Department of Occupational Therapy, Bangladesh Health Professions Institute

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2. ADAPTATION
Shamima Akter
B. Sc (Honours) in Occupational Therapy
& M. Sc in Rehabilitation Science
Assistant Professor,
Department of Occupational Therapy
Bangladesh Health Professions Institute (BHPI)
Centre for the Rehabilitation of the Paralysed (CRP)
Chapain, Savar

3. Activity adaptation is the process of modifying an
activity of daily living, craft, game, sports, or other
occupation to enable performance, prevent
cumulative trauma injury, or accomplish a
therapeutic goal (Radomoski and Latham 2014).
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4.  Modify the activity to make it therapeutic when
ordinary it would not be so.
For example: Tic-tac-toe can be adapted
similarly by drawing the grid on the wall and
using Os and Xs drawn on sticky note
(Radomoski and Latham 2014)..
 To modify the exercise offered by the activity
along therapeutic continuum to accomplish
goals.
For example: checkboards and pieces can
be changed in size so that one can continue
favorite game while continuing to benefit
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5.  To enable a person with physical impairments
to do an activity or task he or she would be
unable to do otherwise.
For example: learn one handed dressing
techniques after having stroke (Radomoski
and Latham 2014).
 Adapting activities, especially work activities
that are engaged in for long period of time, is to
prevent cumulative trauma injury.
For example: Changing table height to reduce
strain on back or upper extremity (RadomoskiTS1_Shamima_2018

6. According to Radomoski and Latham 2014, A
good adaptation:
 Accomplishes the specific goal
 Does not encourage or require odd
movements or postures
 Is not dangerous to the patient
 Intrinsically demands a certain response on
which the patient does not have to
concentrate
 Does not demand the patient (some
contrived adaptations may seem ridiculous
to the patient and thus are embarrassing
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7.  Analyze activity demands, including performance and
contextual requirements
 Identify the problem: what performance and/or
contextual requirements prevent the person from
accomplishing the task?
 Know principles of compensation for the given limitation
 Creatively apply principles of compensation to solve the
problem
 Select appropriate adapted methods and assistive
devices, and specify environmental adaptations to
implement the solution
 Check out all modifications to verify that they solve the
problemTS1_Shamima_2018

8. Grading Adaptation
It is the way in which the
physical, cognitive and
psychological characteristics of
an activity can be gradually
modified or progressed
Adaptation is a way in which the
physical, cognitive, psychological
and environmental features are
changed to complete an activity.
‘Gradability’ is the way that the
physical, cognitive or
psychosocial aspects of the
activities to meet the therapeutic
requirements.
'Adaptability' refers to changes
that are made to the features of
the environment, activity, or tools
that are used in order to
complete activities.
Therapist can make any tasks
harder or easier by changing the
amount of cues, time or weight of
items.
Therapists may modify or adapt
environments or tools to help the
therapeutic process. These
adaptations must beTS1_Shamima_2018

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10. Activity Demand Adaptations Therapeutic Purpose
Body function Position the task relative to
the person
Increase ROM target specific
muscles, motions Enable
performance
Body function Arrange object relative to
each other
Improve perceptual skills
Require specific movements
Decrease energy expenditure
Enable performance
Body function Change lever arms Increase strength
Reduce required strength
Prevent injuries
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11. Activity Demand Adaptations Therapeutic Purpose
Required actions Change level of difficulty Increase cognition
Increase perception
Increase motor planning
Required actions Change material or texture
of materials
Increase strength
Increase coordination
Challenge sensory system
Required actions Change method of doing
activity
Enable performance
increase strength
Increase ROM
Increase coordination and
dexterity
Increase cognitive
perceptual skills
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12. Activity Demand Adaptations Therapeutic Purpose
Sequencing and timing Modify steps Enable performance
Increase attention and
concentration
Increase memory
Sequencing and timing Modify time Enable performance
Increase attention and
concentration
Increase muscular
endurance
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13. Activity
Demand
Adaptations Therapeutic Purpose
Object
properties
Change handles of tools and
utensils
Reduce stress on painful joints
Enable performance
Object
properties
Change the size and shape of
objects
Improve dexterity
Enable performance
Increase strength
Increase ROM
Object
properties
Change color content between
objects
Improve figure-ground discrimination
Enable performance
Object
properties
Modify or use supplemental
tools or utensils
Enable performance
Prevent deformity
Prevent cumulative trauma disorders
Object
properties
Add weights Increase strength
Reduce incoordinated movements
Provide passive ROM
Object
properties
Add springs or rubber bands Increase strength
Reduce incoordinated movements
Provide passive ROM
Assist weak musclesTS1_Shamima_2018

