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Redesigning Lives

Using a specially-designed surfboard swing, pediatric OT Rebecca Chiu MA ’98 gives a vestibular workout to 5-year-old Tara Richardson.

Photo by S. Peter Lopez

Happiness. How to attain it has been the obsession of a generation, with pop formulas freely dispensed by the likes of “Peanuts” creator Charles M. Schultz (“a warm puppy”) and scatman Bobby McFerrin (“don’t worry”). Americans are so preoccupied with happiness there ought to be a science devoted to it. ¶ And, in a way, there is. It’s called occupational science, and practitioners whose work is based on it are called occupational therapists. ¶ What, you may ask, is an occupational therapist? That’s just the trouble. Despite over 80 years of mounting achievement, occupational therapy – OT for short – remains largely unfamiliar, though it touches the lives of millions of stroke and burn survivors; people living with Parkinson’s disease, Alzheimer’s disease, arthritis and cancer; children with developmental disabilities; the well elderly; people with amputations or weight problems; and, increasingly, run-of-the-mill, stressed-out urbanites looking to improve their physical and emotional well-being.

Since in all likelihood you know little about occupational science or therapy – let alone that USC offers bachelor’s, master’s and doctoral degrees in it – you probably also didn’t realize that USC is America’s premier institution in the field. In April 2001 (which happened to be “National Occupational Therapy Month”), for the fourth consecutive year the USC Department of Occupational Science and Occupational Therapy ranked No. 1 (out of 68 accredited programs) in the U.S. News & World Report’s guide to best graduate schools.

In 1997, USC set a milestone for the whole profession when the prestigious Journal of the American Medical Association published its very first article on OT research. The landmark JAMA piece reported the findings of the USC Well Elderly Study – a clinical trial headed by department chair Florence Clark PhD ’82 and professor Ruth Zemke – documenting the striking benefits of occupational therapy on independent-living senior citizens.

“We showed that preventive OT actually slowed down the decline associated with aging, and in some cases improved health,” says Clark, who lectures internationally and has appeared on CNN, National Public Radio and at the National Press Club spreading the good word about her under-appreciated profession.

Florence Clark

Photo by S. Peter Lopez

Despite Clark’s persistent efforts and a stream of proven results, OT remains stubbornly obscure. Consider the 1989 death of pediatric OT giant A. Jean Ayres. The pioneering USC professor’s name is practically synonymous with sensory integration, a leading approach for treating children with a host of developmental problems, including autism and dyslexia.

“Dr. Ayres developed all the concepts,” says OT Terri Nishimura MA ’85. “Yet when she passed away, it was so hard to convince the Los Angeles Times to print an obituary. If she had been a silent movie star in just one film….” Nishimura shrugs.

Though a long-established part of rehab and a staple of inpatient psychiatric care, occupational therapy is largely unrecognized in other arenas.

“When I say I’m an OT, I do sense that people are respectful,” says pediatric therapist Kim Wilkinson MA ’01, who is a Ph.D. student in USC’s world-class occupational science program. “The ‘therapist’ word – it’s impressive. Although,” she adds ruefully, “some people expect a massage, and some people want to lie down on the couch and tell me their problems.”

Appropriately enough, by learning about the science of happiness, you, reader, can create a little. Just by reading this article, you’ll make 73,000 people happier. That’s how many occupational therapists there are in the United States, according to the Bureau of Labor Statistics, and most are eager to promote a better understanding of their profession.

“Imagine never having to answer the question ‘what is occupational therapy?’” a wistful Barbara Kornblau mused in her inaugural address as president of the 50,000-member American Occupational Therapy Association last April. “Imagine a world in which everyone knows … and values what we do.”

So, once and for all, what is occupational therapy? If counseling is “talk therapy,” Clark explains by analogy, then occupational therapy might best be described as “doing therapy.”

It’s a mistake, in this context, to think of “occupation” in the usual sense, the one found at the bottom of your 1040 form. “By occupation, we don’t mean paid employment,” she says. “We mean: that with which we all occupy our time every day, the chunks of daily activity that fill the stream of time and that really comprise the bulk of our existence. It includes work, but it goes beyond that, to what we do for self-care, leisure or spiritual comfort.”

