The Effect of TOAP in Children With CP (TOAP-CP)

The Effect of Task-Oriented Aquatherapy Program (TOAP) on Occupational Performance and Participation in Children With Cerebral Palsy

This study investigates the effects of a task-oriented aquatherapy program (TOAP) on occupational performance, participation, and motivation in children with cerebral palsy. The program was designed based on each child's individually prioritized occupations identified through the Canadian Occupational Performance Measure (COPM).

Twelve children participated in a crossover design. Each child received both the TOAP intervention and conventional rehabilitation exercises in two separate 16-week periods. Interventions were delivered twice per week for 40 minutes per session. Outcomes included occupational performance (COPM), participation (PODCI), and motivation (PMOT). The study aims to provide evidence on whether personalized, meaningful, task-oriented aquatic exercises can improve functional performance and participation in children with cerebral palsy, and to offer structured TOAP protocols for clinicians.

Study Overview

• Status: Completed
• Conditions: Cerebral Palsy (CP)
• Intervention / Treatment: Behavioral: Task-Oriented Aquatherapy Program; Other: Conventional Rehabilitation Exercise

Detailed Description

This study employed an interventional crossover desing to evaluate the effects of a task-oriented aquatherapy program (TOAP) on occupational performance, participate and motivation in children with cerebral palsy. The intervention was grounded in occupational therapy principles and structured according to the Person-Environment-Occupation (PEO) model with an emphasis on meaningful, child-selected occupations performed in an aquatic environment.

Individualized intervention goals were determined prior to the intervention using occupations prioritized by each participant through the Canadian Occupational Performance Measure (COPM). Based on these prioritized occupations, a structured TOAP was developed for each child. The program incorporated task-oriented aquatic activities designed to support functional movement, postural control, balance and engagement while emphasizing active participation and motivation during therapy sessions.

The study consisted of two consecutive 16-week intervention periods. During the first period, one group received the TOAP intervention while the comparison group received conventional rehabilitation exercises commonly used in pediatric neurorehabilitation. Following completion of the first period, the groups crossed over and received the alternate intervention in the second period. This crossover, structure allowed each participant to serve as their own control, thereby reducing inter-individual variability.

All intervention sessions were conducted twice weekly, with each sessions lasting 40 minutes. Interventions were delivered by trained clinicians in an aquatic therapy setting. Outcome assessments were conducted at baseline and at the end of the each intervention period to evaluate changes associated with each treatment condition.

The study protocol was desinged to examine whether a personalized, task-oriented aquatic intervention grounded in meaningful occupations could enhance occupational performance, participation and motivation in children with cerebral palsy and to inform the development of structured aquatic intervention approaches applicable to clinical practice.

• Study Type: Interventional
• Enrollment (Actual): 12
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Altındağ
    • Ankara, Altındağ, Turkey (Türkiye), 06050
      • Hacettepe University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Children with CP classified as GMFCS levels 1-3 and MACS levels 1-3.
• Children and caregivers who voluntarily agreed to participate

Exclusion Criteria:

