often called OT, is the use of treatments to develop,
recover, or maintain the daily living and work skills of
people with a physical, mental or developmental condition.
Occupational therapy is a client-centered practice that
places a premium on the progress towards the client’s goals.
Occupational therapy interventions focus on adapting the
environment, modifying the task, teaching the skill, and
educating the client/family in order to increase participation
in and performance of daily activities, particularly those
that are meaningful to the client.
of occupational therapy
earliest evidence of using occupations as a method of therapy
can be found in ancient times. In c. 100 BCE, Greek physician
initiated humane treatment of patients with mental illness
using therapeutic baths, massage, exercise, and music. Later,
the Roman Celsus
prescribed music, travel, conversation and exercise to his
patients. However by medieval times the use of these strategies
with people considered to be insane was rare, if not nonexistent.
18th-century Europe, revolutionaries such as Philippe
Pinel and Johann
Christian Reil reformed the hospital system. Instead
of the use of metal chains and restraints, their institutions
utilized rigorous work and leisure activities in the late
18th century. This was the era of Moral Treatment, developed
in Europe during the Age
of Enlightenment, where the roots of occupational therapy
Although it was thriving abroad, interest in the reform
movement waxed and waned in the United States throughout
the 19th century. It re-emerged in the early decades of
the 20th century as Occupational Therapy.
and Crafts movement that flourished between 1860 and
1910 also impacted occupational therapy. In a recently industrialized
society, the arts and crafts societies emerged against the
monotony and lost autonomy of factory work .
Arts and crafts were utilized as a way of promoting learning
through doing and provided an outlet for creative energy
and a way of avoiding the boredom that was associated with
long hospital stays, both for mental illness and for tuberculosis.
only a small percentage of occupational therapists continue
to work in the field of mental health, many universities
place a strong emphasis on training students in psycho-social
health profession of occupational therapy was conceived
in the early 1910s as a reflection of the Progressive
Era. Early professionals merged highly valued ideals,
such as having a strong work ethic and the importance of
crafting with one’s own hands with scientific and medical
The National Society for the Promotion of Occupational Therapy,
now called the American
Occupational Therapy Association (AOTA), was founded
in 1917 and the profession of Occupational Therapy was officially
named in 1920.
emergence of occupational therapy challenged the views of
mainstream scientific medicine. Instead of focusing on purely
physical etiologies, occupational therapists argued that
a complex combination of social, economic, and biological
reasons cause dysfunction. Principles and techniques were
borrowed from many disciplines—including but not limited
work—to enrich the profession’s scope. Between 1900
and 1930, the founders defined the realm of practice and
developed supporting theories. By the early 1930s, AOTA
had established educational guidelines and accreditation
In a short 20-year span, they successfully convinced the
public and medical world of the value of occupational therapy
and established standards for the profession.
War I forced the new profession to clarify its role in the
medical domain and to standardize training and practice.
In addition to clarifying its public image, occupational
therapy also established clinics, workshops, and training
schools nationwide. Due to the overwhelming number of wartime
injuries, “reconstruction aides” (an umbrella term for occupational
therapy aides and physiotherapy aides, now known as physical
therapists) were recruited by the Surgeon General. Between
1917 and 1920, nearly 148,000 wounded men were placed in
hospitals upon their return to the states. This number does
not account for those wounded abroad. The success of the
reconstruction aides, largely made up of women trying to
“do their bit” to help with the war effort, was a great
accomplishment. Post-war, however, there was a struggle
to keep people in the profession. Emphasis shifted from
the altruistic war-time mentality to the financial, professional,
and personal satisfaction that comes with being a therapist.
To make the profession more appealing, practice was standardized,
as was the curriculum. Entry and exit criteria were established,
and the American Occupational Therapy Association advocated
for steady employment, decent wages, and fair working conditions.
