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 Senior Vice President: Stephanie Arasim Portnoy
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Library of Congress Cataloging-in-Publication Data

Names: Hattjar, Bernadette, author.
Title: Fundamentals of occupational therapy : an introduction to the
profession / Bernadette Hattjar.
Description: Thorofare : Slack Incorporated, [2019] | Includes
bibliographical references and index.
Identifiers: LCCN 2018034746 (print) | LCCN 2018035368 (ebook) | ISBN
9781630916565 (epub) | ISBN 9781630916572 (web) | ISBN 9781617115981 (pbk.)
Subjects: | MESH: Occupational Therapy | Occupational Therapists | United
States
Classification: LCC RM735.3 (ebook) | LCC RM735.3 (print) | NLM WB 555 | DDC
615.8/515--dc23
LC record available at https://lccn.loc.gov/2018034746

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 This textbook is dedicated to my family, friends, work friends, and students—
both current and past. My strong support system provided me with the courage to
continue working on this book and the proof that hard work really does pay off.
Never give up!
Dedication ...................................................................................................................................v
Acknowledgments ......................................................................................................................ix
About the Author.......................................................................................................................xi
Preface ..................................................................................................................................... xiii
Introduction ..............................................................................................................................xv

Chapter 1 Introduction to the Profession of Occupational Therapy .......................... 1

