RESEARCH ARTICLE
Exploring the Nature of the Intention, Meaning and
Perception Process of the Neuro-occupation Model to
Understand Adaptation to Change
Seyed Alireza Derakhshanrad1‡, Emily Piven2, Seyed Ali Hosseini1,3,
Farahnaz Mohammadi Shahboulaghi4, Homer Nazeran5 & Mehdi Rassafiani4*†
1
Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2
Health Matters First of Florida, Inc., Oakland, FL, USA
3
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4
Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
5
Department of Electrical and Computer Engineering, University of Texas, El Paso, TX, USA
Abstract
The theoretical model of neuro-occupation, intention, meaning and perception, sought to describe the symbiotic
relationship between occupation and the brain, as a chaotic, self-organized, complex system. Lack of evidence
has limited its applicability to practice. The aim of this study was to track the postulates of the model within the
daily experiences of subjects. Structured matrices were created for content analysis, using a qualitative multiplecase-study design, typically used for testing models. An underpinning principle of the model, defined a circular causality feedback process, which was confirmed as described through tracing the repetitive processes within the lived
experience of two Iranian men. The process suggested that continual adaptation occurred in lives interrupted by
cerebrovascular accident, which enabled the subjects to return to expression of meaning through purposeful occupation and continually re-shaped their perceptions. The primary limitation of this study was that it was the earliest
attempt to test the model and to substantiate the process by comparing the similarities and differences between too
few subjects. Future research should identify the same process in more subjects and validate a practical assessment
tool for clients. These findings may inform practitioners about intentional use of occupational challenges to elicit
adaptive behaviours in clients. Copyright © 2015 John Wiley & Sons, Ltd.
Received 29 December 2014; Revised 6 July 2015; Accepted 9 July 2015
Keywords
occupational therapy; neuroscience; non-linear dynamics
Introduction
The human condition is completely individualized and
unpredictable. Change does not follow a linear path
(Royeen, 2003). “Chaotic occupational therapy” (Royeen,
2003, p. 610), incorporating concepts of chaos theory, was
proposed to encourage occupational therapists to
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Derakhshanrad et al.
think differently. Likewise, Creek et al. (2005) argued
that occupational therapy could be understood by
principles of non-linearity and complexity theory.
Agreeing with Royeen, they valued occupational therapy as a complex intervention and noted that occupational therapy as a profession was the result of
integration of several different factors with dynamic
and unpredictable outcomes.
It could be argued that most occupational therapists
may have been more comfortable following familiar
linear thinking patterns and models (Haltiwanger
et al., 2007). Lazzarini (2005) stated that linear thinking
promoted the illusion that occupational therapists’ actions directly produced the behavioural changes that
have been seen in their clients. The fact is that clients
actively chose to respond, which may create an illusion
that the occupational therapists attribute to their treatment (Ikiugu, 2004).
In order to help occupational therapists apply the
non-linearity principles in our profession, Lohman and
Royeen (2002) introduced the theoretical concept of
neuro-occupation as “a holistic approach that assumes
a model of complexity” (p. 528), which was based on
principles of chaos theory and the symbiotic relationship
between the brain and engagement in occupation.
The IMP model of neuro-occupation
Lazzarini (2004) further conceptualized the nature of
brain function by extension of the neuro-occupation
model that described the repetitive process of intention, meaning and perception (IMP) for adaptation of
occupational performance. The brain was described as
self-organized, emergent, unpredictable and under
continuous reconstruction and revision. Cognition
was conceived as a process with dynamic relationships
between the three levels of IMP that operated in a circular feedback loop. Neurodynamics of the IMP process, which was called circular causality, potentially
yielded knowledge for brain development through
learning (Lazzarini, 2004). The definitions of IMP
levels can be found in Table I.
