OCCUPATIONAL THERAPY

Occupational therapy (also abbreviated as OT) is a holistic health care profession that aims
to promote health by enabling individuals to perform meaningful and purposeful activities
across the lifespan. Occupational therapists and occupational therapy assistants are health
professionals that use treatments to develop, recover, or maintain the daily living and work
skills of their patients with a physical, mental or developmental condition. Occupational
therapy is a client-centered practice in which the client has an integral part in the therapeutic
process. The occupational therapy process includes an individualized evaluation during
which the client/family and occupational therapist determine the individual’s goals; a
customized intervention to improve the person’s ability to perform daily activities and reach
his/her goals; and an outcomes evaluation to monitor progression towards meeting 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.
Our Approach to Occupational Science Research
The figure below provides an overview of our conceptual approaches to conducting
occupational science research.

1
Three strengths that are not explicitly highlighted in this figure are:
1. Life span perspective — our research spans infancy through frail elderly, and some
of our work is longitudinal.
2. Study of interrelationships and cross cutting themes — in brief, much of our
research has cut across more than one core, or has deliberately addressed the
intersections of core conceptual areas, such as health, well-being, community re-
integration, family life, and health disparities.
Commitment to socially responsive research — our roots in a practice profession, and our
continued development of therapeutic practices, provide us with a lens directed toward the
“mattering” of scholarship, a desire to make a measurable difference for “real people.”

OCCUPATIONAL THERAPY BASICS

Occupational therapy treatment focuses on helping people achieve independence in all areas
of their lives. OT can help kids with various needs improve their cognitive, physical, and
motor skills and enhance their self-esteem and sense of accomplishment.
Some people may think that occupational therapy is only for adults; kids, after all, do not
have occupations. But a child's main job is playing and learning, and occupational therapists
can evaluate kids' skills for playing, school performance, and daily activities and compare
them with what is developmentally appropriate for that age group.
According to the American Occupational Therapy Association (AOTA), in addition to
dealing with an someone's physical well-being, OT practitioners address psychological,
social, and environmental factors that can affect functioning in different ways. This approach
makes OT 1
 For Teens
 For Kids
 For Parents
Kids Who Might Need Occupational Therapy

According to the AOTA, kids with these medical problems might benefit from OT:

2
  birth injuries or birth defects
 sensory processing disorders
 traumatic injuries (brain or spinal cord)
 learning problems
 autism/pervasive developmental disorders
 juvenile rheumatoid arthritis
 mental health or behavioral problems
 broken bones or other orthopedic injuries
 developmental delays
 post-surgical conditions
 burns
 spina bifida
 traumatic amputations
 cancer
 severe hand injuries
 multiple sclerosis, cerebral palsy, and other chronic illnesses
Occupational therapists might:
 help kids work on fine motor skills so they can grasp and release toys and develop
good handwriting skills
 address hand-eye coordination to improve kids' play skills (hitting a target, batting a
ball, copying from a blackboard, etc.)
 help kids with severe developmental delays learn basic tasks (such as bathing, getting
dressed, brushing their teeth, and feeding themselves)
 help kids with behavioral disorders learn anger-management techniques (i.e., instead
of hitting others or acting out, using positive ways to deal with anger, such as writing
about feelings or participating in a physical activity)
 teach kids with physical disabilities the coordination skills needed to feed themselves,
use a computer, or increase the speed and legibility of their handwriting
 evaluate a child's need for specialized equipment, such as wheelchairs, splints,
bathing equipment, dressing devices, or communication aids
 work with kids who have sensory and attentional issues to improve focus and social
skills
HISTORY OF OCCUPATIONAL THERAPY

3
The earliest evidence of using occupations as a method of therapy can be found in ancient
times. In c. 100 BCE, Greek physician Asclepiades 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 concept of humane treatment of people considered to be insane was rare,
if not nonexistent.
In 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 lie 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.
The Arts 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.
The 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 principles 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.
The 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
to nursing, psychiatry, rehabilitation, self-help, orthopedics, and social 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 procedures 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
World 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

4
wages, and fair working conditions. Via these methods, occupational therapy sought and
obtained medical legitimacy in the 1920s.

Occupational therapy. Toy making in psychiatric hospital. World War 1 era.

The 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".
Evolution of the philosophy of occupational therapy
The philosophy of occupational therapy has changed over the history of the profession. The
philosophy articulated by the founders owed much to the ideals of romanticism, pragmatism
and humanism which are collectively considered the fundamental ideologies of the past
century.
One 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, William 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:
 Occupation has a positive effect on health and well-being.
 Occupation creates structure and organizes time.
 Occupation brings meaning to life, culturally and personally.
 Occupations are individual. People value different occupations
These 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 beliefs 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.

