2. C
anadian occupational thera-
pists have strong historical
ties to the Canadian mili-
tary.1 Occupational therapists were
heavily involved and highly valued2,3
in the rehabilitation of return-
ing injured military members of
World War I and World War II.
By the 1950s, however, the num-
ber of Canadian Forces (CF) occu-
pational therapists had dwindled.
Currently, there are no uniformed,
enlisted occupational therapists in
the CF. Only 4 nonenlisted (civil-
ian) CF occupational therapists
are employed in the Physical Medi-
cine and Rehabilitation Services
Department.
There have been recent attempts to
reintegrate occupational therapy ser-
vices into CF rehabilitation pro-
grams. In order that occupational
therapy is exploited for the benefit
of injured CF members, some core
concepts of the profession are out-
lined and examples provided of the
needs of injured military members
that would warrant the expertise of
occupational therapists.
This article: (1) provides an intro-
duction to occupational therapy
practice and the scope of practice
of occupational therapists; (2) out-
lines some standard occupational
therapy concepts, such as occupa-
tion and the dynamic relationship
between the person, his or her occu-
pations, and his or her environ-
ments; (3) defines occupational
need and issues that may arise from
unmet needs such as disruption,
deprivation, and imbalance, illustrat-
ing these with military examples;
and (4) reports on the current status
of occupational therapists within the
CF, providing reasons for why more
occupational therapists employed by
CF on a permanent basis (hereafter
referred to as “CF occupational ther-
apists”) would augment existing CF
services.
An Outline of Occupational
Therapy Practice
Occupational therapy is a health care
profession founded on the knowl-
edge that engaging in meaningful
occupations promotes health and
well-being. It is “the art and science
of helping people do the day-to-day
activities that are important and
meaningful to their health and well-
being through engagement in valued
occupations.”4(p28) According to
Townsend and Polatajko, “Occupa-
tional therapy enables a just and
inclusive society so that all people
may participate to their potential in
the daily occupations of life.”5(p372)
Occupational therapy crosses
physical-mental health boundaries.
Occupational therapists work to a
biopsychosocial model providing
holistic care management and inter-
ventions for physical, psychological,
emotional, and social issues associ-
ated with disability and functioning.
Spirituality, finding meaning in
everyday life, is an integral part of
the holistic model1,6 because many
people begin searching for spiritual
support during a personal crisis, ill-
ness, loss, or trauma.7
Employment with public and private
organizations means occupational
therapists work in a variety of non-
military settings, including hospitals,
the community, long-term care facil-
ities, and rehabilitation clinics. Many
are self-employed.8 Collaborating
with individuals, families, groups,
and communities to assess degrees
of engagement in everyday occupa-
tions, occupational therapists work
with all age groups, from neonatal to
elderly, providing long-term care, sub-
acute care, and acute care, including
input to emergency clinics.
Work in acute care includes postsur-
gical interventions, hand and upper-
limb rehabilitation, and sensory, per-
ceptual, and cognitive retraining. In
emergency departments, occupa-
tional therapists’ help prevent
unnecessary admission to acute beds
often through equipment and
orthotic provision, referral to com-
munity support, and mobility and
transfers education.
In psychiatric units, occupational
therapists might focus on successful
community integration by teaching
new strategies and providing graded
activities. Attention might be
directed to: (1) increasing energy;
(2) finding a balance among self-care,
productivity, and leisure; (3) social
participation; (4) decision making
and priority setting; and (5) produc-
tivity options that decrease stress.9
The Concept of Occupation
In lay language, “occupation” is
understood as paid work. Occupa-
tional therapists recognize occupa-
tion in a broader sense. Crepeau et al
stated that occupations “include the
day-to-day activities that enable peo-
ple to sustain themselves, to con-
tribute to the life of their family,
and to participate in the broader
society.”4(p28) Thus, occupations
are multifaceted phenomena going
beyond CF members’ everyday
work. Occupations are fundamental
to human health and well-being
because they provide meaning, iden-
tity, and structure to people’s lives
and reflect society’s values and cul-
Available With
This Article at
ptjournal.apta.org
• Listen to a special Craikcast on
the Military Rehabilitation Special
Issue with editors John Childs and
Alice Aiken.
• Audio Podcast: “Advancing the
Evidence Base in Rehabilitation
for Military Personnel and
Veterans” symposium recorded at
APTA Conference 2013, June 28,
2013, in Salt Lake City, Utah.
Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
September 2013 Volume 93 Number 9 Physical Therapy f 1245
3. ture.10 Because humans are occupa-
tional beings,5 occupations have
therapeutic potential.
Occupational therapists categorize
occupations as self-care, productiv-
ity, and leisure.4 Self-care can be
functional mobility and communica-
tion, home management, personal
hygiene, or community activity such
as grocery shopping. Self-care exam-
ples are a CF member dressing him-
self or herself in uniform or walk-
ing to the cafeteria or mess hall to
eat. Productivity includes paid and
unpaid work. Listening to sonar for
enemy submarine or physical fitness
training at the base gym are CF exam-
ples. Leisure activities include social-
izing, outdoor activities, games, and
sports. An example of a leisure activ-
ity might be 2 infantrymen playing
cards in the back of their light
armored vehicle. The term “occupa-
tion,” as used in occupational ther-
apy, is defined in Table 1.
An important skill of occupational
therapists is the ability to analyze
tasks, analyze members’ perfor-
mance in those tasks, and plan inter-
ventions that have a direct effect on
the occupations. Almost every occu-
pation requires a combination of vol-
untary movements and mental pro-
cesses to perform tasks.5
A battle tank driver in Afghanistan is
an example of a CF member who
must execute combinations of psy-
chological and physical processes
required in a complex CF occupa-
tion. A simplified task analysis of 1
aspect of this occupation is the driv-
er’s need to: (1) listen and under-
stand the crew commander’s direc-
tion (psychosocial and cognitive
skills) while staying vigilant for
pedestrians and other vehicles (sen-
sory and cognitive skills), and (2)
look through the episcope to esti-
mate distances of buildings from the
tank (sensory and perception skills)
while manipulating the brake and
throttle and steering the yoke (phys-
ical skills).
The Person-Environment-
Occupation Relationship
Notwithstanding a member’s abili-
ties prior to and following trauma,
engagement in occupations is
affected by the individual’s or popu-
lation’s environment (physical, insti-
tutional, cultural, and social). The
environment can facilitate or create
barriers to participating in society.
Steep slopes and steps in the built
environment can create access barri-
ers. Inadequate policies, procedures,
and standards can create barriers to
services. Social barriers, such as neg-
ative attitudes to disability, can iso-
late people with disabilities.11
Occupation is a function of the fit, or
lack of fit, among the person’s skills
and abilities, the demands of a par-
ticular occupation, and the environ-
ment in which the occupation is per-
formed.12 In addressing occupation,
occupational therapists, therefore,
must attend to the complex dynamic
relationships among a person, his or
her occupation, and his or her
environment.
Occupational Need
Everyone has occupational needs to:
(1) choose daily occupations, (2)
participate in occupations, (3) have a
balance of various occupations in his
or her life (eg, self-care, productivity,
leisure), and (4) engage in personally
meaningful occupations.5,10,13
Unmet occupational needs occur
when an individual or group is
unable to engage in daily occupa-
tions. Unmet needs can lead to occu-
pational disruption, deprivation, or
imbalance.5,10,13
Table 1.
Occupational Therapy Terminology
Terms Definition Canadian Forces (CF) Examples
Occupation Occupations are “day-to-day activities that enable
people to sustain themselves, to contribute to the life
of their family, and to participate in the broader
society.”4(p28) Occupational therapists define
occupations as self-care, productivity, and leisure.4
Self-care: Functional mobility and communication,
home management, personal hygiene, and
community activity such as grocery shopping.
Productivity: Paid or unpaid work.
Leisure activities: Socializing, outdoor activities,
games, and sports.
Occupational Needs
The need to: (1) choose daily occupations, (2) participate in occupations, (3) have a balance of various occupations in one’s life (eg, self-care,
productivity, leisure), and (4) engage in personally meaningful occupations.10,13
Occupational
Disruption
“Occurs when a person’s normal pattern of occupational engagement is disrupted due to significant life
events.”14(p201) Disruptions often are temporary and transient interruptions to a CF member’s normal engagement
in daily occupations. Engagement in occupations can have a mediating effect.
Occupational
Deprivation
A “state in which a person or group of people are unable to do what is necessary and meaningful in their lives due to
external restrictions. It is a state in which the opportunity to perform those occupations that have social, cultural,
and personal relevance is rendered difficult if not impossible.”14(p200)
Occupational
Imbalance
Occurs when a person is unoccupied, underoccupied, or overoccupied.5 “The loss of a balance of engagement in
occupations”16(p173) affects health and well-being.
Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
1246 f Physical Therapy Volume 93 Number 9 September 2013
4. Occupational Disruption,
Deprivation, and Imbalance
and the Canadian Forces
Occupational disruption “occurs
when a person’s normal pattern of
occupational engagement is dis-
rupted due to significant life
events.”14(p201) Being posted to a
new military base, preparing for war,
changing military positions, becom-
ing ill, or grieving over the loss of a
comrade are CF examples of occupa-
tional disruption. Occupational dis-
ruptions are, typically, temporary
and transient interruptions to a CF
member’s normal engagement in
daily occupations.5
When medical conditions have long-
term consequences, occupations can
have a mediating effect. With appro-
priate rehabilitation supports and
resources, the interruptions and con-
sequences can be corrected, and the
person may even have an improved
level of occupational functioning.10
Retired Master Corporal Paul Frank-
lin is an example of how CF mem-
bers overcome and excel after occu-
pational disruption. Master Corporal
Franklin severed both legs during an
explosive device strike in Afghani-
stan in 2006. After tremendous
efforts by Master Corporal Franklin
and involving rehabilitation special-
ists, psychological counselors,
administrative staff, he co-founded
the Northern Alberta Amputee Pro-
gram and the Franklin Foundation.
He is a motivational speaker and has
a book published regarding his strug-
gles and successes titled The Long
Walk Home: Paul Franklin’s Jour-
ney From Afghanistan.15
Occupational deprivation is the
“state in which a person or group of
people are unable to do what is nec-
essary and meaningful in their lives
due to external restrictions. It is a
state in which the opportunity to
perform those occupations that
have social, cultural, and personal
relevance is rendered difficult if
not impossible.”14(p200) At times, reg-
ular and reserve CF members with
severe physical and psychological
issues are left in a “state of preclu-
sion from engagement in occupa-
tions . . . due to factors that stand
outside the immediate control of
the individual.”14(p201) A minority of
severely injured CF members (often
reserve members or regular mem-
bers posted away from large military
bases) who are located in rural areas,
are underemployed or unemployed
due to lengthy disability, and per-
ceive themselves as not having a
“voice” in mainstream society may
be prone to occupational depri-
vation.14 Left unresolved, occupa-
tional deprivation and disruption can
result in secondary psychosocial
issues such as depression and mal-
adaptive behaviors14 such as exces-
sive drinking.
Occupational imbalance occurs
when a person is unoccupied,
underoccupied, or overoccupied.13
According to Molineux, “the loss of a
balance of engagement in occupa-
tions” affects health and well-
being.16(p173) Townsend and Wilcock
stated, “Underemployed people are
at risk for ill health because they are
less likely to experience sufficient
mental, physical and social exercise
that provides meaning and enrich-
ment. . .over-employed people are
also at risk for ill health because they
are too busy to look after them-
selves, their families, or their
community.”13(p82)
Lack of opportunities to participate
in leisure or productivity occupa-
tions also causes occupational imbal-
ance. The effect of impairment or
injury on availability of CF members’
time for elective occupations has not
been researched. However, experi-
ence and research from other groups
indicate that people with disabilities
and functional limitations spend
more time in self-care and passive
activities within their home environ-
ment than people who are nondis-
abled, leaving less time for discre-
tionary activities.17,18
Canadian Forces members who have
mental or physical injuries may expe-
rience an over-engagement in
“health work” (a range of inten-
tional, yet institutionally prescribed,
practices in which people must
engage when they are ill or
injured)19 to the detriment of other
occupations. Experience with mili-
tary members severely injured by
explosives, resulting in amputations,
burns, shrapnel residue, brain injury,
hearing loss, and anxiety, indicates
injured military members spend
much of their day “getting better.”
These severely injured members are
seen by different specialists in vari-
ous locations, are engaged in diverse
therapeutic “homework” over
months or even years, and are taking
numerous medications.
Extensive health work involves tre-
mendous effort, endurance, organi-
zation, and motivation, often leaving
little energy or time for other types
of meaningful occupations. Health
work becomes more complex when
injured CF members experience bar-
riers such as complicated health pol-
icies and procedures that interrupt
the rigorous health work routine.
Refer to Table 1 for a summary.
