need to shop or to shop independently).
Grocery shopping is a weekly routine for many; is actually composed of multiple activities outlined these activities as.
- Identifying items to purchase
- Moving around a store
- Selecting the appropriate item
- Addressing prices, and
- Purchasing the item(s).
The cognitive orientation to daily occupational performance (COOP) approach was used within this study as “a client-centered, performance-based, problem-solving, intervention that enables skill acquisition through a process of strategy use and guided discovery.”,
| Methods|| |
The study was a quantitative, two group pre- and post-test Quasi-experimental study design, For this study, 30 children were taken through convenient sampling method, random grouping, assigning the first child in experimental group and second child in control group and so on for the 30 samples consecutively.
- Children with learning disability diagnosed by psychiatrist
- Children within the age group of 10–14 years
- Children with physical dysfunction
- Children with comorbid condition-like autism.
- The test of grocery shopping skills (TOGSS) – It is used to assess performance of one's ability to shop in the community. It looks at one's executive functioning; specifically the ability to locate and select specific items at the lowest price in a natural environment
- Canadian occupational performance measure (COPM) – It is a criterion-based measures of occupational performance in which clients rate the level of importance of, performance of, and satisfaction with goals in self-care, productivity, and leisure on a 10-point scale
- Performance quality rating scale (PQRS) – It is a criterion-referenced performance-based observation rating scale. Quality of task performance is rated according to a 10-point scale based on the competency of the performance.
Getting approval from the ethical committee, consent from parents, and permission from the institutional head, 30 children with learning disability were screened based on the inclusion and exclusion criteria. The screened children randomly assigned into two group's i.e., Group A and Group B. Then, the tools TOGSS is administered in Pazamudhir supermarket, COPM and PQRS scale was administered before the intervention. Experimental group underwent conventional occupational therapy and COOP intervention, control group underwent conventional occupational therapy and money handling skills training for 12 weeks, 36 sessions thrice in a week, duration of each session was 45 min to 1 h, After 12 weeks of intervention, the posttest was taken using TOGSS, COPM, and PQRS scale.
Cognitive Orientation to Daily Occupational Performance Intervention Protocol
CO-OP is a goal oriented, performance-based approach that makes use of two types of cognitive strategies (1) goal-plan-do check a global cognitive problem-solving strategies and (2) domain-specific strategies, derived through dynamic performance analysis.
1. Preparatory Phase
In preparatory phase first Established contact with parents and explained CO-OP protocol to parents, further information regarding children's areas of difficulty in shopping skills is collected from parents and got contract with parents to ensure resources and support.
After this, using dynamic performance analysis, therapist carried out analysis of actual performance by giving shopping task in natural environment (Pazamudhir supermarket), through this analysis therapist could identify problems such as difficulties in reading shopping list, unable to choose right item, had difficulties in looking at price, and getting correct change and had difficulty in planning and handling the cart in supermarket, on basis of this problem cognitive strategies were identified.
2. Acquisition Phase
- In session 1: Therapist was discussed about cognitive strategies in detail with child in presence of parent and therapist facilitated to the child to identify 5–6 goals and therapist guides in discovering a plan to meet the goal, the child does the plan and subsequently checks to see if the plan worked and child was guided to develop and practice self-talk related to particular skills
- In session 2–26: children's were encouraged to practice the discovered strategies under therapist guidance.
| Results|| |
The data analysis for this study was done using SPSS version 20.0 (IBM, Armonk, NY, USA). Descriptive analyses were performed to characterize groups and inferential analyses to compare performance between the groups (Mann–Whitney U, Wilcoxon Signed-Rank test) were used and to find effectiveness between groups and effect size test were used.
The pretest scores of experimental group and control group TOGSS, COPM, PQRS were analyzed using Mann–Whitney test [Table 1] result showed that there was no significant difference in the pretest of TOGSS, both performance and satisfaction component of COPM and PQRS total and thus posttest can be performed, The posttest of TOGSS, COPM, PQRS where P > 0.05. This indicates that there is homogeneity of the group.
|Table 1: Comparison between experimental and control groups of Test of Grocery Shopping Skills, Canadian Occupational Performance Measure, performance quality rating scale|
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The pre- and post-test scores of individual groups were analyzed using Wilcoxon signed-rank test [Table 2] showed that there was a significant difference in TOGSS, performance, and satisfaction component of COPM, PQRS in both experimental and control group where P < 0.05 according to the scale high score indicates good performs, thus positive rank indicate improvement and vice versa, while ties indicate no improvement. The positive rank in experimental group indicates that all children showed improvement in TOGSS, performance, Satisfaction and PQRS total after COOP intervention and in control group expect one child in PQRS-ties all children showed improvement in performance, satisfaction and PQRS total, The post-test value shows that there is a significant difference in TOGSS, COPM (performance and satisfaction component, and PQRS total where P < 0.05. This indicates that there is an improvement in posttest this explains that experimental group improved in shopping skills when compared to control group.
|Table 2: Comparison of pre- and post-test of Test of Grocery Shopping Skills, Canadian Occupational Performance Measure, performance quality rating scale|
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[Table 3] is comparison of effect size explains which group showed a greater effect on improving the shopping skills and results showed that the experimental group was founded to have a greater effect size when compared to control group.
|Table 3: Comparison of effect size on Test of Grocery Shopping Skills, Canadian Occupational Performance Measure, Performance Quality Rating Scale between experimental and control groups|
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[Graph 1] shows that the posttest values of TOGSS, COPM, and PQRS, in experimental group are much higher than the posttest value of control group.
