註釋 The place of occupational therapy in the care of persons who have a severe dementia has not thus far been explored in an empirical fashion. Occupational therapy has, to date, concerned itself primarily with matters of rehabilitation, function and independence. Such a model is not adequate to address the needs of those with a degenerating condition, and a new frame of reference is proposed, which focuses on well-being rather than function. The initial phase of the research used Dementia Care Mapping to investigate current levels of occupation in severely impaired persons across nine residential settings. Findings correlated closely with two other major studies on engagement; namely, that participants spent at least 60% of their waking day unoccupied or passively occupied. It also demonstrated very low levels of well-being. The main body of the research required the development of a new tool (the Positive Response Schedule for Severe Dementia) to measure well-being in very severely impaired people. Using single system evaluation, it examined the impact of a range of sensori-motor occupations upon the well-being of thirty persons currently living in residential settings. The principal finding of the research was that although sensori-motor activities offer a comfortable and stress-free means of occupation for persons at this level of cognitive impairment, participation in those occupations, and degree of well-being, is largely determined by caregiver presence. The implications of this finding, both for dementia care generally, and for occupational therapy, are discussed. 