OT practitioners work in a wide range of areas, in pediatrics and geriatrics; with hand injuries and brain injuries; with those disabled from birth as well as those disabled by fire, spinal cord trauma or chronic mental illness; and, increasingly, with “normal” folks struggling to curb behavioral problems like overeating and road rage. “It’s situated in everyday life,” says associate professor Mary Lawlor, “and that’s what makes it obscure.”

OTs don’t have a standard uniform but dress in ways that conform to the diverse settings in which they work. “One of the reasons people don’t have a clear picture of the profession is that we all look so different from one another,” says professor Linda Fazio.

Linda Fazio helps student Suzanne Taylor with a T-shirt stenciling project in an introductory OT skills class.

Photo by S. Peter Lopez

What all OTs have in common, however, is the broad mission of assisting clients or patients (neither word does justice to the relationship, says associate professor Diane Parham MA ’80, the former being too commercial, the latter too clinical) to achieve satisfaction in their lives, despite physical or psychological constraints or the pressures of modern society, on a case-by-case basis.

The aim of therapy might be as simple as helping a stroke survivor play bridge again, or as complex as helping a cognitively disabled young man achieve his dream of driving a race car (a real-life case study taught at USC describes how this very young man, under an OT’s sustained guidance, went from passing his driver’s test to taking lessons with a racing pro.)

And here’s where the science of happiness comes in. At the cutting edge of occupational therapy is a new movement, called “lifestyle redesign,” invented and actively practiced at USC.

Clark – who with Zemke and faculty colleagues Jeanne Jackson MA ’86, PhD ’95 and Deborah Mandel MA ’95 did the clinical trials reported in JAMA – calls it “a therapeutic approach for redesigning one’s days in such a way that one can be happy, maximally productive and experience emotional well-being.”

The major health problems of the 21st century are lifestyle-induced, argues Clark, whose private practice includes elderly people as well as those with weight problems, diabetes, heart conditions or trouble managing their daily lives.

“Our bodies weren’t designed for sedentary activity,” she says. “For thousands of years, humans were hunter-gathers. Males burned, on average, 3,000 calories a day, running maybe 10 miles a day with 20 pounds of meat on their backs. The women carried children, relocated campsites, gathered vegetables and processed the meat. With our sedentary lifestyles, we burn at most 1,800 calories a day. By comparison,” she says, “we are atrophied.”

Popular magazines and morning talk shows harp on the evils of poor nutrition, stress and a sedentary existence, yet “I still think Americans don’t fully understand the profound effect what they do every day, what they eat, how much they exercise, their level of happiness has on their health,” she adds. “So I think a lot of Americans need lifestyle redesign.”

One of lifestyle redesign’s basic tenets flies in the face of conventional wisdom. It holds that a person’s health, happiness and character are shaped not only by life’s crises (a stint in Vietnam, the death of a loved one), but also by the vast stretches of time spent in ordinary pursuits. “The ‘everydayness’ of life should not be underestimated in its overall effect over time on health,” says Clark. “Daily activities are the building blocks of the self. Just as we eat certain things at intervals, we are doing things all day long. And whenever we answer the question ‘how was your day?,’ our stories usually label them.”

Learning to label daily activities is a major focus of USC’s occupational therapy curriculum. OT students are expected to understand and personally explore the nature of human occupation on the road to understanding the health and healing process.

On an August afternoon at USC’s Health Sciences campus, about 50 entering OT students have just finished taking their last quiz in the introductory course “Occupational Therapy Skills Theory I,” which includes, among other things, an immersion in the handicrafts that were initially and, at USC, still remain fundamental to the profession.

Displayed around the classroom are the students’ earlier projects: mosaic tile trivets, wood carvings and joint stools, stenciled T-shirts, copper-tooled etchings, paintings, even mop hats cunningly fashioned out of coffee filters. This afternoon’s workshop is devoted to leather tooling. After a brief presentation by professor Linda Fazio on the different grades of hide and the curing process, the students pound their own designs into dampened leather bookmarks, wallets, keychains and hair barrettes; the more ambitious attempt intricate leather lacings.