Via these methods, occupational therapy sought and obtained
medical legitimacy in the 1920s.
therapy. Toy making in psychiatric hospital. World War
profession has continued to grow and expand its scope and
settings of practice. Occupational science, the study of
occupation, was created in 1989 as a tool for providing
evidence-based research to support and advance the practice
of occupational therapy, as well as offer a basic science
to study topics surrounding "occupation".
of the philosophy of occupational therapy
of occupational therapy has changed over the history of
the profession. The philosophy articulated by the founders
owed much to the ideals of romanticism,
which are collectively considered the fundamental ideologies
of the past century.
of the most widely cited early papers about the philosophy
of occupational therapy was presented by Adolf
Meyer, a psychiatrist who had emigrated to the United
States from Switzerland in the late 19th century and who
was invited to present his views to a gathering of the new
Occupational Therapy Society in 1922. At the time, Dr. Meyer
was one of the leading psychiatrists in the United States
and head of the new psychiatry department and Phipps Clinic
at Johns Hopkins University in Baltimore, Maryland.
Rush Dunton, a supporter of the National Society for
the Promotion of Occupational Therapy, now the American
Occupational Therapy Association, sought to promote the
ideas that occupation is a basic human need, and that occupation
is therapeutic. From his statements came some of the basic
assumptions of occupational therapy, which include:
has a positive effect on health and well-being.
creates structure and organizes time.
brings meaning to life, culturally and personally.
are individual. People value different occupations.
philosophies have been elaborated on over time in order
to form the values that underpin the Codes of Ethics issued
by each national association. However, the relevance of
occupation to health and well-being remains the central
theme. Influenced by criticism from medicine and the multitude
of physical disabilities resulting from World
War II, occupational therapy adopted a more reductionistic
philosophy for a time. While this approach led to developments
in technical knowledge about occupational performance, clinicians
became increasingly disillusioned and re-considered these
As a result, client centeredness and occupation have re-emerged
as dominant themes in the profession.
Over the past century, the underlying philosophy of occupational
therapy has evolved from being a diversion from illness,
to treatment, to enablement through meaningful occupation.
This became evident through the development and widespread
adoption of the Canadian
Model of Occupational Performance.
two most commonly mentioned values are that occupation is
essential for health and the concept of holism.
However, there have been some dissenting voices. Mocellin
in particular advocated abandoning the notion of health
through occupation as obsolete in the modern world and questioned
the appropriateness of advocating holism when practice rarely
The values formulated by the American Occupational Therapy
Association have also been critiqued as being therapist
centred and not reflecting the modern reality of multicultural
to the philosophy of occupational therapy is the concept
of occupational performance. In considering occupational
performance the therapist must consider the many factors
that comprise overall performance. This concept is made
more tangible using models such as the person-environment-occupation
model proposed by Law et al. (1996) and the Person-Environment-Occupation-Performance
(PEOP) model developed at the same time by Christiansen
and Baum in the United States.
This approach highlights the importance of satisfactions
in one's occupations, broadening the aim of occupational
therapy beyond the mere completion of tasks to the holistic
achievement of personal well-being.
recent times occupational therapy practitioners have challenged
themselves to think more broadly about the potential scope
of the profession, and expanded it to include working with
groups experiencing occupational deprivation which stems
from sources other than disability. Examples of new and
emerging practice areas would include therapists working
with refugees, and with people experiencing
expanded version of the Canadian
model of occupational performance and engagement (CMOP-E)
encourages occupational therapists to think beyond just
occupational performance and address other modes of occupational
interaction such as occupational deprivation, competence,
and justice. The broader notion of occupational engagement
encompasses all that we do to become occupied and is congruent
with how occupational therapists address issues of occupational
practice in occupational therapy seeks to offer effective,
client-centred services that enable people to engage in
occupations of life. The Canadian Model of Client Centered
Enablement (CMCE) embraces occupational enablement as the
core competency of occupational therapy
and the Canadian Practice Process Framework (CPPF)
as the core process of occupational enablement.
occupational therapist works systematically through a sequence
of actions known as the occupational therapy process. There
are several versions of this process as described by numerous
writers, although all include the basic components of evaluation,
intervention, and outcomes. Creek
has sought to provide a comprehensive version based on extensive
research which has 11 stages.
