Myocardial Infarction And Autism English Literature Essay

The Model of Human Occupation (MOHO) focuses on the interaction between a person, task and his external environment, with the achievement of positive adaptation (Kielhofner, Forsyth, Kramer, Melton, & Dobson, 2009). It explains how occupation is motivated, planned, and performed through engagement in life occupations. Within MOHO, humans are perceived as being made up of three interrelated concepts: volition, habituation, and performance capacity. This helps to explain how occupations are chosen, planned, and performed (Kielhofner et al., 2009). The Theory of Occupational Adaptation (OA) explains the interaction between a person, and how he is able to adapt within his occupational environment (Schultz, 2009).

The objective of this paper is to use MOHO to analyze the occupations of two individuals with disabilities, and the impact on their occupational identity, competence, and adaptation. The theory of OA will be used to explain, compare, and contrast the relationship between personal and contextual factors, and the effect on human performance.

Case Study One: "Boot"

In order to protect the privacy of my community partner, the pseudonym "Boot" will be used to refer to him. Boot is a 50 year old African American male who was diagnosed three years ago with a heart attack. He partakes in several occupations but at a slow pace due to his easy rate of fatigability. He enjoys shopping, cooking, cleaning, maintaining his yard, going to church, being a husband, and most importantly being a grandfather. Boot has a granddaughter whom he is extremely fond of, and they both go to the mall for shopping on weekends. All information used in this analysis was provided by Boot.


Volition refers to the motivation for occupation, a need and desire for an activity or action which is shaped by previous experience (Kielhofner et al., 2009). It emphasizes personal causation, values, and interest. Boot is from a small town in Mississippi where members of his family lived close to one another. During his teenage years, he helped babysit some of his cousins, nephews and nieces with whom he loved playing basketball with. His love for kids made him look forward to having his own children someday. Being a grandparent is an occupation that is immensely fulfilling to him which he has positively adapted to. He has a granddaughter whom he is extremely fond of, and he drops her off and picks her from school daily. Growing up wearing the same suit to church was extremely exciting and fanciful to him, which explains his love for shopping for clothes and groceries. He grew up watching how close his parents were and how his dad used to help his mother with almost everything in the house. His mother kept the house clean, and no one was allowed to wear shoes in the house. Watching his parents perform these activities has been of personal interest, and value to him. It has also been a source of the drive for performing activities such as cleaning the house, maintaining his yard, and cooking.


Habituation is the process, by which occupation is organized into roles, and patterns or routines that are automatic (Kielhofner et al., 2009). In order to develop a habit, actions have to be repeated in a pattern that is consistent with the environment. Boot's daily routine of dropping off and picking up his granddaughter from school has become a pattern that he enjoys doing. His role as a grandparent influences his interaction with his neighbor's kids because they also call him grandpa. He watches them while playing in front of their house or when riding their bikes on the street. He gives them treats sometimes, especially in the summer. This is because he has developed a sense of obligation that goes with the identity of being a grandparent. He also employed the services of a lawn company that mows and trims his grass bi-weekly since he is unable to do it himself. He has cultivated a habit of maintaining his yard by trimming his flowers, and watering his lawn frequently. He cultivated the habit of taking food items out of the refrigerator every day at sunset in preparation for dinner with his wife. His role as a family man and a devoted husband has become more of a habit than a task.

Performance Capacity

Performance capacity is how an individual's physical and mental abilities affect his/ her occupational performance. MOHO stresses the importance of physical and mental capacity for performance and that the experience of being impaired may limit a person's performance (Kielhofner et al., 2009).

Boot is highly functional when it comes to cognitive and physical abilities. His health condition did not affect him mentally or physically. Occupational adaptation theory defines personal adaptation as a human phenomenon that is characterized by disorder, order and reorganization (Schultz, 2009). After his myocardial infarction, he has adapted to his health condition by eating the right food, exercising daily, and having a positive attitude. His psychosocial support increases his level of survival. The family, as an essential team of re-establishment, influences his attitude and mental stability. This support helps him adapt easily and maintains his sentimental balance (Tziallas & Tziallas, 2010).

He socializes freely with people at church and he sometimes attends his granddaughter's school functions with her. Despite his disability, he can drive within a short distance and has learned to maintain his yard at a pace that would reduce the load on his cardiovascular system.

Boot performs most of the activities of daily living (ADLs) independently, although he gets fatigued easily. He now has an occupational therapist that is helping him with the optimization of his performance capacity.