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15. The following adaptation principles to compensate limitations are
stated in Radomoski and Latham 2014:
WEAKNESS
 Use lightweight objects, utensils, and tools
 Let gravity assist
 Provide external support, e.g. sit if trunk or lower
extrimities are weak, use a mobile arm support for
proximal upper extremity weakness, or splint a weak
wrist
 Use assistive devices or methods to stabilize objects
and replace lost functions such as grasp
 Use power tools and utensils
 Use biomechanical principles of levers (e.g., lengthen
the force arm in relation to the resistance arm) and
friction (e.g., increase friction to decrease power
required for pinch or grasp)
 Use two hands or tasks ordinarily done one-handed
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16. Continue…
LOW ENDURANCE AND/OR FATIGUE
 Use energy conservation methods
 Pace work to prevent fatigue
 Use principles listed for weakness that reduce
workload, such as lightweight utensils and power
equipment
 Match activity demands to ability
 Avoid stressful positions and environmental stressors
 Coordinate optimal breathing patterns with movement
during activities to maximize oxygen exchange
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17. Continue…
LIMITED RANGE OF MOTION
 Use long-handled tools and utensils to increase reach
and/or eliminate the need for bending over
 Build up handles to compensate for limited finger
flexion range of motion
 Store frequently used things closer to reduce reach
 Use joint protection techniques
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18. Continue…
IN COORDINATION
 Stabilize the object being worked on, including use of
assistive devices that reduce slipperiness
 Stabilize proximal body parts to reduce degree of
freedom, improving control of distal body parts
 Use heavy utensils, cooking equipment, tools, and so
on
 Use adaptations that reduce or eliminate the need for
fine motor skill (e.g. replace buttons with Velcro)
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19. Continue
LOSS OF THE USE OF ONE SIDE
 Provide assistive devices that substitute for the
stabilizing or holding function of the involved upper
extremity
 Teach one-handed methods for activities ordinarily
done two-handed
 Provide assistive devices that change bilateral tasks
into unilateral tasks
 Improve dexterity of the uninvolved upper extremity if
use of the dominant arm is impaired
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20. Continue…
LIMITED VISIONS
 Blindness
 Organize living space and stress the importance of the
putting everything in its place after use (e.g., in the
pantry cabinets, on refrigerator shelves, and in the
medicine cabinet)
 Use Braille labels or optical scanners to distinguish
canned goods, medications, clothing colors, etc
 Use assistive devices that operate through voice
commands
 Use assistive devices that provide auditory, tactile, or
kinesthetic feedback to compensate for low vision and
blindness
 Eliminate environmental clutter
 Expect tasks to require extra time
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21. Continue…
Low vision
 Provide high color contrast (e.g. white mug for coffee,
colored towels in a white bathroom)
 Increase the light on a task by bringing the light closer,
increasing wattage, or changing the background to
increase contrast
 Use techniques and devices that magnify type or
images
 Reduce visual clutter
 Use organized scanning techniques (e.g., left to right or
top to bottom) when functioning in a stationary
environment
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22. Continue…
DECREASED OR ABSENT SENSATION
 Protect the anesthetic part from abrasions, bruises,
cuts, burns, and decubiti
 Develop habit of using areas with intact cutaneous
sensation to test temperature, e.g., test bath water
temperature with the forearm if finger sensation is
impaired
 Substitute vision for poor awareness of limb position
and limb movement or to detect texture
 Develop habits of directing attention to the affected
part
 Incorporate visual skin inspection into daily ADL
routine
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23. Continue…
POOR MEMORY/ OR EXECUTIVE SKILLS
 Use assistive devices that substitute for memory or
poor organizational skills (e.g. pill minders, day books,
sticky notes, or watches/phones/tablets with
programmable alarms or reminder apps)
 Teach strategies such as writing memos to self,
making to-do and other lists, and placing objects to
gether at the point needed ahead of time
 Develop habits regarding time use and how activities
are to be accomplished
 Teach self-awareness strategies to improve carryover
of adpted methods or devices
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24. Continue…
LOW BACK PAIN & POST BACK SURGERY
 Teach body mechanics for moving and lifting (e.g.,
hold objects close to the body and squat to lower the
body rather than bending over
 Use long-handled or bent-handled equipment or sit to
substitute for bending over
 Change position frequently
 When standing, put one foot up on a step to rotate the
pelvis
 Rest before fatigue results in awkward, careless
movements
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41. REFERENCE
 Trombly CA 1996, Occupational Therapy for
Physical Dysfunction, 5th ed, Mosby Company,
Philadelphia
 Radomski and Trombly-Latham 2008,
Occupational Therapy for Physical Dysfunction
(6th Ed). Philadelphia: Lippincott, Williams and
Wilkins.
 Radomski and Trombly-Latham 2014,
Occupational Therapy for Physical Dysfunction
(7th Ed). Philadelphia: Lippincott, Williams and
Wilkins.
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42. ??? QUESTION ???
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