Adults with disabilities living independently face a cascade of interconnected challenges that traditional clinic-based rehabilitation often fails to address comprehensively. The real-world environment where daily tasks actually unfold—navigating a cluttered kitchen, managing medication schedules, or coordinating household responsibilities—becomes the critical frontier for meaningful functional improvement.
A specialized 10-week home-visit program targeting 13 community-dwelling adults with disabilities demonstrated measurable improvements in executive function and instrumental activities of daily living. The intervention employed the Person-Environment-Occupation-Performance framework, with occupational therapy students conducting eight sessions directly in participants' homes under professional supervision. Participants showed significant gains on the Executive Function Performance Test and Canadian Occupational Performance Measure, with benefits persisting at three-month follow-up in 11 individuals.
This finding challenges the assumption that cognitive rehabilitation requires controlled clinical settings to be effective. The PEOP model recognizes that functional performance emerges from the dynamic interaction between individual capabilities, environmental demands, and meaningful occupations—a complexity that sterile therapy rooms cannot replicate. Home-based interventions allow therapists to identify and modify actual environmental barriers while training skills in the precise contexts where they will be used.
The study's small sample size and single-group design limit generalizability, making randomized controlled trials essential. However, the sustained three-month benefits suggest that context-specific training may produce more durable improvements than traditional approaches. For aging adults seeking to maintain independence, this methodology could represent a paradigm shift toward rehabilitation that prioritizes real-world functionality over standardized assessments.