[Graph 2] shows high effect size in TOGSS, performance, and satisfaction component of COPM, and PQRS in experimental group.
| Discussion|| |
The study was conducted in Rashmika center and Cognito Academy in Coimbatore for 36 sessions within 12 weeks. Totally 30 children diagnosed with learning disability based on inclusion and exclusion criteria were included in this study and children were divided into two groups 15 in the experimental group and 15 in the control group. Assessment tools such asTOGSS, COPM, and PQRS were used as outcome measures. Experimental group underwent conventional occupational therapy and COOP intervention and control group underwent conventional occupational therapy and money handling skills training for 36 sessions.
The mean age of children in experimental group was 9.96 and the mean age of children in control group was 9.96, 24 boys and six girls was included in both the groups.
The shopping skills of children were measured using TOGSS, for which the children were taken to Pazamudhir supermarket. COPM was used to identify a deficit in shopping skills. The children along with parents/teachers identified 5–6 goals related to shopping which were rated on the importance, performance, and satisfaction. Moreover, their performance quality was assessed using PQRS by the investigator.
Improvement in Shopping Skills
All 30 children in experimental and control groups in baseline assessment had difficulties during shopping like they had problem in planning and organizing, i.e., forgets to take cart before taking items in the list, difficulty in reading list, few took item as they wished, difficulty in taking correct size of an item, asked help from the assistants at shopping center many times during shopping, missed item in the list, time management was problematic, and had problem in getting correct change.
In experimental group, improvements were noted like all the children were able to plan and organize the task, when shopping list were given researcher could observe that all the children were able to apply COOP protocol.
During pretest, children had a tendency to impulsively take what they like (pannier, baby corn, cauliflower, butter, and milk) than what was given in the list. At posttest children in experimental group could control self and confined to the list given.
The experimental group in the current study is based on COOP intervention, COOP has specified treatment protocol, and there is a strong convergent evidence that COOP is an effective approach for use with children with developmental coordination disorder (also called motor learning disability).,
The control group also shows significant difference but when compared to the experimental group. The experimental group has improved more than control group.
Effect size calculated shows greater effect size in all components for experimental group and medium to greater effect size on components in the control group. The increased improvement noted in the experimental group can be assumed that COOP was effective to improve shopping skills in children with learning disability.
Canadian Occupational Performance Measure, Performance Quality Rating Scale, and Cognitive Orientation to Daily Occupational Performance Intervention
COPM was used to help children to identify the 5–6 skills they needed, wanted or were expected to perform that were difficult for them to perform during shopping task. After pretest evaluation which was real-life shopping experience, the children could identify easily about their difficulties.
COPM also addressed the skill acquisition and transfer skills which is part of COOP intervention. COOP is a self-instruction training concepts were used and the children were actively encouraged to use the goal-plan-do-check strategy to verbally guide themselves in learning to perform the three skills they had chosen. The children were invited to become members and solve the performance mysteries of the skills they had chosen to learn. Parents were invited to be present when a child performs.
Moreover, PQRS were performance qualities of the child when perform shopping task were rated by therapist.
Statistical analysis of pre- and post-test of COPM and PQRS in [Table 2] shows (where P = 0.001 [<0.05]) expresses the positive effect of COOP approach on children with learning disability in experimental group this correlates with the study done by researcher on improving handwriting skills using COOP which showed positive improvement.
The mean difference between pre- and post-test values of PQRS (exp-21.73, control-4.27) and PQRS each performance component (exp-4.14, 4.86, 4.34, 4.6, and 3.73) and control-1.13, 0.33, 0.93, 1.06, and 0.87) for experimental and control group, respectively, shows that experimental group has improved more than the control group.
Within group analysis of control group also [Table 2] shows significant difference indicating that the controlled group children also showed improvement in the shopping skills. This may be the children's in control group performed task with help (like asking salesgirls to read list, where the item is placed, and asked to check items were low priced).
Overall the control group also shows significant difference but when compared to experimental group. The experimental group has improved more than control group. The increased improvement noted in experimental group can be assumed that COOP was effective to improve shopping skills in children with learning disability, COPM and PQRS data indicated that the children learned to perform skills that they had found difficult.
Effectiveness of Cognitive Orientation to Daily Occupational Performance Intervention
COOP not only improves skills also make them independent and made the children to be confident in his/her task.
Teaching money concept and money handling skill also help in facilitating shopping skills,, but COOP shows higher improvement because COOP uses client-centered approach; problem-based approach so that children identified their problems and tackled using cognitive strategies, which helps them to generalize their problem-solving skills. Thus, COOP can be a promising approach in facilitating shopping skills in children with learning disability.
- The conventional therapy for children given by different therapists may also have had an effect on both the experiment and control group
- At posttest evaluation, the same shopping center is familiar to the children which would have had an effect on the posttest values.
| Conclusion|| |
COOP approach showed significant improvement in shopping skills for learning disability children; they were satisfied with their performance. Thus, COOP approach is effective in improving shopping skills for learning disability children.
The authors would like to thank my parents and brother for their affection and for being pillars of strength when I needed it the most and I My heartfelt thanks to my guide and all the teachers for their support and guidance throughout.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]