Current Status of
Occupational Therapy
Within the Canadian Forces
Rehabilitation Services
Occupational therapists are catego-
rized in CF as “Role Four” care pro-
viders, meaning occupational ther-
apy is viewed as a specialized
profession in which care is delivered
over a protracted period of time. The
military does not typically deploy
Role Four health care professions,
“therefore, OTs [occupational thera-
pists] would not be called upon to
Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
September 2013 Volume 93 Number 9 Physical Therapy f 1247
5. deploy into mission areas, and that
means there is no requirement for
OTs to be CF members” (Brigadier-
General D.E. Martin, written commu-
nication, August 2008). Canadian
Forces occupational therapy differs
from the small but influential US
Occupational Therapy Army Medical
Specialist Corps, which deploys with
combat units and is charged with a
variety of responsibilities,20 includ-
ing running a post-blast concussion
and mild traumatic brain injury (TBI)
clinic.20,21
At present, CF military members
requiring occupational therapy are
referred to civilian businesses that
offer private, contracted short-term
occupational therapy services or to
civilian rehabilitation centers. Pri-
vate occupational therapists from
civilian businesses may be con-
tracted to provide services such as
home modifications and prescription
of medical equipment and may not
assess the occupational needs of CF
members who are their patients.
Canadian Forces occupational thera-
pists are now employed in posts on
some military bases across Canada
(ie, in Edmonton, Alberta; Ottawa,
Ontario; Valcartier, Quebec City; and
Halifax, Nova Scotia). Most work
within rehabilitation clinics, along-
side physical therapists. The CF’s
intent is to expand CF occupational
therapy to every military base in Can-
ada.22 The expectation is that by con-
necting CF occupational therapists
with the numerous civilian occupa-
tional therapists, there will be
increased focus on the occupational
needs of the CF members.
Canadian Forces Health
Culture: Critical Issues for
Occupational Therapy
Culture is defined as “the attitudes,
feelings, values, and behaviours that
characterize and inform society as a
whole or any social group within
it.”23 Culture is typically understood
as national or ethnographic, but busi-
nesses and industry have particular
corporate cultures that distinguish
each from others.24 The CF is one
particular cultural group.
Of particular interest to occupational
therapists are 4 issues: (1) the man-
date for occupational therapists,
(2) the priority to rehabilitate those
who are injured to retain them and
ensure they are physically and men-
tally fit throughout their military
career, (3) the tenet of universality of
service, and (4) the expectation that
those injured will work at their reha-
bilitation as if it were their job.
Some cultural issues limit occupa-
tional therapy practice in the CF.
Others provide insight into the range
of CF “insider” knowledge required
by occupational therapists for suc-
cessful contribution to injured CF
members’ rehabilitation.
Canada’s Department of Defence
states the role of occupational ther-
apists as:
Occupational therapists (OTs) assess
an individual’s functional abilities,
determine a treatment and interven-
tion plan and put it into place;
develop, restore, or maintain skills;
deal with disabilities; attenuate chal-
lenging situations; and adapt the envi-
ronment to promote optimal auton-
omy in the patient’s daily, family,
social, and professional lives. Con-
cretely, OTs seek to assist the individ-
ual in recovering from impaired func-
tions and strengthening those that are
still intact, while teaching the patient
how to deal with the disability and do
things differently. They introduce
technical aids such as wheelchairs,
create and fit orthotic devices, and
adapt ill and injured CF personnel’s
environment, including their home,
vehicle, and workstation.25
Assessment and intervention target-
ing occupational need are absent
from, or not explicitly stated in, the
CF occupational therapists’ mandate.
There is, thus, the potential to over-
look or not deal in detail with the
factors that limit CF members’
progress.
The CF’s priority is to rehabilitate
those who are injured to retain
them22 and ensure they are physi-
cally and mentally fit throughout
their military career.26,27 Occupa-
tional therapists can work across
physical injury into emotional and
psychological health for maximum
rehabilitation. Civilian occupational
therapists limited by contractual
agreements that focus on aids and
adaptations will not be able to offer
the broad range of interventions to
meet the needs of injured members.
Canadian Forces occupational thera-
pists are better situated to ensure
individuals’ successful adaptation to
the range of demands and situations
for military readiness and safe return
to duty.
