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COPing with and CAring for infants with special needs (COPCA) program
Evidence reviewed as of before
01-01-2021 Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); Deleva, V. (MSc App OT) & Majnemer, A. (PhD, OT, FCAHS)Share this
intervention:
COPCA
Introduction
COPCA was developed in the Netherlands to provide early intervention to premature infants who are at high risk of cerebral palsy (CP), targeting their overall development and function (cognitive, motor, and behavioral skills) as well as their families’ wellbeing/function.
COPCA is provided in the child’s home. It uses a “hands-off” strategy to stimulate infants to develop their own strategies/self-produced motor behaviors through trial and error and by means of play (self-generated motor activities). In other words, the physiotherapist is not using their hands to move the child’s body, but is using motivators (toys, people) to get the child to try to move their own body (example: reach towards a toy that makes noise). COPCA aims to encourage the infant to find adaptive motor strategies throughout daily life activities. The ultimate goal is for the child to develop the ability to find an appropriate solution for any given motor task. It is a family-centered program with 2 main components:
1. A family educational component: There is an emphasis on family autonomy by coaching families to cope with their situation and to make their own decisions.
2. A neurodevelopmental component: There is an emphasis on trial and error so that the child can actively learn different ways to move their body themselves and to adapt those movements in different scenarios. First the child explores all the variations of motor possibilities that they can do. Then the child gradually learns to select the most efficient solution for a given task out of his or her motor repertoire. This selection is based on having done self-produced motor activities through trial-and-error.
The goal of COPCA is to provide early intervention to premature infants who are at high risk of cerebral palsy (CP), targeting their overall development and function (cognitive, motor, and behavioral skills) as well as their families’ wellbeing/function.
COPCA has been examined using high quality research studies. It has not been shown to improve infants’ motor behavior, infants’ participation or activity level, or the quality of life of infants and their families more than typical physiotherapy interventions. However, it has been found to promote better infants’ positioning by caregivers during bathing (sitting in the bath as opposed to lying on their backs) which in turn could lead to better child development.
It is important to note that results can vary from person to person.
Sessions will be completed in your home by a COPCA trained physiotherapist. The physiotherapist will use different strategies and toys to help your child try to move their body independently and interact with their environment. Throughout the sessions, the physiotherapist will help you, as a parent, learn to integrate similar activities into your daily routine.
No side effects or risks have been reported in the studies on COPCA. However, if you have concerns, we suggest that you discuss these with the treating therapist.
The studies reviewed examined the impact of COPCA on a population of infants with bilateral/unilateral CP that included all levels of severity (GMFCS levels I through V). There is currently no strong scientific evidence that COPCA works for this population more than other interventions; however, specific intervention elements, such as coaching, may increase empowerment of families and may influence quality of life.
Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.
One high quality RCT (Hielkema et al., 2020B) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on adaptive behaviors among infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Adaptive behaviors were assessed using the Vineland Adaptive Behaviour Scale at mid-treatment (6 months) and at post-treatment (12 months). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving adaptive behaviors in infants at very high risk of CP.
One high quality RCT (Hielkema et al., 2020A) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on cognitive development among infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Cognitive development was assessed using the Bayley Scales of Infant development (BSID – Mental Developmental Index) during treatment (3 and 6 months), at post-treatment (12 months), and at follow-up (21 months). No significant between-group differences were found at any time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving cognitive development in infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
One high quality RCT (Hielkema et al., 2020B) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on coping among families of infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Family coping was assessed by The Utrechtse Coping List (UCL: Palliative coping, Avoiding, Social support seeking, Depressive coping, Expression of negative emotion, Comforting ideas) at post-treatment (12 months). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving coping among families of infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
One high quality RCT (Hielkema et al., 2020B) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on empowerment among families of infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Family empowerment was assessed by the Family Empowerment Scale (FES: Total, Family system, Service system) at mid-treatment (6 months) and at post-treatment (12 months). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving empowerment among families of infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
One high quality RCT (Hielkema et al., 2020B) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors)on the quality of life of families with infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Quality of life was assessed by the Quality of Life – Centraal Bureau voor de Statistiek List at mid-treatment (6 months) and at post-treatment (12 months) and by the Infant and Toddler Quality of Life Questionnaire – parents concepts (ITQOL: Impact emotional, Impact time, Family Cohesion) at post-treatment (12 months). No significant between-group differences were found at any time points.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving quality of life in families of infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
One high quality RCT (Hielkema et al., 2020B) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on stress among families of infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Family stress was assessed using the Nijmeegse Ouderlijke Stress Index -shortened version at post-treatment (12 months). No significant between-group difference was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving stress among families of infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
One high quality RCT (Hielkema et al., 2020B) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on functional skills among infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Functional skills were assessed using the Pediatric Evaluation of Disability Inventory (PEDI: Self-care, Mobility, Social functioning) at mid-treatment (6 months) and at post-treatment (12 months). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving functional skills in infants at very high risk of CP.
