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