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Outspoken OT

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by Michelle Eliason, MS, OTR/L, ITOT

5.0(3 reviews)

12 episodes

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Podcast Overview

This podcast says what needs to be said in occupational therapy—conversations that impact practitioners far beyond the boundaries of “occupation.” When occupational therapy practitioners speak up and engage in the broader discussions of medicine, science, public health, and global wellness, we step into our rightful place as leaders. Topics include: Functional Cognition, Brain Health, OT Politics, AOTA Updates, Outpatient OT, Entrepreneurship, Private Practice, and unapologetically personal opinions.

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10/5/2025

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Recent Episodes

June 15, 2026

Episode 12: OT Does Not have to Choose Between Science and Occupation (1940-1969)

<h1 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Part 4: OT Does Not Have to Choose Between Science and Occupation (1940–1969)</strong></h1> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]"> </p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Episode Description</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">World War II. Polio epidemics. The birth of rehabilitation medicine. The discovery of neuroplasticity. And some of the worst ethical violations in the history of modern healthcare — all happening at the same time, in the same system, often to the same vulnerable populations occupational therapy was built to serve.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The period from 1940 to 1969 is one of the most consequential in OT history — and one of the most misunderstood.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">This is Part 4 of Occupation Under Pressure, and it covers the three decades that built modern rehabilitation. When World War II produced casualties on a scale medicine had never encountered, Colonel Howard Rusk — with support from President Franklin Roosevelt — helped develop a systematic rehabilitation model grounded in the idea that recovery requires more than medicine. It requires engagement, purpose, structure, meaning, and participation. Physical Medicine and Rehabilitation became a formal medical specialty in 1947. Occupational therapists were trained through emergency wartime programs and deployed throughout VA hospitals across the country. The work looked different from the arts-and-crafts era — splint fabrication, ADL training, adaptive equipment, upper extremity rehabilitation, work re-entry, veteran reintegration — but the underlying premise had not changed.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Then polio arrived. Children and adults across the country lost movement, independence, and function. Iron lungs became a symbol of an era defined by fear and dependence. And once again, occupational therapists stepped into the gap — becoming leaders in neuromuscular rehabilitation, pediatric intervention, activity-based strengthening, and functional retraining.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Meanwhile, science was making a discovery that would eventually reshape everything. Researchers were beginning to demonstrate that the nervous system could change. Donald Hebb's foundational principle — that neurons that fire together wire together — offered the first scientific explanation for something occupational therapists had been observing clinically for decades. Purposeful activity was not simply keeping people busy. It was reshaping the brain itself.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">But while rehabilitation science was advancing, healthcare was also producing some of its darkest chapters. The Guatemala Syphilis Experiments. Henrietta Lacks. Willowbrook State School. The Jewish Chronic Disease Study. Vulnerable populations — people with disabilities, institutionalized individuals, minority communities — were exploited in the name of scientific progress. These violations eventually forced the development of the Nuremberg Code, the Declaration of Helsinki, informed consent standards, and research oversight frameworks that still govern healthcare today. And in parallel, disabled people themselves were organizing — building the earliest foundations of what would become the disability rights movement.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">OT was present throughout all of it. And the profession was growing — more scientific, more medically integrated, more sophisticated than it had ever been. Willard and Spackman's textbook was published. OTA education was formally established. Research infrastructure expanded. By any external measure, the profession was thriving.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">But by the late 1960s, therapists were beginning to ask a question that would ignite the next major shift in OT history: in becoming what the healthcare system needed, had the profession drifted away from what it was originally meant to be?</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Michelle's Hard Take</strong> pushes back on the most common framing of this era — that it was the period when OT became too medical and lost its roots. Her argument is more precise and more uncomfortable: the problem was not that OT became more scientific. The problem was that the profession began confusing its tools with its purpose. Goniometry, splints, biomechanical frameworks, sensory integration protocols — these are powerful tools. But they were never the destination. The destination has always been the person. The participation. The life.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The weekly challenge asks you to take one intervention you use almost automatically and ask a single question: what is this actually helping the person get back to? Not the impairment. The life. Then put that answer in your documentation.