Circular causality process
A circular causality process was described as a phenomenon controlled by the complex interrelationships
among three levels of IMP within the brain (Lazzarini,
2005). The circular causality process began by
30
Table I. Definitions of levels based on Lazzarini’s IMP model of
neuro-occupation
Levels
Intention
Meaning
Perception
Definitions
A state of readiness in the brain that enabled an
individual to select and define goal-directed action(s)
in order to fulfil need and desire
Timeless actions that were historically accumulated
formed meanings that were maintained within oneself
through an individual’s life-long history of goal
development and goal-directed actions and choices
Attitudes and beliefs were shaped, which changed
perception and awareness of the person about his or
her own conditions
IMP = intention, meaning and perception.
hypothesis formulation at the intention level. Then, at
the meaning level, the hypothesis was tested by trial
and error actions in the environment. Eventually, at
the perception level, information was created as a result
of trial and error testing that modified or formed new
perceptions (Lazzarini, 2005). This viewpoint explained how humans regulated behaviour and adapted
successfully to challenging environmental conditions
and executed complex occupational performance by
creating meaning through engagement in occupations.
Perturbance has been considered as any condition or
opportunity that is introduced to the human system
that causes circular causality to happen as a response
(Lazzarini, 2004). A person may respond to an internal
(i.e. neurological event) or external perturbance (i.e. a
significant person or situation that is deemed important). Thus, without an individual’s response or reaction, it can be said there was no perturbance. The
effect of the perturbance established a new initial condition and moved the person from a steady state of homeostasis to the edge of chaos. Dynamical change and
adaptation of a complex system were found to occur
at the edge of chaos (Stacey, 2011). The edge of chaos
has been described as the area where creativity occurs
and constraints facilitate formation of new options for
action and choice that are based on circumstances at
that point in time (Lazzarini, 2005). In fact,
perturbance is necessary in order for the process of circular causality to take place in clients. Yet, the recognition of perturbance that occurred can be attributed to
several factors, such as past experience, genetics, environmental context, arousal state, attention and the intentional state that determines how fast an individual
responds by going through the IMP process of circular
causality (Lazzarini, 2004).
Derakhshanrad et al.
Literature review
Some papers explaining the theoretical concepts of
neuro-occupation described the interdependent relationship between the brain, the nervous system and
the intentionality to restore or seek meaningful occupational performance (Walloch, 1998; Howell, 1999;
Way, 2000; Gutman and Biel, 2001; Lohman and
Royeen, 2002) but did not provide research evidence
for clinical practice. Walloch (1998) explained the potential benefits of neuro-occupation as an integral part
in designing a treatment programme based on meaningful occupations. Howell (1999) theoretically sought
to report the positive effect of meaningful occupation
of self-care tasks on the sensory organization of the reticular activating system in patients receiving intensive
care. Similarly, Way (2000) used neuro-occupation as
a foundational framework to discuss the relationship
of play as a meaningful occupation of children and
their autonomic nervous system. Gutman and Biel
(2001), in their theoretical paper, explored the role of
meaningful occupation, as it mediated states of depression and well-being within the framework of neurooccupation. In order to clear up the link between hand
therapy and occupation-based practice, Lohman and
Royeen (2002) conceptually explored the theoretical
concept of neuro-occupation by connecting the clinical
phenomenon of post-traumatic stress disorder with
traumatic hand injuries.
Haltiwanger et al. (2007) presented a retrospective
case analysis to evaluate the behavioural changes made
by a male subject with alcoholism and depression. By
comparing linear thinking commonly used by occupational therapists with non-linear thinking of IMP
model, they effectively illustrated how the interactions
between client intentional state, his meaning and his
perceptual state to shape new adaptive patterns of behaviour could help occupational therapists look differently at their roles at shaping behaviour in clients. The
paper showed that non-linear thinking was technically
superior to linear thinking because the clients were
given all of the credit for their own behavioural responses, whereas the occupational therapist was cited
for creativity and skill in finding the right perturbance.
