Chapter 40 Theory of Occupational Adaptation Sally W. Schultz

Learning Objectives After reading this chapter, you will be able to: State the features of occupational adaptation (OA) that most distinguish it from other occupation-based theories of practice. Describe the necessity of using the Guide to Therapeutic Reasoning for an OA-based treatment program. Describe key aspects of the OA Guide to Evaluation and Intervention.

Learning Objectives (Continued) Explain why the therapeutic use of self is one of the most powerful therapeutic tools. Explain why it is necessary for therapists to use an articulated theory to develop an authentic occupation- based practice.

Intellectual Heritage The theory of occupational adaptation (OA) describes the integration of two global concepts in occupational therapy: Occupation Adaptation The intellectual heritage of OA dates back to the founders of OT and also contemporary theorists in and outside the field

Guiding Assumptions of OA Theory Practice based on OA assumes as clients become more adaptive they become more functional Founders of OA proposed six guiding assumptions about the relationship between occupational performance and human adaptation Each assumed to be normative and applicable across lifespan

Guiding Assumptions (Continued) Competence in occupation is a lifelong process of adaptation to internal and external demands to perform Demands to perform occur naturally as part of the person’s occupational roles and the context (person– occupational environment interactions) in which they occur Dysfunction occurs because the person’s ability to adapt has been challenged to the point at which the demands for performance are not met satisfactorily

Guiding Assumptions (Continued) The person’s adaptive capacity can be overwhelmed by impairment, physical or emotional disabilities, and stressful life events The greater the level of dysfunction, the greater is the demand for changes in the person’s adaptive processes Success in occupational performance is a direct result of the person’s ability to adapt with sufficient mastery to satisfy the self and others

Introduction to the Theory of Occupational Adaptation The OA process describes the interaction of the person, the environment, and the internal adaptive processes that occur when individuals engage in their daily occupations The model is presented in a linear format The model of the OA process is based on three overarching elements: (a) the person, (b) the occupational environment, and (c) their interaction

Person: Internal Factors of the OA Process The left side of the model is devoted to the internal factors: those that occur within the person The desire for mastery is a constant factor in the OA process The person is made up of the individual’s unique sensorimotor, cognitive, and psychosocial systems

Occupational Environment: External Factors of the OA Process The right side of the model is devoted to external factors that affect the person The external process also begins with the demand for mastery The second external factor is the occupational environment

Interaction of Internal and External Factors: OA Process The internal and external factors continuously interact with each other through the modality of occupation The ongoing interaction of the person’s desire for mastery and the occupational environment’s demand for mastery creates a third constant: the press for mastery The press for mastery yields the occupational challenge

Interaction of Internal and External Factors (Continued) The occupational role expectations of the person and of the occupational environment intersect in response to the unique occupational challenge that the individual experiences The occupational response is the outcome—the observable by-product of the adaptive response The occupational adaptation process begins at the top of both the left and right sides of the model at the same time

The OA Process: Adaptive Response Subprocesses Within the broad occupational adaptation process, there are three subprocesses that are internal to the person: The generation subprocess is activated by a mechanism that explains how an adaptive response is created The evaluation subprocess is activated when the individual assesses the quality of the occupational response The integration subprocess communicates negative results to the person

Introduction to Practice Based on the Theory of Occupational Adaptation OA directs practice to be focused on the therapeutic use of occupation to promote clients’ adaptation The primary intervention goal is to maximize the client’s effectiveness in using his or her own ability to be adaptive The OA Clinical and Professional Reasoning Process provides a systematic progression of questions that practitioners uses to frame overall thinking

Interruption in the OA Process When the normative OA process is seriously disrupted, the person’s adaptive responses are often inadequate Impairments in person systems place significant limits on the individual’s ability to effectively use former or existing adaptive responses Cognitive issues often further limit the ability to adapt

Strengths and Limitations Strengths of OA include: A theoretical orientation that is holistic Assumptions adhere to the ideas of occupation and adaptation that are inherent in the profession’s history and philosophy Limitations include: Practitioners who believe that intervention based on meaning is not practical in everyday practice Lack of an OA assessment tool

Research There have been two main OA assumptions and related outcomes under study: First, OA-based interventions will have a greater effect on functional independence than therapy based on traditional ADLs, tested by the Functional Independence Measure (FIM) Second, OA-based interventions will result in greater generalization of skills learned in therapy than traditional OT rehabilitation methods