</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>In This Episode</strong></h2> <ul class="[li_&]:mb-0 [li_&]:mt-1 [li_&]:gap-1 [&:not(:last-child)_ul]:pb-1 [&:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3"> <li class="font-claude-response-body whitespace-normal break-words pl-2">World War II and the scale of injury that forced healthcare to ask not just how to save lives but how to rebuild them</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Colonel Howard Rusk, President Roosevelt, and the development of systematic rehabilitation medicine</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">PM&R becomes a formal medical specialty in 1947 — and OT's role inside it</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">What OT practice actually looked like in the wartime VA system — how far it had evolved from the arts-and-crafts era</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The polio epidemics of the 1940s and 1950s — iron lungs, mass disability, and OT's leadership in neuromuscular rehabilitation</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Donald Hebb and the discovery of neuroplasticity — the first scientific explanation for what OT had been doing all along</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The ethical violations running parallel to rehabilitation progress: Guatemala, Henrietta Lacks, Willowbrook, the Jewish Chronic Disease Study</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The Nuremberg Code, the Declaration of Helsinki, and the birth of informed consent</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The early disability rights movement — National Federation of the Blind, Paralyzed Veterans of America, community mental health advocacy</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">How OT responded to the scientific revolution: biomechanical frameworks, kinesiology, sensory integration, bottom-up models</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Willard and Spackman, OTA education, expanding research infrastructure — the profession at its most organized</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The question emerging by the late 1960s: where did occupation go?</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The Hard Take: the problem was not scientific integration — it was confusing the tools with the purpose</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Why rehabilitation methods are the vehicle, not the destination</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Progress without humanity is dangerous. Humanity without progress is limited. OT has always lived between those two realities.</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Your weekly challenge: reconnect one intervention to one life role</li> </ul> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Key Figures and Concepts</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Colonel Howard Rusk, President Franklin Roosevelt, Donald Hebb, Willard and Spackman</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Neuroplasticity, Physical Medicine and Rehabilitation, Biomechanical Approaches, Sensory Integration, Bottom-Up Intervention Models, Informed Consent, Disability Rights Movement</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Key Events and Dates</strong></h2> <p class="font-claude-response-body break-words whitespace-pre-wrap leading-[1.7]">1940s–1950s — Polio epidemics and OT's expansion into neuromuscular rehabilitation 1947 — PM&R established as a formal medical specialty 1940s–1960s — Guatemala Syphilis Experiments, Henrietta Lacks, Willowbrook State School, Jewish Chronic Disease Study Post-WWII — Nuremberg Code and Declaration of Helsinki developed Mid-20th century — Earliest foundations of the disability rights movement established</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Your Challenge This Week</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Pick one intervention you use almost automatically. Strengthening. Balance training. Sensory work. Cognitive rehabilitation. Upper extremity recovery. Then ask yourself one question: what is this actually helping the person get back to? Not the impairment. Not the body structure. The life. The role. The routine. The relationship. The identity. The occupation. Then put that answer in your documentation, your goal writing, and your clinical reasoning. Rehabilitation methods are not the destination. They are the vehicle. This week, reconnect one intervention to one life role — and remember why the intervention mattered in the first place.</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Series Context</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">This is Part 4 of Occupation Under Pressure, an eight-part series on the real sociopolitical history of occupational therapy.</p> <p class="font-claude-response-body break-words whitespace-pre-wrap leading-[1.7]">Part 1 covered 1790–1899: occupation before OT existed. Part 2 covered 1900–1919: the birth of the profession. Part 3 covered 1920–1939: the first identity crisis. This episode covers 1940–1969: reconstruction, reductionism, and the rise of rehabilitation medicine.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Next episode: the 1970s and 1980s arrive, and occupational therapists begin pushing back — hard. The philosophical revolution that follows will challenge everything the profession had spent three decades building. And the debate it ignites will sound remarkably familiar.</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Connect and Continue the Conversation</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">If this episode reframed something you thought you understood about OT's relationship with medicine, share it with a colleague who is still choosing sides. Leave a review, send a message, and stay outspoken.</p>