Statement of the problem
The literature review revealed a lack of applied research
regarding the IMP model of neuro-occupation, which
was insufficient to establish acceptance of the model the
field. Further, since the introduction in the
literature, occupational therapists have not produced
practical tools for assessment and re-assessment of clients for use by busy occupational therapists in clinical
practice. Therefore, testing the model was necessary,
in order to provide research and simpler explanations
of IMP process to advance the model.
Research question and aim
The research question was as follows: Can the IMP
model of neuro-occupation be applied to trace the process in clients who have demonstrated resilience
behaviour?
The aim of this research was to retrospectively track
the IMP process of circular causality in the lived experience of resilient Iranian subjects with postcerebrovascular accident (CVA), so as to test the model
and substantiate the process of circular causality of the
IMP framework.
Method
Qualitative research design
The qualitative content analysis method in case study
research was the design of choice in this inquiry when
testing the IMP model of neuro-occupation, as these
two cases were the first part of a much larger
multiple-case analysis (Kohlbacher, 2005). Qualitative
case study design has been advocated in occupational
therapy clinical research as a methodology that could
provide evidence for theoretical models to be validated
and further expanded (Fisher and Ziviani, 2004). By
using a deductive rather than inductive approach to
thematic analysis of this case study (Walshe et al.,
2004), construction of a structured matrix based on
the definitions of IMP levels of the circular causality
process enabled schematic representation for data analysis and provided an audit trial that promoted rigour
and integrity of the research (Rosenberg and Yates,
2007). Further, this matrix analysis provided a focused
analytical tool for tracking the IMP process, established
credibility and trustworthiness of findings through
representing the raw data entered into matrix cells
and simplified the analysis and interpretation of qualitative data (Marsh, 1990). Through provision of a
structured opportunity to identify relationships between levels of IMP in the phenomenon of circular
causality, the matrices provided practical help to find
similarities and differences between the participants’
experiences (Averill, 2002). The use of multiple cases
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Derakhshanrad et al.
in this qualitative case study research provided trustworthy data for transferability (external validity) and
dependability (reliability) that was “… considered robust and worthy of continued investigation or interpretation” (Yin, 2003, p. 47).
Procedures
The original study for dissertation research was approved by the Research and Ethics Committee of the
University of Social Welfare and Rehabilitation Sciences in Tehran, Iran. In order to investigate how multiple subjects experienced the circular causality process,
the subjects were asked about their feelings and reactions after experiencing the stroke and the significant
events, people or situations they recalled that influenced them, years after the initial perturbance of
CVA. Subjects were interviewed with approved semistructured questions. Repetitive interviews, lasting
about 2 hours and 50 minutes for the first participant
and 3.5 hours for the second participant, were accomplished for saturation of data. The interviews were
audiotaped and transcribed verbatim. These two subjects were selected for the paper as they shared commonalities in the process, yet there was latency
between the actions of subjects over time by
comparison.
Subjects
Iranian subjects were defined as Persians, at least
18 years old, male or female, who demonstrated resilience behaviour, previously experienced 1 year or more
of living with a CVA and had cognitive abilities to participate interactively in long interviews. The rationale
for selecting resilient subjects for the study was as
follows:
characteristics of resilience would be suitable cases to
study the phenomenon of circular causality. It was not
important to determine whether a person had preexisting resilience or developed post-CVA resilience because the purpose of the research was to trace the IMP
process in individuals who were recovering from a
CVA. Subjects with resilient traits were sought because
of the assumption that resilient individuals have the
propensity to overcome obstacles encountered during
the process of adaptation to change.
Screening instrument
The Connor–Davidson Resilience Scale (CD-RISC)
was selected to screen potential subjects for resilience
qualities. The total score for this scale ranged from 0
to 100, and higher scores would be a sign of greater resilience (Connor and Davidson, 2003). The first author
calculated that the average mean score of the scale was
65, obtained from three Iranian validation studies for
use with the Iranian population. Dr Jonathan Davidson
recommended that 65 be accepted arbitrarily as the sufficient score of resilience for acceptance in this study
(personal conversation, 14 May 2013). Connor and
Davidson (2003, p. 77) summarized 17 most notable
characteristics of resilient people, some of which were
as follows:
“View change or stress as a challenge/
opportunity”, “Commitment”, “Recognition of
limits to control”, “Personal or collective goals”,
“Strengthening effect of stress”, “Realistic sense
of control/having choices”, “Action-oriented
approach”, “Tolerance of negative affect”,
“Adaptability to change”, and “Optimism”.