5
The 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 supports
it. 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
practice. Central 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). 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.
In 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 homelessness. The 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 enablement
today.
Enabling occupation
Best 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 therapy process
An 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. Creekhas sought to provide a comprehensive version based on extensive research
which has 11 stages.
The Canadian Practice Process Framework (CPPF), has eight action points and three
contextual elements.
Fearing, Law, and Clarksuggested 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.
The 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.
Areas of practice in occupational therapy
The 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.

6
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.
In each area of practice below, an OT can work with different populations, diagnosis,
specialities, and in different settings.

Occupational therapy during WWI: bedridden wounded are knitting.

Children & Youth
Occupational 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, and education.
Occupational therapy with Children and Youth may take a variety of forms:
 Promoting a wellness program in schools to prevent childhood obesity
 Facilitating hand writing development in school-aged children
 Promoting functional skills for living in children with developmental disabilities
 Providing individualized treatment for sensory processing difficulties
 Addressing psychosocial needs of a child and teaching effective coping strategies

Health & Wellness

The 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 As a
practice area, health and wellness can include a focus on the following
 Prevention of disease and injury
 Prevention of secondary conditions
 Promotion of the well-being of those with chronic illnesses
 Reduction of health care disparities

7
  Enhancement of factors that impact quality of life
 Promotion of healthy living practices, social participation, and occupational justice
Mental Health

According to the World Health Association, 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. Occupational therapists help
individuals with mental illness acquire the skills to care for themselves or others including the
following: schedule maintenance
 routine building
 coping skills
 medication management
 employment
 education
 community access and participation
 social skills development
 leisure pursuits
 money management
 childcare
Productive Aging

8
Occupational 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 or Alzheimer’s Disease (AD). 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.
Rehabilitation

Occupational 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.
Occupational therapy with adult rehabilitation, disability, and participation may take a variety
of forms:
 Working with adults with autism at day rehabilitation programs to promote successful
relationships and involvement in the community Increasing 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 fatigue management
 Training 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
 Using and implementing new technology such as speech to text software and
Nintendo with video games Communicating via telehealth methods as a service
delivery model for clients who live in rural areas Providing 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
Travel Occupational Therapy
Because 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

9
facility. Assignments may run as short as 8 weeks or as long as 9 months, but typically last
13–26 weeks in length
While the average wages of a permanent occupational therapist in the United States are
approximately $68,000/year, traveling occupational therapists enjoy much 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. Most commonly (43%),
travel occupational therapists enter the industry between the ages of 21-30. The BLS reports
that in May 2009, the average annual income for occupational therapy assistants 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% brought in approximately $68,450
Work & Industry
Occupational 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.
Emerging Practice Areas
As society changes, individuals' occupational needs change as well. In order to ensure
occupational therapy stays modern, the American Occupational Therapy Association
develops a list of emerging practice areas in which occupational therapists may play a role.
The following are the most current emerging practice areas..
Children & Youth
 A Broader Scope in Schools
 Autism
 Bullying
 Childhood Obesity
 Driving for Teens With Disabilities
 Transitions for Older Youths
Education
 Distance Learning
 Re-entry to the Profession
Health & Wellness
 Chronic Disease Management
 Obesity
 Prevention
Mental Health
 Depression
 Recovery and Peer Support Model
 Sensory Approaches to Mental Health
 Veterans’ and Wounded Warriors’ Mental Health
Productive Aging
 Community Mobility and Older Drivers
 Aging in Place and Home Modifications
 Low Vision
 Alzheimer’s Disease and Dementia
Rehabilitation
 Autism in Adults
 Cancer Care and Oncology
 Hand Transplants and Bionic Limbs

10
  New Technology for Rehab
 Telehealth
 Veteran and Wounded Warrior Care
Work and Industry
 Aging Workforce
 New Technology at Work
Occupational therapy approaches
Services typically include:
 Teaching new ways of approaching tasks
 How to break down activities into achievable components e.g. sequencing a complex
task like cooking a complex meal
 Comprehensive home and job site evaluations with adaptation recommendations.
 Performance skills assessments and treatment.
 Adaptive equipment recommendations and usage training.
 Environmental adaptation including provision of equipment or designing adaptations
to remove obstacles or make them manageable
 Guidance to family members and caregivers.
 The use of creative media as therapeutic activity
Activity analysis
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
Theoretical Frameworks
Occupational Therapists use a number of theoretical frameworks to frame their practice. Note
that terminology has differed between scholars. Theoretical bases for framing a human and
their occupation being include the following:
Frames of Reference/Generic models
Frames 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".Occupational Therapy Frame of References/Models:
 Person Environment Occupation Performance Model (PEOP) (Charles Christiansen &
Carolyn Baum)
 Occupational Therapy Intervention Process Model (OTIPM) (Anne Fisher and others)
 Occupational Performance Model (OPM)
 Model of Human Occupation (MOHO) (Gary Kielhofner and others)
o MOHO 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.
 Canadian Model of Occupational Performance and Engagement (CMOP-E)
 Occupational Performances Model - Australia (OPM-A) (Chris Chapparo & Judy
Ranka)
 The 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.
 Kawa (River) Model (Michael Iwama)
 Functional Information-Processing Model
 Biomechanical Frame of Reference

