"And teach agony to sing": an afternoon with Eleanor Clarke Slagle

Using published works, archival correspondence, interviews with contemporaries, and historical commentary, an imagined conversation is presented between Eleanor Clarke Slagle (1871-1942) and three of her actual contemporaries. As a founder of the National Society for the Promotion of Occupational Therapy (later to become the American Occupational Therapy Association [AOTA] and a past-president and executive secretary of AOTA for 21 years, Slagle came in contact with a host of therapists as well as men and women who influenced her and the occupational therapy profession, most particularly Julia Lathrop, Adolf Meyer, William Rush Dunton, Jr., and Ida Sands. Emphasis is placed on some of her early life experiences; Hull House; and the evolution of the occupational therapy belief system, including occupations, curative work, and spiritual rehabilitation (i.e., self-respect, interests, ambition, happiness, economic usefulness, success). Special attention was taken to reflect Slagle's typical use of language and the vernacular of the mid-1930s. Extensive study was undertaken, through reading Slagle's published works, to remain true to her use of language.

Occupational therapy in full-inclusion classrooms: a case study from the Moorpark model

This article provides a historic review of the movement toward integrated classroom placements as well as the characteristics of full-inclusion classrooms relevant to occupational therapy school-based practice. A full-inclusion model adopted by the Moorpark Unified School District is described. This model incorporates occupational therapy as a vital and integral component of the school's inclusive education efforts.

The historical development of neuroscience in physical rehabilitation

Neuroscience and occupational therapy in physical rehabilitation have developed along parallel tracks. As physicians began to study the neural bases of motor control, they also began to reconsider the sequelae of "hopeless" diagnoses as conditions that they could influence. This change in some physicians' understanding of the neural mechanisms of motor control influenced other clinicians' ideas about patient care. Early work on treatment of patients with cerebral palsy and polio led to improvements in treatment approaches used to facilitate motor skill and functional motor ability in patients with upper motor neuron disorders. From the 1950s to the present, therapists have refined their treatment techniques as knowledge from neuroscience has become available. A few therapists, who are gradually increasing in number, have turned to the laboratory to study basic neuroscience problems that affect clinical treatment. This article describes the development of neuroscience research and neurorehabilitation theories and indicates common themes.

Outcomes research: the history, debate, and implications for the field of occupational therapy

The field of occupational therapy, as with all facets of health care, has been profoundly affected by the changing climate of health care delivery. The combination of cost-effectiveness and quality of care has become the benchmark for and consequent drive behind the rise of managed health care delivery systems. The spawning of outcomes research is in direct response to the need for comparative databases to provide results of effectiveness in health care treatment protocols, evaluations of health-related quality of life, and cost containment measures. Outcomes management is the application of outcomes research data by all levels of health care providers. The challenges facing occupational therapists include proving our value in an economic trend of downsizing, competing within the medical profession, developing and affiliating with new payer sources, and reengineering our careers to meet the needs of the new, nontraditional health care marketplace.

The use of drama and puppetry in occupational therapy during the 1920s and 1930s

The occupational therapy literature was reviewed to determine how drama was used as a clinical modality in the 1920s and 1930s. It appears that the emergence of the Little Theater Movement in the early 1900s, which enabled amateurs to perform publicly, provided the impetus for occupational therapists to use drama as purposeful activity. The theatrical modes most frequently used were pageantry, puppetry, and comedic plays. Additionally, the collective nature of drama facilitated group-centered treatment. Noble, a psychiatrist at Sheppard and Enoch Pratt in Maryland, used drama for insight-oriented therapy and recommended that occupational therapists use drama for treatment of persons with mental illness. Drama in occupational therapy still exists in some psychiatric settings, although a new discipline known as drama therapy, which is a division of the creative arts therapies, has arisen. Although drama therapy addresses psychodynamic goals, drama also can be used in occupational therapy to promote competence, enhance self-concept, and improve socialization.

The profession's image, 1917-1925, Part II: Occupational therapy as represented by the profession

This second part of a two-part article examines the representation of occupational therapy during its formative years, 1917-1925. It focuses on the image of the profession as it was described in the early professional journals and compares this image with that projected by the media (as described in Part I). Both the media and professional literature presented a similar image of occupational therapy: that of a profession that offered the promise of returning persons with disabilities to useful occupation within society. In today's health care system, where every profession espouses the goal of returning patients to full functioning, it is important to remember that in 1917 only one profession held that goal. The portrayal in the media and in the professional literature of occupational therapy at that time confirms this image.

