1. Occupational Adaptation to Disability

2. The beginning 1987 TWU starting PhD Sally Schultz and Janette Schkade
2003 a full model for practice
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3. Basic Assumptions Function  Adaptation Vs. Adaptation  Function?
(give a man a fish vs. teach him to fish)

4. 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!)
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5. Assumption 2
Life happens. You will have pressures to perform just by doing things in different environments.
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6. Assumption 3
Dysfunction = I can’t meet the demands of the environment or my own expectations.
Did you feel like this last summer?
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7. Assumption 4 Barriers to my ability to cope: Impairment Disabilities
Life
Trying to plan a wedding in OT school
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8. 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
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9. Assumption 6
Occupational performance results from adapting to environmental demands and personal expectations
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10. 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
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11. What is your current challenge?
Specific
Cognitive, sensorimotor, psychological

12. 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)

13. 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?

14. 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?

15. 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
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16. 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
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17. Focus on barriers to adaptation
Client’s approach to problem
Lack of generating ideas
Lack of evaluation of responses
Stuckness
Diminished adaptive capacity, etc.
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18. 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)
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19. 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?