Chapter 2 Practice in Mental Health and Psychosocial Occupational Therapy ..... 17
Chapter 3 Practice in the Physical Disability Arena .................................................... 33
Chapter 4 Practice in Pediatrics and Work With Individuals Under
Age 18 Years ..................................................................................................... 59
Chapter 5 Theoretical Foundation, Frames of Reference, and Practice
Models for the Occupational Therapy Profession ..................................... 71
Chapter 6 Legislation and Its Effect on Current Occupational Therapy Practice:
The Past 60 Years............................................................................................. 93
Chapter 7 Trendsetters and Significant People in the Profession............................ 105
Chapter 8 Technology and Occupational Therapy .................................................... 115
Chapter 9 Future Initiatives: Programming for the 21st Century ........................... 127
 This book would never have been completed without the ongoing support and
understanding of everyone at SLACK Incorporated, especially Brien Cummings.
I gratefully thank my family and friends for their encouragement and prompt-
ing me to “keep going” on this book despite many personal and some professional
setbacks. I am grateful to work in a supportive environment at Gannon University
in Erie, Pennsylvania, and I completed this book to set a good example of diligence
and focus for myself and my students.
I would certainly be remiss if I did not thank those who have passed on in my
family because, at times, their divine intervention kept me going.
 Bernadette Hattjar, DrOT, MEd, OTR/L, CWCE has been an occupational thera-
pist since 1985. Since that time, she has worked in both the clinical and academic
settings. Her experience and dedication to the field of occupational therapy moved
her to consider what new, fledgling students really needed to know and understand
about their field of study. The impetus for writing this textbook was an exercise in
taking away, rather than adding information about the profession.
Dr. Hattjar has written and presented to professionals extensively for more than
30 years about a variety of topics including service learning, learning styles, sexual-
ity, legacy-building opportunities, mental health issues, industrial rehabilitation
practice, and intervention techniques used for pediatric clients with mental health
and behavioral issues.
She has been actively involved in professional associations at the local, state,
and national levels and has held the office of responsibility and leadership in these
organizations.
For the past 15 years, she has taught master- and doctoral-level students in occu-
pational therapy programs housed at Gannon University in Erie, Pennsylvania.
 This book is the result of two divergent paths I have traveled in my personal and
professional lives.
Personally, and using my more than 20 years of teaching in higher education
and almost 40 years in the occupational therapy profession overall, I have never felt
that such a diverse and creative field had an introductory textbook that presented
a solid foundation to the profession. The textbooks that were available did not pro-
vide fledgling students with a good skill set for what was to come their way, either
academically or personally. I never felt that the textbooks offered a picture of what
new, incoming students needed to know. I reviewed myriad texts for the introduc-
tory course; some were quite abbreviated, and others were large and far too extensive
and conceptually involved for new students. I reflected back to when I began my
academic career as a new student in occupational therapy and wondered, “What did
I really need to know at the onset?”
Professionally (although I realize the vastness of the profession), I have always
felt that perhaps we were providing confounding information that new students
would not comprehend because of their lack of a knowledge base. I also realized that
students frequently confabulate information, but that doesn’t necessarily mean it is
correct or useful. It is just more information. If knowledge is not based on a good,
solid skill set, it really isn’t usable or the type of practical knowledge that one pro-
cures within the profession.
In preparing to develop and then write this textbook, I reviewed many introduc-
tory textbooks and tried to secure a clear picture of what others included, both cur-
rently and over the past 45 years. I felt that “editing” the information from current
and past scholars would be an easy task. I couldn’t have been more wrong. It is much
easier to add than to take away pieces of information. I would constantly question
and weigh out how important an item was and, in some cases, why some things were
included and others were not. This was to be the bane of my existence for many
months! I finally got to a point where I decided that the basics of the profession could
be included in this book, but all of the minutia included in some other textbooks did
not add to a welcoming introductory textbook nor was it necessary. Such specific
and particular information will be presented in the curriculum classes that follow.
However, students using this textbook will have a good general idea of what to expect
from their occupational therapy education.
As I wrote this textbook, life happened to me, as it always does to each one of us,
and each life experience taught me something about what is important and what is
not. This sense provided me with a firm belief that this textbook will guide—and I
hope motivate and inspire—new, incoming occupational therapy students to move
forward in their academic lives.
Welcome to one of the most diverse, creative, and fulfilling professions: occupa-
tional therapy.
—Bernadette Hattjar, DrOT, MEd, OTR/L, CWCE
 A foundation provides stability, strength, and a point from which everything that
follows is based. A building must have a solid foundation to sustain weight, stress,
wear and tear, unforeseen disasters, and the effects of time. A relationship must have
a solid and broad foundation to withstand whatever life presents to the individuals
involved—be it positive or negative, good or bad. A profession must have a solid
foundation to determine where it came from (origin and inception), where it has
been (history), and where it is going (practice trends and tendencies, development,
evolution). Only by understanding what comprises the foundation of any element or
concept can we understand its past, present, and future.
The occupational therapy profession has a rich and diverse past that can be traced
to the late 19th century. From its origin to the present, paradigms have shifted, the
world has become replete with technology, and societal structure and world aware-
ness have become blurred from the more proper and rigid concepts of the late 1800s
and early 1900s to the global community of today. Interestingly, many of the original
concepts on which the profession was based still hold true today, more than 100
years later. This provides evidence that the concepts and beliefs of the originators of
occupational therapy were and are accurate, appropriate, and correct.
Among these tried-and-true concepts are the following:
1. Analysis of activity: Our forerunners believed that for any task to be therapeu-
tic and both helpful and useful to the client, it had to be assessed and reduced
to its smallest component parts. In our activity analysis of today, we assess a
task or activity to determine its overall composition—the physical, psychologi-
cal, and related components that are part of the activity—and then match the
activity to our Occupational Therapy Practice Framework (OTPF; American
Occupational Therapy Association [AOTA], 2010) to determine elements of
the profession that are addressed by the activity and that apply to the client’s
diagnosis, needs, skills, and deficits.
2. Therapeutic use of self: Early therapists acknowledged the need to be compas-
sionate, confidential, empathetic, informed, and attentive to the needs of the
client. Today’s therapists adhere to an ethical code of conduct (AOTA, 2008)
and practice standards to ensure the duality of being both a professional and a
service provider to individuals who are in need of our services.
3. Educational preparedness: At the dawn of the profession, the educational
process was quite different from the extensive process of today’s accredited
occupational therapy programs (Accreditation Commission for Occupational
Therapy Education, 2013); however, specific elements of physiology, anatomy,
and psychology that were applicable to practice in the early 20th century still
apply today. Additional educational layers of human development, human
pathology, neurology, kinesiology, and abnormal psychology are included then
and now to enrich and broaden the scope of knowledge. For the student, this
may generally help you understand why you are taking courses within your
educational program, both currently and in the future. Remember that the
xvi Introduction

