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The healing nature of occupation.

A garden is a metaphor for life. Most things will grow when you tend to them, but you must first plant the seeds. Nurture the soil and new growth will emerge. Now and then weeds must be removed to prevent them from spreading. In less than ideal conditions, a garden will require intervention to reach its full potential. You are responsible for making your garden bloom. To bring in the butterflies, you must nurture your soul.

Moses Kai Hamilton was born in a small beach house on the north shore of the island of Kauai, Hawaii. During his first year of life, Hamilton lived in an off-grid Swiss Family Robinson style tree house. Hamilton spent the early years of his life on the Big Island of Hawaii where his parents made a living as farmers. Hamilton and his three younger brothers enjoyed the native lifestyle of picking mangoes, climbing coconut trees, and raising chickens and goats. They participated in every outdoor activity the islands had to offer, including fishing, hiking, and surfing, which was his favorite pastime. Hamilton's middle name, "Kai," means ocean water in Hawaiian. "I have always been drawn to the water," Hamilton said.

Hamilton provided the cover art for the spring 2017 edition of The Open Journal of Occupational Therapy (OJOT) (Figure 1). "Pali Kai" is a 11"x14" painting made from acrylic on canvas. At age 26, Hamilton was involved in a tragic motor vehicle accident. Driving home from work one evening, Hamilton approached a curve at a high rate of speed. He lost control of his vehicle and it veered off the road. "I remember everything that happened that night, but not the accident," he said. Hamilton woke up in the intensive care unit at Queens Medical Center on the island of Oahu. He sustained a spinal cord injury (SCI) to his cervical vertebrae. The location and severity of SCI will determine the amount of function maintained. Hamilton's injury resulted in quadriplegia, or loss of movement and sensation in all four extremities.

When Hamilton woke up, he was confused and on heavy medication. He relied on a ventilator to breathe. "I can't describe the horror of being stuck in that bed. I couldn't move. I couldn't breathe. I couldn't talk. It was traumatizing," he said. After a few weeks, Hamilton was transferred to Kaiser Permanente Medical Center for further evaluation. Doctors told Hamilton and his parents, Hawk and Cherry, that he would never breathe without the ventilator. "I was very lucky to have my parents there to advocate for me," he said. Cherry reached out to Craig Hospital, in Englewood, CO. The respiratory therapists at Craig Hospital provided the necessary information and training to Hamilton's care team at Kaiser Permanente. This collaboration was critical to successfully wean Hamilton off the ventilator. "The respiratory therapists at Craig were an important resource to get me breathing on my own again," he said. No longer dependent on the ventilator, Hamilton spent time in the garden, watching the sky and reconnecting with nature. "This made me feel better," he said.

Hamilton was now appropriate for continued rehabilitation. He transferred to the Rehabilitation Hospital of the Pacific to receive occupational and physical therapy services. Upon arrival, Hamilton was introduced to the Louis Vuitton Creative Arts Program, known today as the REHAB Creative Arts Program (, 2011). Hamilton always had an aptitude for art, but it was never his passion. He found the art program intriguing. For the first 2 weeks, he attended class as an observer. Hamilton's art instructor introduced him to two classmates learning to mouth paint with brushes affixed to a mouth piece. The art instructor encouraged Hamilton to try. His first attempt resulted in a piece far more abstract than he anticipated. "It was really hard at first," he said. "It looked like the colors were splashed all over the canvas." Hamilton was frustrated. He thanked the instructor, but he left the class convinced mouth painting was not for him. The day before Hamilton returned home, the art instructor approached him with a parting gift. "He gave me a few mouth pieces to take home and said, 'you never know'." The seeds were planted, but Hamilton would not realize their potential until many months later.

According to The Occupational Therapy Practice Framework: Domain and Process, "Occupational therapy practitioners are concerned with the end result of participation and thus enable engagement through adaptations and modifications to the environment or objects within the environment when needed" (American Occupational Therapy Association [AOTA], 2014, p. S1). Individuals who receive occupational therapy services post SCI are encouraged to use their remaining strengths to compensate, or adapt for loss. Mouth-held appliances, or mouth sticks, have been well documented in occupational therapy literature since the early 1950s (Toor, Tabiat-Pour, & Critchlow, 2015). A study by Smith (1989) found mouth sticks are most commonly introduced to individuals with SCI at the C3 and C4 levels to facilitate independence during practical tasks, such as writing, typing, and painting.

A year after Hamilton was discharged he became more physically active. "I grew bored watching television and wanted to make better use of my time," he said. He remembered the mouth pieces given to him at the hospital. Armed with a set of watercolor paints and a fresh sheet of paper, he gave painting a second chance. This time Hamilton painted a face. It was abstract and not your typical color scheme, but overall it came out much better than his first painting. "That was fun," he thought. Hamilton painted a second face. This one turned out very different from the first. "It looked terrified," he said. Hamilton believes his early paintings were a reflection of his struggle to accept his new life.