June 11, 2026

Episode 11: The Fight That Never Ended, OT's First Identity Crisis (1920-1939)

<h1 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>The Fight That Never Ended: OT's First Identity Crisis (1920–1939)</strong></h1> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Episode Description</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Have you ever sat through a faculty meeting, a conference presentation, or a social media debate about whether OT is too medical or not medical enough — and wondered why the profession is still having this conversation?</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The answer is in this episode.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The years between 1920 and 1939 were the first time occupational therapy looked in the mirror and asked what it actually was. The profession was barely three years old when the forces pulling it apart became impossible to ignore. Medicine was growing more scientific, hospitals more structured, rehabilitation more measurable — and OT found itself caught between the values that created it and the system it was trying to join. Meaning, purpose, identity, creativity, and participation on one side. Measurement, standardization, efficiency, and medical legitimacy on the other.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Both sides were right. At the same time. And that is exactly what made it so hard.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">This is Part 3 of Occupation Under Pressure, and it covers the two decades that gave the profession its first formal organizational structure, its first educational standards, and its first open internal division. In 1921 the National Society for the Promotion of Occupational Therapy became AOTA. In 1935 AOTA partnered with the American Medical Association to establish educational standards — a move that brought credibility and recognition and immediately raised new questions about how much medicine should shape a profession built on something medicine had historically struggled to measure.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Out of that tension came two identifiable camps. The Diversionists, who believed crafts and meaningful occupation were therapeutic in themselves — restorative of identity, purpose, and agency. And the Therapists, who argued occupation was primarily a vehicle for improving measurable function, strength, endurance, and performance. The profession was not divided over whether occupation mattered. It was divided over why it mattered. And that distinction, Michelle argues, is the fault line that every subsequent OT debate has been running along ever since.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The episode also places this identity crisis inside its full historical context — the height of the American eugenics movement, the beginning of the Tuskegee Syphilis Study, segregation embedded throughout healthcare and education, and the forced closure of OT's first school for training African American practitioners. While occupational therapy was fighting to define itself, it was doing so inside a society actively debating whose lives were worth valuing. That context matters for understanding both what the profession was up against and what it was fighting for.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The Hard Take challenges the framing of the entire debate. Michelle's argument is not that OT should choose between science and meaning, between the medical model and the social model, between function and participation. Her argument is that the false choice itself is the problem — and that OT was never designed to pick a side. It was designed to bridge. The profession's future, she contends, depends on becoming more rigorous and more scientifically precise while refusing to trade away the thing that made it irreplaceable in the first place: the capacity to see a person's whole life and help put it back together.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The weekly challenge asks you to find one place in your practice where you have accepted a false choice — and build a bridge instead.