研究目的: 本研究旨在探討中老年中風個案篩選及從事日常職能活動時使用的調適策略，以及主要成年子女照顧者的照顧價值觀與照顧策略對個案調適策略使用的影響。
研究方法: 本研究有目的地從一國科會研究計畫第二年的個案中，選擇符合條件的五位中風個案及他們的主要成年子女照顧者(七位)，以質性訪談及參與觀察收集資料。每一次訪談及觀察皆全程錄音，並於事後轉錄為逐字稿及撰寫田野筆記。並統整第一、二年的訪談與觀察記錄，參考紮根理論所列之原則進行分析及確保研究的品質。
研究結果: 中風個案在日常職能活動中使用的調適策略包括自我限制或停止參與可能造成負面影響或子女負擔的活動、著重從事能夠維持身體功能或身體健康的活動、安排從事自己可勝任的活動、與接受外籍看護協助。主要成年子女照顧者期望個案達到有條件的功能獨立、確保個案從事活動安全無虞、維持個案身體功能或改善身體健康、與維持個案與外籍看護相處和諧等想法影響了個案使用的調適策略。
討論: 本研究以刪選、最佳化與代償模式(Selection, optimization, and compensation model, SOC model)與交易論(transactionalism)兩個理論架構檢視研究結果。「自我限制或停止參與可能造成負面影響或子女負擔的活動」，「著重從事能夠維持身體功能或身體健康的活動」為刪選策略的運用；「安排從事自己可勝任的活動」為最佳化策略的運用，而「接受或安排外籍看護協助」則是個案代償策略的運用。職能科學領域近年應用交易論探究職能活動。本研究結果支持職能活動發生在脈絡中，並非一個個人的經驗，而是個人與脈絡之互動經驗。中風個案藉由篩選與安排日常活動達到調適，亦支持職能活動扮演交易(transaction)的媒介，具有轉變個體的功能。
結論與臨床建議: 本研究呈現中風個案使用的職能調適策略，與主要成年子女照顧者價值觀與照顧觀念等對調適策略的影響。研究結果支持在成人生理職能治療領域採以家庭為中心的介入模式，以及結合SOC模式於以職能為中心的臨床實務。

Purpose: The purpose of this study is to examine how middle and older stroke survivors adapt through occupational choices. The influences of primary adult child’s caregiving values and expectations on the process of decision making about the use of occupational strategies are also investigated.
Methods: This study purposively recruited 5 stroke survivors and 7 primary adult child caregivers from second-year participants of a NSC project. Semi-structured interviews and participant observations were conducted for data collection. All interviews were audio recorded and transcribed verbatim. Field notes were completed after each observation and interview. The analysis was supplemented with the transcripts and the field notes from the previous year of NSC project. Grounded theory approach was adopted as a framework to analyze the data.
Results: The adaptive strategies those 5 stroke survivors used in their daily occupations are “limit or cease participation in activities that may contribute to negative outcomes or impose burdens on primary adult child caregiver,” “emphasize activities that maintain or improve physical health and function,” “maximize participation in the activities or tasks with which they are competent,” “ask for the assistance of foreign domestic helpers,” and “maintain regular daily routines.” Adult child caregivers’ expectations influenced the strategy the older adults chose. They expected that stroke survivors to have conditional independence. They also emphasized safety concerns, maintenance or improvement of physical function and health, and a harmonious relationship between stroke survivors and foreign domestic helpers.
Discussion: The research findings can be further examined with the perspectives of selection, optimization and compensation model (SOC model) and transactionalism. “Limit or cease participation in activities that may contribute to negative outcomes or post burdens on primary adult child caregiver,” and “emphasize activities that can maintain or improve physical health and function” are the use of selection strategy; “maximize participation in activities or tasks they are competent with” is the use of optimization strategy; and “ask for the assistance of foreign domestic helpers” is the use of compensation strategy. Transactionalism is an emerging theoretical perspective to understand occupations in occupational science. The results support that occupations are contextualized, and embedded with interactions between individuals and contexts. In addition, occupations also act as the transaction medium. The selection and organization of occupations contribute to stroke survivors’ adaptation.
Conclusion: This research explores the changes in the occupational participation of stroke survivors from the perspective of adaptation. The primary adult child’s caregiving values and strategies are also investigated. The research findings advocate for involving family members in adult rehabilitation in Taiwan, and integrating concepts of selection, optimization, and compensation model in occupation-based clinical practice.