Recruitment
• Resilience, the dynamical process of adaptation
(Luthar and Cicchetti, 2000) and the ability to rebound and reform oneself following stress and to
cope with the aftermath of an event, has provided
practitioners with insight about people who were
successful living with chronic disabilities for intervention development (Kralik et al., 2006).
• Resilience was deemed successful adjustment by people with disability that followed a CVA (Sarre et al.,
2013).
Having found purpose and meaning despite adversity
(Fine, 1991), subjects who demonstrated measurable
32
A convenience sample of 18 community-dwelling potential subjects was recruited from a rehabilitation facility in Shiraz, Iran. All 18 potential subjects were called
and informed about the research. After identifying
those who were able to speak and willing to participate
in the study, the first author arranged a meeting to qualify them for interview. At the end of this recruitment
process that took place between July 2014 and September 2014, only 2 out of 18 met the criteria for the study.
The reasons for attrition were low scores on the CDRISC scale or poor communication skills because of
aphasia or comprehension issues. Then, informed
Derakhshanrad et al.
consent was signed and an interview followed. The two
subjects were interviewed at their home. These cases
might be considered case scenarios rather than full case
reports as the analysis was targeted and focused.
Interpretative process
A structured matrix was designed to categorize behaviour according to the characteristics of the three IMP
levels by consensus of four occupational therapists.
The contents from each participant’s transcribed interviews that met the definitions of IMP levels identified
in Table I were extracted and entered in the matrix cells
as quotations in order to substantiate the three levels of
the circular causality process. Perturbances were
tracked in each row in sequence, as they were recognized and reported (Tables II and III). The matrix
was then graphed as a strategy to be used in search of
the relationships between levels of IMP to describe
the phenomenon of circular causality. The researchers
summarized the results of matrix analysis for each individual that captured how each subject responded to the
change of the initial conditions and tracked successive
perturbances as they were described over time.
Findings
Two subjects were identified as resilient because they
scored greater than 65 points on the CD-RISC. Subjects
acknowledged that they had a joyful, meaningful life
with their families that was suddenly disrupted after
the stroke. Both Persian subjects were male with residual disabilities in the upper and lower extremities, secondary to left hemiplegia. They were independent in
their instrumental activities of daily living and basic activities of daily living with no evidence of cognitive impairment. Both were at Brunnstrom’s Stage V for arm
and hand (Trombly, 2008).
Pseudonyms were assigned to protect confidentiality: Ali, a 65-year-old, who was 8 years post-CVA and
scored 86 on the CD-RISC, and Hamid, a 48-yearold, who was 4 years post-CVA and scored 89 on the
CD-RISC.
Case illustrations
Ali’s recall of his process of adaptation
At the edge of chaos in the immediate hours at the
hospital following the internal perturbance of the
CVA, Ali felt fearful, confused and disorganized about
his new condition. At the meaning level, it occurred
to him that “There are many people who don’t have
feet or hands, but they feel alive, then why [can I] not
I feel like them?” Then, at this level, Ali strived to restore meaning and health, which fuelled his motivation
to recover. He established one goal to address his new
Table II. Matrix display for three subsequent perturbances identified by Ali
Process of circular causality
Perturbance
Intention
Physical therapist’s “My physiotherapist helped
recommendation
me by offering good exercise.”
Son-in-law’s
encouragement
to drive
Daughter’s advice
Meaning
“I was practicing the stationary exercise
bike two hours a day for a year … I
couldn’t even hold my foot on the pedal
during the first weeks [after CVA, so] I
had it fastened against the pedal.”