</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>In This Episode</strong></h2> <ul class="[li_&]:mb-0 [li_&]:mt-1 [li_&]:gap-1 [&:not(:last-child)_ul]:pb-1 [&:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3"> <li class="font-claude-response-body whitespace-normal break-words pl-2">How occupational therapy transformed organizationally between 1920 and 1939 — from NSPOT to AOTA, from emerging practice to national profession</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The 1935 AOTA-AMA partnership: what it gave OT and what it cost</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The emergence of the Divertionist versus Therapist divide — and why the debate was never really about crafts</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Why the question was never which side was right but how to bring both sides together</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The eugenics movement at its American peak — Carrie Buck, forced sterilization, and the broader context of whose lives were considered worth supporting</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The Tuskegee Syphilis Study, segregation in healthcare, and the closure of OT's first school for African American practitioners</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The Hard Take: OT's greatest threat was never medicine or measurement — it was uncertainty about its own identity</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Why Michelle does not think OT was ever supposed to be anti-medical — and what the founders were actually trying to build</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The false choice that has followed OT for a century: medical model or social model, function or meaning, science or occupation</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">Why the future of OT depends on refusing to separate rigor and humanity</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">OT's mental health scope of practice reality: recognized in every state, formally credentialed in almost none</li> <li class="font-claude-response-body whitespace-normal break-words pl-2">The precision rehabilitation argument: why OT should be leading those conversations, not running from them</li> </ul> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Key Figures and Organizations</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Eleanor Clarke Slagle, American Occupational Therapy Association (formerly NSPOT), American Medical Association</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Key Events and Concepts</strong></h2> <p class="font-claude-response-body break-words whitespace-pre-wrap leading-[1.7]">1921 — NSPOT becomes AOTA 1932 — Tuskegee Syphilis Study begins 1935 — AOTA-AMA educational standards partnership The Divertionist versus Therapist divide The American eugenics movement at its peak Buck v. Bell and forced sterilization Segregation in OT education</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Your Challenge This Week</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Find one place in your practice where you have accepted a false choice. One intervention, one patient, one session. Build a bridge. Use a meaningful occupation and measure it. Address mental health while targeting function. Combine participation with objective outcomes. Combine meaning with measurement. Then ask yourself: what happened when I stopped choosing and started integrating? Document it. Reflect on it. Because that is exactly what OT was trying to figure out in the 1920s and 1930s — and the answer still matters today.</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Series Context</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">This is Part 3 of Occupation Under Pressure, an eight-part series on the real sociopolitical history of occupational therapy.</p> <p class="font-claude-response-body break-words whitespace-pre-wrap leading-[1.7]">Part 1 covered 1790–1899: the philosophical roots of occupation before the profession existed. Part 2 covered 1900–1919: the forces and founding moment that made OT a formal profession. This episode covers 1920–1939: the first identity crisis — and the debates that never really ended.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Next episode: the world hands OT another defining challenge. War returns. And the question is no longer what kind of profession OT wants to be — it is whether the profession can prove its value fast enough to survive what is coming.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">The wheel of change moves slowly. It always has. But it only moves because someone is willing to push it.</p> <h2 class="font-claude-response-body break-words whitespace-normal leading-[1.7]"><strong>Connect and Continue the Conversation</strong></h2> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">If this episode made you rethink a debate you thought was modern, share it with someone who needs the historical context.</p> <p class="font-claude-response-body break-words whitespace-normal leading-[1.7]">Leave a review, send a message, and stay outspoken.</p>