內政部統計處（民99）。中華民國98年老人狀況調查報告。取自：
http://sowf.moi.gov.tw/stat/Survey/老人/98年老人調查分析.pdf
衛生署國民健康局（民96）。第六次中老年身心社會生活狀況健康長期追蹤調
查。取自：https://olap.bhp.doh.gov.tw/search/ListHealth1.aspx?menu=1&mode=5&year=96
行政院勞工委員會（民101）。家庭外籍看護工政策及申請資格之Q&A。取自：
http://www.cla.gov.tw/cgi-bin/Message/MM_msg_control?mode=viewnews&ts=4f951cdd:2cca
陳向明(民91)。社會科學質的研究。台北市：五南。
徐儀明(民93)。談孝道的意義與儒家思想。孔學與人生，27，52-56。
朱瑞玲與章英華(民90)。華人社會的家庭倫理與家人互動:文化及社會的變遷效果。取自：http://blog.huayuworld.org/gallery/9886/華人社會的家庭倫理與家人互動.pdf
張玲慧、王劼、施陳美津與毛慧芬(民99)。獨立與依賴意涵的重新檢視。台灣職能治療研究與實務雜誌，6，111-120。
Strauss, A. C. & Corbin, J. M. (1998).質性研究概論 (徐宗國譯)。台北市：巨流。
原著出版年：1990年。
蔡幸嶧(民96)。臺灣外籍家庭看護工之現象與省思兼檢視長期照顧政策。取自：臺灣博碩士論文知識加值系統。 
Ahlström, S., & Bernspång, B. (2003). Occupational performance of persons who have suffered a stroke: A follow-up study. Scandinavian Journal of Occupational Therapy,
10, 88-94.
Almeida, D. M. (2005). Resilience and vulnerability to daily stressors assessed via diary methods. Current Directions in Psychological Science, 14, 64-68.
ATLAS.ti Scientific Software Development GmbH (1993-2010). ATLAS.ti. (5.71) [computer software]. Berlin, Germany: ATLAS.ti scientific software development GmbH.
Bäckström, B., & Sundin, K. (2009). The experience of being a middle-aged close relative of a person who has suffered a stroke, 1 year after discharge from a rehabilitation clinic: A qualitative study. International Journal of Nursing Studies, 46, 1475-1484.
Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). Cambridge, UK: Cambridge University Press.
Baltes, M. M., & Carstensen, L. L. (1996). The process of successful ageing. Ageing and Society, 16, 397-422.
Baltes, P. B. (1997). On the incomplete architecture of human ontogeny: Selection, optimization, and compensation as foundation of developmental theory. American Psychologist, 52, 366-380.
Becker, G. (1993). Continuity after a stroke: Implications of life-course disruption in old age. The Gerontologist, 33, 148-158.
Berg, B. L. (1998). Qualitative research methods for the social sciences. (3rd ed.). Needham, MA: Viacom.
Bernard, H. R. (2011). Research methods in anthropology. (5th ed.). Lanham, MD: AltaMira Press.
Biegel, D. E., Sales, E., & Schulz, R. (1991). Family caregiving in chronic illness. Newbury Park, CA: SAGE.
Bjorklund, B. R. & Bee, H. L. (2008). The journey of adulthood. (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Boynton, S., Linda, I., & Chang, B. (1994). Effective coping with stroke disability in a community setting: The development of a causal model. Journal of Neuroscience
Nursing, 26, 193-203.
Burton, C. R. (2000). Living with stroke: A phenomenological study. Journal of Advanced Nursing, 32, 301-309.
Christiansen, C. (1996). Three perspectives on balance in occupation. In R. Zemke & F. Clark (Eds.), Occupational science: The evolving discipline (pp. 417-435). Philadelphia, PA: F. A. Davis.
Christiansen, C. H., & Townsend, E. A. (2004). Introduction to occupation: The art and science of living. Upper Saddle River, NJ: Prentice Hall.
Coombs, U. E. (2007). Spousal caregiving for stroke survivors. Journal of Neuroscience Nursing, 39, 112-119.
Csikszentmihalyi, M. (1993). Activity and happiness: Toward a science of occupation. Journal of Occupational Science, 1, 38-42.
Curtin, M., & Fossey, E. (2007). Appraising the trustworthiness of qualitative studies: Guidelines for occupational therapists. Australian Occupational Therapy Journal, 54, 88-94.
Denzin, N. (1970). The research act in sociology. London: Butterworth.
Denzin, N. (1989). Intepretive biography. Thousand Oaks, CA: SAGE.
Dickie, V. (2009). What is occupation? In E. B. Crepeau, E. Cohn, & B. A. Boyt. (Eds.), Willard & Spackman’s occupational therapy (11th ed., pp. 15-21). Baltimore, MD:
Lippincott Williams & Wilkins.
Dickie, V., Cutchin, M. P., & Humphry, R. (2006). Occupation as transactional experience: A critique of individualism in occupational science. Journal of Occupational Science, 13, 83-93.
Donnellan, C., Hevey, D., Hickey, A., & O’Neill, D. (2006). Defining and quantifying coping strategies after stroke: A review. Journal of Neurology, Neurosurgery & Psychiatry, 77,
1208-1218.
