Occupational Adaptation Theory

There are many models that provide healthcare professionals with a filter in how they view and asses occupational challenges that individuals encounter. The occupational adaptation (OA) model is based on the assumption that the more adaptable an individual is, in an ever-changing environment, the more functional they become (Schultz, 2014).

This assumption is what separates the OA model from other models (Schultz, 2014). The person-environment-occupation (PEO) model, for example, typically assesses environmental barriers which impede an individual's functional performance and make modifications to the environment to improve occupational performance (Brown, 2014).

While the PEO model is successful in promoting the best fit between an individual, their environment, and their occupation (Brown, 2014), other healthcare professionals find success through the use of the OA model by promoting adaptability within the environment (Schultz, 2014).

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History of Occupational Adaptation

The theory of occupational adaptation was developed by Janette Schkade and Sally Schultz in 1992 at Texas Woman's University (Schultz, 2014). Schkade and Schultz were part of the faculty who was challenged by the dean of the program at Texas Woman's University to develop a Ph.D. program in occupational therapy (Schultz, 2014).

It was agreed upon that occupation and adaptation were important concepts of occupational therapy (Schultz, 2014). When the Ph.D. program was established, occupational adaptation was foundational to their philosophy and research (Schultz, 2014). The focus of the theory of occupational adaptation is to enhance overall performance (Schultz, 2014). By developing this theory, Schkade and Schultz's goal was to develop adaptive skills and successfully achieve personal adaptation. Furthermore, the theory of occupational adaptation is based on the relationship between occupational performance and human adaptation (Schultz, 2014).

Occupational Adaptation Theory

Occupational performance is defined as having the ability to carry out roles, routines, and tasks in response to demands of the environment (Ranka, J., & Chapparo, C. 1997). The OA theory emphasizes the influence of the interaction between the environment and an individual on occupational performance (Schultz, 2014).

Schkade and Schultz found that the more adaptive a person becomes, the more functional they are which improves overall occupational performance. Personal adaptation is defined as an ongoing change of order and disorder, and reorganization (Schultz, 2014). The environment is an area that is largely out of one's control; to be functional in an ever-changing area, it is best to adjust to the given circumstance (Schultz, 2014). Schematic Schkade, J. K., ; Schultz, S. (1992)

Occupational Adaptation Process Model

In the occupational adaptation process model by Schkade ; Schultz (1992), the person is influenced by internal factors which demand adaptation and create a desire for mastery. An individual's internal factors are influenced by the sensorimotor, cognitive, and psychosocial systems (Schultz, 2014). These systems are responsible for responses to the environment and challenges (Schultz, 2014).

The occupational environment poses external factors in which an individual's roles and occupations take place (Schultz, 2014). The occupational environment creates a demand for mastery and is strongly associated with a person's physical, social, and cultural background (Schultz, 2014). External factors largely affect an individual's response and ability to adapt (Schultz, 2014). Through occupation, there is constant interaction between an individual and the occupational environment (Schultz, 2014).

Due to the consistent interaction between a person and his or her environment, occupational challenges arise and a press for mastery is created (Schultz, 2014). The occupational role expectation is contingent upon the environment and demands for adaptation in response to the occupational challenge (Schultz, 2014). When an individual adapts to changes in the environment, this is called the "occupational response" (Schultz, 2014).

Role of Occupational Therapist

The theory of occupational adaptation focuses on developing an individual's adaptive skills through therapeutic use of occupation (Schultz, 2014). The therapeutic use of occupation uses occupational activities to promote the desire to adapt and succeed (Schultz, 2014). The techniques that are used to promote the desire to adapt are crucial for success or otherwise could provide the opposite results and inhibit the desire to adapt (Schultz, 2014).

Interferences that often impede an individual's success are poor approach, repetition of ineffective exercises, depression, and frustration (Schultz, 2014). Therapists should grade activities using the "just right" approach so that a person feels successful, but is still challenged (Schultz, 2014). While some interferences can be overcome for success, deficits in sensorimotor, cognitive, and psychosocial systems place significant limitations on an individual's ability to respond with adaptations (Schultz, 2014). The role of the therapist is not to take away a person's challenges, but to help them to discover their ability to adapt (Schultz, 2014).