11
 o The 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.
 Rehabilitative (compensatory)
 Neurofunctional (Gordon Muir Giles and Clark-Wilson)
 Cognitive Disabilities
 Dynamic Systems Theory
 Sensory Integration
 Lifestyle Performance Model (Fidler)
 Client-Centered Frame of Reference
 This Frame of Reference is developed from the work of Carl 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 Therapy Process.
 Cognitive-Behavioural Frame of Reference
 Psychodynamic Frame of Reference
 Ecological of Human Development Model
 Recovery Models & Self-Management Models
o Curtin pARTicipation Model
o Knowledge Translation of Self-Management Models,Life-Skills Tree
ModelOccupational Therapy - Mahidol Clinical System (OT-MCS) Model
Occupational therapy and ICF
The International 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”. The ICF 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 frameworkFurther 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.

12
Although the ICF 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 ICF in order to ensure correct communication about specific concepts. ] The ICF 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 terminology The ICF is an
overarching f ramework for current therapy practices.
Dispelling misconceptions about occupational therapy

A common misconception about occupational therapists is that the contribution towards the
recovery of a patient is not as important as that of medics, or psychological therapists. On the
surface, a lot of occupational therapist interventions can appear simple.
The misunderstanding is that everyday activities are simple and easy to do. While this may be
true most of the time, someone struggling with either their mental or physical health may
have a very different experience of trying to bathe, cook or access public transport
independently. Occupational therapists put great value on learning how to break down these
activities, and make them accessible for everyone.

Occupational Therapy Code of Ethics and Ethics Standards (2010)

PREAMBLE
The American Occupational Therapy Association (AOTA) Occupational Therapy Code of
Ethics and Ethics Standards (2010) (“Code and Ethics Standards”) is a public statement of
principles used to promote and maintain high standards of conduct within the profession.
Members of AOTA are committed to promoting inclusion, diversity, independence, and
safety for all recipients in various stages of life, health, and illness and to empower all
beneficiaries of occupational therapy. This commitment extends beyond service recipients to
include professional colleagues, students, educators, businesses, and the community.
Fundamental to the mission of the occupational therapy profession is the therapeutic use of
everyday life activities (occupations) with individuals or groups for the purpose of
participation in roles and situations in home, school, workplace, community, and other
settings. “Occupational therapy addresses the physical, cognitive, psychosocial, sensory, and
other aspects of performance in a variety of contexts to support engagement in everyday life
activities that affect health, well being, and quality of life” AOTA, 2004). Occupational
therapy personnel have an ethical responsibility primarily to recipients of service and
secondarily to society.

13
The Occupational Therapy Code of Ethics and Ethics Standards (2010) was tailored to
address the most prevalent ethical concerns of the profession in education, research, and
practice. The concerns of stakeholders including the public, consumers, students, colleagues,
employers, research participants, researchers, educators, and practitioners were addressed in
the creation of this document. A review of issues raised in ethics cases, member questions
related to ethics, and content of other professional codes of ethics were utilized to ensure that
the revised document is applicable to occupational therapists, occupational therapy assistants,
and students in all roles.
The historical foundation of this Code and Ethics Standards is based on ethical reasoning
surrounding practice and professional issues, as well as on empathic reflection regarding
these interactions with others (see e.g., AOTA, 2005, 2006). This reflection resulted in the
establishment of principles that guide ethical action, which goes beyond rote following of
rules or application of principles. Rather, ethical action is a manifestation of moral character
and mindful reflection. It is a commitment to benefit others, to virtuous practice of artistry
and science, to genuinely good behaviors, and to noble acts of courage.
While much has changed over the course of the profession’s history, more has remained the
same. The profession of occupational therapy remains grounded in seven core concepts, as
identified in the Core Values and Attitudes of Occupational Therapy Practice (AOTA, 1993):
altruism, equality, freedom, justice, dignity, truth, and prudence. Altruism is the individual’s
ability to place the needs of others before their own. Equality refers to the desire to promote
fairness in interactions with others. The concept of freedom and personal choice is paramount
in a profession in which the desires of the client must guide our interventions. Occupational
therapy practitioners, educators, and researchers relate in a fair and impartial manner to
individuals with whom they interact and respect and adhere to the applicable laws and
standards regarding their area of practice, be it direct care, education, or research (justice).
Inherent in the practice of occupational therapy is the promotion and preservation of the
individuality and dignity of the client, by assisting him or her to engage in occupations that
are meaningful to him or her regardless of level of disability. In all situations, occupational
therapists, occupational therapy assistants, and students must provide accurate information,
both in oral and written form (truth). Occupational therapy personnel use their clinical and
ethical reasoning skills, sound judgment, and reflection to make decisions to direct them in
their area(s) of practice (prudence). These seven core values provide a foundation by which
occupational therapy personnel guide their interactions with others, be they students, clients,
colleagues, research participants, or communities. These values also define the ethical
principles to which the profession is committed and which the public can expect.
The Occupational Therapy Code of Ethics and Ethics Standards (2010) is a guide to
professional conduct when ethical issues arise. Ethical decision making is a process that
includes awareness of how the outcome will impact occupational therapy clients in all
spheres. Applications of Code and Ethics Standards Principles are considered situation-
specific, and where a conflict exists, occupational therapy personnel will pursue responsible
efforts for resolution. These Principles apply to occupational therapy personnel engaged in
any professional role, including elected and volunteer leadership positions.
The specific purposes of the Occupational Therapy Code of Ethics and Ethics Standards
(2010) are to
1. Identify and describe the principles supported by the occupational therapy profession.
2. Educate the general public and members regarding established principles to which
occupational therapy personnel are accountable.
3. Socialize occupational therapy personnel to expected standards of conduct.
4. Assist occupational therapy personnel in recognition and resolution of ethical dilemmas.