MOHO also emphasizes that an individual's occupation results from the interaction of his or her volition, habituation, and performance capacity (Kielhofner et al., 2009). It is important to understand the environment in which an occupation takes place. The environment is made up of the physical, social, cultural, economic, and political aspects that influence how occupations are being motivated, organized and performed. Boot's occupation as a grandparent involves driving, and taking care of his granddaughter in his home before her mother returns from work. The physical environment is relatively conducive for him because his neighborhood is relatively quiet, and his street is not too busy. Boot gets support and companionship from his wife whenever she returns from work. She sits with him in the garage where he reads newspapers while he watches his granddaughter ride her bike or play in the front yard. She would ask him what he had for lunch and how his day had been. His wife also makes sure he takes his medicines at the right time and makes sure he eats right, checks his blood pressure and follows the doctor's advice. His daughter usually stops by his house daily to make sure he is doing well and will sometimes bring groceries for him. Boot is thankful for his family's support and his identity as a family man is built around taking care of his house, children, and grandchild. He loves spending time with his family, and this provides him with the context of meaningful life and good health. Through his life experience and from babysitting his nephew and nieces, he attends to the needs of his wife, children and granddaughter and has learned to adapt to the challenges that come with post myocardial infarction.

Feedback. Boot is experiencing both positive and negative feedbacks. The support he receives from his friends and family and the ability to adapt to new dietary changes gives him hope. He once said, "I am lucky I got a second chance in life and I hope to start working sometime soon" (Boot, personal communication, Jan.-Mar. 2013). The financial constraint of not being able to work and earn an income has been a major challenge in his life because activities like shopping and vacation that were considered necessary are now luxury to him.

Dynamics. Boot can no longer work as a post office manager. He gets tired easily, so he needs to take things slow. He was such a strong man who enjoyed playing basketball, travelling with his wife and kids, and he also enjoyed fishing. Since he is not working presently and does not earn any income, Boot has learned to adapt to his financial situation by going to the mall to exercise and window shop. He also contracted the mowing of his lawn, but he trims and cuts his flowers himself. He has adapted to eating with no salt and has stopped eating fried or canned foods.

Case Study Two: Temple Grandin

This case study is based on the biography of Temple Grandin. How The Girl Who Loved Cows Embraced Autism And Changed The World. Temple Grandin is a 63 year old female, born in New England (Montgomery, 2012). At the age of 2, she was diagnosed with autism. Her father said she was mentally challenged and should be taken to a mental institution, but her mother did not give up. She sought the best care and teaching for Temple. Her treatments included intensive speech therapy, which helped in reinforcing her communicative abilities. Temple began to speak at the age of 4. Her occupations include animal welfare audit, meat plant inspection, scientist, and designing.


According to Montgomery, "Temple was exceptionally creative in kindergarten that she made kites that would fly behind her tricycle, parachutes out of scarves, and also made costumes with her friends" (2012 p.32). She had a mouse as a pet and knew all the neighborhood animals. Temple also loved carpentry. When Temple was a teenager, she visited her aunt's farmhouse where she cared for horses, made some repairs, and built a gate that a driver could open without having to get down from the car. She loved watching how peaceful the big cattle were when receiving hands on treatment like vaccines. Temple was fascinated by the cattle chute. She got in the chute to experiment its effect on cattle and humans. "She said she felt relaxed like the way a small child feels when wrapped in the arms of his/ her mother or father, certain that everything would be alright, and thirty minutes later, she felt calm and happy, and her anxieties disappeared". (Montgomery, 2012, p.64). This inspired her to build a squeeze machine to help her calm her nerves and relax. These unique skills and interest served as an incentive to learn, grow, and be inspired to perform complicated projects like designing facilities for slaughter houses.


As a child, Temple had a structured daily routine. She played with her sister, designed costumes with her friends, and she had several animal playmates (Montgomery, 2012). In middle school, Temple could not tell anyone what she was thinking, and that was a source of frustration for her. The only way she communicated was by throwing temper tantrums. She attended a more structured high school that was more attentive to children with special needs; where she designed and built a ski tow with her friends. She also enjoyed riding horses and working in the horse barn, which she was proud of. Caring for animals became a habit that was more valuable to her than her academic work, and her love for animals led to her adoption of a barn dog and cat.

Performance Capacity

As an autistic child, Temple experienced several challenges especially in her social interactions and speech (Montgomery, 2012). Most people did not understand what she said, what she was feeling, how she acted and what she thought. According to Montgomery, - "some wondered even if she was thinking" (2012, p.2). In addition, Prothmann, Ettricht, & Prothmann affirmed that "studies show that autism affects the ability to establish social interactions. However, people with autism establish close social relationships with nonverbal communicating and intentionally acting animals" (2009, p.161).

