The Kawa model: The power of culturally responsive occupational therapy

Michael K. Iwama, Nicole A. Thomson, Rona M. MacDonald

Research output: Contribution to journalReview articlepeer-review

63 Scopus citations


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' day-to-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.

Original languageEnglish (US)
Pages (from-to)1125-1135
Number of pages11
JournalDisability and Rehabilitation
Issue number14
StatePublished - 2009
Externally publishedYes


  • Culturally responsive
  • Culture
  • Kawa
  • Model
  • Occupational therapy
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation


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