scope of this profession is broad, so your knowledge and educational prepara-

tion must reflect this fact.
4. Theoretical framework: Early practice was related to a physical medicine
knowledge base, a psychoanalytic and “asylum” approach to mental illness, and
developmental or genetic childhood manifestations. The occupational therapy
profession aligned itself with the status quo of the day, as did other health care
professions. In the middle of the 20th century, occupational therapy began to
develop its own theories for interventions, and this continues today. A theoreti-
cal framework provides our profession with a structured set of guidelines for
evaluation, intervention, and techniques. The particular theory that is used by
the therapist is reflective of the facility, the client diagnosis groups, and the
vision of the organization.
5. Acknowledgment of professional differences: Occupational therapy has never
thought of itself as the “be all” of health care professions or presented itself
in that manner. Occupational therapy has and does work with a variety of
health care providers to meet the needs of the client in a holistic, functional,
and purposeful manner. It is crucial that the occupational therapy professional
understand the parameters and domain of the profession. This is probably best
understood by viewing the OTPF.
6. Belief in a life balance: Therapists subscribe to the belief that there must be a
balance among work, rest, and leisure and play. When any of the basic elements
are done to excess or not at all, the individual’s life becomes “out of sync,” and
problems arise. In other words, too much of one thing upsets the balance in a
person’s life. When one adds on any illness, injury, or disability to this situa-
tion, the concept of balance and equilibrium becomes more easily understood.
Both early therapists and therapists of today use a variety of intervention tools
to assess and remedy a client’s out-of-sync life, including a very basic check-
list format of activities done during a typical day or week called an “Activity
Configuration”. Early practitioners believed that the mandate for structure and
daily time and activity balance promoted health. This still holds true today in
our busy society and in our profession.
7. Structure and consistency: Early days of the profession can be linked to 18th
century Europe and “moral treatment” concepts of structure, nutrition, social
and interpersonal interaction, gainful involvement in activity or tasks and
chores, adequate rest, self-care and hygiene, and the development of personal
levels of worth and esteem within a hospital or asylum setting. All of these
things revolved around a structured, consistent schedule. Realizing that many
clients had no concept of consistency and structure, the hospital or asylum
structure promoted client awareness of responsibility, contributions, interac-
tion, and self-satisfaction. This element holds true in the occupational therapy
profession of the 21st century. One only needs to view a daily schedule of a
client in rehabilitation to understand that the components of structure and
consistency remain basic elements of client care today.
The components of the profession’s past that hold true today are discussed
throughout this textbook. To provide consistency and structure, each chapter is
 Introduction xvii

organized in the same manner. Key words are introduced at the beginning of each
chapter and fully discussed and demonstrated in the specific chapter. The introduc-
tion to each chapter provides a basic history and review of specific details related to
the chapter topic. History related to the chapter topic is presented for the student
to understand how the specific topic or practice area has developed. “Questions to
Consider for Student Learning and Reasoning” discuss appropriate evaluations and
interventions that are commonly used in regard to the chapter topic. Each chapter is
consolidated into the “Summary” section of each chapter as a means of both review-
ing and highlighting important components for the student.
The intent of this introductory and foundational textbook is to provide entry-level
occupational therapy students with the information and tools they will need to better
understand, synthesize, and integrate the diverse elements of the profession into their
professional-level courses, where in-depth understanding of these basic concepts
occurs in an occupational therapy education program.

Accreditation Commission for Occupational Therapy Education. (2013). ACOTE standards for OTA,
OTR Master and OTR doctorate programs. Bethesda, MD: AOTA Press.
American Occupational Therapy Association. (2008). The Occupational Therapy Code of Ethics.
Bethesda, MD: AOTA Press.
American Occupational Therapy Association. (2012). Occupational Therapy Practice Framework:
Domain & process. American Journal of Occupational Therapy, 62, 635–682.