• Severe intellectual disability
• MAS levels 3-4
• Surgery or botulinum toxin injection within the past 6 months
• Significant hearing or vision impairment interfering with assessment
• Medical conditions preventing exercise (e.g., cardiovascular failure)
• Conditions preventing aquatic exercise (e.g., infection, open wound, incontinence)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Study Group; Receives tailored occupation-based task-oriented aquatherapy program	Behavioral: Task-Oriented Aquatherapy Program; A 16-week program where each child engages in activities tailored to their five most important occupations, identified via COPM. Sessions are 40 minutes, twice weekly, focused on improving occupational performance, participation, and motivation. The program is structured, individualized, and designed to enhance engagement and functional outcomes in children with CP.; Other Names: Study Group Intervention
Active Comparator: Control Group; Receives conventional rehabilitation exercise program	Other: Conventional Rehabilitation Exercise; Participants received standard rehabilitation exercises including activities to improve gross and fine motor skills, balance, coordination, muscle strength, joint range of motion, and cardiovascular capacity.; Other Names: Control Group Intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Occupational Performance	Canadian Occupational Performance Measure (COPM), a client-centered outcome measure that assessing performance (COPM-Performance) in the child's top five occupations. Minimum value:1 Maximum value: 10 Higher score indicates greater performance.	Baseline, up to 16 weeks (end of the first period), up to 32 weeks (end of the second period).
Occupational Satisfaction with Performance	Canadian Occupational Performance Measure (COPM), a client-centered outcome measure that assessing occupational satisfaction with performance (COPM-Satisfaction) in the child's top five occupations. Minimum value:1 Maximum value: 10 Higher score indicates greater performance.	baseline, up to 16 weeks (end of the first period), up to 32 weeks (end of the second period).
Participation	Pediatric Outcomes Data Collection Instrument (PODCI) consists of six subscales. A Global Functioning Score (PODCI-GF) is calculated by summarizing the results of all six subscales. In the present study, participation and overall functional status were evaluated primarily using the PODCI-GF, as it provides a comprehensive representation of the child's overall functional participate. Minimum Value:0 Maximum Value:100 Higher score indicates better overall functioning	Baseline, up to 16 weeks (end of the first period), up to 32 weeks (end of the second period).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Motivation	Pediatric Motivation Scale (PMOT) consists of 19 items grouped into six subscales assessing different dimensions of motivation. A Total Motivation Score (PMOT-T) is obtained by summing the scores of all six subscales. In the present study, motivation to participate in rehabilitation programs was evaluated primarly using the PMOT-T, as it provides a comprehensive representation of the child's overall motivation toward rehabilitation. Minimum value:19 Maximum value: 114 Higher score indicates greater motivation.	Baseline, up to 16 weeks (end of the first period), up to 32 weeks (end of the second period).

Collaborators and Investigators

• Sponsor: Hacettepe University
• Investigators: Study Director: Sedef Şahin, Assoc. Prof., Hacettepe University; Principal Investigator: Aybike Baykan, PT, MSc, Etimesgut Belediyesi Engelsiz Yaşam Özel Eğitim ve Rehabilitasyon Merkezi

Publications and helpful links

General Publications

• Baykan A., Serebral Palsi Tanılı Çocuklarda Görev Odaklı Su İçi Egzersizin Okupasyonel Performans ve Katılım Üzerine Etkisi, Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü Ergoterapi Programı Yüksek Lisans Tezi, Ankara, 2023.

Helpful Links

• Hacettepe University Occupational Therapy Department Thesis Collection

Study record dates

Study Major Dates

• Study Start (Actual): June 6, 2022
• Primary Completion (Actual): May 23, 2023
• Study Completion (Actual): May 23, 2023

Study Registration Dates

• First Submitted: December 8, 2025
• First Submitted That Met QC Criteria: January 8, 2026
• First Posted (Estimated): January 16, 2026

Study Record Updates

• Last Update Posted (Estimated): January 16, 2026
• Last Update Submitted That Met QC Criteria: January 8, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: aquatic therapy; occupational therapy; motivation; pool therapy; water exercise therapy
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy
• Other Study ID Numbers: AYBIKE-TOAP-CP-CROSSOVER-23

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

De-identified data for each participant, including:

COPM scores (performance and satisfaction) PODCI scores (participation) PMOT scores (motivation) Demographic information (age, sex, GMFCS and MACS levels)

• IPD Sharing Time Frame: IPD and supporting information will be available beginning 6 months after publication of the study results and will remain accessible for 5 years thereafter.
• IPD Sharing Access Criteria: Data will be accessible to qualified researchers who submit a methodologically sound proposal. Requests must be reviewed and approved by the principal investigator. Data will be shared via secure transfer under a data use agreement ensuring confidentiality and ethical use.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No