Despite the need for occupational therapy to emphasize client-specific occupational performance, primary emphasis in stroke rehabilitation continues to be on the remediation of client factors and self-care. Such practice leaves many survivors of stroke with continuing performance deficits. Two case studies demonstrate a novel, alternative approach. The Cognitive Orientation to Daily Occupational Performance (CO–OP) treatment is a performance-based, problem-solving approach to developing functional skills that are client centered. CO–OP was used to guide treatment with 2 older women. The findings suggest that the approach has the potential to successfully help clients with stroke achieve their everyday occupational goals and support continued research in this area. This work will lead to a pilot randomized controlled trial.

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