Hamilton practiced painting for hours each day. "The more I did it, the better I got. The better I got, the more I wanted to do it," he said. Hamilton progressed from watercolors to acrylics and oil paints. His subject matter also matured from painting faces, to a face with a body, to scenes from nature. He developed his own techniques, use of color, and a signature impressionist style. Hamilton describes his work as playful, bold, and exaggerated. He has always admired the impressionist movement, especially the work of Vincent Van Gogh. Hamilton noted that Van Gogh "also struggled with stress and anxiety, but through his art he found peace." Painting nurtured Hamilton's soul. As a result, his art grew better and sweeter.

After a spinal cord injury, maintaining functional independence is essential to quality of life and social participation. "Being able to manipulate the physical world with my body is huge for me," said Hamilton. In the profession of occupational therapy, the term independence does not imply physical interaction with objects in the environment (AOTA, 2014). Participation in a meaningful activity may be facilitated through various means, including environmental modifications, adaptations, and assistive technology. Hamilton received occupational therapy for vocational training. "I didn't see the benefits at the time, but once I became more accepting of my new life I was able to apply the skills learned to the activities I enjoyed," he said. Hamilton currently owns approximately 100 Bonsai trees of various sizes and shapes. He actively participates by researching Bonsai care online and providing detailed instructions to caretakers who assist with grooming the tiny trees. "There's never a good time to become disabled, but technology has made life for the disabled a lot easier," he said.

Hamilton's motivation to paint comes from making the most out of life. "My inspiration comes from everything, including the stars, the ocean, and life in Hawaii," he said. Known for its dramatic landscapes, beautiful beaches, and cultural diversity, the island of Kauai nurtures Hamilton's enthusiasm for life. His favorite subjects to paint include Kauai's scenic north shore and portraits of native Hawaiian people. Hamilton says he often works on up to six paintings at a time. On average, smaller paintings take approximately 1 week to finish. One of Hamilton's favorite larger paintings, "Grand Pa's Mele," measures 18"x22" and took approximately six months to complete. In it, an older gentleman rests on the trunk of a coconut tree strumming a ukulele. Hamilton refers to the man as a Paniolo, or Hawaiian cowboy. His farm is visible far off in the distance. The man's face is weathered and his eyes reveal a quiet sadness. "Art is about interpretation for me. I'm not trying to catch a photograph, I'm trying to catch a feeling." Painting has provided Hamilton with an outlet for self-expression and stress relief. It helps to release pent up energy so Hamilton can sleep better at night. "Each painting is like an entry in a diary," he said.

Participation in a meaningful occupation helped Hamilton find his path in life. "Half the fun of art is being able to share my work with others, and to see how it brings them happiness," he said.

Hamilton decided to share his paintings with the community in Hanalei. He set up a mobile art studio at the town shopping center and started painting. People enjoyed watching him paint, and Hamilton enjoyed the social interaction. Several people expressed interest in purchasing his art work. Cherry Hamilton opened a pop-up shop, which she cleverly named "Mo's Art," to sell her son's paintings. Through this venture, Hamilton has met some amazing people from all walks of life. He especially enjoys interacting with children and individuals with disabilities. Knowing that his art has the potential to help people who are struggling is meaningful to Hamilton. "You can do anything you put your mind to. Disability is not an image, it's a new road. You have to find your own path." Moses Hamilton believes life can be wonderful even when it is not easy. When a tragic accident left Hamilton paralyzed from the chest down, he found comfort and healing in art. As he became more accepting of his new life, Hamilton applied the skills he learned in rehabilitation to participate in meaningful occupations. "Happiness is like a garden," he said. "It doesn't happen by itself. You are the only one who can make your soul bloom."

Jennifer Fortuna


Credentials Display

Jennifer Fortuna, MS, OTR/L

DOI: 10.15453/2168-6408.1399

Additional Information

Visit the Occupation and the Artist Gallery to see Moses Hamilton's work: Learn about the Association of Mouth and Foot Painting Artists (MFPA): Learn about the Creative Arts Program at the Rehabilitation Hospital of the Pacific: Visit Moses Hamilton's online store "Mo's Art": Follow Moses Hamilton's journey on Facebook:


American Occupational Therapy Association (AOTA). (2014). Occupational therapy practice Framework: Domain and process (3rd ed.). The American Journal of Occupational Therapy, 68(1), S1-S48.

Smith, R. (1989). Mouth stick design for the client with spinal cord injury. American Journal of Occupational Therapy, 43(4), 251-255.

Toor, I. K., Tabiat-Pour, S., & Critchlow, S. B. (2015). Mouth sticks: Their past, present and future. British Dental Journal, 219(5), 209-215.

Caption: Figure 1. Spring 2017 Cover of OJOT
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Author:Fortuna, Jennifer
Publication:Open Journal of Occupational Therapy
Article Type:Report
Geographic Code:1U9HI
Date:Mar 22, 2017
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