14
The Occupational Therapy Code of Ethics and Ethics Standards (2010) define the set of
principles that apply to occupational therapy personnel at all levels:
DEFINITIONS
Recipient of service: Individuals or groups receiving occupational therapy.
Student: A person who is enrolled in an accredited occupational therapy education program.
Research participant: A prospective participant or one who has agreed to participate in an
approved research project.
Employee: A person who is hired by a business (facility or organization) to provide
occupational therapy services.
Colleague: A person who provides services in the same or different business (facility or
organization) to which a professional relationship exists or may exist.
Public: The community of people at large.
BENEFICENCE
Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-
being and safety of the recipients of their services.
Beneficence includes all forms of action intended to benefit other persons. The term
beneficence connotes acts of mercy, kindness, and charity (Beauchamp & Childress, 2009).
Forms of beneficence typically include altruism, love, and humanity. Beneficence requires
taking action by helping others, in other words, by promoting good, by preventing harm, and
by removing harm. Examples of beneficence include protecting and defending the rights of
others, preventing harm from occurring to others, removing conditions that will cause harm
to others, helping persons with disabilities, and rescuing persons in danger (Beauchamp &
Childress, 2009).
Occupational therapy personnel shall
A. Respond to requests for occupational therapy services (e.g., a referral) in a timely
manner as determined by law, regulation, or policy.
B. Provide appropriate evaluation and a plan of intervention for all recipients of
occupational therapy services specific to their needs.
C. Reevaluate and reassess recipients of service in a timely manner to determine if goals
are being achieved and whether intervention plans should be revised.
D. Avoid the inappropriate use of outdated or obsolete tests/assessments or data obtained
from such tests in making intervention decisions or recommendations.
E. Provide occupational therapy services that are within each practitioner’s level of
competence and scope of practice (e.g., qualifications, experience, the law).
F. Use, to the extent possible, evaluation, planning, intervention techniques, and
therapeutic equipment that are evidence-based and within the recognized scope of
occupational therapy practice.
G. Take responsible steps (e.g., continuing education, research, supervision, training) and
use careful judgment to ensure their own competence and weigh potential for client
harm when generally recognized standards do not exist in emerging technology or
areas of practice.
H. Terminate occupational therapy services in collaboration with the service recipient or
responsible party when the needs and goals of the recipient have been met or when
services no longer produce a measurable change or outcome.
I. Refer to other health care specialists solely on the basis of the needs of the client.
J. Provide occupational therapy education, continuing education, instruction, and training
that are within the instructor’s subject area of expertise and level of competence.
K. Provide students and employees with information about the Code and Ethics
Standards, opportunities to discuss ethical conflicts, and procedures for reporting
unresolved ethical conflicts.