Well and good, but this kind of craft production shouldn’t carry college – let alone graduate – credit, should it?

OT students in Julie McLaughlin Gray’s physical disabilities laboratory simulate a method of working with stroke patients on arm and hand motions needed in the kitchen.

Photo by S. Peter Lopez

“That’s not at all an uncommon view,” Fazio says, “and there are many OT programs that have no craft in their programs at all. They have purposefully dropped it out. But USC has always maintained this interest. Our goal is the application of theory to practice.”

Crafts such as the leather work Fazio is teaching her students today have had a place in mental health since psychiatrist William Rush Dunton Jr., the so-called “father of occupational therapy,” first fitted a metalworking shop for the treatment of patients at Sheppard and Enoch Pratt Asylum in Baltimore in 1895. By 1906, Harvard psychiatrist Herbert J. Hall was using handweaving, woodcarving, metalwork and pottery to treat his neurasthenia patients (albeit less with the goals of assessment or therapy than on the theory that “an idle hand is the devil’s playground”).

Over time, OT theorists realized that craft actually opens a window into the soul. Through “task analysis” – a set of OT principles used to break down any activity into its most basic components – a trained therapist observing someone at work on a craft can cull vast amounts of information not only about that person’s fine-hand control but also about his ability to categorize, to sequence, to focus, to use tools and to accomplish goals – in short, his ability to think.

It isn’t hard to see how crafts play a central role in the training of occupational therapists. As the students learn to manipulate the different media, they gain awareness of an inner orchestra of sensory instruments that these “simple tasks” variously pluck and strike – and they come to realize that most human tasks are, in fact, diabolically complex.

“For a student to come out of an OT program and not have any background in any craft is now almost an oversight,” says Fazio. “There are many arenas where OTs are using it to make therapy appealing developmentally.”

Craft workshops are just one side of an OT’s education, however. Earlier this morning, in their “Foundations of Occupation/Kinesiology” class, the same 50 students now banging away at rawhide were dipping their hands in formaldehyde, running their fingers over the network of nerve fibers that make up a human spinal cord. Handling cadavers is nothing new to them. Before they entered the OT program, undergraduates and graduates alike completed prerequisite lab courses in anatomy and physiology, as well as psychology, sociology and anthropology. Some, like Amy Bardin, a senior double-majoring in occupational therapy and psychology, had contemplated a career in medicine (she still dreams of being a coroner someday) before settling on OT.

Students are drawn to occupational therapy for a wide variety of reasons. Fazio, who specializes in occupational therapy for the mentally ill, entered the profession as a way to bridge her seemingly incompatible interests in psychoanalysis and weaving. Others are drawn to the field by a personal brush with calamity.

“I originally had exposure to OT when my grandmother had a stroke,” says Los Angeles-based pediatric OT Amy Siebert MA ’98.

“What was really important was the way the OT brought the family in, trained us and made us a part of the rehab.”

Diane Rose was blithely charting a course to become a middle-school Spanish teacher when random tragedy changed everything. In her junior year at Vanderbilt University, Rose watched one of her best friends die after he was crushed by a tree in a tornado. A two-week bedside vigil in the ICU prompted Rose to devote her life to therapy. Now a second-year master’s student in OT, she looks forward to finishing her professional education and going back home to Plano, Texas, where she hopes one day to open her own OT practice.

But it isn’t easy to sketch a typical OT beyond the stereotypical features of a female who is naturally nurturing, empathic and able to motivate others to become fully engaged in a world of activity. Although over 95 percent of occupational therapists are currently women, each year more and more males are attracted to the profession, says Clark. Of the 50 students in Fazio’s introductory skills-theory class, four are male (and in recent years, Clark says, the percentages have been higher).

Jackie Mardirossian pumps iron under OT grad student Asia Taylor’s supervision. Mardirossian participates in Florence Clark’s weekly lifestyle redesign therapy group for weight management.