One high quality RCT (Hielkema et al., 2020A) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on gross motor function among infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). In this high quality RCT, infants were randomized to receive the COPCA program or typical infant physiotherapy. Gross motor function was assessed using the Gross Motor Function Measure (GMFM-88, GMFM-66, GMFM-adapted) and the Alberta Infant Motor Scale during treatment (3 and 6 months), at post-treatment (12 months), and at follow-up (21 months). No significant between-group differences were found at any time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving gross motor function in infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
One high quality RCT (Hielkema et al., 2020B) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on quality of life among infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V). This high quality RCT randomized infants to receive the COPCA program or typical infant physiotherapy. Infant quality of life was assessed using the Infant and Toddler Quality of Life Questionnaire – child concepts (ITQOL: Physical abilities, Growth and development, Bodily pain/discomfort temperament and moods, Getting along with others, General health perceptions, Change in health) at post-treatment (12 months). No significant between-group difference was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program (focus: family coaching & infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving quality of life in infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
Two high quality RCTs (Hielkema et al., 2011; Hielkema et al., 2020a) investigated the effects of Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on motor development among infants at very high risk for CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
The first high quality RCT (Heilkema et al., 2011) randomized infants to receive the COPCA program or typical infant physiotherapy (TIP). Motor development was assessed using the Infant Motor Profile (IMP) during treatment (3, 4, 5 months), at post-treatment (6 months), and at follow-up (18 months). No significant between-group differences were found at any time points.
The second high quality RCT (Heilkema et al., 2020a) randomized infants to receive the COPCA program or TIP. Motor development was assessed using the IMP and the Bayley Scales of Infant development (BSID – Psychomotor Developmental Index) during treatment (3 months), at mid-treatment (6 months), at post-treatment (12 months) and at follow-up (21 months). No significant between-group differences were found at any time points.
Conclusion: There is strong evidence (Level 1a) from two high quality RCTs that the COPCA program (focus: infants self-producing motor behaviors) is as effective as the comparison intervention (typical infant physiotherapy) in improving motor development in infants at very high risk of CP (later diagnosed with bilateral/unilateral CP, GMFCS levels I-V).
One high quality RCT (Dirks et al., 2016) investigated the effects of a Coping and Caring for Infants with Special Needs (COPCA) program (focus: a family education + neurodevelopmental program targeting infants self-producing motor behaviors) on positioning of infants with high risk of developmental disability (including cerebral palsy). In this high quality RCT, infants were randomized to receive COPCA or traditional infant physiotherapy (TIP). Positioning during bathing (sitting, supine) was measured using recorded videos at post-treatment (6 months) and follow-up (18 months). A significant between-group difference was found for the sitting position at post-treatment, favoring COPCA vs. TIP.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the COPCA program is more effective than the comparison intervention (traditional infant physiotherapy) in improving positioning for infants at high risk of developmental disability (including CP).
References
Dirks, T., Hielkema, T., Hamer, E. G., Reinders-Messelink, H. A., & Hadders-Algra, M. (2016). Infant positioning in daily life may mediate associations between physiotherapy and child development-video-analysis of an early intervention RCT. Research in developmental disabilities, 53-54, 147–157. https://doi.org/10.1016/j.ridd.2016.02.006
Hielkema, T., Blauw-Hospers, C. H., Dirks, T., Drijver-Messelink, M., Bos, A. F., & Hadders-Algra, M. (2011). Does physiotherapeutic intervention affect motor outcome in high-risk infants? An approach combining a randomized controlled trial and process evaluation. Developmental medicine and child neurology, 53(3), e8–e15. https://doi.org/10.1111/j.1469-8749.2010.03876.x
Hielkema, T., Hamer, E. G., Boxum, A. G., La Bastide-Van Gemert, S., Dirks, T., Reinders-Messelink, H. A., Maathuis, C., Verheijden, J., Geertzen, J., Hadders-Algra, M., & L2M 0-2 Study Group (2020). LEARN2MOVE 0-2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy: neuromotor, cognitive, and behavioral outcome. Disability and rehabilitation, 42(26), 3752–3761. https://doi.org/10.1080/09638288.2019.1610508 (Hielkema et al., 2020A)
Hielkema, T., Boxum, A. G., Hamer, E. G., La Bastide-Van Gemert, S., Dirks, T., Reinders-Messelink, H. A., Maathuis, C., Verheijden, J., Geertzen, J., & Hadders-Algra, M. (2020). LEARN2MOVE 0-2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy: family outcome and infant’s functional outcome. Disability and rehabilitation, 42(26), 3762–3770. https://doi.org/10.1080/09638288.2019.1610509 (Hielkema et al., 2020B)
A group of lifelong disorders affecting a person’s movement, coordination, and muscle tone and which are the result of damage to the brain before, during, or shortly after birth.
Gross Motor Functional Classification System. It is a tool used to categorize the gross motor skills of children with cerebral palsy into 5 different levels across 5 age bands. It evaluates the child’s abilities in sitting, walking and wheeled mobility as well as the type of assistive devices needed for mobility. The levels are assigned based on the severity of the limitations, ranging from mild (level I) to severe (level V).
Refers to the development of the brain and the nervous system with the goal of achieving the highest level of performance and functioning possible (memory, attention, social skills, ability to learn, etc.)
