Need a new way to think about your patient’s barriers and strengths?  Do you find visualization and abstract ideas helpful in brainstorming for solutions? You might enjoy exploring the Kawa – a Japanese OT framework.  The Kawa Framework is attributed to Dr. Michael Iwama and is recognized as one of the first model of practice for rehabilitative sciences developed outside the Western world.

Kawa is the Japanese word for river.  To set the stage, think of the types of rivers you have seen in your life.  What are the key features that made those rivers different?  There are slow moving, wide and placid rivers running across a level plain; raging, churning rivers tumbling over boulders down mountainsides; and rivers with high steep banks that twist and turn across the landscape surging and receding dependent on the river’s width.

Now that you have a picture of rivers in your mind, think of the natural features of rivers.  What do you see in the rivers that you pictured? Each of those features represents a facet of a patient’s life.

• Water: life flow or energy levels
• Riverbanks:  the social environment, cultural background and physical environment in which the patient lives.  All are inseparable from the patient’s life flow.
• Rocks:  obstacles, many times immovable, that need to be navigated.  The rocks may be the focus of the therapeutic intervention
• Driftwood:  the patient’s unique skills, strengths, and characteristics that can help support the therapeutic journey

The last concept of the framework is space – space to pursue dreams, interest and passions.  How can the OT help modify or change the riverbanks, rocks and driftwood to enhance a patient’s life flow or energy levels?

The application of this frame of reference in an OT setting can help the patient and the OT identify pathways to greater functionality and health.  Describing their life with an abstract model can help patients better articulate the path of their life, define the major obstacles that are most overwhelming to them, and identify the natural supports they can draw on to succeed.

Some applications of the Kawa model emphasis a patient’s connection with the natural world.  Others use the model to establish and honor the patient’s culture and background.  The Kawa framework has been used across diagnoses and patient groups including MS, stress, mental health, aging in place, acute care rehab and grief.

Have you ever explored the use of Kawa or incorporated the framework into your practice?  Tell me about your experience!