
C. A. BROWN ET AL.
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necessary to relocate to environments of interest to get the
right backdrop for the photograph. In order to descend and
ascend the stairs, muscles responsible for hip flexion, knee
flexion, dorsi-flexion, hip extension, knee extension, and
plantar flexion were necessary. As well, to hold on to the
railing and maintain balance, shoulder abductors, elbow
flexors and extensors, finger flexors and extensors, as well
as the postural muscles were necessary. In order to walk,
the muscles mentioned previously for stair climbing, as well
as those responsible for trunk rotation and shoulder flexion
and extension were necessary. This task required a higher
level of muscle strength of a 4-as the muscles were working
to move through less than half the range of motion against
gravity and the resistance created by my body weight (Stu-
dent 1).
The individual would need to be able to endure standing,
squatting, and sitting. These activities may need to be done
while carrying varying weights (depending on the props)
for a varying amount of time (depending on how long it
takes to set things up and take the picture). Light activities
for a 70 kg person such as standing require approximate 2
METs or 140 Kcals/hour; sitting would require approxi-
mately 1.4 METs or 100 Kcal/hr. Photography, I believe,
can be classified as a light activity, which according to the
classification would require approximately 50 to 200 KCals
per hour for a 70 kg person (Student 2).
Students were able to apply the theoretical principles of bio-
mechanics to identify opportunities for both adapting and for
grading the demands of the activity:
Equipment such as scissors as well as paper thicknesses
could also be used to develop strength … If the client had
difficulties in fine motor movements, camera settings where
the digital camera takes the photograph on a timer, or a tri-
pod could be used (Student 1).
By gradually increasing the weight of the camera or even
the weight of the props that need to be manipulated, the
client can increase their strength as well as their structural
stability (Student 2).
Students were also able to discuss the limitations and relative
merits of the biomechanical perspective.
...the biomechanical approach does not consider client’s
interests, cognition, motivation, or levels of pain. Therefore,
this approach to activity analysis is not ideal, as the activity
of expressing pain through art is a highly personal activity
which involves a high degree of emotional and psychologi-
cal aspects which are ignored by this model (Student 1).
Students proved equally capable when applying other theo-
retical perspectives. Student 3 reflected on the environment, as
defined by the MOHO (Kielhofner, 2008) in relation to her
performance of the photography task.
The social environment included the instructors, my partner,
and other classmates. These factors influenced my motiva-
tion, interpretation, and performance of the activity. After
seeing what images others were creating, I was motivated
to work harder at my image in order to meet the high stan-
dards that were being set. Interpretations of my image from
others also influenced how I interpreted my own image and
how I altered it.
Students articulated an appreciation for multiple perspectives
so as to best match the therapeutic approach with the desired
outcomes.
Through the activity analysis with the biomechanical and
MOHO theoretical approaches, we have an understanding
of the complex nature of the activity of creating an art piece
to express pain (Students 1 and 3).
Not only can this activity address physical limitations, it
also has the potential to employ and challenge occupational
participation, the environmental and the personal (emo-
tional, cognitive and spiritual) faculties (Students 2 and 4).
And lastly, students were overwhelmingly positive in their
comments about this type of learning activity where personal
lived experience forms a foundation for developing clinical
skills and insights. The following comments are paraphrased
from the feedback students provided at the completion of the
module:
I hope to encounter more learning opportunities like this
during my training
I am strongly motivated to learn more about the subject
It increased my understanding of the subject, especially
through the personal projects
It was an advantage to have both the science/models and
the art parts of expression being combined in such a way
One of the student co-authors of this paper wrote the follow-
ing reflection on what it was like to use personal lived experi-
ence with pain as part of the learning activity.
Given that the experience of depicting pain through pho-
tography was personal, it allowed me to get a better appre-
ciation of what my client may be going through. Not only
did this experience afford me the opportunity to develop a
stronger sense of empathy for my client, but it also allowed
me to brainstorm of ways to modify and grade the activity
from a therapist’s perspective (Student 4).
Discussion and Conclusion
We believe that this theoretical perspective article has met
both of our original aims. Specifically, we determined that situ-
ated learning opportunities can be afforded in the course mod-
ules required in the curriculum. Additionally, there is evidence
from the students’ work cited in this paper to support our con-
clusion that the module met the learning objective of develop-
ing scholarship and ability to apply theory-informed practice.
Much has changed in the 30 years plus since Shapiro and
Shanahan (1976) raised the concern about how educators can
develop teaching and learning strategies that help occupational
therapy students, ultimately practitioners, to value scholarship
and theory-informed practice. We now have access to a vast
array of educational technologies and have a diverse range of
robust theoretical constructs upon which to build. Additionally,
in many countries, our students are no longer undergraduates
but rather enter the profession at the graduate entry masters
level or clinical doctorate. And yet, the profession’s struggle to
both value and build capacity in theory-informed practice re-
verberates across this period of time.
We believe that Vygotsky’s (1962) concept that Most
Knowledgeable Others have a strong influence on the values
and practices of novice therapists holds important lessons for
occupational therapy educators. Shapiro and Shanahan (1976)
concluded their discussion of teaching theoretical concepts with
a quote from Vygotsky on the nature of effective learning de-