If occupational therapists are to take seriously their espoused commitment to enabling equitable access to participation in occupation, the inequitable conditions of people's lives will need to be addressed. Critical occupational therapy is a committed form of practice which acknowledges that well-being cannot be achieved solely by enhancing individuals' abilities, and that consequently endeavours also to address the conditions of people's lives.
The Kawa (Japanese for river) model, developed by Japanese and Canadian rehabilitation professionals, presents an important and novel alternative to contemporary 'Western' models of rehabilitation. Rather than focussing primarily on the individual client, the Kawa model focusses on 'contexts' that shape and influence the realities and challenges of peoples' dayto-day lives. The first substantial model of rehabilitation practice developed outside of the West illuminates the transactional quality of human-environment dynamics and the importance of inter-relations of self and others through the metaphor of a river's flow. The model's reflection of Eastern thought and views of nature presents a useful point of comparison to familiar rational and mechanical explanations of occupation and well-being. In this article, the rationale for an alternative model in rehabilitation is presented, followed by an explanation of the structure and concepts of the Kawa model. Implications for culturally responsive practice as well as the model's significance to the advancement of culturally safe rehabilitation worldwide are discussed.
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