The profession's image, 1917-1925, Part I: Occupational therapy as represented in the media

This first part of a two-part article examines how occupational therapy was represented in the media during the formative years of the profession, 1917-1925. Through an examination of 44 articles published in The New York Times during these years, three common themes emerged: restoration of persons with disabilities to social usefulness, the many facets of occupational therapy, and achieving public recognition of occupational therapy. This analysis indicates that the media portrayed occupational therapy as a small but important profession primarily concerned with restoring patients to economic and social usefulness. This favorable portrayal was in keeping with the values of the times and may have contributed to promoting public acceptance of the profession.

Influence of the U.S. military and occupational therapy reconstruction aides in World War I on the development of occupational therapy

The development of occupational therapy was heavily influenced by an early evolved relationship between orthopedists and reconstruction aides during the first World War. Orhopedists were largely responsible for both the presence of occupational therapy in the war and the eventual acceptance (by army personnel) of women fulfilling this military function. As a result of gender issues of that time--characterized by a dearth of employment opportunities for women and by a general resistance to women in military roles--this affiliation with orthopedists in World War I served to promote occupational therapy within the military environment. This affiliation also marked an early willingness by occupational therapists to accept the medical model as one guide for clinical practice.

Weaving the warp and weft of occupational therapy: an art and science for all times

This article employs a metaphor of weaving in order to analyze, both historically and critically, the art and science of occupational therapy. To spark reflection about where occupational therapy has been, is now, and would like to progress as the new century approaches, the article is thematically organized around the profession's two most fundamental convictions. These convictions are termed the warp and weft of occupational therapy. The warp of occupational therapy is defined as our philosophical belief that engagement in occupation can favorably influence health. The weft of occupational therapy is defined as our humanistic value of respect for the person. Occupational therapy is, in turn, regarded as a powerful tapestry of human potential that unfolds when this belief and value are therapeutically applied. By analyzing selective clinical, educational, and research initiatives throughout this century, the article is dedicated to the continued adherence to, and development of, occupational therapy's core principles.

The fullness of empathy: reflections and illustrations

Seven core values are said to undergird the profession of occupational therapy, with empathy serving as a hallmark of one of those values-personal dignity. This inquiry explores the meaning of empathy within a practice that holds occupation at its center. The literature on empathy in both philosophy and the behavioral sciences yields cogent thoughts about the fullness of empathy and its characteristics actions. The Healing Heart, the biography of a pioneer therapist, Ora Ruggles, shows the manner in which occupational therapists can be empathic in their practice. These reflections and illustrations serve to sharpen the vision of occupational therapists as persons who reach for both the hands and the hearts of others.

Bridging conflicting ideologies: the origins of American and British occupational therapy

Occupational therapy practice has bridged two contradictory value systems for more than 100 years. This article describes the origins of practice ideas in both the United States and Britain and demonstrates that founding members of the occupational therapy profession all shared a core of humanistic beliefs while embracing the emerging paradigm of scientific medicine. The result has been an intellectual tension between the biological and the psychosocial aspects of practice. For more than 75 years, occupational therapists struggled to balance the art and science of patient care; recent debates on modalities, practice domains, and research priorities indicate that the unifying core of the profession is occupation that considers a person's mind and body.

Moral treatment: how a caring practice lost its rationale

The 19th-century practices of moral treatment and phrenology serve as historical examples of a narrowing focus in health care and reveal the manner in which theories can shape practice. The story of moral treatment, as it is told in connection with phrenology, emphasizes the push for success and right solutions. The push followed several shifts in the conceptualization of mental illness, the last of which proved moral therapy unreasonable. If practitioners in this century hope to ensure that the heart of moral treatment will withstand the effects of ever-changing theories, they must hold caring attitudes, words, and actions at the center of their practice.

Graded activity: legacy of the sanatorium

Occupational therapists in all areas of practice grade therapeutic activities to help patients progress toward their goals. It is proposed in this paper that the concept of graded activity originated in German tuberculosis sanatoria in the late 1800s, when patients were required to walk on graded (sloped) land for exercise. British physician Marcus Paterson included work, as well as walking, in his graduated exercise program for tuberculosis patients and was honored for this innovation at the founding meeting of the National Society for the Promotion of Occupational Therapy (NSPOT). George Barton, Susan Tracy, and Herbert Hall were among the NSPOT members who contributed to the development of graded activity as a principle in occupational therapy intervention. The military rehabilitation programs established during World War I provided additional impetus, and by the mid-1920s, graded activity was recognized as central to the profession.

