Environmental modifications make changes to the environment—not the client or the occupation—in order to improve client performance of the occupation in question. We often think of this in terms of adaptive equipment, and while the use of adaptive equipment is indeed one means of modifying the environment, it is not the only means, and when we limit ourselves to adaptive equipment when considering the environmental context, we subsequently limit our impact as occupational therapists.

But how do we modify the environment? It starts with taking a step back to evaluate the situation and identify the barriers to function. Once we have identified these barriers, we can consider the impact that the environment has, or could have, on these barriers.

Allow me to demonstrate with an example. I was recently attempting to cut my toddler son’s hair. Like most toddlers, even distraction with a toy with wasn’t sufficient to overcome the inherent wiggles, and the haircut was looking perhaps even worse than the long hair I was attempting to rectify. So I opted to stop before causing further damage and to reattempt the next day. I considered the situation and the barriers—his inability to hold still—as well as my desired outcome—a decent haircut. Armed with this information, I considered the environment and how I might modify the environment in order to achieve the desired outcome without waiting for him to change and outgrow the wiggles. And my solution was this: on the second attempt, I used a video on my phone—a much more novel stimulus that required no movement on his part—to capture and maintain his attention throughout the process. Then I modified placement of the phone to direct his gaze either forward or down as needed to properly cut his hair. These environmental modifications, though simple, allowed me to achieve the outcome I desired without having to make changes to either the child or the task.

As you work with clients in your own practice, take a moment to pause and consider the barriers to success and the impact the environment is having on those barriers. Sometimes a small modification to the environment can have a significant impact on client performance and outcomes, making the difference between failure and success.