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10807-00_FM.qxd 2/11/08 4:31 PM Page i W & S ’ ILLARD PACKMAN S Occupational Therapy 10807-00_FM.qxd 2/11/08 4:31 PM Page ii 10807-00_FM.qxd 2/11/08 4:31 PM Page iii ELEVENTH EDITION W & S ’ ILLARD PACKMAN S Occupational Therapy Elizabeth Blesedell Crepeau, PHD, OTR, FAOTA England Professor of Occupational Therapy Occupational Therapy Department College of Health and Human Services University of New Hampshire Durham, New Hampshire Ellen S. Cohn, SCD, OTR, FAOTA Clinical Associate Professor Occupational Therapy Department Sargent College of Health and Rehabilitation Sciences Boston University Boston, Massachusetts Barbara A. Boyt Schell, PHD, OTR, FAOTA Professor & Graduate Coordinator Occupational Therapy Department Brenau University Gainsville, Georgia 10807-00_FM.qxd 2/11/08 4:31 PM Page iv Acquisitions Editor: Emily Lupash Managing Editor: Matt Hauber / Laura Horowitz Marketing Manager: Allison Noplock Production Editor: Gina Aiello Designer: Holly McLaughlin Compositor: Circle Graphics 11th Edition Copyright © 2009, 2003, Lippincott Williams & Wilkins, a Wolters Kluwer business. Copyright © 2003 Lippincott Williams & Wilkins; Copyright © 1998 Lippincott-Raven Publisher; Copyright © 1993, 1988, 1983, 1978, 1971, 1963 by J. B. Lippincott Company; Copyright © 1954, 1947 by J. B. Lippincott Company 351 West Camden Street 530 Walnut Street Baltimore, MD 21201 Philadelphia, PA 19106 Printed in the United States. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employ- ees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via website at lww.com (products and services). Chapter 11,An Excerpt from The Book of Sorrows, Book of Dreams: A First-Person Narrative, and the color plates are copyright ©2008 Mary Feldhaus-Weber. 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Willard & Spackman’s occupational therapy. — 11th ed. / [edited by] Elizabeth Blesedell Crepeau, Ellen S. Cohn, Barbara A. Boyt Schell. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-7817-6004-1 ISBN-10: 0-7817-6004-6 1. Occupational therapy. I. Willard, Helen S. II. Crepeau, Elizabeth Blesedell. III. Cohn, Ellen S., OTR. IV. Schell, Barbara A. Boyt. V. Title: Occupational therapy. VI. Title: Willard and Spackman’s occupational therapy. [DNLM: 1. Occupational Therapy. 2. Rehabilitation, Vocational. WB 555 W692 2008] RM735.W5 2008 615.8'515—dc22 2007049604 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. How- ever, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and uni- versal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reac- tions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. When citing chapters from this book, please use the appropriate form. The APA format is as follows: [Chapter author last name, I.] (2009). Chapter title. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard and Spack- man’s occupational therapy (11th ed., pp. x – x). Philadelphia: Lippincott Williams & Wilkins. Dickie, V. (2009). What is occupation? In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.). Willard and Spackman’s occupational therapy (11th ed., pp. 15 – 21). Philadelphia: Lippincott Williams & Wilkins. 10807-00_FM.qxd 2/11/08 4:31 PM Page v Colonel Brandon to Miss Dashwood: “What can it do? Give me an occupation or I shall run Mad!” JANE AUSTEN, Sense and Sensibility 10807-00_FM.qxd 2/11/08 4:31 PM Page vi 10807-00_FM.qxd 2/11/08 4:31 PM Page vii Dedication Helen Hopkins, Ed.D, OTR, FAOTA and Helen D. Smith, MS, OTR, FAOTA Co-Editors, Willard and Spackman’s Occupational Therapy 5th through 8th editions Helen Hopkins and Helen D. Smith edited the 5th through the 8th editions of Willard and Spackman’s Occupational Therapy. Helen Hopkins was a founding member of the Occupational Therapy Department at Tem- ple University. She chaired this program for many years prior to her retirement in 1986. Helen Smith was a long time faculty member at Tufts University—Boston School of Occupational Therapy retiring in 1998. The two “Helen’s” were both dedicated and caring teachers who were deeply committed to the learning of their students. They were equally dedicated to occupational therapy. For many years we could count on seeing them together at the AOTA Willard and Spackmanto their successors, they remained Annual Conference. Whether talking to and sharing stories interested in the evolution of the book and supportive of with former students, Willard and Spackmancontributors, our work as editors. We are grateful for their many years or to their many colleagues, they always were encouraging of service and dedicate this edition to them to honor their and thought provoking. Even after passing the editorship of contribution to the profession. vii 10807-00_FM.qxd 2/11/08 4:31 PM Page viii

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This market-leading text and reference provides the most current, comprehensive presentation of occupational therapy concepts and practice. Following the authors' clear guidance and expertly crafted exercises, readers will learn how to apply a client-centered, occupational and evidence-based approac