While visiting a rehabilitation centre, I observed an occupational therapist using Functional Electrical Stimulation (FES) with a client who presented with an upper extremity hemiplegia due to a stroke. FES, a technique that uses electrical currents to activate nerves innervating upper and lower limbs that are paralysed, was being used to promote wrist extension. I was surprised to see an occupational therapist using a treatment approach that fell under the physical agent modality (PAM) category. PAMs are ‘those procedures and interventions that are systematically applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance’ (Bracciano et al., 2012: 1). Categories of PAMs include superficial thermal agents, deep thermal agents, and electrotherapeutic agents and mechanical devices. ‘PAMs use various forms of energy to modulate pain, modify tissue healing, increase tissue extensibility, modify skin and scar tissue, and decrease edema or inflammation’ (Bracciano et al., 2012: 1). Given that PAMs have traditionally been the professional domain of physiotherapists and other related practitioners, this raises a philosophical question: do PAMs fall under a client-centred, occupation-focused approach to occupational therapy service provision? This has generated some debate in the field previously (Stancliff, 1998; Wolf, 1995). PAMs appear to be used more in the context of the therapist applying or doing a physically based intervention to the client passively instead of the client actively engaging in an occupation. Some authors suggest that PAMs are appropriate for occupational therapy practice use when they are used as a preparatory method that can be used alongside a purposeful activity or during occupational engagement (Bracciano and Mu, 2009). A position statement about PAMs published by the American Occupational Therapy Association (AOTA, 2012) endorses this. Thinking of a person engaging in self-care, productivity, or leisure occupations in their daily living environment, applying PAMs to clients does not appear to fall under an occupational approach to practice. Our forte is promoting clients’ involvement in daily occupations that are relevant, meaningful, rehabilitative, educational, and/ or achievable. I am in no way trying to cast the use of PAMs with clients in a negative light, however, I am proposing that they may be not the most suitable intervention option within the scope of occupational therapy practice. In my view, if you think a client would benefit from the application of a PAM, then he/she should be referred to our physiotherapy colleagues. Occupational therapists who do use PAMs need to be sure they have the specialist skills to use them safely and appropriately, that it fits within the practice guidelines mandated by professional licensing boards and regulatory bodies in the jurisdictions where they practice, and that malpractice insurance policies cover therapists who utilize PAMs. I encourage further debate about this issue.