June 8, 2026

Episode 10: Occupation Under pressure: The Birth of a Profession (1900-1919)

<h2>Episode Description</h2> <p>The early 1900s were not a quiet time to be building a new profession. America was industrializing, medicine was becoming increasingly scientific and measurable, and two completely opposing philosophies about disability and human worth were competing for dominance in the same cultural landscape. One said certain people were a burden on society. The other said every person deserved opportunity, dignity, and the chance to participate in life.</p> <p>Occupational therapy was born on the side of that second argument. In this episode, <strong>Part 2 of the eight-part series Occupation Under Pressure,</strong> Michelle traces the forces that transformed occupation from a philosophy into a formal profession. From the early reformers who prescribed meaningful activity before OT had a name, to the Reconstruction Aides who served soldiers returning from World War I with injuries medicine could stabilize but could not fully rehabilitate, to the six individuals who gathered at Consolation House on March 15, 1917 and founded what would become AOTA — this is the story of why occupational therapy exists. But this episode does not stop at the history.</p> <p><strong> Michelle's Hard Take</strong> challenges one of the most common narratives in OT education: that the profession was born because medicine failed. Her argument is more precise — and more uncomfortable.</p> <p>Medicine did not fail. Medicine was incomplete. And the distinction between those two things has enormous consequences for how occupational therapists understand their role in modern healthcare, position themselves within medical systems, and make the case for their own value.</p> <p>This episode also confronts the tension that has followed OT for over a century: the pull between scientific rigor and human-centered practice, between proving legitimacy within medicine and preserving the profession's original mission. It is a tension that was present at the founding. It is still present today.</p> <p><strong>Weekly Challenge:</strong></p> <p>The weekly challenge asks you to do one thing: pick one patient and document the participation problem — not just the impairment. Because that is exactly what the founders were doing in 1917. And it is still exactly what the profession exists to do.</p> <h2>In This Episode:</h2> <ul> <li> <h2>Why occupational therapy emerged during the same era as the eugenics movement, and what that contrast reveals about the profession's founding values</h2> </li> <li> <h2>The early contributors who shaped OT before it had a name: Herbert Hall, Susan Tracy, Adolf Meyer, and William Rush Dunton Jr. How World War I created a problem medicine alone could not solve — and why that problem became the tipping point for a new profession</h2> </li> <li> <h2>The founding of NSPOT on March 15, 1917 — who was in the room and why it mattered The Hard Take: OT was not born because medicine failed — it was born because survival and participation are not the same thing</h2> </li> <li> <h2>Why Michelle argues the future of OT depends on thriving within medicine, not positioning itself against it</h2> </li> <li> <h2>The scope of practice reality: OTs can address mental health in all 50 states, yet most states still do not formally recognize them as mental health providers</h2> </li> <li> <h2>What precision rehabilitation actually means — and why the concepts OT has always practiced are healthcare concepts, not soft concepts Your weekly challenge: document the participation problem, not just the impairment</h2> </li> </ul> <h2><strong>Key Figures Mentioned</strong></h2> <p>Herbert Hall, Susan Tracy, Adolf Meyer, William Rush Dunton Jr., George Barton, Eleanor Clarke Slagle, Susan Cox Johnson, Thomas Kidner, Isabel Newton</p> <h2><strong>Key Dates </strong></h2> <ol> <li> <h2>1907 — Indiana passes the first involuntary sterilization law in the United States</h2> </li> <li> <h2>1910 — Susan Tracy publishes Studies in Invalid Occupations</h2> </li> <li> <h2>1917 — The United States enters World War I; Reconstruction Aides established</h2> </li> <li> <h2>March 15, 1917 — Founding of the National Society for the Promotion of Occupational Therapy at Consolation House Series Context</h2> </li> </ol> <h2><strong>Next episode: </strong></h2> <p>OT enters the 1920s and 1930s and faces its first real identity crisis. The question shifts from whether OT belongs in healthcare to what kind of profession it is going to be. A profession rooted in meaning? A profession rooted in medicine?</p> <p>Michelle warns that fight never really ended.</p> <h2><strong>Your Challenge This Week </strong></h2> <p>Pick one patient. Ask yourself: what problem am I solving that medicine cannot? Then look at your documentation. Did you document the participation problem — or only the impairments?</p> <p>This week, document the life problem. Document the reason OT exists.</p> <h2><strong>Connect and Continue the Conversation</strong></h2> <p>If this episode challenged how you think about OT's place in healthcare, share it with a colleague who needs to hear it. Leave a review, send a message, and stay outspoken.</p>

12 total episodes available

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What is Outspoken OT?: This podcast says what needs to be said in occupational therapy—conversations that impact practitioners far beyond the boundaries of “occupation.” When occupational therapy practitioners speak up and engage in the broader discussions of medicine, science, public health, and global wellness, we step into our rightful place as leaders.

Topics include: Functional Cognition, Brain Health, OT Politics, AOTA Updates, Outpatient OT, Entrepreneurship, Private Practice, and unapologetically personal opinions.
How often does this podcast release new episodes?: This podcast updates daily.
Where can I listen to this podcast?: This podcast is available on 4 platforms including Apple Podcasts, Spotify, and more. You can also use the RSS feed directly.
Does this podcast accept guests?: Information about guest appearances is not available.

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