Date of Award

Summer 8-21-2021

Document Type


Degree Name

Doctor of Occupational Therapy (OTD)


Occupational Therapy

First Advisor

Dr. Peggy Wittman, EdD, OTR/L


This opinion paper introduces a global, top-down, bottom-up, and lateral perspective on occupation, known as the Ledesma Cephalocaudal-Remote Approach, which can be used to build an integrated, holistic occupational therapy practice. This approach combines the Ayres (1960, 1966, 1972, 1979) cephalocaudal and vestibular sensory-motor development (confirmed by Lane et al., 2019); the Wilke et al. (2017) remote interoceptive, proprioceptive, and nociceptive stretching, based on Myers (2017) myofascial chain approach; the Serino (2019) peripersonal and multisensory-motor approach; the Leisman et al. (2016) bidirectional dynamic influence of motor activity and cognition approaches, and the Sadil (2019) evidence for rapidly learned low-level associations without top-down knowledge approach. The Ledesma Cephalocaudal-Remote Approach leads both practitioner and client through conscious sensory-motor experiences that develop and maintain a healthy functional self-relationship. Engaging in whole human organism range of motion/position activity develops the physical health of embodied occupational capabilities. Examples include lying down, crawling, kneeling, sitting, standing, and walking. Therapeutic use of self is employed consciously as an interpersonal tool by the occupational therapist to experience whole human organism range of motion/position activity. Once the therapist develops proficiency, they then employ therapeutic use of self again to mentor the client. This practitioner mode redefines the role of the occupational therapist from facilitator to mentor, which is a significant contribution to the existing “modes of practice” in the intentional relationship model (Taylor, 2008). A description of experiencing and teaching the first (physical) phase of practice, known as “Beginner Phase,” is provided to illustrate application of the model in occupational therapy practice.


Capstone project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor or Occupational Therapy