Canadian Practice Process Framework (CPPF),
has eight action points and three contextual elements.
Law, and Clark
suggested a 7 stage process. A central element of this process
model is the focus on identifying both client and therapists
strengths and resources prior to beginning to develop the
outcomes and action plan.
Occupational Therapy Practice Framework: Domain and Process
(2nd edition) (AOTA, 2008) presents a 3 stage process, and
includes interrelated constructs that define and guide practice.
of practice in occupational therapy
role of occupational therapy allows occupational therapists
to work in many different settings, work with many different
populations and acquire many different specialties. This
broad spectrum of practice lends itself to difficulty categorizing
the areas of practice that exist, especially considering
the many countries and different health care systems. In
this section, the categorization from the American Occupational
Therapy Association is used. However, there are other ways
to categorize areas of practice in OT, such as physical,
mental, and community practice (AOTA, 2009). These divisions
occur when the setting is defined by the population it serves.
For example, acute physical or mental health settings (e.g.:
hospitals), sub-acute settings (e.g.: aged care facilities),
outpatient clinics and community settings.
each area of practice below, an OT can work with different
populations, diagnosis, specialities, and in different settings.
therapy during WWI: bedridden wounded are knitting.
therapists work with infants, toddlers, children, and youth
and their families in a variety of settings including schools,
clinics, and homes.
Occupational therapists assist children and their caregivers
to build skills that enable them to participate in meaningful
occupations. Occupational therapists also address the psychosocial
needs of children and youth to enable them to participate
in meaningful life events. These occupations may include:
normal growth and development, feeding, play, social skills,
therapy with Children and Youth may take a variety of forms:
a wellness program in schools to prevent childhood obesity
hand writing development in school-aged children
functional skills for children with developmental disabilities
individualized treatment for sensory processing difficulties
psychosocial needs of a child and teaching effective
practice area of Health and Wellness is emerging steadily
due to the increasing need for wellness-related services
in occupational therapy. A connection between wellness and
physical health, as well as mental health, has been found;
consequently, helping to improve the physical and mental
health of clients can lead to a general increase in wellness.
a practice area, health and wellness can include a focus
on the following:
of disease and injury
of secondary conditions
of the well-being of those with chronic illnesses
of health care disparities
of factors that impact quality of life
of healthy living practices, social participation, and
to the World Health Organization, mental illness is one
of the fastest growing forms of disability.
There is a focus on prevention and treatment of mental illness
in populations including children, youth, the aging, and
those with severe and persistent mental health issues.
Occupational therapists provide mental health services in
a variety of settings including hospitals, day programs,
and long-term-care facilities.
therapists help individuals with mental illness acquire
the skills to care for themselves or others including the
access and participation
therapists work with older adults to maintain independence,
participate in meaningful activities, and live fulfilling
lives. Some examples of areas that occupational therapists
address with older adults are driving, continuing to live
at home, low vision, and dementia
When addressing driving, driver evaluations are administered
to determine if drivers are safe behind the wheel. To enable
independence of older adults at home, occupational therapists
perform fall screens and evaluate older adults functioning
in their homes and recommend specific home modifications.
When addressing low vision, occupational therapists modify
tasks and the environment.