15
 L. Ensure that occupational therapy research is conducted in accordance with currently
accepted ethical guidelines and standards for the protection of research participants
and the dissemination of results.
M. Report to appropriate authorities any acts in practice, education, and research that
appear unethical or illegal.
N. Take responsibility for promoting and practicing occupational therapy on the basis of
current knowledge and research and for further developing the profession’s body of
knowledge.
NONMALEFICENCE
Principle 2. Occupational therapy personnel shall intentionally refrain from actions that
cause harm.
Nonmaleficence imparts an obligation to refrain from harming others (Beauchamp &
Childress, 2009). The principle of nonmaleficence is grounded in the practitioner’s
responsibility to refrain from causing harm, inflicting injury, or wronging others. While
beneficence requires action to incur benefit, nonmaleficence requires non-action to avoid
harm (Beauchamp & Childress, 2009). Nonmaleficence also includes an obligation to not
impose risks of harm even if the potential risk is without malicious or harmful intent. This
principle often is examined under the context of due care. If the standard of due care
outweighs the benefit of treatment, then refraining from treatment provision would be
ethically indicated (Beauchamp & Childress, 2009).
Occupational therapy personnel shall
A. Avoid inflicting harm or injury to recipients of occupational therapy services, students,
research participants, or employees.
B. Make every effort to ensure continuity of services or options for transition to
appropriate services to avoid abandoning the service recipient if the current provider
is unavailable due to medical or other absence or loss of employment.
C. Avoid relationships that exploit the recipient of services, students, research
participants, or employees physically, emotionally, psychologically, financially,
socially, or in any other manner that conflicts or interferes with professional judgment
and objectivity.
D. Avoid engaging in any sexual relationship or activity, whether consensual or
nonconsensual, with any recipient of service, including family or significant other,
student, research participant, or employee, while a relationship exists as an
occupational therapy practitioner, educator, researcher, supervisor, or employer.
E. Recognize and take appropriate action to remedy personal problems and limitations
that might cause harm to recipients of service, colleagues, students, research
participants, or others.
F. Avoid any undue influences, such as alcohol or drugs, that may compromise the
provision of occupational therapy services, education, or research.
G. Avoid situations in which a practitioner, educator, researcher, or employer is unable to
maintain clear professional boundaries or objectivity to ensure the safety and well-
being of recipients of service, students, research participants, and employees.
H. Maintain awareness of and adherence to the Code and Ethics Standards when
participating in volunteer roles.
I. Avoid compromising client rights or well-being based on arbitrary administrative
directives by exercising professional judgment and critical analysis.
J. Avoid exploiting any relationship established as an occupational therapist or
occupational therapy assistant to further one’s own physical, emotional, financial,
political, or business interests at the expense of the best interests of recipients of
services, students, research participants, employees, or colleagues.

16
 K. Avoid participating in bartering for services because of the potential for exploitation
and conflict of interest unless there are clearly no contraindications or bartering is a
culturally appropriate custom.
L. Determine the proportion of risk to benefit for participants in research prior to
implementing a study.

AUTONOMY AND CONFIDENTIALITY

Principle 3. Occupational therapy personnel shall respect the right of the individual to
self-determination.
The principle of autonomy and confidentiality expresses the concept that practitioners have a
duty to treat the client according to the client’s desires, within the bounds of accepted
standards of care and to protect the client’s confidential information. Often autonomy is
referred to as the self-determination principle. However, respect for autonomy goes beyond
acknowledging an individual as a mere agent and also acknowledges a “person’s right to hold
views, to make choices, and to take actions based on personal values and beliefs”
(Beauchamp & Childress, 2009, p. 103). Autonomy has become a prominent principle in
health care ethics; the right to make a determination regarding care decisions that directly
impact the life of the service recipient should reside with that individual. The principle of
autonomy and confidentiality also applies to students in an educational program, to
participants in research studies, and to the public who seek information about occupational
therapy services.
Occupational therapy personnel shall
A. Establish a collaborative relationship with recipients of service including families,
significant others, and caregivers in setting goals and priorities throughout the
intervention process. This includes full disclosure of the benefits, risks, and potential
outcomes of any intervention; the personnel who will be providing the intervention(s);
and/or any reasonable alternatives to the proposed intervention.
B. Obtain consent before administering any occupational therapy service, including
evaluation, and ensure that recipients of service (or their legal representatives) are
kept informed of the progress in meeting goals specified in the plan of
intervention/care. If the service recipient cannot give consent, the practitioner must be
sure that consent has been obtained from the person who is legally responsible for that
recipient.
C. Respect the recipient of service’s right to refuse occupational therapy services
temporarily or permanently without negative consequences.
D. Provide students with access to accurate information regarding educational
requirements and academic policies and procedures relative to the occupational
therapy program/educational institution.
E. Obtain informed consent from participants involved in research activities, and ensure
that they understand the benefits, risks, and potential outcomes as a result of their
participation as research subjects.
F. Respect research participant’s right to withdraw from a research study without
consequences.
G. Ensure that confidentiality and the right to privacy are respected and maintained
regarding all information obtained about recipients of service, students, research
participants, colleagues, or employees. The only exceptions are when a practitioner or
staff member believes that an individual is in serious foreseeable or imminent harm.
Laws and regulations may require disclosure to appropriate authorities without
consent.