Photo by S. Peter Lopez

One of them, 32-year-old R.J. Navarro, has a background in policing, having spent the last seven years as an officer in USC’s Department of Public Safety. Navarro dreamed of being an OT since he was 9, inspired (he admits with embarrassment) by one of those uplifting made-for-TV movies about an athlete paralyzed in a motorcycle accident and the therapist who helps him rediscover joy in life.

“It was kind of dumb, but I was like: ‘Oh yeah, that’s what I want to do,’” recalls Navarro, now a senior and planning to go on to master’s and doctoral studies in OT. Being in the gender minority doesn’t trouble him. “The way I see it is, it makes me more marketable,” he says.

People aren’t necessarily the only beneficiaries of occupational therapy. When the Los Angeles Zoo asked Jane Goodall (now a USC distinguished adjunct professor in occupational science, anthropology and occupational therapy) to consult on upgrading its chimpanzee exhibit, the famous primatologist brought Clark and then-occupational science doctoral student Wendy Wood MA ’88, PhD ’95 into the project.

Before 1988, the chimps had lived in dark, cramped quarters and played on a concrete mound.

“Chimps in the wild are used to having a lot of different kinds of textured surfaces,” Clark says. But that wasn’t the only problem. Goodall and Clark understood that the chimps were bored and “occupationally deprived” in their concrete environment. “In the wild, chimps have a lot to do,” Clark says. “They have opportunities to play, to climb trees and swing on limbs, and to forage. Well, the chimps in the L.A. Zoo were doing very few of those activities, and they were becoming deeply pathological.”

In a nutshell, they needed occupational therapy. So why not apply the tools of “lifestyle redesign” to create an environment in which the chimps would be encouraged to engage in enjoyable and challenging activities? Wood’s dissertation contributed some of the early research that justified the zoo’s $5 million “Chimpanzees of Mahale Mountains” exhibit, which now includes waterfalls and grassy hills.

Such cross-disciplinary excursions are hardly new. Until the 1980s, when occupational science was founded at USC, OT was a professional discipline without its own social-science research base. “We tried to build our practice by importing knowledge from other sciences,” says Clark.

“We needed to use the ideas coming out of evolutionary biology, neuroscience, anthropology, psychology and sociology. But those fields were not adequately addressing the concerns that we have,” says Parham. “Finally we figured no one is going to do this, so we have to.”

In 1988, USC hosted the first symposium in the infant science, with Jane Goodall as its keynote speaker. The following year, the department unveiled the world’s first PhD program in occupational science. Today, besides the yearly symposiums, there’s an international society and a scholarly journal, The Journal of Occupational Science.

Terri Nishimura and Diane Parham trained under and now follow in the footsteps of pediatric OT pioneer A. Jean Ayres.

Photo by S. Peter Lopez

Outside disciplines still do and probably always will play an important role in occupational science, but the relevant work happens on the margins of those disciplines, says Clark, citing University of Chicago psychologist Mihaly Csikszentmihalyi as a classic example. It was Csikszentmihalyi who developed the concept of “flow” – that state of bliss one enters when doing an activity in which challenge and skills are perfectly matched. The concept is central to occupational therapy, but it was discovered on the edge of the broader discipline of psychology.

For this reason, occupational scientists keep the disciplinary revolving door well greased. For the department’s 14th Occupational Science Symposium next January, the keynote speaker is slated to be philosopher Charlene Haddock, an expert on Jane Addams’ and John Dewey’s pragmatism and its expression at Hull House during the Progressive era in the United States. Last year’s symposium featured Candace Pert, a Georgetown neuroscientist known for her pioneering work in identifying opiate receptors, and an all-star line-up of guest lecturers that included Rutgers anthropologist Lionel Tiger, a pioneer in the biological origins of human social behavior; UC Berkeley philosopher John Searle, a leading philosopher of the mind and consciousness; and USC psychologist Adrian Raine, a controversial researcher into the biological foundations of criminality. An earlier symposium spotlighted sculptor J. Seward Johnson Jr., whose famous ultra-realistic bronzes celebrate everyday activities like reading the newspaper at the bus stop.

