Occupational therapy with the
animated dead
Gordon Muir Giles, PhD OTR/L FAOTA
A note on Terminology
• Occupational therapists use APA nonhandicapping language and as such avoids the
colloquial and now considered pejorative
“Zombie” and prefers “animated dead”
• We would prefer to use person first language (but
they are not people)
• This term is consistent with the DSM-5 term for
vampire of “undead”
• Animated dead is currently only included in the
DSM-5 as a research diagnosis included for
further study
Learning Objectives
After participating in this workshop the
participant will understand:
• Occupational therapy assessment principles
applied to the animated dead
• Occupational therapy interventions for the
animated dead
• Safety precautions and contraindications for
working with the animated dead
Origins of the animated dead
• In the historical past it used to be considered
to result from voodoo magic
• Now known to be the result of the improper
disposal of radioactive waste or the result of
• Usually the result of government malevolence
or ineptitude
• Single case reports include parasitic origin (see
“The Wrath of Khan”)
Diagnostic issues
• Diagnosis of the animated dead is essentially a
two step procedure
– Dead or not dead
– Animated or not animated
Occupational therapy and the
animated dead
• Occupational therapists strive to be client-centered,
occupation-based and to use evidence-based practice.
• Search of Pub-Med data base for “Animated dead”
yield 31 citations and for “Zombie” (with the species
filter “human”) yields 28 articles.
• None of these are RCT and only 3 are review articles
and these are reviews of lower level evidence
• There is no specific occupational therapy literature
related to the animated dead so that in what follows
we are forced to rely on other disciplines expert
opinion and single-case report.
Rating scales
• Rancho Los Amigos Level of Cognitive
Functioning Scale (Hagan, 1988):
Level 4.The patient is very confused and
agitated about where he or she is and what is
happening in the surroundings. At the
slightest provocation, the patient may become
very restless, or aggressive. The patient may
enter into incoherent conversation (only some
viral strains).
Defining characteristics of the
animated dead
• Low (actually non-existent) blood pressure
• Low body temperature (actually room
• Hyperphagia (brains preferred, but any flesh will
• Other symptoms vary by viral strain (see next
• Note the undead are also room temperature but
they bleed (i.e., have blood pressure)
Viral strains
NLD Type 1* no language (grunts)1
NLD Type 2 and 3 Limited language*
T-EDL 1 no language (grunts)2
WDS 1, 2, 3, and 4 No language3
WWZ 1 Collective action and attracted by noise,
avoids sick people4
of the Living Dead
Days Later
3Walking Dead
4World War Z
Known to say ”Send more paramedics over CB radio while eating the brains of a paramedic”
Occupational Therapy Assessment
• Occupational therapists pride themselves on
being client-centered and so the first step in
the assessment is the occupational profile in
which the goals of the client are assessed.
• Goals of the animated dead are to eat brains –
and other body parts limiting the need for
Occupational therapy assessment
• Analysis of occupational performance.
• Mostly limited to Feeding skills
• Often hampered by food loss due to
inadequate lip closure
Occupational therapy Interventions
• Occupational therapist focus on ADL and IADLs
– Feeding continued
– As with other populations with significant
neurocognitive disorder feeding skills are influenced
by motivational factors. Persons with Major
neurocognitive disorder will be more able to eat
highly motivating foods (e.g., ice-cream, ethnically
appropriate foods).
– Animated dead will show the highest level of feeding
skills when eating human brains.
Occupational therapy Interventions
• Occupational therapist focus on ADL and
• Areas where little motivation is evident
– Continence
– Dressing
– Personal hygiene
– Mobility (for gait see PT evaluation), but see
cognitive skills later this presentation
– Domestic skills
Cognitive skills
• Like many individuals with major
neurocognitive disorders the animated dead
typically do not follow directions.
• They will however follow you – often rapidly
• Poor safety awareness is endemic with the
animated dead – not so surprising since they
are dead so it is unclear what safety means.
Clinical Practice Note
• With zombies it is sometimes hard to maintain
the focus on a positive therapeutic
relationship, but it is important to remember
that zombies “love you for what is on the
Evans, R. G. (2006). Fat zombies, Pleistocene tastes, autophilia and the
"obesity epidemic". Healthcare Policy, 2(2), 18-26.
Lenaghan J. (1997). Zombies in the night. Nursing Standard, 11(40), 17.
Nijsten, M. W., & Statius van Eps, L. W. (1984). The pathogenesis of
zombies: Paranormal phenomenon scientifically explained? Ned Tijdschr
Geneeskunde, 128(51), 2412-2415.
Palmer B. (2008). Snow White and the zombies. European Eating Disorders
Review, 16(3), 245. doi: 10.1002/erv.874.
Raspberry W. (1978). Turning patients into zombies. Washington Post, 11,
A25. - Surely not peer-reviewed.
Skokowski P. (2002). I, zombie. Conscious Cognition, 11(1), 1-9.
Thornhill, J., Clements, D., & Neeson, J. (2008). Myths, "zombies" and
"damned lies" plague Canadian healthcare systems: What's a researcher
to do? Healthcare Quarterly, 11(3), 14-15.

Occupational therapy with the animated dead