“I hardly pushed the clutch then I felt
that I could do this … I realized that I
could be able to drive.”
“When I sat in my car for the
first time after the stroke, I tried
to drive a short distance. Although
everybody disagreed over the
driving, my son-in-law encouraged
me in my choice.”
“After that I tried not to use the wheelchair
“After the stroke I used to sit in a
wheelchair while I was at the airport. at the airport [and] recently I moved
around the airport by myself. It is joyful.”
This is because it was difficult for
me to walk in a crowded places.
One day my daughter asked me
not to use the wheelchair anymore
because I was able to walk.”
Perception
“I think that the fundamental cause
of my foot recovery was practicing
the bike for a year. It helped me
very much.”
“It was a hundred percent helpful
[because] it caused me not to feel
helpless.”
“Sometimes you may not comprehend
something [but] the recommendation
from someone provides the spark that
could activate your mind and causes a
change [in your thinking].”
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Derakhshanrad et al.
Table III. Matrix display for three subsequent perturbances identified by Hamid
Process of circular causality
Perturbance
Occupational therapist’s
encouragement
Wife’s encouragement to
perform activities of daily
living without help
Encouragement from
boss to return to work
Intention
Meaning
Perception
“He encouraged me so much.
For example; when I extended
my hand, he clapped in delight.”
“While my wife helped me to
do my occupations, she also
told me repeatedly that I could
do my occupations by myself.”
“I was very happy doing any exercise
that he wanted me to do … [he]
inspired hope and confidence in me.”
“Her words of encouraging eventually
instilled confidence into me and one
day I took a shower by myself without
her help. The day when I took a shower
it looked like I climbed a mountain!”
“When I encountered my workers and
did my job duties … I tried to do my
job as perfect as before.”
“He caused me to preserve myself.”
“The CEO told my family to
bring me back to work.”
“She also caused me to preserve
myself.”
“Return to workplace helped me to
revive my spirit … I found out that
I wasn’t dead and I was alive. My
confidence began to grow [and] I
came to this conclusion that I can.”
situation (Intention) and to try to restore his capabilities again (Meaning). Consequently, at the end of this
first cycle of circular causality, Ali experienced a new
perceptual state (perception), described as, “my attitude of gratitude” identifying positive patterns of expectancy and hope for recovery.
The second circular causality process began at the
intention level with a new perturbance by a nurse when
Ali refused to obtain assistance with walking in his hospital room. Subsequently, Ali made the hypothesis that
he could be able to regain his ability to walk by himself.
Independent walking was the most meaningful for him
during the first hours after stroke and he was able to establish behavioural goals to achieve that. At the Meaning level, Ali tested his hypothesis on the second day of
hospitalization when he stood alone and walked leaning against the wall for a short distance. It was through
hypothesis testing that Ali created meaning, and he
perceived himself differently,
Hamid’s experience of adaption was considerably
slower. Hamid revealed that after the CVA
perturbance, he perceived that life had lost all meaning
and he would never find meaning again in life. This
perception initiated a steady state of sadness, inertia
and depression that lasted 5 months. Despite all of the
efforts of a physiotherapist, he did not develop goals
for recovery and found no motivation to change. Finally, he reacted to perturbance that was initiated by a
significant family member:
The day after the admission to hospital I got out
of the bed by myself. Then, I walked 4 steps
leaning against the wall and moved towards the
toilet in the room and washed my hands and face.
I dragged my left foot on the ground but I moved
towards the toilet. That was so important to me
[because] I found out that I could walk and do
my occupations, [then], I felt that this disease
could not overwhelm me and I am invincible.
One day my brother-in-law suggested [to] me to
drive his car. I told him that I can’t because I was
not able to catch the steering wheel and push the
clutch, but he insisted on me driving the car [by
himself]. At that moment, I tried to drive the
car. Although I drove a short distance, I found
out that I can drive. When I realized that I can
drive, it made me better. That was the first fillip
[stimulus] that caused me to feel that I can.