Occupational science is by definition interdisciplinary, says Parham. “It must be interdisciplinary, because we’re looking at many dimensions of a human being – what people do in everyday life: the physical, the cultural, the interpersonal, the psychological aspects, the personal history.

“There’s so much you need to integrate together that it calls for a synthesis of interdisciplinary knowledge. It is broad, intentionally so.”

The occupational science research spilling out of USC is making waves of its own and, appropriately, the waves are interdisciplinary. Last year, professors Cheryl Mattingly and Geyla Frank, both of whom have their primary academic appointments in the Department of Occupational Science and Occupational Therapy, won major prizes from the American Association of Anthropology. Mattingly was honored for her contributions to “therapeutic narratives” theory in Healing Dramas and Clinical Plots (Cambridge University Press, 1998); and Frank for outstanding ethnography in her book, Venus on Wheels (University of California Press, 2000), a cultural biography of a woman born without arms or legs.

Meanwhile, the landmark USC Well Elderly Study – which followed 350 seniors aged 60 to 89 over a three-year period – has gerontologists and health policymakers on the edge of their seats. The original 1997 study showed that after receiving weekly two-hour OT group sessions for nine months, seniors displayed measurable improvements in vitality, mental and physical wellness and other general health indicators. Control groups (including one that had engaged in social activities but received no therapy) meanwhile experienced declines on all fronts over the same span.

Pediatric OT Rebecca Hendricks ’94, MA ’96 works in a therapy gym with 20-month-old Joshua Hodgson, who was born with Down’s Syndrome.

Photo by S. Peter Lopez

A follow-up study, published this past January in the Journal of Gerontology: Psychological Sciences, indicates that even six months after seniors had stopped receiving group OT, its benefits largely persisted – an extraordinary outcome with profound significance for the managed-care industry. Sixty percent of the government’s Medicare and Medicaid budget goes to nursing home care, notes Clark, pointing at the enormous savings implied in keeping seniors healthy and living independently longer. Kaiser Permanente recently partnered with USC to explore the feasibility of replicating the study with their enrollees to determine whether to include the intervention as one of its benefits for seniors.

In other research, Clark and her colleagues at USC and Rancho Los Amigos National Rehabilitation Center are now involved in a comprehensive study of the causes of recurring bed sores, a painful and costly problem (each surgical treatment can run $60,000) that plagues survivors of spinal cord injuries.

“It’s fascinating, because approximately 60 percent of our sample are ex-gang members who were paralyzed through gunshot wounds,” says Clark, equally excited by the cultural aspects of her work as the physiological. Other health professions may have looked at the problem in terms of pressure-sore reduction techniques or skin type, but “no one has ever gone in to see what the everyday lives of these people are like, how their daily activities contribute to pressure sores.”

In her work with patients struggling with weight issues, Clark has used lifestyle redesign as a workable alternative to expensive and risky weight-reduction procedures such as stomach bypass surgery. “One of the women in my first group was referred after she had asked for a stomach bypass,” says Clark. “In 20 weeks of lifestyle redesign she lost 42 pounds and said she was coming to believe the surgery may not be necessary.”

A tiny girl with Down’s syndrome sits in a blue plastic bin three times her size. To the untrained eye, it looks like nothing much is happening. But under her therapist’s watchful guidance, 19-month-old Bailey is actually getting a sensory workout. As her short legs and arms press against objects in the bin, she’s bombarded by tactile stimuli. As her hand angles to grab a particular toy, she exercises fine motor skills, muscle and joint perception, eye-hand control. As Bailey reaches for a new toy held out by her OT, she works on trunk rotation and postural security.

A few rooms over, another diminutive girl sits at a toddler-size table spooning apple sauce, which she has generously sprinkled with Cheerios, into her mouth. It may not look like much, but to her parents, it’s little short of a miracle.

Hearing aids snake from both of Jenay’s ears, but that’s the least of the 2-year-old’s problems. Born with multiple disabilities, as a baby she had such a poor suck-swallow-breathe pattern that she could only feed in her sleep. Later, she struggled to go from a sitting to a crawling position.

