Recommended reading Schultz, 2009. Theory of Occupational Adaptation. In Crepeau, E.B, Cohn, E.S. & Schell. B.A. 2009. Willard's & Spackman's Occupational Therapy. 11th Edition. Philadelphia: Lippincott Williams & Wilkins.

Introduction

Occupational adaptation was first developed as a frame of reference in 1992 by Schkade and Schultz. The frame of reference further developed into a theory aimed at describing the link between the two fundamental constructs of occupational therapy, namely; occupation and adaptation. The distinction between the theory of occupational adaptation and other occupation focused frameworks is that occupational adaptation intervention focuses on improving adaptiveness, whereas others focus on improving functional skills. Some of the theory's concepts are similar to those of other models such as spatiotemporal adaptation, model of adaptation through occupation, Model of Human Occupation and the model of occupation.

The theory of occupational adaptation is based on the following assumptions about occupational performance and human adaptation:

• 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 and ability to adapt result in success in occupational performance.

The occupational adaptation process

The process describes the interaction between three elements of occupational adaptation; the person, the environment and their interaction. Each element is fluid and dynamic. Change in one element influences other elements. The primary goal of the occupational adaptation process is to achieve mastery over the environment. This process is dynamic, self-organising, complex and its elements are highly interactive, although the diagrammatic representation of the theory is in a linear format.

Occupational adaptation theory postulates that personal adaptation is a human phenomenon that is constantly in a process characterized by disorder, order and reorganization. The desire, demand and press for mastery are constantly present within an occupational environment.

Diagrammatic Representation of Occupational Adaptation

The elements of occupational adaptation

Person

The person is represented on the left side of the diagram and focuses on the internal factors of the person. The occupational adaptation process in this element begins with a constant factor of desire for mastery. The person is made up of systems that are unique to the individual and these are: sensorimotor, cognitive and psychosocial systems. All occupations involve all the person systems and the contribution of each system shifts depending on the circumstances surrounding the specific occupation.

Occupational Environment

This is represented on the right side of the diagram and it focuses on the external factors of the occupational adaptation process that affect the person. The process in the occupational environment begins with a constant demand for mastery. Any circumstance in the occupational environment presents a demand for mastery.

The occupational environment is the dynamic and experiential context within which the person engages in occupations and occupational roles. The three types of occupational environment are self-care, leisure/play and work and each of these is affected by the person's experiential context. This context comprises of the physical, social and cultural influences. The physical influences relate to the actual physical setting in which occupations take place. The social influence refers to the participants in the occupational environment and the cultural influences could be the norms, rituals, practices, traditions and habits that are present in the occupational environment.

Interaction

Presented as the middle section of the diagram, interaction focuses on the interplay between the external and the internal factors that continuously interact through occupation. The constant factor is press for mastery which yields the occupational challenge. This press for mastery is created by demand and desire for mastery. Expectations of occupational roles and occupational environment intersect in response to the presented occupational challenge then a demand for adaptation occurs. In response to this demand, the person creates an internal adaptive response to the situation and then an occupational response is produced. An occupational response is an observable outcome of the adaptive response, which refers to an action and behaviour carried out in response to an occupational challenge.

Adaptive Response

An adaptive response is made up of three subprocesses that are internal to the person. The three subprocesses are; the generation subprocess, the evaluation subprocess and the integration subprocess and these explain the adaptive response activated by the person in response to an occupational challenge. Through the subprocesses, the person plans the adaptive response, evaluates the outcome and integrates the evaluation as adaptation.

Generation Subprocess

This is the anticipatory part of human adaptation that has two stages; the adaptive response mechanism stage and the adaptation gestalt stage. The adaptive response mechanism comprises of the adaptation energy, adaptive response behaviours as well as the adaptive response modes that activate the generation subprocess.

• Adaptation energy is used at either the primary or the secondary level of cognitive awareness. The primary level of cognitive awareness is engage when a person is focused on and trying to generate an adaptive response. Whereas, when a person is not focusing all energies on trying to generate a response, but happens to generate a response, energy on the secondary level of cognitive awareness was being utilized.
• Adaptive response modes constitute the person's strategies and patterns of generating an adaptive response that were developed through life experiences. When presented with an occupational challenge, the person selects a response based on experience and acts accordingly. At times the outcome is unsuccessful and the person would modify the response mode and probably be successful. A new response mode is created when a person is presented with a challenge that different from previous experiences. Dysfunction occurs when the challenge exceeds the person's adaptive capacity.
• Adaptive response behaviours are classified into hyperstable behaviours, hypermobile behaviours or transitional behaviours. Hyperstable behaviours are often less successful as the person persistently attempts the same solution for an occupational challenge. When a person engages in hypermobile behaviours, there is a rapid move from one solution to the other with little success. Engaging in transitional behaviours enables the person to blend both hyperstable and hypermobile behaviours to arrive at a solution. This provides a greater opportunity for a successful outcome.

Adaptation Gestalt

This is the second stage of generating an adaptive response in which the person prepares his/her sensorimotor, cognitive and psychosocial systems to carry out the plan of action. The organization of the systems creates an adaptation gestalt.

An internal adaptive response to an occupational challenge results from engaging both the adaptive response mechanism and the adaptation gestalt. The person's internal adaptive response can be assessed through observation and analysis of how the person approaches tasks, engages in problem-solving and the end result.

Evaluation Subprocess

This subprocess is activated when the individual engages in as personal assessment of the quality of occupational response generated. The assessment is done by evaluating own experience of mastery, regarded as relative mastery because it is a personal assessment. Relative mastery uses, efficiency, effectiveness, satisfaction to self and others as measures. There is little need for further adaptation if the person finds the occupational response assessment positive. However, if the overall assessment result is negative, the integration subprocess communicates the information to the person, to begin the process of adaptation.

Function - Dysfunction continuum

• The inability to generate an appropriate adaptive response as a result of personal factors or environmental factors could lead to dysfunction.
• Imbalance between the desire and demand for mastery could lead to inability to adapt to an occupational challenge, therefore dysfunction.
• Dysfunction also occurs when challenges exceed the person's capacity to adapt.
• The more adaptive the individual, the more functional.

Implications for Practice

• Main goal- client's ability to adapt is used to maximise 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 the agent of own change

References

Schultz, 2009. Theory of Occupational Adaptation. In Crepeau, E.B, Cohn, E.S. & Schell. B.A. 2009. Willard's & Spackman's Occupational Therapy. 11th Edition. Philadelphia: Lippincott Williams & Wilkins

[Online] Theory of Occupational Adaptation - Overview by Dr Sally Schultz

Schkade, J. & Schultz, S. 1992. Occupational Adaptation: Toward a Holistic Approach for Contemporary Practice, Part 1. American Journal Of Occupational Therapy. 46 (9) p29 -p37