occupational therapy occupational therapy occupational therapy (ot) is a healthcare profession. it involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. the field of ot consists of health care practitioners trained and educated to improve mental and physical performance. occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. it is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (ots) and occupational therapy assistants (otas). while ots and otas have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments. not to be confused with occupational medicine. occupational therapyus navy occupational therapists providing treatment to outpatientsicd-9-cm93.83meshd009788 the american occupational therapy association defines an occupational therapist as someone who "helps people across their lifespan participate in the things they want and/or need to do through the therapeutic use of everyday activities (occupations)". definitions by professional occupational therapy organizations outside north america are similar in content. common interventions include: helping children with disabilities to participate in school and social situations (independent mobility is often a central concern) training in assistive device technology, meaningful and purposeful activities, and life skills. physical injury rehabilitation mental dysfunction rehabilitation support of individuals across the age spectrum experiencing physical and cognitive changes assessing ergonomics and assistive seating options to maximize independent function, while alleviating the risk of pressure injury education in the disease and rehabilitation process advocating for patient health typically, occupational therapists are university-educated professionals and must pass a licensing exam to practice. currently, entry level occupational therapists must have a master's degree while certified occupational therapy assistants require a two-year associate degree to practice in the united states. individuals must pass a national board certification and apply for a state license in most states. occupational therapists often work closely with professionals in physical therapy, speech–language pathology, audiology, nursing, nutrition, social work, psychology, medicine, and assistive technology. history early history the earliest evidence of using occupations as a method of therapy can be found in ancient times. in c. 100 bce, greek physician asclepiades treated patients with a mental illness humanely 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 interventions with people with mental illness 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 used rigorous work and leisure activities in the late 18th century. this was the moral treatment era, developed in europe during the age of enlightenment, where the roots of occupational therapy lie. although it was thriving in europe, interest in the reform movement fluctuated 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 took place between 1860 and 1910 also impacted occupational therapy. in the us, a recently industrialized country, the arts and crafts societies emerged against the monotony and lost autonomy of factory work. arts and crafts were used to promote learning through doing, provided a creative outlet, and served as a way to avoid boredom during long hospital stays. eleanor clarke slagle (1870-1942) is considered to be the "mother" of occupational therapy. slagle, who was one of the founding members of the national society for the promotion of occupational therapy (nspot), proposed habit training as a primary occupational therapy model of treatment. based on the philosophy that engagement in meaningful routines shape a person's wellbeing, habit training focused on creating structure and balance between work, rest and leisure. although habit training was initially developed to treat individuals with mental health conditions, its basic tenets are apparent in modern treatment models that are utilized across a wide scope of client populations. in 1915 slagle opened the first occupational therapy training program, the henry b. favill school of occupations, at hull house in chicago. slagle went on to serve as both aota president and secretary. in 1954, aota created the eleanor clarke slagle lectureship award in her honor. each year, this award recognizes a member of aota "who has creatively contributed to the development of the body of knowledge of the profession through research, education, or clinical practice." development into a health profession in the united states of america occupational therapy. toy making in psychiatric hospital. world war i era. 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 (nspot), now called the american occupational therapy association (aota), was founded in 1917 and the profession of occupational therapy was officially named in 1921. william rush dunton, one of the founders of nspot and visionary figure in the first decades of the profession struggled with "the cumbersomeness of the term occupational therapy", as it lacked the "exactness of meaning which is possessed by scientific terms". other titles such as "work-cure", "ergo therapy" (ergo being the greek root for "work"), and "creative occupations" were discussed as substitutes, but ultimately, none possessed the broad meaning that the practice of occupational therapy demanded in order to capture the many forms of treatment that existed from the beginning. occupational therapy during wwi: bedridden wounded are knitting. the emergence of occupational therapy challenged the views of mainstream scientific medicine. instead of focusing purely on the medical model, 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 physical therapy, 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. the early twentieth century was a time in which the rising incidence of disability related to industrial accidents, tuberculosis, world war i, and mental illness brought about an increasing social awareness of the issues involved. the entry of the united states into world war i was also a crucial event in the history of the profession. up until this time, occupational therapy had been concerned primarily with the treatment of people with mental illness. however, u.s. involvement in the great war and the escalating numbers of injured and disabled soldiers presented a daunting challenge to those in command. the military enlisted the assistance of nspot to recruit and train over 1,200 "reconstruction aides" to help with the rehabilitation of those wounded in the war. with entry into world war ii and the ensuing skyrocketing demand for occupational therapists to treat those injured in the war, the field of occupational therapy underwent dramatic growth and change. occupational therapists needed to be skilled not only in the use of constructive activities such as crafts, but also increasingly in the use of activities of daily living. there was a struggle to keep people in the profession during the post-war years. 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. the 1920s and 1930s were a time of establishing standards of education and laying the foundation of the profession and its organization. eleanor clarke slagle proposed a 12-month course of training in 1922, and these standards were adopted in 1923. educational standards were expanded to a total training time of 18 months in 1930 to place the requirements for professional entry on par with those of other professions. the first textbook was published in the united states for occupational therapy in 1947, edited by helen s. willard and clare s. spackman. the profession continued to grow and redefine itself in the 1950s. the profession also began to assess the potential for the use of trained assistants in the attempt to address the ongoing shortage of qualified therapists, and educational standards for occupational therapy assistants were implemented in 1960. the 1960s and 1970s were a time of ongoing change and growth for the profession as it struggled to incorporate new knowledge and cope with the recent and rapid growth of the profession in the previous decades. new developments in the areas of neurobehavioral research led to new conceptualizations and new treatment approaches, possibly the most groundbreaking being the sensory integrative approach developed by a. jean ayres. the profession has continued to grow and expand its scope and settings of practice. occupational science, the study of occupation, was founded in 1989 as an academic discipline to provide foundational research on occupation to support and advance the practice of occupation-based occupational therapy, as well as offer a basic science to study topics surrounding "occupation". in addition, occupational therapy practitioner's roles have expanded to include political advocacy (from a grassroots base to higher legislation); for example, in 2010 pl 111-148 titled the patient protection and affordable care act had a habilitation clause that was passed in large part due to aota's political efforts as noted in aota's centennial website (aota, 2017). furthermore, occupational therapy practitioners have been striving personally and professionally toward concepts of occupational justice and other human rights issues that have both local and global impacts. the world federation of occupational therapist's resource centre has many position statements on occupational therapy's roles regarding their participation in human rights issues. as of 2021, u.s. news & world report ranked occupational therapy as #19 of their list of '100 best jobs'. philosophical underpinnings the philosophy of occupational therapy has evolved 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 assumptions have been developed over time and are the basis of the values that underpin the codes of ethics issued by the national associations. the relevance of occupation to health and well-being remains the central theme. in the 1950s, criticism from medicine and the multitude of disabled world war ii veterans resulted in the emergence of a more reductionistic philosophy. 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. three commonly mentioned philosophical precepts of occupational therapy are that occupation is necessary for health, that its theories are based on holism and that its central components are people, their occupations (activities),