Ali went through a process of continual adaptation
over and over as other perturbances occurred. Such
perturbances included the following: the introduction
Driving was the perturbance that ushered Hamid to the
edge of chaos. In this situation, the intention that initiated his performance was formulating the hypothesis
34
of the physical therapist and occupational therapist that
offered him assistance to change, tangible results and
hope towards his goal, his son-in-law’s encouragement
to drive and his daughter’s recommendation that Ali
stop using a wheelchair at the airport. See Ali’s matrix
in Table II.
Hamid’s recall of his process of adaptation
Derakhshanrad et al.
about the possibility of being able to drive again. Although fearful, Hamid tested his hypothesis to see if
he could drive by himself. Finally, his perception
changed when he imagined his ability to drive again.
With the lifting of his steady state at the edge of chaos,
Hamid began to demonstrate resilient behaviour.
Just as Ali experienced, Hamid went through a process of continual adaptation with subsequent
perturbances. These perturbances included an occupational therapist that wisely enhanced Hamid’s selfconfidence with each resulting ability that he regained,
his encouraging wife that instilled confidence into him
and the experience of returning to work. See Hamid’s
matrix in Table III.
Discussion
As independently self-regulating systems, humans have
the capability to control their intentions and meanings
(Crabtree, 2000), whereby they actively create perceptual patterns (Freeman, 2005). From this perspective,
it is worth considering that both subjects chose different attitudes and behaviours reacting to the internal
perturbance of an unforeseen CVA (Price et al.,
2012). Thus, this is to say that a subject’s individualized
perception of his or her condition has contributed to
varied reactions to a CVA and dissimilar occupational
performance between people (Ikiugu, 2004). From
the perspective of the IMP model of neuro-occupation,
it was the process of developing new perceptions that
seemed to propel these subjects into two distinctively
different pathways of subsequent occupational performance, which reflected the uniqueness of selforganizing behaviour of each occupational human being (Lazzarini, 2004; Haltiwanger et al., 2007). Further,
both participants experienced their own repertoire of
intention, meaning and perception responses in reaction to the internal perturbance of a CVA, which led
them to perform uniquely personal occupational performance. Ali self-organized quickly and demonstrated
motivation and adaptive responses quickly in a matter
of days, whereas Hamid still demonstrated maladaptive
responses 4 months post-CVA.
Ali demonstrated early resilient behaviour, which
may have been a historical personality characteristic
that enabled him to look at this situation positively,
problem-solve new ways to satisfy the need for meaning from occupational performance and form goals
for recovery and restoration of the self. In comparison,
Hamid remained in a steady state of depression that
ended with his response to a new perturbance. Hamid
attached importance and meaning to the act of driving,
so that re-experiencing previously meaningful activity
with a family member served to re-establish his hope,
inspiration and motivation. Driving might have been
posed by an occupational therapist as a perturbance,
but was not. Instead, the perturbance was delivered,
perhaps most effectively, by Hamid’s brother-in-law.
Each subject determined what was personally significant to him and subsequently found new meaning, evidenced by each individual’s goal formation responses
that ultimately re-shaped perception. This was the reason why Hamid’s resilient behaviour emerged after he
re-experienced driving, and until the perturbance occurred, he did not progress.
Each of the perturbances reported by both subjects
activated the circular causality process that was identified by Lazzarini’s IMP process. This conclusion was
drawn from the structured matrices addressing and
tracking the concepts of the IMP model of neurooccupation. As shown by the data in two matrices
(Tables II and III), the process of developing new
self-perceptions was traced with the onset of new
perturbances that heightened awareness and facilitated
development of new meanings and new levels of perception that resulted in adaptation and motivation to
perform as occupational beings. For example, as can
be seen from the data in Table III, the occupational
therapist’s encouragement became instrumental as a
perturbance that boosted Hamid’s self-esteem. There
was no further inquiry about the quality of the protocol
for the therapist’s treatment, as this was not the intent
of the study. Additionally, there were no research findings in the neuro-occupation literature to further enrich this discussion. In a qualitative single case study
about “continuity of identity” of a male status postCVA, Price et al. (2012, p. 111) suggested that by improving self-esteem, resilience behaviours may be fostered in clients by occupational therapists. Suffice to
say that the role of the occupational therapist has been
reported to be limited to skilled planning of a
perturbance (Haltiwanger et al., 2007).
