Occupational Therapists

• Craft materials1917–1945

  Craft materials and purposeful activity (the original OT toolkit)

  The founding toolkit of occupational therapy was literally the craft supply closet: weaving looms, woodworking tools, leather-working equipment, garden plots, and kitchen facilities. Eleanor Clarke Slagle at Hull House and William Rush Dunton at Sheppard Pratt Asylum developed graded craft activity as the therapeutic medium, selecting activities whose complexity could be progressively increased to match a patient's improving function. The craft frame was both a theoretical statement (humans are occupational beings; purposeful activity heals) and a practical constraint (psychiatric hospitals and Army rehabilitation wards had no other equipment). This era ended not because craft activity became obsolete but because the profession's scope expanded beyond it into activities of daily living, physical rehabilitation, and vocational training after WWII.

  Effect on the work

  Craft-based OT was entirely labor-intensive and therapist-directed. No tools existed to assist documentation, assessment, or treatment delivery. Every therapeutic interaction was face-to-face and time-intensive.

• Standardized assessment instruments1945–1975

  Standardized assessment instruments and ADL training equipment

  The rehabilitation demands of World War II veterans pushed occupational therapy beyond craft work into structured, measurable activities of daily living (ADL) training. OTs developed adaptive equipment for feeding, dressing, and grooming; standardized functional assessments such as the Barthel Index (1965); and upper extremity hand therapy protocols using therapeutic putty, pinch gauges, and range-of-motion goniometers. Helen Willard and Clare Spackman's 1947 textbook, "Principles of Occupational Therapy," codified these assessment tools and ADL training methods and remained the standard OT clinical reference for decades. The shift from craft-based to ADL-centered OT coincided with the profession's move from psychiatric hospitals into physical rehabilitation settings, where functional independence rather than psychological engagement was the primary outcome measure.

  Effect on the work

  Standardized tools increased clinical consistency and created a defensible evidence base for OT reimbursement. They did not reduce the labor intensity of OT practice; each assessment and each ADL training session still required hands-on OT time. What they produced was documentation that third-party payers (and eventually Medicare) could audit.

• Sensory integration therapy1974–1995

  Sensory integration therapy and neurodevelopmental frames (Ayres, Bobath)

  A. Jean Ayres, an OT and educational psychologist at the University of Southern California, published "Sensory Integration and Learning Disorders" in 1972 and "Sensory Integration and the Child" in 1979, establishing sensory integration (SI) as a scientifically grounded OT frame of reference. Ayres developed the Sensory Integration and Praxis Tests (SIPT) in 1989 as the first standardized, norm-referenced battery for diagnosing sensory processing disorders in children. Simultaneously, Berta and Karel Bobath's neurodevelopmental treatment (NDT) framework was being adopted in adult neurological OT, providing a systematic approach to stroke and TBI rehabilitation. These theoretical frameworks transformed OT from an arts-and-crafts profession into a clinical science. They also created distinct specialty tracks -- pediatric sensory integration and adult neurology OT -- that remain the core of the profession today and both require intensive in-person, hands-on clinical presence.

  Effect on the work

  Sensory integration certification training (the SIPT administration requires special training; Ayres Sensory Integration certification requires post-graduate coursework) elevated the skill and market value of specialized pediatric OTs. The NDT framework did the same in adult neurological rehab. Both increased OT income potential in specialty settings.

• Computer-assisted adaptive technology1990–2015

  Computer-assisted adaptive technology and AAC (augmentative and alternative communication)

  The Americans with Disabilities Act of 1990 created a legal mandate for workplace and educational accommodation that made assistive technology (AT) a core OT practice area. Occupational therapists became the primary clinical evaluators and prescribers of computer access technology: switch-adapted keyboards, eye-gaze systems, voice recognition software (Dragon Dictate predated the modern cloud era, used on-device from the early 1990s), and AAC devices for patients who could not speak. The low-vision and wheeled mobility specializations also grew rapidly in this era as AT hardware became more capable and insurance coverage for AT evaluation expanded. Electronic health records began entering hospital OT departments in the early 2000s (CPOE systems, PointClickCare for SNFs beginning around 2000), adding the first digital documentation layer to OT clinical workflows.

  Effect on the work

  AT evaluation and prescription became a revenue-generating specialty skill for OTs, particularly in pediatric, spinal cord injury, and ALS populations. EHR adoption increased documentation burden but also created the substrate on which AI documentation tools would eventually be built.

• EHR-integrated clinical documentation2010–2020

  EHR-integrated clinical documentation (WebPT, Net Health Therapy, PointClickCare)

  The Meaningful Use incentive program under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 drove hospitals and rehabilitation facilities to adopt electronic health records at scale. For OTs in hospital-based inpatient rehab and outpatient settings, this meant WebPT (founded 2008) and similar rehab-focused EHRs became the dominant clinical workflow tools. SNF and long-term care OTs migrated to PointClickCare. The AOTA's 2025 Workforce Survey found that by this era, 77% of OTs reported spending an average of 2.5 hours per day on documentation. The structured EHR imposed CMS-specific documentation requirements -- functional limitation language, skilled care justification, therapy necessity narrative -- that were not previously mandated. Documentation became the largest single time burden in OT practice and the most prominent friction point the profession sought to address.

  Effect on the work

  EHR adoption did not reduce OT headcount but substantially changed what OTs spent their clinical time doing. The 2.5-hour-per-day documentation burden consumed roughly 30% of an 8-hour clinical day, reducing the proportion of time available for direct patient care. This created both a quality-of-work-life problem (documentation burden is the top OT job dissatisfier per AOTA 2025) and an efficiency opportunity that AI documentation tools would later address.

• Telehealth OT2020–present

  Telehealth OT and AI documentation (COVID expansion to present)

  On April 30, 2020, CMS added occupational therapists to the list of qualified Medicare telehealth providers for the first time, retroactive to March 1, 2020, in response to COVID-19. Before this date, OT services were not reimbursable under Medicare telehealth policy. Telehealth OT expanded rapidly: video-based hand therapy, cognitive rehabilitation, home safety assessments via screen-share, and school-based OT via secure video became standard practice modalities. Simultaneously, AI documentation tools (WebPT AI Documentation, Net Health Therapy AI, Dragon Copilot in hospital settings, PointClickCare AI in long-term care) began automating the drafting of OT treatment notes, progress notes, and evaluation reports. AJOT's 2025 systematic review confirmed that AI is most active in documentation, adaptive technology assessment, digital telerehab monitoring, and autism-spectrum screening, while hands-on sensory integration therapy, ADL retraining with physical cueing, orthosis fabrication, and caregiver training retain high human-irreducibility. The net effect of this era is a profession where the documentation burden that consumed 30% of clinical time is becoming AI-manageable, freeing OTs for more direct patient care, while the hands-on therapeutic core remains by design non-automatable.

  Effect on the work

  Telehealth expanded OT access to rural and home-bound patients, growing the addressable market without requiring physical clinic infrastructure. AI documentation tools are projected to recover significant portions of the 2.5-hour-per-day documentation burden, potentially increasing OT clinical capacity per practitioner without increasing headcount. The net employment effect is expected to be labor-augmenting rather than labor-displacing.

What's changing in your day

Three parts of your work where AI is already doing real lifting, and what stays yours.