But eating was Jenay’s biggest hurdle. A year ago, she was either gagging on or regurgitating everything she valiantly swallowed. Poor coordination and tongue movement were compounded by her aversions to a number of textures and tastes (merely brushing the dust from a cheese puff on her lip was enough to send Jenay into dry-heaves). Today, under the beaming eye of her therapist, she gamely gobbles a variety of foods, including formerly gag-inducing terrors like pudding and chewing challenges like goldfish crackers.

It may seem strange for tots to be receiving occupational therapy, until you realize that the normal occupation of infants and toddlers is to develop physically and cognitively, primarily during play.

When, for whatever reason, that isn’t happening, OT has a role to play. Therapists may help the parent involve the child in a healthier round of daily activities (a type of lifestyle redesign), or provide the kind of play and “workouts” the child needs to develop her capacities.

Jenay and Bailey are clients at Pediatric Therapy Network, a Torrance, Calif.-based nonprofit clinic with close ties to USC. Not only are more than half of PTN’s roughly 40 professional staffers alumni of USC’s occupational therapy program, but more importantly, the center is the official training site for USC’s advanced graduate course in sensory integration, taught by faculty member and leading SI expert Diane Parham.

Parham and the other PTN directors all trained with SI pioneer A. Jean Ayres at USC, and the whole facility embodies Ayres’ “therapy-should-be-child’s-play “philosophy.

Its gaily painted, undersea-themed waiting room was designed to the specifications of the parents of PTN’s clients – hundreds of special-needs kids who, the parents say, have spent far too much of their young lives in scary, sterile doctors’ offices.

Inside, the children can work one-on-one with their therapists in three therapy gyms equipped with suspended helicopter- and surfboard-swings, hammocks, rubber tires and trapezes above, and bouncy blue cushioned mats below. One therapy gym sports a rock-climbing wall (used in motor-planning therapy).

Next door, PTN runs two early intervention programs for children from 18 months to 3 years old diagnosed with or at risk for developmental delays. Throughout the facility are nooks where the kids can receive specialized therapy in everything from oral-motor eating to handwriting to auditory processing.

“We are a research, education and treatment center,” says Terri Nishimura, the center’s director of program development. “We currently see over 800 kids on a weekly basis for OT, physical therapy or speech therapy. We also provide school-funded therapy. We service 17 different school districts and 165 schools.”

In the field of sensory integration therapy, PTN is the world capital, in large part thanks to the USC-based advanced course that Parham teaches there. Started back in 1977 by Ayres herself, the ongoing four-month certificate program draws therapists from around the globe. This fall’s seminar includes participants from Singapore and Malta. Recent past participants have come from Thailand, Israel, Sweden and Germany. The therapists study sensory integration theory with Parham in the classroom, then get abundant clinical experience working with PTN’s young patients under the supervision of the senior occupational therapists.

Back in the mid-1990s, the Bureau of Labor Statistics cited occupational therapy as one of the fastest growing professions in the nation – slated for 72 percent growth within the decade. With the cutbacks in health care in recent years, these predictions have been revised downward; nevertheless, projected growth remains impressive: 21 percent to 35 percent for the next five years.

And with the current turn in world events and the economy, the need for occupational therapists is likely to increase exponentially, Clark says, as it did during World War I and World War II.

Says Fazio: “The demand for occupational therapists in skilled nursing facilities has decreased in recent years, due to Medicare cutbacks, but opportunities in settings such as community service agencies, mental health facilities and schools are on the rise.

“In the past two years, our students have been finding employment opportunities in a wide variety of practice areas.”

Advocates see OT’s star as very much on the ascendant. “I think we’re going to be major players in diabetes, heart disease, obesity and cancer – the four major problems facing health care in the 21st century,” says Clark, “because lifestyle is such an important factor in terms of outcomes and prevention.”

Certainly the potential is tremendous. Consider: A hundred years ago, people went to see a dentist if and only if a tooth ached more than they could stand. Today, most of us go at least twice a year. Fifty years ago, only individuals with severe mental illness received psychotherapy. Today it’s commonplace for those with the most ordinary problems to seek counseling. Lifestyle redesign promises to bring occupational therapy to a similar footing.

