Toward a Science of Adaptive ResponsesLorna Jean King, OTR, FAOTA

1978 Eleanor Clarke Slagle Lecture Presented By:

Samantha Beaumont

1978 Major events US President: Jimmy Carter Unemployment rising Value of US dollar is declining 98% American homes have a TV Volkswagen stops production of Beetle Teachers strike First legal gambling casino opens in Atlantic City Commerce Department announces that hurricane names

will no longer be exclusively female Sweden bans aerosol spray because it harms ozone Louise Brown = first baby born from in vitro fertilization

(England)

Movies

Music

Birthdays

Lorna Jean King, OTR, FAOTAMay 17, 1923-Nov 4, 2006

Born in Denver, CO 1944 Bachelor of Science in Occupational Therapy from Milwaukee-Downer College 1945-1947 Intructor at USC 1948-1950 Graduate studies at USC 1949-1950 Staff therapist at Downey School for Girls in CA 1950-1953 Director of OT at Square and Compass Crippled Children’s Clinic in

Tuscon, AZ 1957-1958 Graduate studies at University of Arizona 1964-1966 Staff therapist at AZ State Hospital Until 1974 Director for Rehabilitative Therapies for AZ State Hospital

• Researched/developed sensory-integration techniques 1973 Roster of Fellows of the AOTA 1978-2004 Founded/Directed/CEO of Children’s Center for Neurodevelopmental

Studies in Glendale, AZ• Nonprofit school and therapy center for children with autism and other

developmental delays Published 14 articles Major contributor to sensory integration techniques

OT’s Need for a Comprehensive Theory

Specialties have become own professions due to lack of unifying theory

Health care system won’t be able to support so many fragmented professions• Funding• Educational resources• Political power

Clients want to know how and why treatment works• No longer act as passive patient• Need an underlying structural framework

Difficulties in Constructing a Science of Occupation

Occupational therapy was based on common sense • Purposeful Behavior

• “The more familiar something is to us, the more difficult it is to subject it to scientific inquiry”(254)

Therapists have trouble communicating due to the various levels in which purposeful behavior can be organized• E.g. cognitively, biochemically, culturally…

• Need a systems approach (well-rounded)

Difficulties in Constructing a Science of Occupation

Theory/science of OT should provide:1. A unifying concept that will apply to all areas of

specialization

2. A framework that will clearly distinguish occupational therapy theory and techniques used from those of other disciplines

3. A model that is readily explainable to other professionals and to consumers

4. A theory that is adequate for scientific elaboration and refinement

Adaptation as a Unifying Concept

“Adaptation” and “adaptive” unify OT specialty areas• Found in majority of OT articles

• Familiar terms as is “occupation”

Need to make these implicit terms explicit

Question: How do you define adaptation?

Adaptation as a Unifying Concept

Evolutionary adaptation:• Changes in

structure/function of organism due to natural selection

• Slow process

• Contributes to survival of species

Individual adaptation • Adjustments made by

the individual

• Enhances personal survival

• Contributes to fulfillment of personal potential

Adaptation as a Unifying Concept

Adaptedness: relationship between individual and environmental demands

States of health/disease reflect the individual’s ability to adapt effectively (or not) to environment• This is why adaptation should be used as a

model for occupational therapy

Characteristics of the Adaptive Process

Four distinct features of individual (not evolutionary) adaptation:

1. Adaptation demands that the individual take a positive role

Adaptive response is actively created Client plays an active role in OT treatment

• Can be appropriate or maladaptive (still active)

Question: What are some ways the client canappropriately or maladaptively play an active role in

OT?

Characteristics of the Adaptive Process

2. Adaptation is called forth by the demands of the environment

OTs structure the environment and demands to illicit a particular adaptive response

Adaptive responses need to be carried out in real-life environment• OT does this! = Makes OT unique

• Repetitive exercise doesn’t generalize to real-life

Characteristics of the Adaptive Process

3. Adaptive response is organized most efficiently at the subcortical (unconscious) level

E.g. client with brain damage & cup Therapist needs to structure situation to

illicit subcortical adaptive response from client

Characteristics of the Adaptive Process

3. Subcortical adaptive response (cont.) We have a natural subcortical capacity to learn

• Why its difficult to THINK about how to perform automatic tasks

• Why OTs use purposeful activity & not exercise

• Focus attention on object/outcome

• Organize sensory input and motor output subcortically

Characteristics of the Adaptive Process

3. Subcortical adaptive response (cont.) Double-motivation in OT

• The activity itself (immediate motivation)

• E.g. Catch ball

• Adapting

• Recovering from illness, maintaining health, etc.

