Two people come in the same week with the same shoulder. One wants to serve a tennis ball again. The other wants to reach the top shelf and get a shirt on without help.
Same joint, same injury on paper, and two different plans. That gap is roughly where physical therapy ends and occupational therapy begins.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
The short version
Physical therapy is aimed at the body part. Restore the motion, rebuild the strength, resolve the pain, get the mechanics working again.
Occupational therapy is aimed at the day. The "occupation" in the name means everything that occupies your time: dressing, cooking, bathing, driving, handling a phone, getting through a shift at work. An occupational therapist starts from the task you cannot do and works backward to whatever is stopping you, which might be strength, or coordination, or memory, or simply that your kitchen is arranged for a version of you that had two working hands.
Dr. Dave Kashuba puts the split in patient terms. Some people, he says, are "building up their rotator, building up their knee, building up their ankle to go back running, playing sports. Other people are just wanting to get off the chair and be able to make themselves a pot of coffee without pain." Both are legitimate goals, and they get different plans.
Dr. Dave Kashuba, Ph.D., OTR, who founded our clinic in 1991 and still treats patients, is an occupational therapist himself. So the OT side of the building has never been an afterthought here.
PT and OT side by side
If you like things laid out in a grid, here's how the two compare at our clinic. The overlap is real, and plenty of people see both, but the starting points are different.
| Question | Physical therapy | Occupational therapy |
|---|---|---|
| Where it starts | The movement: how far, how strong, how painful | The task: what you need to get done, and what's stopping you |
| Typical goals | Restore motion, strength and balance, and reduce pain | Get back to dressing, bathing, cooking, working and the rest of your day |
| Common reasons people come | Back and neck pain, joint replacements, sports injuries, balance and falls | Stroke, hand and arm injuries, arthritis that gets in the way of daily tasks, return to work, memory and attention changes |
| Who you'd see here | Kayla Dorsey, PT, DPT, or Logan Van Sant, PT, DPT | Dr. Dave Kashuba, Ph.D., OTR, Joan “Joni” Janik, OTD, or Laura Drumm, MS, OTR/L, CHT, CLT |
| Do you need a referral? | In most cases no, under Florida's direct access law, though some plans want one | Depends on your plan; the front desk checks |
| Medicare | Covered when medically necessary; KX threshold of $2,480 in 2026, shared with speech therapy | Covered when medically necessary; its own separate $2,480 KX threshold in 2026 |
That last row trips people up, so a word on it. The KX threshold isn't a cap. Once your charges for the year pass that figure, the clinic adds a code to your claims confirming the care is medically necessary and documented, and therapy carries on. Our 2026 Medicare guide and the glossary entry on the KX modifier explain it properly.
Nobody gets a cookie cutter
Dave is blunt about why the distinction matters: "no cookie cutters. Everyone gets evaluated, everyone gets treated differently. In many industries that's not politically correct, but in ours it is."
His reasoning goes past paperwork. "No two bodies are alike, no two human beings are alike," he said on the show. "The parts, they're generally the same, but nobody has the same set." Everyone has a slightly different angle to produce the same motion, which is why we train our therapists to look at the person rather than the diagnosis.
Practically, that means the evaluation decides the discipline, whatever the referral slip says. The answer might be physical therapy or occupational therapy, and often it is both, running together, with the two therapists talking to each other about the same patient.
What occupational therapy actually does here
Our occupational therapy program works on activities of daily living: the dressing, bathing and cooking that independence is made of. It covers upper extremity function and coordination, which is where it hands off to and borrows from our certified hand therapy program. It includes post-stroke recovery, where the work is task specific rather than general conditioning. It covers cognitive rehabilitation, the memory and attention and problem solving side of living safely on your own. And it covers return to work, using graded conditioning and simulated job tasks, which is why so much of our workers' compensation work sits on the OT side.
Our occupational therapy is for adults. We don't offer pediatric OT, in-home visits or driving evaluations. Everything happens at the clinic.
Daily living, one task at a time
Activities of daily living, or ADLs, are the self-care tasks most people do without thinking. Our patient glossary's example of one is “buttoning a shirt with one hand after shoulder surgery,” which tells you how specific the work gets. Therapy practices the task itself, in the order you do it, and changes the method until you can do it on your own. Sometimes that means a dressing aid or a built-up grip. Sometimes it just means doing things in a different order.