“It used to be the OT worked only with people with chronic disease and disabilities after they’ve had a stroke, or diabetes, or suffered the consequences of being overweight and inactive,” says Clark.

“But now we’re moving into prevention, and therefore, to whom does this not apply?

“It does not apply to people who are living happily in a way that promotes their health. But how many people in the United States right now are really doing that?”

A Herstory of Excellence

A procession of visionary matriarchs led USC to its current position as the nation’s – and probably the world’s – occupational therapy mecca.

OT luminaries Mary Reilly ’51, Margaret Rood and A. Jean Ayres MA ’54, PhD ’61

The way Shay McAtee ’75, MA ’88 tells it, her father – a prominent Los Angeles orthopedic surgeon – tricked her into studying OT at USC. Back in 1972, he casually invited her on a tour of the USC-affiliated Rancho Los Amigos National Rehabilitation Center in Downey, Calif. – now one of the nation’s top 10 rehab hospitals and then-headquarters of USC’s occupational therapy program. “I didn’t know that was actually my entry interview,” McAtee laughs, but 30 years later, she applauds the wisdom of dear-old-interfering dad. “Every time I’ve come back to USC for something, it’s made me even prouder and feel gladder about being an OT,” says the Torrance-based pediatric practitioner and occasional USC clinical instructor.

The university’s preeminence in OT is rooted in its history: Over the past half-century, most of the profession’s leading lights were faculty or students here, and very often both.

Topping the list is retired Captain Mary Reilly ’51, a distinguished USC professor who gained international renown in the late 1960s for her groundbreaking insights into occupational behavior. Reilly is considered by many to have been the voice of democracy for her profession, broadening its focus to make it truly responsive to the occupational needs of the American people.

During World War II, shiploads of maimed soldiers arrived in rehab hospitals across the country, and occupational therapists helped them get back to a meaningful life. After the war, “ OT became more and more medicalized,” recounts associate professor Diane Parham. The rise of “science” in the medical model, she notes, also drove sister disciplines like nursing toward measurement of physical details and observable behavior.

“It was Mary Reilly who said: ‘Hey everybody, wake up. We have to get back to the idea of why our profession exists,’” Parham says. “She moved the whole profession of OT away from simply looking at physical details about an individual client, and back to the idea of using time to be engaged in meaningful activity.” And it was Reilly, now retired and living in Fairfield, Calif., who boldly declared occupational therapy to be one of the great ideas of the 20th century.

“Play as spontaneous joyous risk-taking in a safe space, and games as means of learning rules, values and traditions, will become humanity’s antidote to the alienating effects of technique,” predicted former OT chair Elizabeth Yerxa ’52, MA ’53 – another leading light in the evolution of OT. Yerxa is considered the founder of “occupational science,” an academic discipline that concerns itself with building knowledge about occupation using qualitative as well as quantitative research to advance OT practice. In 1989, USC became the first school to offer a doctoral degree in occupational science.

The late Margaret Rood was USC’s very first star, credited with almost single-handedly building USC’s OT program from scratch in 1942, and setting the program on the fast track to greatness. Just three years later, largely through the implementation of “war emergency courses,” the program had 90 students.

The honor roll wouldn’t be complete without the late A. Jean Ayres MA ’54, PhD ’61, the pioneer who first identified and described sensory integration dysfunction, previously thought to be a broad spectrum of unrelated and unexplained cognitive and perceptual-motor problems. An educational psychologist and post-doctoral scholar at UCLA’s Brain Research Institute as well as an OT professor at USC, Ayres understood that a host of disparate symptoms – from an aversion to certain textures or sounds to clumsiness, lethargy or fear of unexpected movement – were signs of inefficient neurological processing. With her husband Franklin Baker, an engineering photographer skilled in wood- and metal-working, Ayres went on not only to develop the sensory integration model of treatment, but to design and build the scooterboard ramps, trapeze rigging and other specialized gym equipment now used the world over to treat children with SI problems.