Dowswell, G., Lawler, J., Dowswell, T., Young, J., Forster, A., & Hearn, J. (2000). Investigating recovery from stroke: A qualitative study. Journal of Clinical Nursing, 9,
507-515.
Draper, P., & Brocklehurst, H. (2007). The impact of stroke on the well-being of the patient's spouse: An exploratory study. Journal of Clinical Nursing, 16, 264-271.
Duke, J., Leventhal, H., Brownlee, S. & Leventhal, E. A. (2002). Giving up and replacing activities in response to illness. Journal of Gerontology: Psychological Science, 57B, 367-376.
Ellis-Hill, C. S., Payne, S., & Ward, C. (2000). Self-body split: Issues of identity in physical recovery following a stroke. Disability and Rehabilitation, 22, 725-733.
Eriksson, G. & Tham, K. (2010). The meaning of occupational gaps in everyday life in the first year after stroke. OTJR: Occupation, Participation, and Health, 30, 184-192.
Falter, L. B., Gignac, M. A. M., & Cott, C. (2003). Adaptation to disability in chronic obstructive pulmonary disease: Neglected relationships to older adults' perceptions of independence. Disability and Rehabilitation 25, 795-806.
Folkman, S. & Moskowitz, J.T. (2004). Coping: Pitfalls and promise. Annual Review of Psychology, 55, 745-774.
Forster, A. (2005). Caregiver burden in stroke. Current Medical Literature: Stroke Review, 9, 127-131.
Frank, G. (1996). The concept of adaptation as a foundation for occupational science research. In R. Zemke & F. Clark (Eds.), Occupational science: The evolving discipline (pp. 47-55), Philadelphia, PA: F. A. Davis.
Freund, A. M., & Baltes, P. B. (1998). Selection, optimization, and compensation as strategies of life management: Correlations with subjective indicators of successful aging. Psychology and Aging, 13, 531-543.
Geertz, C. (1973). The interpretation of cultures: Selected essays. New York, NY: Basic Books.
Gignac, M. A. M., Cott, C., & Badley, E. M. (2000). Adaption to chronic illness and disability and its relationship to perceptions of independence and dependence. Journal of Gerontology: Psychological Sciences, 55B, 362-372
Green, T. L., & King, K. M. (2009). Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: A descriptive qualitative study. International Journal of Nursing Studies, 46, 1194-1200.
Greenwood, N., & Mackenzie, A. (2010). Informal caring for stroke survivors: Meta-ethnographic review of qualitative literature. Maturitas, 66, 268-276.
Hammersley, M., & Atkinson, P. (2007). Ethnography: Principles in practice. New York, NY: Taylor & Francis.
Han, B., & Haley, W. E. (1999). Family caregiving for patients with stroke : Review and analysis. Stroke, 30, 1478-1485.
Hocking, C. (2009). Contribution of occupation to health and well-being. In E. B. Crepeau, E. Cohn, & B. A. Boyt (Eds.), Willard & Spackman's occupational therapy (11th ed., pp. 45-54). Baltimore, MD: Lippincott Williams & Wilkins.
Holstein, J. A., & Gubrium, J. F. (1995). The active interview. Thousand Oaks, CA: SAGE.
Hooyman, N. R., & Kiyak, H. A. (2010). Social gerontology: A multidisciplinary perspective. Boston, MA: Pearson.
Jongbloed, L. (1994). Adaptation to a stroke: The experience of one couple. American Journal of Occupational Therapy, 48, 1006-1013.
Kvale, S. (1996). Interviews: An introduction to qualitative research interviewing. Thousand Oaks, CA: SAGE.
Lampinen, J., & Tham, K. (2003). Interaction with the physical environment in everyday occupation after stroke: A phenomenological study of visuospatial agnosia.
Scandinavian Journal of Occupational Therapy, 10, 147-156.
Larson, E., Wood, W., & Clark, F. (2003). Occupational science: Building the science and practice of occupation through an academic discipline. In E. B. Crepeau, E. S. Cohn & B. A. Boyt (Eds.), Willard & Spackman's occupational therapy (11th ed., pp. 15-26). Philadelphia, PA: Lippincott Williams & Wilkins.
Lawlor, M. C. & Mattingly, C. (2009). Understanding family perspectives on illness and disability experiences. In E. B. Crepeau, E. S. Cohn & B. A. Boyt (Eds.), Willard &
Spackman's occupational therapy (11th ed., pp. 33-43). Baltimore, MD: Lippincott Williams & Wilkins.
Lindmark, B., & Hamrin, E. (1995). A five-year follow-up of stroke survivors: Motor function and activities of daily living. Clinical Rehabilitation, 9, 1-9.
Low, J. T. S., Payne, S., & Roderick, P. (1999). The impact of stroke on informal carers: A literature review. Social Science & Medicine, 49, 711-725.