The “principle of universality of ser-
vice” states, “Canadian Force mem-
bers are liable to perform general
military duties and common defence
and security duties, not just the
duties of their military occupa-
tion.”28 To ensure effectiveness of
CF, this principle overrides that of
the Canadian Human Rights Act sec-
tion 15(2) “duty to accommodate”
those with injury, illness, or disabil-
ity.28 Every civilian occupational
therapist receiving a referral for
return-to-work rehabilitation would
necessarily need to spend quite
some time researching the spec-
trum of duties expected of injured
members. Canadian Forces occupa-
tional therapists would have knowl-
edge of the range of general military,
defense, and security duties that an
injured member might be required
to carry out so as to undertake a
thorough vocational assessment and
return-to-work plan.
Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
1248 f Physical Therapy Volume 93 Number 9 September 2013
6. As in the past, injured military per-
sonnel must remain “military obli-
gated to do their duty,”1(p91) which,
in this case, is to become rehabili-
tated. The expectation is that injured
members will work at their rehabili-
tation as if it were their job.
Although rehabilitation is usually a
priority for civilians with trauma, it
does not always carry the same cru-
cial focus as it does for CF members.
Canadian Forces occupational thera-
pists have a tacit understanding of
the CF and members’ obligation
so as to provide timely, military-
focused rehabilitation interspersed
with discretionary occupations that
meet members’ occupational needs.
According to Besemann, “Most sol-
diers . . . start their rehabilitation at
the level of function that exceeds the
end-state among civilians.”22(pS140)
The seriousness of some injuries
means rehabilitation can be a long
process requiring determination of
the injured member, continuity of
rehabilitation, health team cohesion
for comprehensiveness, and the spe-
cialist skills of a CF occupational
therapist.
Future Occupational
Therapy and the
Canadian Forces
Program effectiveness and efficiency
studies would help with decisions
about service provision, but the
small number of CF occupational
therapists makes specific CF occupa-
tional therapy program evaluations
and research unfeasible. There are,
however, American clinical studies
and reports that can inform practice.
American military occupational ther-
apy evidence-based clinical practice
guidelines are available in areas such
as mild TBI.29 Research studies have
been conducted on various special-
ties, such as burns.30 Reports of poly-
trauma31 and combat stress casual-
ties32 show the complexity of
rehabilitation and demonstrate the
adaptability of military occupational
therapists and the range of expertise
needed.
Notwithstanding the quality of CF
health care, there are gaps. A report
on national defense stated:
As effective as current Canadian
Forces health care and social support
programs are, there is room for
improvement. Concern has been
expressed over the ability of the Cana-
dian Forces to meet the needs of sol-
diers recovering after being injured in
combat in Afghanistan and in other
operations. Of particular worry is
the ability of the military health care
system to care for the growing num-
ber of those suffering operational
stress injuries (OSI), including post-
traumatic stress disorder (PTSD).33(p1)
Psychosocial interventions for
addressing OSI and PTSD are inter-
woven within the biopsychosocial
model for populations of injured CF
members: (1) those with transient,
intermittent injuries; (2) those
returning from overseas missions
with very serious injuries or severe
injuries; and (3) those with perma-
nent injuries who are transitioning
from the CF into civilian life. These
categories are informal, with no
clear boundary regarding the type of
injuries or the degree of injury sever-
ity for each. The information is sum-
marized in Table 2.
Interventions are related to eliminat-
ing or minimizing barriers to the per-
son, the environment, or the occu-
pation to reduce occupational
disruption, deprivation, and imbal-
ance and improve chances of suc-
cessful occupational engagement.
Members With Transient
and Intermittent Injuries:
Promoting Military
Readiness Through
Occupation
Occupational therapy assessment of
those experiencing short-term inju-
ries or illness (eg, postsurgery, pain,
strains and sprains, mental and phys-
ical fatigue—the bulk of those seen
in the CF rehabilitation clinics) deter-
mines the impact of the injury or
illness on CF members’ occupations.
Mental and physical abilities can be
improved by a schedule of graded
activities (person). In-garrison assess-
ment might focus on the workspace,
such as maintenance hangers, work-
shops, gymnasiums, classrooms, and
office settings, for ergonomic modi-
fications, provision of specialist
equipment, or environmental altera-
tions (environment). Insider CF
knowledge of the fundamentals of
high-risk CF trades, including the
essential components of jobs and
minimal operational and physical fit-
ness standards, facilitates interven-
tion planning that targets adaptation
of the trades tasks (occupation),
making them simpler or less
demanding and promoting greater
success.4
Canadian Forces occupational thera-
pists can assist in assessing whether
injured CF members will return
safely to their position in a modified
fashion or be transferred for a limited
time to another position that is both
meaningful and essential to the mis-
sion at hand. For instance, a CF occu-
pational therapist would assess the
work capacity of an injured mem-
ber in CF duties requiring lifting,
pushing, pulling, work tolerance,
and psychosocial areas such as main-
taining attention, concentration, and
memory.