17
 H. Maintain the confidentiality of all verbal, written, electronic, augmentative, and non-
verbal communications, including compliance with HIPAA regulations.
I. Take appropriate steps to facilitate meaningful communication and comprehension in
cases in which the recipient of service, student, or research participant has limited
ability to communicate (e.g., aphasia or differences in language, literacy, culture).
J. Make every effort to facilitate open and collaborative dialogue with clients and/or
responsible parties to facilitate comprehension of services and their potential
risks/benefits.
SOCIAL JUSTICE
Principle 4. Occupational therapy personnel shall provide services in a fair and
equitable manner.
Social justice, also called distributive justice, refers to the fair, equitable, and appropriate
distribution of resources. The principle of social justice refers broadly to the distribution of
all rights and responsibilities in society (Beauchamp & Childress, 2009). In general, the
principle of social justice supports the concept of achieving justice in every aspect of society
rather than merely the administration of law. The general idea is that individuals and groups
should receive fair treatment and an impartial share of the benefits of society. Occupational
therapy personnel have a vested interest in addressing unjust inequities that limit
opportunities for participation in society (Braveman & Bass-Haugen, 2009). While opinions
differ regarding the most ethical approach to addressing distribution of health care resources
and reduction of health disparities, the issue of social justice continues to focus on limiting
the impact of social inequality on health outcomes.
Occupational therapy personnel shall
A. Uphold the profession’s altruistic responsibilities to help ensure the common good.
B. Take responsibility for educating the public and society about the value of
occupational therapy services in promoting health and wellness and reducing the
impact of disease and disability.
C. Make every effort to promote activities that benefit the health status of the community.
D. Advocate for just and fair treatment for all patients, clients, employees, and colleagues,
and encourage employers and colleagues to abide by the highest standards of social
justice and the ethical standards set forth by the occupational therapy profession.
E. Make efforts to advocate for recipients of occupational therapy services to obtain
needed services through available means.
F. Provide services that reflect an understanding of how occupational therapy service
delivery can be affected by factors such as economic status, age, ethnicity, race,
geography, disability, marital status, sexual orientation, gender, gender identity,
religion, culture, and political affiliation.
G. Consider offering pro bono (“for the good”) or reduced-fee occupational therapy
services for selected individuals when consistent with guidelines of the employer,
third-party payer, and/or government agency.

PROCEDURAL JUSTICE
Principle 5. Occupational therapy personnel shall comply with institutional rules, local,
state, federal, and international laws and AOTA documents applicable to the profession
of occupational therapy.
Procedural justice is concerned with making and implementing decisions according to fair
processes that ensure “fair treatment” (Maiese, 2004). Rules must be impartially followed and
consistently applied to generate an unbiased decision. The principle of procedural justice is
based on the concept that procedures and processes are organized in a fair manner and that
policies, regulations, and laws are followed. While the law and ethics are not synonymous

18
terms, occupational therapy personnel have an ethical responsibility to uphold current
reimbursement regulations and state/territorial laws governing the profession. In addition,
occupational therapy personnel are ethically bound to be aware of organizational policies and
practice guidelines set forth by regulatory agencies established to protect recipients of
service, research participants, and the public.
Occupational therapy personnel shall
A. Be familiar with and apply the Code and Ethics Standards to the work setting, and
share them with employers, other employees, colleagues, students, and researchers.
B. Be familiar with and seek to understand and abide by institutional rules, and when
those rules conflict with ethical practice, take steps to resolve the conflict.
C. Be familiar with revisions in those laws and AOTA policies that apply to the
profession of occupational therapy and inform employers, employees, colleagues,
students, and researchers of those changes.
D. Be familiar with established policies and procedures for handling concerns about the
Code and Ethics Standards, including familiarity with national, state, local, district,
and territorial procedures for handling ethics complaints as well as policies and
procedures created by AOTA and certification, licensing, and regulatory agencies.
E. Hold appropriate national, state, or other requisite credentials for the occupational
therapy services they provide.
F. Take responsibility for maintaining high standards and continuing competence in
practice, education, and research by participating in professional development and
educational activities to improve and update knowledge and skills.
G. Ensure that all duties assumed by or assigned to other occupational therapy personnel
match credentials, qualifications, experience, and scope of practice.
H. Provide appropriate supervision to individuals for whom they have supervisory
responsibility in accordance with AOTA official documents and local, state, and
federal or national laws, rules, regulations, policies, procedures, standards, and
guidelines.
I. Obtain all necessary approvals prior to initiating research activities.
J. Report all gifts and remuneration from individuals, agencies, or companies in
accordance with employer policies as well as state and federal guidelines.
K. Use funds for intended purposes, and avoid misappropriation of funds.
L. Take reasonable steps to ensure that employers are aware of occupational therapy’s
ethical obligations as set forth in this Code and Ethics Standards and of the
implications of those obligations for occupational therapy practice, education, and
research.
M. Actively work with employers to prevent discrimination and unfair labor practices,
and advocate for employees with disabilities to ensure the provision of reasonable
accommodations.
N. Actively participate with employers in the formulation of policies and procedures to
ensure legal, regulatory, and ethical compliance.
O. Collect fees legally. Fees shall be fair, reasonable, and commensurate with services
delivered. Fee schedules must be available and equitable regardless of actual payer
reimbursements/contracts.
P. Maintain the ethical principles and standards of the profession when participating in a
business arrangement as owner, stockholder, partner, or employee, and refrain from
working for or doing business with organizations that engage in illegal or unethical
business practices (e.g., fraudulent billing, providing occupational therapy services
beyond the scope of occupational therapy practice).
VERACITY