• May or may not be known to client

• Primary goal of OT OTs need to explain benefits of purposeful activity over

exercise to define professional role• Differentiate OTs from PTs

Characteristics of the Adaptive Process

4. Adaptive response is self-reinforcing Each success is a motivator to take on

the next (more difficult) challenge

Question: Can you think of an activity that you continuously want to push yourself to the next level?

Summary of Characteristics of the Adaptive Process

Basic characteristics of OT derive from the corresponding elements of adaptation:

1. It is an active response2. It is evoked by the specific environmental demands of

needs, tasks, and goals3. It is most efficiently organized below the level of

consciousness, with conscious attention being directed at objects or tasks

4. It is self-reinforcing, with each successful adaptation serving as a stimulus for tackling the next more complex environmental challenge

(Page 259)

Developmental Learning as an Adaptive Process

Organizing sensory information and creating an appropriate response is a continuous adaptive process • Important for all ages

Effects of sensory deprivation are cumulative

Immobilization = worst kind of sensory deprivation

Developmental Learning as an Adaptive Process

Sensory deprivation may lead to psychotic symptoms• E.g Elderly man undergoing surgery

Psychotic symptoms in terms of adaptation:• Disadaptation: failure of organization and response

• E.g. Confusion and disorientation

• Maladaptation: the sensory data is organized incorrectly, leading to an inappropriate response• E.g. Hallucinations and delusions

Developmental Learning as an Adaptive Process

Another aspect of hospital-induced sensory deprivation is motivational loss (Zubek)• Great implications for rehab and therapy

• Correlated with abnormal brain waves• Motivational loss lasts longer than abnormal brain waves

• Future: provide as much mobility as possible early on to give person sensory input so motivational loss does not form

• Question: As OTs, how can we ensure our clients continue to be motivated during therapy?

Therapeutic Adaptation to Change or Stress

1. Adaptation to physical change OT specialization in physical disabilities

studies the individual’s adaptation to physical change

Question: What are some adaptations that OTs may discuss with their clients with physical disabilities?

Therapeutic Adaptation to Change or Stress

2. Adaptation to stress of hospitalization Stress elicits fight or flight response

• Corticosteroid secretion

• E.g. Strangeness of hospital

Although rest is prescribed, individuals should perform activities to relieve stress

Diversional activities= Stress management

Therapeutic Adaptation to Change or Stress

3. Adaptation to reduce stress reactions in psychiatric conditions

Symptoms = problems in developmental learning, perception and communication• Lead to stress (chemically & emotionally)

• Further inhibits the sensory-integrative processes

Symptoms = disadaptations or maladaptations

Use of sensory-integration therapy leads to improvement in coping behaviors• Reduces stress hormones and increases individual’s sense of

well-being

Conclusion Adaptive process can provide a theoretical framework to OT

because: • It can be applied to all specialty areas as a unifying concept• It will differentiate OT from other professions• It is readily explainable to other professionals and

consumers• It is adequate in depth to allow for scientific elaboration and

refinement

“If this paper spurs others to articulate a more suitable theory [for OT], it will have served its purpose” (265)

Challenges OTs to begin constructing a science of adaptive responses

References

Historical events in 1978. Retrieved from http://www.hisdates.com/years/1978-historical-events.html

Morris, K. The life and work of Lorna Jean King. S. I. Focus Magazine, (Winter 2007). Retrieved from http://www.sifocus.com/files/LJKing_ SIFocus0107.pdf

Padilla, R. (2005). A professional legacy: The Eleanor  Clarke Slagle lectures in occupational therapy  1955- 2004. Bethesda, MD: Amer. Occupational Therapy  Assn. pp 253-266.

Pearson, S. (2004). The year 1978 from the people  history.  Retrieved from http://www.thepeoplehistory.com/1978.html