If it ain't Broke, Why Rehabilitate it? Canadian Occupational Therapy in the Rehabilitation Era, 1950-1985

Abstract

An increase in healthcare funding as well as the rehabilitation needs of Canadians enabled an expansion of practicing occupational therapists over the Rehabilitation Era, spanning the 1950s-1980s. Canada saw changes to hospital system funding through the transition to public healthcare, advances in medicine allowing more individuals to live with disabilities, and population growth, among many compounding factors resulting in more Canadians wanting or needing occupational therapy. Coined the “Rehabilitation Era” due to the growth of rehabilitation and a remedial focus in care through the use of the medical model, occupational therapists employed a multi-pronged approach to help meet the demand for their services. The context of the Rehabilitation Era highlighted and contributed to occupational therapists’ challenges in defining what skills lay within, and outside of, their professional boundaries. Occupational therapists’ fragile professional identity entering a period of rapid growth led to a variety of new areas of practice. When Canada transitioned to a publicly funded healthcare system, it created a system disturbance for healthcare professionals to redefine their areas of expertise. Due to a combination of occupational therapy’s relatively small size, a predominantly female composition, and entering this transition as a role subjugated under physicians, occupational therapy had difficulty fully realizing the opportunities available. Further, due to other professions and the healthcare system more broadly shifting in focus to remediation, occupational therapists found themselves frequently uncomfortable and poorly aligned with predominant models of practice. Over the course of the Rehabilitation Era, occupational therapy diversified drastically. Factors including gender, power structures, perceived and legitimate control over a knowledge base, and the external understanding of the role, each influenced the trajectory of the profession’s evolution. Occupational therapy’s absence of societal understanding of the scope of practice, value to the healthcare system, and professional expertise has consistently limited its ability to meet all criteria of professionalism. These challenges were highlighted particularly strongly during the Rehabilitation Era with the rapid changes to the healthcare and education systems. Given occupational therapy’s challenges in philosophical alignment with the medical model and the expanding areas of practice facilitated through the Rehabilitation Era, if it wasn’t broken, why did occupational therapy choose rehabilitation?