Ten milestone issues in AOTA history

This paper identifies 10 professional questions that the author has labeled milestone issues in the history of the American Occupational Therapy Association. Subjects encompassed by these issues are medical control, certified occupational therapy assistants, licensure, proficiency testing, entry-level degrees, treatment media, maintenance of competency, whether occupational therapists serve patients or clients, professional autonomy, and the status of occupational therapy as a profession. Although this paper is primarily a factual record of events and discussions referenced in official publications, the reader will recognize the insertion of author commentary and opinion in several of the issues discussed.

Embracing our past, informing our future: a feminist re-vision of health care

Using a feminist perspective, this paper explores the roots of the practice of healing and medicine. It traces the role of women in health care from prehistorical times, through the present, and into the future discussing the changing paradigms that the author identifies as (a) the Prototypic Paradigm: Mysticism and Healing; (b) the Scientific Paradigm: Curing; and (c) the Paradigm of Inclusion: Caring, Curing, and Healing. The role and status of women in society are reflected within these paradigms, and the changing status of the profession of occupational therapy is discussed within this framework. The unique skills and contributions of occupational therapy more closely fit within the Paradigm of Inclusion and can support us as health care leaders within the changing world of the 21st century.

Opening feminist histories of occupational therapy

This paper frames the history of occupational therapy in feminist terms. It focuses on gender segregation in occupational therapy, the influence of class and race in shaping opportunities for occupational therapists, and the place of feminism in the goals and achievements of the occupational therapy profession. Such issues have been addressed by feminist scholars in histories of women in medicine, nursing, and other helping professions. These sources help place the achievements of occupational therapy within the context of women's historic entry and advancement in the American work force.

Structuring education: development of the first educational standards in occupational therapy, 1917-1930

The movement to standardize educational preparation in occupational therapy grew as the profession developed following World War I. This paper explores the debates that surrounded the evolution of occupational therapy's first sanctioned educational system. A variety of professionals involved in the formation of occupational therapy engaged in these debates. They focused their attention primarily on whether education should be regulated and, if so, how that education might be structured. Each coveted different views about how the fledgling profession might develop. These early debates signify one of the first attempts to identify a vision for the evolution of occupational therapy.

History of federal legislation for persons with disabilities

This paper discusses federal legislation relating to persons with disabilities and it divides into 13 areas. Several areas of legislation, such as education and basic education, have a long history beginning with World War I. Laws related to other areas, such as federal support for developing technology, have been adopted only within the past 5 years. The Americans With Disabilities Act of 1990 (ADA) (Public Law 101-336), which guarantees civil rights to Americans with disabilities, has five titles, and each is summarized. Although the ADA provides for Americans with disabilities to be included in American society, it has some major limitations, including the lack of an affirmative action requirement and of provisions for the education and training of persons with disabilities so that they can qualify for employment. Several of the federal laws related to persons with disabilities have affected the field of occupational therapy either favorably or adversely. The conclusion is drawn that occupational therapists need to be alert to pending legislation to promote the role of occupational therapy in serving persons with disabilities.

Exploring educational boundaries: occupational therapy and the multiple-entry-route system, 1970-1982

Since the mid-1960s, occupational therapy has maintained a multiple-entry-route educational system that provides professional preparation leading to certification for a variety of candidates. This paper focuses on the 1970s and recounts a time marked by exploration of an assortment of entry-level routes that embraced the concept of laddering and included proficiency testing and career mobility programs. The paper reviews the educational debates that occurred while occupational therapy tested the limits of innovative educational mechanisms. Although the American Occupational Therapy Association debated new options for professional preparation and temporarily instituted one additional educational avenue in those years, by 1982 its educational system returned to its mid-1960s design.

Point of departure (a play about founding the profession)

Through a combination of recorded conversations, published speeches, and correspondence, insights are gained into some perspectives of William Rush Dunton, Jr., MD (1868-1966), one of the founders of the occupational therapy movement. His views on the spirit of research and the differentiation of occupational therapy and physical therapy are offered. His personal feelings about some of his contemporaries--Adolf Meyer, Eleanor Clarke Slagle, and George Edward Barton--are also related. The events leading to the creation of the National Society for the Promotion of Occupational Therapy in 1917, the forerunner of the American Occupational Therapy Association, Inc., are detailed.