The American Occupational Therapy Association (AOTA) recently shared recommendations for providing evidence-based OT solutions. As we begin to set up our treatment sessions, we should always consider the client’s deficits and goals for achieving functional improvement.

We can easily fall into patterns of service delivery which may not optimize our time with our residents.  Remember, “skilled therapy” should always include clinical reasoning, critical thinking and creativity through activity analysis.  If the activity could be easily be performed independently by the resident or supervised by a non-licensed individual, it is not considered skilled OT services.

Five key components to consider for professional Occupational Therapy interventions:

  1. Don’t provide intervention activities that are non-purposeful (e.g., cones, pegs, shoulder arc, arm bike). Using valued activities is at the core of occupational therapy. Meaningful activities are motivating, build endurance, and increase attention.

  2. Don’t provide sensory-based interventions without documented assessment results of difficulties processing or integrating sensory information. Sensory issues are complex, and an intervention that does not address the correct problem can be ineffective or even harmful.

  3. Don’t use physical agent modalities (PAMs) without providing purposeful and occupation-based intervention activities. Using heat, cold, mechanical devices, electrotherapeutic, and other agents without incorporating a purposeful activity is not occupational therapy.

  4. Don’t use pulleys for individuals with a hemiplegic shoulder. Overhead pulleys often lead to shoulder pain among stroke survivors and other individuals with hemiplegia, and should be avoided. Gentler, controlled range of motion exercises and activities are preferred.

  5. Don’t provide cognitive-based interventions (e.g., paper-and-pencil tasks, table-top tasks, cognitive training software) without direct application to occupational performance. Occupational therapy interventions related to cognition should be part of an activity that is important to the person.

More information on AOTA’s Choosing Wisely program is available on the organization’s website. (

Beth Reigart
Clinical Operations Specialist