Application to Occupational Therapy

This theory can be successfully applied in intervention in schools, home care, inpatient and outpatient rehabilitation, and mental health (Schultz, 2014). Thus, there is a wide variety of individuals that could benefit from this model including children, people who have had strokes, post-surgery or injured patients, individuals with dementia, and caregivers (Schultz, 2014).

People who have had strokes, specifically, have been successful with this model because of the structure and focus that it provides (Schultz, 2014). Therapists have guided these patients using this model by providing adaptive strategies for their new roles (Schultz, 2014). Therapists have also found success using this model in rehabilitation interventions (Schultz, 2014).

Whether it is post-surgery or injury, therapists have found that their patients are more successful and engaged when the intervention plan includes strategies of adaptation within their daily occupational role (Schultz, 2014). In schools, this model has been successful when paired with the occupation of reading model for children who experience difficulty reading (Schultz, 2014).

The OA model was used to engage children in meaningful reading activities where they feel confident and successful (Schultz, 2014). Therapists found that when adjusting the reading level, children experienced relative mastery (Schultz, 2014). While the goal of most intervention is improved performance, the OA model focuses on promoting adaptability, which improves overall performance (Schultz, 2014).

Conclusion

The ecological model is similar to the OA model in that they both emphasize the influence that the environment has on an individual's occupational performance (Schultz, 2014; Brown, 2014). While the OA model focuses on the importance of adaptability within the environment (Schultz, 2014), the ecological model focuses on modifying the environment for optimal performance (Brown, 2014).

The person-environment-occupation (PEO) model, specifically, relates function or dysfunction to a person's fit to the environment (Brown, 2014). Dysfunction, according to the PEO model, is due to a poor person-environment fit and can be rectified by changing the environment (Brown, 2014).

The PEO model is based on the idea that therapists should focus on changing the environment to enhance performance rather than changing the individual (Brown, 2014). Consequently, an individual's occupational success is then limited to the confines of the environment that has been adjusted to their capabilities (Schultz, 2014).

For example, a child that has difficulty attending to tasks in a loud room: changing the individual's environment to a quiet room would result in improved occupational performance, but the child is then limited to functional performance within the means of a quiet environment. The OA model adequately prepares a person for an ever-changing environment that they can adapt to, therefore their occupations are not limited to one environment (Schultz, 2014).

For example, a child that has difficulty attending to tasks in a loud room: a child that is guided on how to adapt in a loud environment through the use of headphones will then be able to apply their new found adaptive skills in other environments. The OA model differs from other models through collaboration with the person and by instilling confidence as well as empowering them with skills that can be applied throughout all of their occupations (Schultz, 2014).

I feel most aligned with the OA model because it focuses on life skills that are important to be successful throughout life (Schultz, 2014). The OA model is limitless in the population and settings that it can be applied in, which creates stability and structure to help people thrive (Schultz, 2014). In an ever-changing environment that is inevitable, the OA model provides the necessary structure and guidance to function throughout life (Schultz, 2014).

References

• Brown, C. (2014). Ecological Models in Occupational Therapy. In Willard and Spackman's Occupational Therapy (12th ed., pp. 494-504). Philadelphia: Lippincott Williams & Wilkins.
• Model of occupational adaptation process. (1992). In Occupational adaptation: Toward a holistic approach to contemporary practice (Part 1).
• American Journal of Occupational Therapy. Retrieved September 20, 2018, from https://ajot.aota.org/article.aspx?articleid=1875314.
• Ranka, J., & Chapparo, C. (1997). Occupational Performance Model (Australia). Retrieved September 1, 2018, from http://www.occupationalperformance.com/definitions/
• Schkade, J. K., & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach to contemporary practice, Part 1. American Journal of Occupational Therapy, 46, 829-837. doi:10.5014/ajot.46.9.829
• Schultz, S. W. (2014). Theory of Occupational Adaptation. In Willard and Spackman's Occupational Therapy (12th ed., pp. 527-540). Philadelphia: Lippincott Williams ; Wilkins.
• Schultz, S. , ; Schkade, J. K. (1992). Occupational adaptation: Toward a holistic approach to contemporary practice, Part 2. American Journal of Occupational Therapy, 46, 917-926. doi:10.5014/ajot.46.10.917

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