Critically, CF members’ sensory pro-
cessing, cognition, and ability to reg-
Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
September 2013 Volume 93 Number 9 Physical Therapy f 1249
7. ulate emotions can be impaired after
a traumatic event, affecting their abil-
ity to engage in social situations and
participate in self-care and work
tasks. Enabling CF members to
re-engage in tasks by supporting
them in planning and initiating daily
schedules and in organizing their
own contacts and associations is an
important contribution of CF occu-
pational therapists.
Members Who Are Severely
Injured: Promoting Timely
Progress Through
Occupation
Those identified as being very seri-
ously injured or severely injured
because of military mission injuries
are top priority for CF rehabilitation.
During acute and subacute phases of
very serious and severe injury, and
before the option of preparing to
return to work, the road to full
recovery is long, often isolating, frus-
trating, and painful and can be filled
with months and years of health
work. Canadian Forces occupational
therapists can assess and treat per-
sonnel who are very seriously
injured or severely injured at various
stages of recovery, agreeing on a
plan for amelioration of limitations
to engagement in occupations.
Hospital and home visits during the
acute phase may place priority on
the environment and occupation. In
addition to determining and ordering
essential equipment such as wheel-
chairs to lessen dependency and
coordinating work for home modifi-
cations such as ramps and stair lifts
to reduce lengthy wait times, CF
occupational therapists can provide
ongoing support for the CF member
and family to ensure success. A
graded program of occupation focus-
ing on early self-care intervention
establishes the expectation and pos-
sibility of independence in bathing,
toileting, and dressing and supports
caregivers through education, in par-
ticular therapy strategies, handling
techniques, and coping mechanisms.
Home discharge planning involving
the injured military member and fam-
ily and rehabilitation professionals
starts early to accommodate the per-
son’s functional level.
Issues related to the person may
begin at the subacute stage. Outpa-
tient occupational therapy rehabilita-
tion, preferably in-garrison to main-
tain military bonds and associations,
enables new or existing skills to be
developed through: (1) relaxation
techniques, (2) problem solving on
home-front issues, (3) stress and
Table 2.
Potential Occupational Therapist Roles
Populations of Injured Canadian Forces (CF) Members
Occupational Therapist Role: Interventions Focused on
Eliminating or Minimizing Barriers to the Person, the
Environment, or the Occupation
Transient, intermittent injuries: Those experiencing short-term injuries or
illness (eg, postsurgery, pain, strains and sprains, mental and physical
fatigue—the bulk of those seen in the CF rehabilitation clinics).
Expected outcome: To minimize occupational disruption.
Person: Mental and physical abilities may be improved by a schedule
of graded activities.
Environment: In-garrison assessment: workspace (maintenance
hangers, workshops, gymnasiums, classrooms, and office settings)
for ergonomic modifications, environmental alterations, or
provision of specialist equipment.
Occupation: Intervention planning that targets adaptation of the
trades’ tasks, making them simpler or less demanding.
Severely injured: Those identified by the military health system as being very
seriously injured or severely injured because of domestic or overseas military
mission injuries.
Expected outcome: To decrease occupational deprivation and imbalance.
Person: Development of new or existing skills such as stress and
anger management classes, assertiveness training, relaxation
techniques, cognitive-behavioral training, and problem solving on
home-front issues. Pain and sleep monitored; advice and initiation
of habit training.
Environment: Ordering essential equipment such as wheelchairs to
lessen dependency and coordinating work for home modifications
such as ramps and stair lifts to reduce lengthy wait times, plus
family support for adherence and success.
Occupation: A graded program of early self-care intervention and
support for caregivers through education in particular therapy
strategies, handling techniques, and coping mechanisms.
Transitioning injured: Once CF members fully transfer from the CF, they
often are titled veteran. If injured CF members do not return to their former,
or an alternative, military position (due to institutional barriers or personal
choice), CF occupational therapists can augment existing military
transitioning services.
Expected outcome: To decrease occupational disruption, deprivation, and
imbalance.