Clearly, the process of circular causality repeatedly
occurred for both subjects. At some point, both subjects reached their maximum level of gain associated
with new Intention, Meaning and Perceptual levels,
while still having some residual level of spasticity impairment. Complete recovery was not possible, but
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Derakhshanrad et al.
each subject adapted and seemed to reach a level of
restored occupational performance that they were
comfortable with. Crabtree (1998) explained the importance of this phenomenon as a natural aspect of
human performance. He suggested that this process
of making and expressing meaning would present an
ideal situation for a person that is not tied to a particular ability. As a comparative example, a person who
is born without limbs or a person with mental retardation might create meaning using the same process
as would a well-known scientist. It is argued that the
end of occupational therapy would be to assist people
with deficits in performance to create and find meaning through “occupation as intentional, organized human performance” (Crabtree, 1998, p. 205).
Implications for occupational
therapy
In this age of evidence-based practice, occupational
therapists are limited in their prediction of client
outcomes, due to the uniqueness of clients and the
nature of non-linearity (Creek et al., 2005). A
neuro-occupational perspective suggests that the occupational therapist’s role is to create meaningful
perturbances as a facilitator of change, and it is the
client that must do all of the work that is required
to adapt, as a self-organizing human system
(Haltiwanger et al., 2007).
The findings of this research have two-fold implications for consideration when designing therapeutic
interventions. First, the concept that a person responds to an internal or external perturbance may
be an important underpinning of the IMP model of
neuro-occupation. Second, the facilitation of the
IMP process of circular causality may foster resilience
in clients in his or her drive for restoration of occupational performance. The occupational therapist uses
his or her personal creativity and accumulated historical knowledge of the client, in order to pose an effective perturbance that challenges, motivates, directs
personal goal formation and may unpredictably affect
change in the client’s perception. Clients may respond
slowly or quickly to perturbance or not at all, implying that the client did not consider the effort a
perturbance. When a practitioner poses an intervention based on awareness of what had been meaningful
at one time to the client, it may be taken by the client
as a perturbance that restores hope and motivation.
36
The accumulated assessment of the client and observation of his or her response leads to choosing the
“right” perturbance that potentially targets the important change at the perception level. These principles
of the human system may be applicable to all humans
with or without disability.
Limitation
Preliminary findings were developed from two cases
using a targeted matrix qualitative method, which was
focused on the definitions of the IMP model. Research
should continue to enable make this model practical
for everyday use in occupational therapy. Practical
tools have not yet been developed, but are essential to
improve the practicality of use of the model in clinical
settings.
Future research
This study will be continued to validate and support
the model with more cases, in order to extend credibility and trustworthiness of the patterns that emerge
across a larger number of subjects and to lead to development of a clinical tool. Research by others should
identify the IMP process in clients and further contribute to the development of valid tools.
Conclusion
This study was the first attempt to apply the model in
more practical use by substantiating the IMP process
described in the literature about the neuro-occupation
model proposed by Lohman and Royeen (2002) and
Lazzarini (2004) that described the process by which
occupational performance occurred in complex occupational human beings. It examined the dynamism of
circular causality process in the experience of two resilient individuals and evaluated the effect of perturbance
on humans as complex adaptive human systems, thus
adding credence to the model.
Conflict of interest
None declared.
Acknowledgements
The findings of this paper present some of the preliminary research findings in partial completion of a PhD
for the first author that will contribute to validating
and extending conceptually the IMP model of neuro-
Derakhshanrad et al.
occupation. The authors would like to thank all the
subjects who participated in this study.
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