19
Principle 6. Occupational therapy personnel shall provide comprehensive, accurate, and
objective information when representing the profession.
Veracity is based on the virtues of truthfulness, candor, and honesty. The principle of veracity
in health care refers to comprehensive, accurate, and objective transmission of information
and includes fostering the client’s understanding of such information (Beauchamp &
Childress, 2009). Veracity is based on respect owed to others. In communicating with others,
occupational therapy personnel implicitly promise to speak truthfully and not deceive the
listener. By entering into a relationship in care or research, the recipient of service or research
participant enters into a contract that includes a right to truthful information (Beauchamp &
Childress, 2009). In addition, transmission of information is incomplete without also ensuring
that the recipient or participant understands the information provided. Concepts of veracity
must be carefully balanced with other potentially competing ethical principles, cultural
beliefs, and organizational policies. Veracity ultimately is valued as a means to establish trust
and strengthen professional relationships. Therefore, adherence to the Principle also requires
thoughtful analysis of how full disclosure of information may impact outcomes.
Occupational therapy personnel shall
A. Represent the credentials, qualifications, education, experience, training, roles, duties,
competence, views, contributions, and findings accurately in all forms of
communication about recipients of service, students, employees, research participants,
and colleagues.
B. Refrain from using or participating in the use of any form of communication that
contains false, fraudulent, deceptive, misleading, or unfair statements or claims.
C. Record and report in an accurate and timely manner, and in accordance with
applicable regulations, all information related to professional activities.
D. Ensure that documentation for reimbursement purposes is done in accordance with
applicable laws, guidelines, and regulations.
E. Accept responsibility for any action that reduces the public’s trust in occupational
therapy.
F. Ensure that all marketing and advertising are truthful, accurate, and carefully presented
to avoid misleading recipients of service, students, research participants, or the public.
G. Describe the type and duration of occupational therapy services accurately in
professional contracts, including the duties and responsibilities of all involved parties.
H. Be honest, fair, accurate, respectful, and timely in gathering and reporting fact-based
information regarding employee job performance and student performance.
I. Give credit and recognition when using the work of others in written, oral, or
electronic media.
J. Not plagiarize the work of others.
FIDELITY
Principle 7. Occupational therapy personnel shall treat colleagues and other
professionals with respect, fairness, discretion, and integrity.
The principle of fidelity comes from the Latin root fidelis meaning loyal. Fidelity refers to
being faithful, which includes obligations of loyalty and the keeping of promises and
commitments (Veatch & Flack, 1997). In the health professions, fidelity refers to maintaining
good-faith relationships between various service providers and recipients. While respecting
fidelity requires occupational therapy personnel to meet the client’s reasonable expectations
(Purtillo, 2005), Principle 7 specifically addresses fidelity as it relates to maintaining collegial
and organizational relationships. Professional relationships are greatly influenced by the
complexity of the environment in which occupational therapy personnel work. Practitioners,
educators, and researchers alike must consistently balance their duties to service recipients,

20
students, research participants, and other professionals as well as to organizations that may
influence decision-making and professional practice.
Occupational therapy personnel shall
A. Respect the traditions, practices, competencies, and responsibilities of their own and
other professions, as well as those of the institutions and agencies that constitute the
working environment.
B. Preserve, respect, and safeguard private information about employees, colleagues, and
students unless otherwise mandated by national, state, or local laws or permission to
disclose is given by the individual.
C. Take adequate measures to discourage, prevent, expose, and correct any breaches of
the Code and Ethics Standards and report any breaches of the former to the
appropriate authorities.
D. Attempt to resolve perceived institutional violations of the Code and Ethics Standards
by utilizing internal resources first.
F. Avoid using one’s position (employee or volunteer) or knowledge gained from that
position in such a manner that gives rise to real or perceived conflict of interest
among the person, the employer, other Association members, and/or other
organizations.
G. Use conflict resolution and/or alternative dispute resolution resources to resolve
organizational and interpersonal conflicts.
H. Be diligent stewards of human, financial, and material resources of their employers,
and refrain from exploiting these resources for personal gain.