Person: Sleep/hygiene advice, community services resources,35 goal
planning, provision of skills in conflict resolution, communication,
financial and time management, and methods of solving specific
problems.38
Environment: Possible interventions specific to the family (eg,
locating community resources such as social supports, child care,
family counseling).35
Occupation: Vocational assessments to evaluate aptitudes, interests,
and work skills to identify suitable employment.
Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
1250 f Physical Therapy Volume 93 Number 9 September 2013
8. anger management classes, (4) asser-
tiveness training, and (5) cognitive-
behavioral training. Pain and sleep
would be monitored, advice pro-
vided, and habit training initiated.34
These life strategies are valued and
used by military members when
faced with exceptional circum-
stances35 and show the potential for
helping those returning from the
Gulf War and experiencing mental
and physical health issues.36
The ultimate outcome of occupa-
tional therapy for military personnel
with very serious and severe injuries
is to decrease occupational depriva-
tion and imbalance and promote
full occupational recovery in per-
sonal and military lives. In essence,
occupational therapists assist the
injured person to either return to the
military (and, therefore, prepared for
military readiness) or begin transi-
tioning to a full and active civilian
life.
Members With Permanent
Injuries: Transitioning Into
Civilian Life
Once CF members fully transfer from
the CF, they are often titled veteran.
If injured CF members do not return
to their former, or an alternative, mil-
itary position (due to institutional
barriers or personal choice), CF
occupational therapists can augment
existing military transitioning ser-
vices. The stress of combat and
returning home can cause maladap-
tive behaviors. One veteran research
participant stated that within 2
weeks post-deployment, he was
drinking every night. He stated,
“[Was I] drinking every night
because [I] am glad to be home, or
have a problem?” Another veteran
reported, “A lot of people binge
drink . . . because of some of the
stuff that they see over there,
too.”35(p26) Early intervention helps
prevent maladaptive behaviors such
as alcohol and substance abuse.37
Early intervention for veterans with
anger, anxiety, depression, and
insomnia might focus on the person,
helping veterans understand and
take control of their health by pro-
viding insight to triggers and using
relaxation and visualization tech-
niques. The CF occupational thera-
pist also might advise on sleep
hygiene, be a resource for commu-
nity services,35 facilitate goal plan-
ning, and provide skills in conflict
resolution, communication, financial
and time management, and methods
of solving specific problems.38
Veterans’ families, concerned with
what to expect after the serviceman
or servicewoman leaves the military,
benefit from knowledge of positive
and productive interactions that
respect individual family members’
roles. Canadian Forces occupational
therapists also might offer advice on
community resources such as social
supports, child care, and family
counseling.35 These interventions
focus on the family environment.
Vocational and leisure occupations
are of critical importance to vet-
erans as they transition into civil-
ian life. Many military specialties
(eg, machine gunner) are not trans-
ferable to civilian life.35 Canadian
Forces occupational therapists
undertake vocational assessments
to evaluate aptitudes, interests, and
work skills to identify suitable
employment. A functional capacity
evaluation (FCE) is a battery of tests,
using questionnaires, real and simu-
lated workstations, and standardized
tests, to evaluate capacity in aspects
of functioning such as bending,
fine and gross dexterity, reaching,
crouching, lifting, carrying, walk-
ing, stamina, speed, flexibility, and
endurance.39
Results of an FCE may be used for
planning in-garrison rehabilitation,
or to determine whether a CF mem-
ber has the aptitude and skill neces-
sary for a particular job or whether
retraining or further education is
required.40 Veterans often exhibit
high motivation to succeed in
retraining22 and education.41 How-
ever, they also may face barriers
such as physical limitation, symp-
toms associated with OSI and PTSD,
and academic challenges associated
with TBI. A CF occupational thera-
pist can work with student veterans
to overcome these issues.35
Although not all returning veterans
have physical or mental difficulties,
many face challenges in the transi-
tion from military to civilian life.35,42
A survey of 1,853 veterans showed
returning to civilian life creates
dilemmas.42
Conclusion and
Recommendations
This article summarizes occupational
therapy practice in long-term and
short-term settings, drawing atten-
tion to occupational therapists’
expertise in acute care and emer-
gency department settings, a wider
application than currently used by
CF Physical Medicine and Rehabilita-
tion Services. Occupational therapy
for individuals with symptoms of OSI
or PTSD is highlighted.
The term “occupation” is catego-
rized as self-care, productivity, and
leisure, and occupation is identified
as the therapeutic medium. If left
unaddressed, occupational needs
can lead to occupational disruption,
deprivation, and imbalance, produc-
ing or exacerbating secondary health
issues for CF members.
