OCCUPATIONAL ADAPTATION MODEL

                                  OCCUPATIONAL ADAPTATION MODEL

1.      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.

·         The name of the model comes from combining the concepts of occupation and adaptation, which were both foundational concepts for occupational therapy.

·         Schultz and Schkade (1997) defined adaptation as a change in one’s response to the environment when encountering an occupational challenge. As they stated, “This change is implemented when the individual’s customary response approaches are found inadequate for producing some degree of mastery over the challenge”

·         Their definition of adaptation encompasses two important aspects:

Ø  The need for a changed response  

Ø  The idea of mastery.

                          In emphasizing the need for a changed response

·         In emphasizing the need for a changed response, Schultz (2009) stated, “Most occupational therapy is driven by the assumption that, as clients become more functional, they will be more adaptive.”   

·         Therapists may incorrectly assume that as the patient acquires more functional skills, or begins using assistive devices, adaptation is occurring. [However], the individual’s internal adaptation may remain unchanged.”

·         Their definitions and discussions suggest that occupational adaptation is a process that must occur internally, within the individual.

                         The idea of mastery

·         The model is based on the assumption that individuals desire mastery, environments demand it and the interaction between the two presses for it.

2.      AIMS AND GOAL

·         The Occupational Adaptation (OA) model aims to provide a framework for conceptualizing the process by which humans respond adaptively to their environments.

·         Theory of occupational adaptation and other occupation focused frame works is that occupational adaptation intervention focuses on improving adaptiveness where as others focuses on improving functional skills  

3.      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

4.      ELEMENTS:

               3.1 Person

• —  Relates to the internal factors that affect the person
• —  Constant factor is desire for mastery
• —  Person is made up of systems: sensorimotor, psychosocial & cognitive that are unique to the individual
• —  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
• —  An observable outcome of the adaptive response is called the occupational response
• —  Mastery over environment is an innate human condition

               3.2 Occupational Environment:

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

               3.3 Interaction:

• —  Constant factor is press for mastery
• —  Interaction between desire for mastery and demand for mastery= press for mastery, creating an occupational challenge
• —  Internal & external factors continuously interact through occupation
• —  Actions & behaviour carried out in response to an occupational challenge

5.      OCCUPATIONAL ADAPTATION PROCESS:

·         Made up of three subprocesses that are internal to the person:

Ø  Generation subprocess

Ø  Evaluation subprocess

Ø  Integration subprocess

·         Through the sub processes one plans the adaptation response, evaluates outcome and integrates evaluation as adaptation

               Generation subprocess

·         Anticipatory part of human adaptation consisting of two stages

·         Stage one is activated by adaptive response mechanisms that consists of:

Ø  adaptation energy- primary & high level of cognitive awareness

Ø  adaptive response mode- strategies & patterns established through life experience. They can be new, existing or modified

Ø  adaptive response behaviour may be hyperstable, hypermobile or transitional

·         Stage two:

Ø  Person prepares to carry out planned action by configuring body systems

Ø   Body systems: sensorimotor, cognitive and psychosocial

Ø  Characterized by an adaptation gestalt

Ø  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
• —  Experience of relative mastery  
• —  Overall assessment of the occupational event

               Integration subprocess

• —  Engaged when there is need for further adaptation
• —  Adaptive response integration subprocess

6.      FUNCTION-DYSFUNCTION:

·         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

7.      IMPLICATION OF 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.