While working with individuals with AD, occupational therapists
focus on maintaining quality of life, ensure safety, promote
independence, and utilize retained abilities.
therapists address the needs of rehabilitation, disability,
and participation. Occupational therapists provide treatment
for adults with disabilities in a variety of settings including
hospitals (acute rehabilitation, in-patient rehabilitation,
and out-patient rehabilitation), home health, skilled nursing
facilities, and day rehabilitation programs. When planning
treatment, occupational therapists address the physical,
cognitive, psychosocial, and environmental needs involved
in adult populations across a variety of settings.
therapy with adult rehabilitation, disability, and participation
may take a variety of forms:
with adults with autism at day rehabilitation programs
to promote successful relationships and involvement
in the community
the quality of life for a cancer survivor or individual
with cancer by engaging them in occupations that are
meaningful, providing therapy for lymphedema management,
implementing anxiety and stress reduction methods, and
individuals with hand amputations how to put on and
take off a myoelectrically controlled limb as well as
training for functional use of the limb
and implementing new technology such as speech to text
software and Nintendo Wii video games
via telehealth methods as a service delivery model for
clients who live in rural areas
services for those in the armed forces such as cognitive
treatment for traumatic brain injury, training and education
towards the use of prosthetic devices for amputations,
and treatment for psychological distress as a result
of post-traumatic stress disorder
of the rising need for occupational therapists,
many facilities are opting for travel occupational therapists—who
are willing to travel, often out of state, to work temporarily
in a facility. Assignments may run as short as 8 weeks or
as long as 9 months, but typically last 13–26 weeks in length.
therapists may also work with clients who have had an injury
and are trying to get back to work. Testing may be completed
to simulate work tasks in order to determine best matches
for work, accommodations needed at work, or the level of
disability. Work conditioning and hardening are approaches
used to restore performance skills needed on the job that
may have changed due to an illness or injury. Occupational
therapists can also prevent work related injuries through
ergonomics and on site work evaluations.
new ways of approaching tasks
to break down activities into achievable components
e.g. sequencing a complex task like cooking a complex
home and job site evaluations with adaptation recommendations.
skills assessments and treatment.
equipment recommendations and usage training.
adaptation including provision of equipment or designing
adaptations to remove obstacles or make them manageable
to family members and caregivers.
use of creative media as therapeutic activity
analysis has been defined as a process of dissecting an
activity into its component parts and task sequence in order
to identify its inherent properties and the skills required
for its performance, thus allowing the therapist to evaluate
its therapeutic potential.
Therapists use a number of theoretical frameworks with which
to frame their practices. Note that terminology has differed
between scholars. Theoretical bases for framing a human
and their occupation being include the following:
of reference and generic models
of reference or generic models are the overarching title
given to a collation of compatible knowledge, research and
theories that form conceptual practice.
More generally they can be defined as "those aspects which
influence our perceptions, decisions and practice".
Environment Occupation Performance Model
Therapy Intervention Process Model (OTIPM) (Anne Fisher
Performance Process Model (OPPM)
of Human Occupation (MOHO)
(Gary Kielhofner and others)
was first published in 1980. It explains how people
select, organise and undertake occupations within
their environment. The model is supported with evidence
generated over thirty years and has been successfully
applied throughout the world.
Model of Occupational Performance and Engagement (CMOP-E)
Performances Model - Australia (OPM-A) (Chris Chapparo
& Judy Ranka)
OPM(A) was conceptualized in 1986 with its current
form launched in 2006. The OPM(A) illustrates the
complexity of occupational performance, the scope
of occupational therapy practice, and provides a
framework for occupational therapy education.
(River) Model (Michael Iwama)
Frame of Reference
Biomechanical Frame of Reference is primarily concerned
with motion during occupation. It is used with individuals
who experience limitations in movement, inadequate
muscle strength or loss of endurance in occupations.
The Frame of Reference was not originally compiled
by Occupational Therapists, and Therapists should
translate it to the Occupational Therapy perspective,
to avoid the risk of movement or exercise becoming
the main focus.
