Accompagnement d’enfants présentant des troubles des fonctions exécutives après lésion cérébrale acquise : principes, recommandations, et exemple d’intervention avec l’approche CO-OP

Summary :

Summary:
Introduction: Acquired brain injury (ABI) in children often causes cognitive impairments, particularly in executive functions (EF). These impairments affect independence, autonomy and participation. Occupational therapy plays a central role in helping these children achieve their occupational goals. This article presents the current state of knowledge on the rehabilitation of EF deficits, current recommendations, and illustrates these principles through a study using the CO-OP approach.
Situation and context: EF support intentional and appropriate behaviour in everyday life. However, few interventions have proven effectiveness in children. The literature does highlight several key principles: an ecological approach, providing interventions focused on daily live activities, using metacognitive strategies, and encouraging active involvement of caregivers, etc.
Intervention: a single-case experimental design study evaluated the effectiveness of the CO-OP approach in 12 children with severe EF deficits after ABI. CO-OP, a metacognitive problem-solving approach, led to significant and lasting improvements in occupational performance, as well as a transfer of skills to untrained goals. The involvement of caregivers proved to be decisive in facilitating goal achievement and maintenance.
Analysis and discussion: many approaches lack evidence of effectiveness and may come at the expense of other beneficial activities. Ecological, fun, repeated interventions involving family offer the highest level of evidence.
Conclusion: the CO-OP approach appears to be effective with this population. It illustrates the need for personalised, ecological and family-centred interventions, while highlighting the major challenge of rapidly implementing efficient approaches in clinical practice.

Article rédigé par :

• 

  Hélène Lebrault

  Ergothérapeute,
  docteur en neurosciences
  Pôle Enfants – Hôpitaux Paris-Est
  Val-de-Marne, site de Saint-Maurice,
  Saint-Maurice
  Sorbonne Université, GRC 24,
  Handicap moteur et cognitif et Réadaptation
  (HaMCRe), Paris
  helene.lebrault@ght94n.fr

  
  
• 

  Mathilde Chevignard

  Médecin de médecine physique
  et réadaptation, PhD, HDR
  Pôle Enfants – Hôpitaux Paris-Est
  Val-de-Marne, site de Saint-Maurice,
  Saint-Maurice
  Sorbonne Université, CNRS, INSERM,
  Laboratoire d’imagerie biomédicale, LIB,
  Paris
  Sorbonne Université, GRC 24,
  Handicap moteur et cognitif
  et réadaptation (HaMCRe), Paris
  mathilde.chevignard@ght94n.fr