Hands and arms
Dr. Matt Butler, MD, a fellowship trained hand and upper extremity orthopedic surgeon with HSS, explained on Episode 16 of our Pain 2 Power show why he chose the hand: “That's how we all interact with our environment… something that people take for granted until it starts bothering them.” That's the occupational therapy view in one sentence. When a hand or wrist is the limiting factor, our OTs and Laura Drumm's hand therapy program work as one plan, the protocol-driven repair work on one side and the daily-function retraining on the other.
Back to work after an injury
A lot of the people our occupational therapists see are working age, and the goal is specific: back to the job, safely, without the injury coming straight back. That usually means hands, wrists, elbows and shoulders, and the repetitive strain that comes from doing one motion all shift. Treatment rehearses the parts of your job that matter, at the loads, heights and pace the job involves, and progress gets reported in those same terms. That's also what an adjuster or case manager needs to see before a release. The glossary has a short definition of a return-to-work program.
Ergonomics belongs here too. Sometimes the fastest win is a different chair, a repositioned monitor, a different tool grip, or a piece of adaptive equipment that takes a task from impossible to routine, while the strength catches up.
Memory, attention and the thinking side
Occupational therapy also covers cognitive rehabilitation: memory, attention, sequencing and problem solving, aimed at practical things like managing medications, following a recipe or getting through a household routine. That side came up on our show in an unexpected way when Susan Mann of Bright Minds Processing joined us for Episode 15. She came to the subject through her children, and then through her husband's traumatic brain injury, and she named occupational therapists among the professionals in her local network. Our post on occupational therapy after a stroke goes deeper into what that work looks like for adults.
Where the two overlap
Plenty of recoveries need both. Because we're a Medicare-certified Comprehensive Outpatient Rehabilitation Facility, physical therapy, occupational therapy and certified hand therapy happen in the same building, under one plan, with the same team reading the same notes. Two common cases show how that works.
After a stroke
One person might need a physical therapist for walking and balance, an occupational therapist for dressing and cooking, and our certified hand therapist for a hand that has gone weak or partly closed. Three disciplines, one patient, and the three people involved work down the hall from each other. Nobody is carrying notes between separate clinics.
After shoulder surgery
The physical therapy side follows your surgeon's protocol to bring back motion first and strength after, so you can reach, lift and sleep without guarding. The occupational therapy side deals with the weeks in between, when you need to get dressed, wash your hair and cook dinner with one arm out of action. Our shoulder pain page covers the PT half in more depth.
The signal that you need one of us
Orthopedic surgeon Dr. Richard Weiner, on our podcast, gave the cleanest version of when to stop waiting. You seek help, he said, "when your symptoms interfere with ADLs, which means activities of daily living."
That's a useful test because pain scores don't come into it. Pain is hard to rank and easy to talk yourself out of. Whether you can carry a laundry basket up the stairs is not. Dave says the same thing in his own words: you know it is time when you cannot do the normal things you like to do. People retire for a reason, and the reason was not a rocking chair.
A few everyday signs that point toward occupational therapy in particular: you've started avoiding the jar lids, the buttons or the car keys; you've rearranged the kitchen around a bad hand; you're back at work but quietly doing half the job one-handed; or someone close to you has noticed you're losing track of things you used to manage without thinking.
Which one should you ask for?
You do not have to decide. That is the evaluation's job, and getting it wrong is not on you.
Come in and tell us what you cannot do right now. If the answer is a motion, we will probably start on the physical therapy side. If the answer is a task, we will probably start on the occupational therapy side. If it is both, you will see both, in the same building, with people who compare notes.
The first visit is about an hour, one-on-one, and treatment usually begins that day. Medically necessary physical and occupational therapy are both covered by Medicare, which requires a physician to certify your plan of care, and our front desk verifies your benefits before you come in.
We serve North Palm Beach and the surrounding Palm Beaches, including West Palm Beach. Call 561-624-4263 or request an evaluation. Our FAQ answers more occupational therapy questions, and you can hear Dave work through this on the Pain 2 Power podcast.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.