Muir Giles and Clark-Wilson)
Performance Model (Fidler)
Frame of Reference
Frame of Reference is developed from the work of
Rogers. It views the client as the center of
all therapeutic activity, and the client's needs
and goals direct the delivery of the Occupational
Frame of Reference
Frame of Reference
of Human Performance Model
Models & Self-Management Models
Translation of Self-Management Models
Therapy - Mahidol Clinical System (OT-MCS) Model
therapy and ICF
Classification of Functioning, Disability and Health (ICF)
is a framework to measure health and ability by illustrating
how these components impact one’s function. This relates
very closely to the Occupational Therapy Practice Framework
as it is stated, “The profession’s core beliefs are in the
positive relationship between occupation and health and
its view of people as occupational beings”.
is also built into the 2nd edition of the practice framework.
Activities and participation examples from the ICF
overlap Areas of Occupation, Performance Skills, and Performance
Patterns in the framework. The ICF
also includes contextual factors (environmental and personal
factors) that relate to the context in the framework. In
addition, body functions and structures classified within
the ICF help describe the client factors as described in
the OT framework.
exploration of the relationship between occupational therapy
and the components of the ICIDH-2 (revision of the original
International Classification of Impairments, Disabilities,
and Handicaps (ICIDH); later becoming the ICF)
was conducted by McLaughlin Gray.
First, the ICF
is an international framework and provides an opportunity
for the occupational therapy field to become better known
across the globe. Second, the ICF
provides occupational therapists with a global language
to describe their expertise to the larger international
health care community. The ICF
uses a positive, holistic language emphasizing skills, capacities,
and strengths of an individual rather than focusing on one’s
deficits and disabilities. This is similar to the outlook
of occupational therapists. Third, the ICF
includes environmental and personal contextual factors which
are incorporated into the theory behind occupational therapy.
It is important to take into consideration an individual’s
personal, environmental, and occupational factors to develop
an effective intervention.
The last notable application of the ICF
to occupational therapy is the recognition of cultural patterns
in occupation. Culture has significance on an individual’s
activities and participation and it is important to keep
this in mind when treating an individual.
can be very useful for occupational therapists, it is noted
in the literature that occupational therapists should use
specific occupational therapy vocabulary along with the
in order to ensure correct communication about specific
might lack certain categories to describe what occupational
therapists need to communicate to clients and colleagues.
It also may not be possible to exactly match the connotations
of the ICF
categories to occupational therapy terms. The ICF
is not an assessment and specialized occupational therapy
vocabulary should not be replaced with ICF
is an overarching framework for current therapy practices.
Occupational Therapy Day
27 is World Occupational Therapy Day and celebrates the
many different ways occupational therapists can change the
lives of others.
In honor of World Occupational Therapy Day, occupational
therapists from around the world participate in an Occupational
Therapy Global Day of Service (OTGDS)
This event gives occupational therapy practitioners and
students worldwide the opportunity to give back to their
communities through service and to promote the profession
through helping others. Through social media, participants
were also able to communicate with the global occupational
therapy community to discuss their OTGDS activities and
learn about how others are celebrating World Occupational
Therapy Day. Providing free treatment, volunteering at local
organizations, and participating in community events are
some of the ways occupational therapists celebrate OTGDS
and World Occupational Therapy Day.
Therapy Professionals: Education and Salary
Occupational Therapists typically hold Masters or Doctoral
degrees in Occupational Therapy from an ACOTE accredited
institution. To practice in the United States, occupational
therapists must receive a master's degree and pass a licensing
examination to become certified by the National Board for
Certification in Occupational Therapy (NBCOT).
average wages of a permanent occupational therapist in the
United States are approximately $76,400/year. Traveling
occupational therapists may have higher wages (approximately
$113,600/year). They also enjoy benefits such as free housing,
health/medical insurance, travel reimbursement, loyalty
bonuses, and a 401k plan [reference needed]. Most
commonly (43%), travel occupational therapists enter the
industry between the ages of 21-30. The average annual income
for occupational therapy assistants as of 2009 was $50,840.
The middle 50% earned between $41,200 and $59,890. Salaries
for the lowest 10% were around $33,350, while the highest
10% earned approximately $68,450, with top pay upwards of