E. Avoid conflicts of interest or conflicts of commitment in employment, volunteer roles,

or research.
F. Avoid using one’s position (employee or volunteer) or knowledge gained from that
position in such a manner that gives rise to real or perceived conflict of interest
among the person, the employer, other Association members, and/or other
organizations.
G. Use conflict resolution and/or alternative dispute resolution resources to resolve
organizational and interpersonal conflicts.
H. Be diligent stewards of human, financial, and material resources of their employers,
and refrain from exploiting these resources for personal gain.
F. Avoid using one’s position (employee or volunteer) or knowledge gained from that
position in such a manner that gives rise to real or perceived conflict of interest
among the person, the employer, other Association members, and/or other
organizations.
G. Use conflict resolution and/or alternative dispute resolution resources to resolve
organizational and interpersonal conflicts.
H. Be diligent stewards of human, financial, and material resources of their employers,
and refrain from exploiting these resources for personal gain.

21
References

American Occupational Therapy Association. (1993). Core values and attitudes of

occupational therapy practice. American Journal of Occupational Therapy, 47, 1085–
1086.

American Occupational Therapy Association. (2005). Occupational therapy code of ethics

(2005). American Journal of Occupational Therapy, 59, 639–642.

American Occupational Therapy Association. (2006). Guidelines to the occupational therapy

code of ethics. American Journal of Occupational Therapy, 60, 652–658.

American Occupational Therapy Association. (2004). Policy 5.3.1: Definition of

occupational therapy practice for State Regulation. American Journal of Occupational
Therapy, 58, 694-695.

Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New
York: Oxford University Press.

Braveman, B., & Bass-Haugen, J. D. (2009). Social justice and health disparities: An
evolving discourse in occupational therapy research and intervention. American Journal
of Occupational Therapy, 63, 7–12.

Maiese, M. (2004). Procedural justice. Retrieved July 29, 2009, from

http://www.beyondintractability.org/essay/procedural_justice/

Purtillo, R. (2005). Ethical dimensions in the health professions (4th ed.). Philadelphia:
Elsevier/Saunders.

Veatch, R. M., & Flack, H. E. (1997). Case studies in allied health ethics. Upper Saddle
River, NJ: Prentice-Hall.

Quiroga, Virginia A. M., PhD (1995), Occupational Therapy: The First 30 Years.(1900-
1930). Bethesda, Maryland: American Occupational Therapy Association, Inc. ISBN
978-1-56900-025-0

Peloquin, S. (1989). Moral Treatment: Contexts Considered. American Journal of

Occupational Therapy,43(8), p. 537-544

Colman, W. (1992). Maintaining autonomy: The struggle between occupational therapy and
physical medicine. American Journal of Occupational Therapy, 46, 63-70.

Yerxa, E., Clark, F., Jackson, J., Pierce, D., & Zemke, R. (1989). An introduction to
occupational science, A foundation for occupational therapy in the 21st century.
Haworth Press.

Hocking, C (2004). Making a difference: The romance of occupational therapy. South

African Journal of Occupational Therapy, 34(2), 3-5.

22
Breines, E (1990). Genesis of occupation: A philosophical model for therapy and theory.
Australian Occupational Therapy Journal, 37(1), 45-49.

Chapparo, C. and Ranka. J. (2000). Clinical reasoning in occupational therapy .( 2nd ed.).
Oxford, Butterworth Heinemann Ltd.

Meyer, A (1922). The philosophy of occupation therapy.Archives of Occupational Therapy,

1, 1-10.

Christiansen, C.H.(2007). : Adolf Meyer Revisited:Connections between Lifestyle, resilience

and illness. Journal of Occupational Science 14(2),63‐76.

Townsend, E.A& Helene ,J. P. (2007). Enabling Occupation II: Advancing an Occupational
Therapy Vision for Health, Well-Being & Justice Through Occupation. Ottawa: CAOT
Publications ACE. ISBN 978-1-895437-76-8

Douglas, F M (2004). Occupational still matters: A tribute to a pioneer. British Journal of

Occupational Therapy, 67(6), 239.

Whiteford, G. and Fossey, E. (2002). Occupation: The essential nexus between philosophy,
theory and practice. Australian Occupational Therapy Journal, 49(1), 1-2.

Polatajko, H (2001). The evolution of our occupational perspective: The journey from
diversion through therapeutic use to enablement. Canadian Journal of Occupational
Therapy, 68(4), 203-207.

Mocellin, G. (1988). A perspective on the principles and practice of occupational therapy.

Generally they need to eat loads of bananas and chocolate. British Journal of
Occupational Therapy, 51(1), 4-7.

23