Occupational Adaptation to Disability
The beginning 1987 TWU starting PhD Sally Schultz and Janette Schkade 2003 a full model for practice 12/7/2018
Basic Assumptions Function Adaptation Vs. Adaptation Function? (give a man a fish vs. teach him to fish)
Assumption 1 We are driven to master activities our whole life from our own motivations and because of social expectations and environmental demands. (see, no such thing as laziness!) 12/7/2018
Assumption 2 Life happens. You will have pressures to perform just by doing things in different environments. 12/7/2018
Assumption 3 Dysfunction = I can’t meet the demands of the environment or my own expectations. Did you feel like this last summer? 12/7/2018
Assumption 4 Barriers to my ability to cope: Impairment Disabilities Life Trying to plan a wedding in OT school 12/7/2018
Assumption 5 The greater the gap between what I expect to do and what I can do, the more I need to change the way I’m doing things. Requirements Requirements Grades Grades Working Study Habits Not working 12/7/2018
Assumption 6 Occupational performance results from adapting to environmental demands and personal expectations 12/7/2018
Occupational Challenge Person Systems Occupational Environment Desire for Mastery Press for Mastery Demand for Mastery Occupational Challenge Person Systems Occupational Environment Occupational Role Expectations Generate Adaptive Response Incorporate into Occupational Environment Occupational Response Integrate Learning Evaluate Outcome Assess Response Outcome 12/7/2018
What is your current challenge? Specific Cognitive, sensorimotor, psychological
Generate an Adaptive Response Adaptive Response Mechanism Adaptive Energy Primary Secondary Adaptive Response Mode Existing Modified New Adaptive Response Behaviors Hyper-stable Hyper-mobile Stable Adaptation Gestalt Sensorimotor Psychosocial Cognitive A) Adaptive Response Mechanism (the internal process we go through to come up with a solution) + B) Adaptation Gestalt (approach we take to the problem)
Adaptive Response Mechanism Adaptive Energy Primary Secondary Adaptive Response Mode Existing Modified New 3. Adaptive Response Behaviors Hyper-stable Hyper-mobile Stable Primary- do you find yourself initially focused with high energy and high concentration and remain there for the duration? Secondary- at first highly focused then leave and do something else? Return to a task and find that you had made progress on a solution while engaged in something else? Existing- did you use a method that you had before? Modified-did you have to change/adapt your usual way of doing things? New-have to take an entirely new approach? Response- Do you feel stuck? Do you feel like you are running around in no apparent direction? Balance between thoughtful problem solving and creativity?
Adaptation Gestalt (Plan of Action) Sensorimotor Psychosocial Cognitive What categories have your strategies focused on in the past? Have you practiced mm testing, transfers? Have you managed anxiety related to working with a new client? Or fieldwork educator? What happens when your configuration (allocation of resources) doesn’t fit the situation? You walk into an acute care room. The client is connected to several electrical devices that beep. There are several tubes leading to various fluids. You have been told to complete an initial assessment. What does your gestalt look like?
Adaptive Response Evaluation Subprocess Measures relative mastery of: efficiency effectiveness satisfaction to self satisfaction to society Example, little boy is satisfied with his C that cost him 30 minutes of study, but his mom is not 12/7/2018
Main goal of OT Maximize the client’s effectiveness in using his or her own ability to be adaptive because: As person becomes more adaptive, becomes more functional 12/7/2018
Focus on barriers to adaptation Client’s approach to problem Lack of generating ideas Lack of evaluation of responses Stuckness Diminished adaptive capacity, etc. 12/7/2018
Successful Outcomes Occupational Adaptiveness Self-initiated adaptations Increased relative mastery Generalization to novel activities In qualitative studies, clients repeatedly reported a focus on self-identity not on skills (which is what OT had focused on) 12/7/2018
Adjusting to Disability Adaptive Response Mechanism Adaptive Energy Primary Secondary Adaptive Response Mode Existing Modified New Adaptive Response Behaviors Hyper-stable Hyper-mobile Stable Adaptation Gestalt Sensorimotor Psychosocial Cognitive How much energy? What kind? Is a new approach needed? Has the client ever had to deal with a change in self-identity? Is the client in denial? What are the strategies and behaviors he/she is using to cope? What resource in the gestalt is the client depending on? Intellectualizing? Seeking medical information only? Focused on skills while in denial? Remember all three are needed. If the client is ignoring a component in the gestalt, why? Lack of resources, knowledge, underlying physical capacity?