There is a clear link between physi-
cal and mental health issues. Occu-
pational therapists are an important
part of the health care team because
they focus on the potential relation-
ships among all aspects of func-
tioning as they affect CF members’
performance. Occupational therapy
skills of home modifications and
Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
September 2013 Volume 93 Number 9 Physical Therapy f 1251
9. provision of aids such as wheel-
chairs and orthotic devices are
well accepted by Physical Medicine
and Rehabilitation Services. This
understanding can be expanded to
include: (1) occupational therapy
assessment of dynamic relationships
among people, occupations, and
their environments and the ameliora-
tion or reduction of barriers; (2) the
ability to analyze tasks, analyze mem-
bers’ performance in tasks, and the
planning of interventions that have a
direct effect on the occupations; and
(3) return-to-work assessment and
graded tasks and schedules to facili-
tate safe and efficient return to duty.
Occupational therapists provide
interventions that address not only
the body but also the mind and spirit
of injured servicemen and service-
women. A range of interventions is
available for those with transient,
intermittent injuries; those returning
from overseas missions with very
serious injuries or severe injuries;
and those with permanent injuries
transitioning from the Canadian
Forces into civilian life.
Most occupational therapy services
are supplied by civilian occupational
therapists. This article points out
that occupational therapists in civil-
ian practice are not necessarily able
to provide the range or depth of
interventions necessary for CF mem-
bers. Canadian Forces members,
therefore, may not be receiving the
care they need to meet their obliga-
tions to return to duty.
Four CF occupational therapists are
currently employed with Physical
Medicine and Rehabilitation Ser-
vices. Employing a CF occupational
therapist on every Canadian military
base to liaise with civilian occupa-
tional therapists will improve the
quality of military member care.
However, directly employing more
CF occupational therapists to take
responsibility for the total rehabilita-
tion of injured military members has
the potential to provide a more com-
prehensive and cohesive occupa-
tional therapy service.
Ms Brown provided concept/idea/project
design. Both authors provided writing.
Ms Brown worked as and is currently work-
ing as a consultant for Veterans Affairs Can-
ada for young ex-military members with
mental and physical health issues.
Part of the manuscript was presented at the
Canadian Military and Veteran Health
Research Forum 2011; November 15, 2011;
Kingston, Ontario, Canada.
DOI: 10.2522/ptj.20120162
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Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context
September 2013 Volume 93 Number 9 Physical Therapy f 1253
![The Meaning of Occupation,
Occupational Need, and Occupational
Therapy in a Military Context
Helen Viola Brown, Vivien Hollis
Despite occupational therapists having strong historical ties to the Canadian military,
there are currently no uniformed occupational therapists and only a few permanent
occupational therapists employed by Canadian Forces. Occupational therapy is pro-
vided, in the main, through civilian occupational therapists. Occupational therapists
have unique skills that can contribute to the existing Canadian Forces Physical
Medicine and Rehabilitation Services Department. To establish the depth and scope
of their work, this article explains the theoretical underpinnings of occupational
therapy. Examples are provided of possible occupational therapy for populations of
Canadian Forces members: (1) those with transient, intermittent injuries; (2) those
returning from overseas missions with very serious injuries or severe injuries; and
(3) those with permanent injuries who are transitioning from the Canadian Forces
into the civilian workforce. Interventions for mental health issues are interwoven
with those targeting physical issues. The article suggests that occupational therapists
employed on a permanent basis by the Canadian Forces can contribute in a more
comprehensive manner to the wider rehabilitation of Canadian Forces members. The
article has applicability to occupational therapy military services in other countries.
H.V. Brown, MOT (reg), Faculty of
Rehabilitation Medicine, Univer-
sity of Alberta, 8205 114 St, 3-48
Corbett Hall, Edmonton, Alberta,
T6G 2G4 Canada. Address all cor-
respondence to Ms Brown at:
hgough@ualberta.ca.
V. Hollis, PhD, MSc, TDipCOT,
Faculty of Rehabilitation Medi-
cine, University of Alberta.
[Brown HV, Hollis V. The meaning
of occupation, occupational need,
and occupational therapy in a mil-
itary context. Phys Ther. 2013;
93:1244–1253.]
© 2013 American Physical Therapy
Association
Published Ahead of Print:
January 17, 2013
Accepted: January 10, 2013
Submitted: April 5, 2012
Military Rehabilitation
Special Issue
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