Week 3 Presentation: Theory of Occupational Adaptation

Theory of OA Introduction

• Integrates original constructs of occupational therapy

  • Occupation and adaptation into a single interactive construct

• Originally a frame of reference, but further developed into a theory

• Distinction between other interventions is the focus on improving adaptiveness versus functional skills

• Similarities to models such as spatiotemporal adaptation, model of adaptation through occupation, MOHO, the model of occupation

Guiding Assumptions

• Competence in occupation is a lifelong process of adaptation to demands to perform

• Demands to perform occur naturally as part of person: occupational environment interactions

• When demand for performance exceeds person’s ability to adapt, dysfunction occurs

• Adaptive capacity can be overwhelmed by disability, impairment and stress

• The greater the level of dysfunction, the greater the demand for change in adaptive process

• Sufficient mastery + ability to adapt= success in occupational performance

• These assumptions are about the relationship between occupational performance and human adaptation

Occupational Adaptation Process

• Characterized by constant desire, demand and press for mastery within an occupational environment

• Dynamic, self-organizing, complex and highly interactive process, despite linear representation

• Main objective is to achieve mastery over environment

• Describes interaction between 3 elements:

  • The person

  • The environment

  • The interaction between person and environmentl

• Each element is in a fluid and dynamic

• A change in one element influences other elements

• Through occupational adaptation people achieve mastery over their health and well-being

The Elements: Person

• Represented by the left side of the diagram

• Relates to the internal factors that affect the person

• Constant factor is desire for mastery

• Is made up of systems:

  • Sensorimotor

  • Psychosocial

  • Cognitive

• All occupations involve all the systems

• The contribution of each system shifts, depending on the occupational circumstances

• Creates an internal adaptive response to an occupational challenge

• Mastery over environment is an innate human condition

Occupational Respons

• An observable outcome of the adaptive response

The Elements: Occupational Environment

• Represented on the left side of the diagram

• Constant factor is demand for mastery

• Encompasses external factors that affect the person

• Dynamic and experiential context within which the person engages in occupations & occupational roles

• Types of occupational environment are

  • Self-care

  • Leisure/play

  • Work

• Each type of environment is influenced by social, cultural and physical factors that are part of the person’s experiential context

The Elements: Interaction

• Represented in the middle of the diagram

• Constant factor is press for mastery

• Interaction between desire for mastery and demand for mastery= press for mastery, creating an occupational challenge

• Internal and external factors continuously interact through occupation

• Actions and behavior carried out in response to an occupational challenge

Occupational Adaptation Process: Subprocesses

• Made up of 3 subprocesses that are internal to the person

  • Generation subprocess

  • Evaluation subprocess

  • Integration subprocess

• Through the subprocesses one plans the adaptation response, evaluates outcome, and integrates evaluation as adaptation

Generation Subprocess

• Anticipatory part of human adaptation consisting of two stages

Generation Subprocess: Stage 1

• Is activated by adaptive response mechanisms that consists of:

  • a) Adaptation energy- primary & high level of cognitive awareness

  • b) Adaptive response mode- strategies & patterns established through life experience. They can be new, existing or modified

  • c) Adaptive response behaviour may be hyperstable, hypermobile or transitional

Generation Subprocess: Stage 2

• a) Person prepares to carry out planned action by configuring body systems

• b) Body systems: sensorimotor, cognitive and psychosocial

• c) Characterized by an adaptation gestalt

• d) Adaptive response mechanism (stage 1)+ adaptation gestalt (stage 2)= internal adaptive response

Evaluation Subprocess

• Personal assessment of the quality of occupational response- relative mastery

• Relative mastery comprises of efficiency, effectiveness, satisfaction to self and others.

• When personal assessment yields positive results, there is little need for further adaptation

• If assessment yields negative results, the integration subprocess relays the information back to the person

Integration Subprocess

• Engaged when there is need for further adaptation

Function-Dysfunction Continuum

• When demand for performance exceeds person’s ability to adapt, dysfunction occurs

• Continuous inability to generate an appropriate occupational response to an occupational challenge could result in dysfunction

• The more adaptive the person, the more functional he/she is in daily activities

Implications for Practice

• Main goal:

  • Client’s ability to adapt is used to maximize effectiveness to adapt

• Client is assisted in choosing occupational roles and these guide treatment

• Using occupational readiness and occupational activity

• OT focuses on clients ability to adapt by directing intervention towards the three subprocesses

• Treatment needs to progress quickly to meaningful activities

• Therapeutic use of occupation as a tool to promote adaptive capacity of clients

• To improve adaptiveness, intervention is focused on improving and activating client’s internal adaptive response

• OT manages the occupational environment to promote the client’s ability to adapt

• Client is agent of own change