Matson, N. (1994). Coping, caring and stress: A study of stroke carers and carers of older confused people. British Journal of Clinical Psychology, 33, 333-344.
Mayo, N. E., Wood-Dauphinee, S., Cote, R., Durcan, L., & Carlton, J. (2002). Activity, participation, and quality of life 6 months poststroke. Archives of Physical Medicine and
Rehabilitation, 83, 1035-1042.
McCann, T. V., Clark, E. (2003). Grounded theory in nursing research: Part 1—methodology. Nurse Research, 11, 7-18.
McCurdy, D. W., Spradley, J. P., & Shandy, D. J. (2005). The cultural experience: Ethnography in complex society (2nd ed.). Long Grove, IL: Waveland.
Morgan, D., & Jongbloed, L. (1990). Factors influencing leisure activities following a stroke:
An exploratory study. Canadian Journal of Occupational Therapy, 57, 223-229.
Murray, C. D., & Harrison, B. (2004). The meaning and experience of being a stroke survivor: An interpretative phenomenological analysis. Disability and Rehabilitation, 26, 808-816.
O’Connell, B., Hanna, B., Penney, W., Pearce, J., Owen, M., & Warelow, P. (2001). Recovery after stroke: A qualitative perspective. Journal of Quality in Clinical Practice, 21, 120-125.
Persson, D., Eklund, M., & Isacsson, A. (1999). The experience of everyday occupation and its relation to sense of coherence: A methodological study. Journal of Occupational Science, 6, 13-26.
Pilkington, B. (1999). A qualitative study of life after stroke. Journal of Neuroscience Nursing, 31, 336-347.
Pound, P., Gompertz, P., & Ebrahim, S. (1998). A patient-centered study of the consequences of stroke. Clinical Rehabilitation, 12, 338-347.
Rittman, M., Faircloth, C., Boylstein, C., Gubrium, J. F., Williams, C., Van Puymbroeck, M., & Ellis, C. (2004). The experience of time in the transition from hospital to home
following stroke. Journal of Rehabilitation Research & Development, 41, 259-268.
Rochette, A., Tribble, D. St-T., Desrosiers, J., Bravo, G., & Bourget, A. (2008). Adaptation and coping following a first stroke: A qualitative analysis of a phenomenological
orientation. International Journal of Rehabilitation Research, 29, 247-249.
Sales, E. (1991). Family caregiving in chronic illness. Thousand Oaks, CA: SAGE.
Salter, K., Hellings, C., Foley, N., & Teasell, R. (2008). The experience of living with stroke: A qualitative meta-synthesis. Journal of Rehabilitation Medicine, 40, 595-602.
Sayer, A. (2010). Method in social science: A realist approach (2 ed.). London: Routledge.
Secrest, J. A., Thomas, S. P. (1999). Continuity and discontinuity: The quality of life following stroke. Rehabilitation Nursing, 24, 240-246.
Seidman, I. (2006). Interviewing as qualitative research: A guide for researchers in education and the social sciences. New York, NY: Teachers College Press.
Skaff, M. M., & Pearlin, L. I. (1992). Caregiving: Role engulfment and the loss of self. The Gerontologist, 32, 656-664.
Stanley, M. (1995). An investigation into the relationship between engagement in valued occupations and life satisfaction for elderly south australians. Journal of Occupational Science, 3, 100-114.
Stone, S. D. (2005). Being as doing: Occupational perspectives of women survivors of hemorrhagic. Journal of Occupational Science, 12, 17-25.
Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: SAGE
Thompson, H. S., & Ryan, A. (2009). The impact of stroke consequences on spousal relationship from the perspective of person with stroke. Journal of clinical nursing,
18, 1803-1811.
Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40, 922-935.
Townsend, E. (1997). Occupation: Potential for personal and social transformation. Journal of Occupational Science, 4, 18-26.
Van Nes, F., Runge, U., & Jonsson, H. (2009). One body, three hands and two minds: A case study of the intertwined occupations of an older couple after a stroke. Journal of
Occupational Science, 16, 194-202.
Wallenbert I, Jonsson H. (2005). Waiting to get better: A dilemma regarding habits in daily occupations after stroke. American Journal of Occupational Therapy, 59, 218-24
White, J. H., MacKenzie, L., Magin, P., & Pollack, M. R. P. (2008). The occupational experience of stroke survivors in a community setting. OTJR: Occupation, Participation and Health, 28, 160-167.
Wilcock, A. (1993). A theory of the human need for occupation. Journal of Occupational Science, 1, 17-24.
Wilcock, A. (1995). The occupational brain: A theory of human nature. Journal of Occupational Science, 2, 68-73.
Wilcock, A. A. (1998). An occupational perspective of health. Thorofare, NJ: Slack.