Temple lacked emotional cues and was withdrawn (Montgomery, 2012). She is highly functioning autistic, meaning that she does not need constant assistance and can perform most of the ADLs. Her cognitive skills are more functional than the average person diagnosed with autism, which is the main reason for her academic achievements.


As a child, Temple's father thought she was retarded (Montgomery, 2012, p.2) and was not supportive of her. Her mother loved her regardless and believed she was not mentally ill. The only support she had was from her mother. In elementary school, Temple had the support of her classmates who believed she was one of them and would support her when anyone teased her on the playground. She had difficulties in middle school where the student population was more than that of her elementary school. She was also sensitive to the sound of the school bell, light, noise, students banging lockers, and the echoes in the hallways. The school cafeteria was a place she dreaded so she would eat fast and flee to the gym in order to avoid people teasing her. In high school, Temple got the support of friends and her science teacher, Mr. Carlock who used her fixation to motivate her. He helped her jump start her career with the experimentation of the squeeze machine (Montgomery, 2012).

Through the conduction of the experiments and her life experiences with animals, she knew she wanted to be a scientist - to invent and create. (Montgomery, 2012). She adapted to the challenges that come with autism with the desire for mastery. In the theory of occupational adaptation (OA), the quest for mastery is a constant factor that is always present in a person's life (Schultz, 2009). Using her sensorimotor, cognitive, and psychosocial skills, Temple studied hard to improve her grades, went to college and earned a degree.

Feedback. As a child, Temple received a lot of negative feedback from her father who labeled her "retarded"(Montgomery, 2012, p.2) to her mates in middle school who called her names such as weirdo or dummy. "She did not like these words, and it made her punch or slap her tormentor" (Montgomery, 2012, p.40). Temple has always received positive feedback from her mother who believed in her ability to learn like non autistic children. In high school, she received positive feedback from her friends and science teacher who believed she was creative and of intense interest.

Dynamics. After building the squeeze machine, Temple showed that being autistic can also mean being smart (Montgomery, 2012). She conducted her first scientific experiment by testing the machine on her friends and writing their reactions down. She saw this as an opportunity to gain independence and after graduating from her undergraduate studies, she pursued her masters in animal science. She wanted to study the behavior of cattle in different types of cattle chutes. Temple's talent in drawing helped her in developing her visual and observation skills in designing cattle facilities and contributing to the welfare of animals. Her sensitivity to the environment enhanced her visualization ability, which gave her an insight into the minds of cattle and domestic animals (Montgomery, 2012).

Differences and Similarities between Boot and Temple

It is evident from the analysis of Boot and Temple that they do not have a lot in common in terms of their disability. Boot's myocardial infarction occurred three years ago while Temple has lived with a developmental disability (autism) for over 60 years (Montgomery, 2012).

Temple was not emotionally attached to anyone (Montgomery, 2012). She did not interact with people, and her speech was not clear. She could not explain what she was feeling to anyone and was teased and called names by school mates and even her biological father. Boot is a caring family man who loves his wife, children, and grandchild dearly. He likes to socialize by visiting friends. He goes to church twice a week and goes to the mall every weekend with his wife to window shop and to walk in the mall as a form of exercise. Boot has always had the support of his immediate and extended family while Temple's only psychosocial support is her mother. She has never been interested in having a husband or children. She used her drawing ability as an abstract to read the minds of animals and was able to imagine what they were feeling. She once said, "If you figure out what emotion is driving a behavior,- from a little hen to a gerbil to a horse- you can know how to give the animal a better life. (Montgomery, 2012, p.15). Unlike Temple, Boot does not know anything about abstract thinking, and he has never owned a pet.

The main similarity between Boot and Temple is that they are both physically and mentally functional. Temple has always loved riding horses while she was a child and was able to drive from one slaughter house to another. She was also highly innovative and creative. Boot still drives around, and he is mentally stable. He loves to fix things around the house and maintain a beautiful garden and lawn. They have both adapted to their occupational roles despite their disability. Both Temple and Boot are able to perform most ADLs.

Using the theory of occupational adaptation, Boot and Temple have both been able to achieve mastery of the environment (Schultz, 2009). Boot adapted to his disability by taking his granddaughter to school and back every day of the week. He also makes sure he maintains his yard and helps his wife with grocery shopping and laundry. Temple's desire for mastery is to prove that she is innovative and not crazy. She thinks in the abstract and feels what animals feel. This personal factor prompted her to study animal science, and she is now an advocate for livestock handling.