“We contributed three of the major theorists in the early years of research in our discipline – Reilly, Ayres and Rood – a proud record unmatched by any other program,” said retired professor Florence Cromwell MA ’52 at the department’s Heritage Dinner in October 2000. “USC has had a profound influence on the development of occupational therapy in the U.S. – in education, research, clinical practice and professional role development.”

Something Old, Something New

A 19th-century preservation project may hold the keys to 21st-century questions about how a high-tech lifestyle impacts health and happiness

In an exquisitely preserved Victorian mansion a few blocks north of the University Park campus, USC is forging historic links – both therapeutic and poetic – with the past. Two years ago the Department of Occupational Science and Occupational Therapy established this renovated Queen Anne-style beauty (the 1894 Cockins House) as the USC Center for Occupation and Lifestyle Redesign, the world’s first center dedicated to the study of how everyday activities shape human health and well-being in modern life. From its graceful spires and carved scrollwork to its period furniture and wallpaper, the new center breathes the authentic Arts and Crafts period, and there’s profound symbolism in that, according to OT chair Florence Clark, who regards her department as the spiritual heir to the Chicago School of Sociology, the intellectual nerve center of the turn-of-the-century Settlement Movement.

To understand this, you must understand that the philosophical roots of occupational therapy trace back to pragmatic philosophers John Dewey and George Herbert Mead, as well as social work pioneer Jane Addams, who received the Nobel Peace Prize in 1931 for her work at Hull House, a sort of proto-community center for Chicago immigrants living in abject poverty. Premised, in Dewey’s words, on an “endeavor to nurture human life even in its most humble and least promising forms,” settlement houses rose up through the early 1900s in major American cities specifically to help a wave of immigrants gain basic domestic and workplace skills to allow them to be successful in their adopted country.

Another such effort was George Barton’s Consolation House in New York. An architect and an amputee, Barton established his settlement house to offer various kinds of therapy for a better quality of life. Deeply aware of the effects of aesthetics, Barton paid careful attention to the wallpaper, the furnishings, the ambiance of each room in Consolation House, all informed by the Arts and Crafts movement.

Clark sees the USC lifestyle redesign center as a 21st-century reinterpretation of Settlement Movement ideas, down to the Arts of Crafts connections (USC has prior ties to the movement through its stewardship of the historic Gamble House). “We want to reclaim a lot of that tradition,” she says, “especially since USC has been recognized for its involvement in community development, growth and outreach. We wanted to be part of that in a forward-thinking yet traditional way.”

Like the settlement houses and early occupational therapy settings, the Center for Lifestyle Redesign is a magnet for community programs. In the near future, Clark envisions a large community-based practice operating here, as well as crafts workshops geared for the center’s mostly poor, mostly Latino neighbors. Last winter’s Victorian holiday party set the stage, bringing together USC’s entire OT community with neighbors from Sunshine Mission/ Casa de Rosas, a homeless shelter with strong ties to the department’s undergraduate residence, OT House.

But community outreach is only half the picture. The lifestyle redesign center also facilitates cutting-edge research. Here, the department’s 29-member faculty and dozens of graduate students have the chance to analyze occupation with scientific precision. On the third floor of this fully handicapped-accessible building are two adjacent research spaces – one dotted with computer workstations, the other lined with long tables perfect for craft projects.

Both will be equipped with technology to monitor vital signs, opening the door to a host of comparative studies on the physiological and psychological states of people engaged in different occupations. The ultimate goal, of course, is to detect how engagement in different activities affects physiology and thereby get clues to what constitutes an optimal balance of work, rest and leisure.

At the risk of sounding like an alarmist, Clark openly worries: “We don’t know the full impact of the screen, or the impact of being cooped up all day, or of children watching 20 to 30 hours of TV a week,” she says.

“We’re raising a generation of people over-focused on passive activity. I even worry about surgeons. Who are tomorrow’s surgeon’s going to be? If children aren’t doing a lot of fine-motor activities – using crayons, making things with their hands – they may not develop the same kind of dexterity as past generations.”

Redesigning Lives

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