When Susan Jones* was diagnosed with muscular dystrophy and eventually lost her ability to walk, she began to feel helpless, depressed and “knew life just wasn’t going to be the same.” As an in-patient at New York City-based New York University Medical Center’s Rusk Institute of Rehabilitation, she fought depression by spending as much time as possible in the Rusk gardens.

As she grew to know the name of each flower and plant, Jones developed horticulture and gardening skills, re-gaining a sense of autonomy after the profound loss of control she felt following her diagnosis.

Jones says the horticultural therapy (HT) program was “life changing,” allowing her to regain control over her environment by using plants to redesign her home and garden following her discharge from the hospital.

Now, after creating a plant room in her New York home, she has a self-made “sanctuary, a quiet healing space,” where she can nurture and cultivate plants and entertain family and friends who are amazed at her transformation. Jones says gardening has given her a “reason to go on living and a way to live with illness.”

According to Matthew Wichrowski, MSW, HTR, a Rusk senior horticulture therapist, the therapeutic garden or nature-based setting “with its stress-reducing, mood-enhancing qualities sets the stage for soothing therapeutic interaction, while group or individual work in the setting can foster behavioral and social learning to help reduce maladaptive behavior.”

The low cost of horticultural therapy makes it one way to help patients reach therapeutic goals through task adaptation and environmental modification. Watching Jones’ transformation from silent and withdrawn to happily discussing sun, soil and seeds with fellow patients, Wichrowski says she benefited from the socialization aspects of HT, using her knowledge to create a home therapy program.

“Through her work with us, ‘Susan’ learned a new hobby,” Wichrowski says. “She was able to re-decorate her house in a way that was compatible with her
abilities and the effects of her disease. She is able to share this hobby with her friends.” He adds, “Her new hobby also helped her manage stress and put her in a good mood. Overall, this instilled hope and empowered her to battle her illness.”

A Versatile Program

Horticultural therapy activities can be adapted for virtually any population because patients benefit from simply working with plants in a natural setting.
Wichrowski says the therapy provides for a wide range of benefits including:

• Physical activity: HT encourages tolerance, endurance, strength and range of motion through fine motor skill exercises.
• Cognitive/memory: HT helps patients develop sequencing and problem solving skills.
• Emotional/ stress reduction: HT often creates improved mood and an enhanced self-concept through successful completion of a task that satisfies nurturing needs.
• Social: HT offers a wide range of therapeutic benefits that can be realized through group activities. For example, HT helps patients to develop socialization skills, imitation learning, improve their understanding of universality and instill hope.

Originally a social worker, Wichrowski became interested in horticultural therapy after observing HT’s dramatic results with behaviorally-challenged autistic adults. Wichrowsky says, “I noticed a huge difference in the frequency of maladaptive behaviors in individuals I knew from working with them in a group-home setting as compared to [working with them in] a greenhouse.”

Sensory Processing

For patients with sensory processing disorders (SPD), HT can gently introduce them to textures and olfactory experiences that might otherwise cause over-stimulation. The natural environment’s soothing effects often helps patients to relax, making them more receptive to new experiences and sensory stimuli.

Wichrowski works with SPD patients by presenting them with the “vast array of sensory experiences provided by the natural environment,” he says. “The soothing quality of nature-based sensory experiences is therapeutic and when utilized properly, [it] can reduce the often overwhelming quality of certain stimulatory experiences for the patient.”

While HT helps to sooth the central nervous system, it can also help re-generate brain connections damaged as the result of illness or injury and regulate maladaptive sensory processing experiences. Wichrowski says our “evolution within the context of the natural environment” creates “a natural connection to the various stimuli present in nature and this can assist a person with TBI, CVA, or other sensory processing difficulties in re-establishing connections within the brain [branching after an injury].”

Pediatrics

At Rusk, pediatric patients with cerebral palsy benefit from the gentle physical work of horticultural activities. Because the environment is non-threatening, yet stimulating, it helps to motivate the children who enjoy “having something tangible to show for their therapeutic work,” Wichrowski says.

Because HT is often used as a form of group therapy, the setting helps to foster socialization skills. For children born with disabilities, “therapy in a garden setting allows for normalization experiences and generalizes to healthy recreational and vocational pursuits after they go home,” Wichrowski says.

Horticulture activities often present the opportunity for patients to interact with children from the community through garden programs and informal community events. Rusk’s award-winning therapeutic play garden is also a favorite activity for neighborhood children, which presents additional “normalizing social experiences and spontaneous play activities” for pediatric patients at the center, Wichrowski says.

According to Wichrowski, pediatric patients also benefit from the cognitive exercises and learning potential the HT environment offers. For example, patients learn more about their world through working with plants that provide food products. He also works with patients to explore geography, climatic zones and ecosystems through plant origins.

Geriatrics

When working with geriatric patients, Wichrowski says gardening helps to reverse “the inevitable changes in autonomy control in their lives, especially when they move to an assisted living, nursing home or other setting from their homes.”

The gentle exercise involved in HT helps geriatric patients to maintain muscle density that reduces with age. Wichrowski says, “HT benefits those in this stage of life by enhancing mood and reducing stress, providing mild to moderate exercises to maintain physical ability, while at the same time providing something tangible to be satisfied with and proud of.”

One of the most satisfying experiences for horticultural therapists is watching a patient use HT lessons to create a home therapy regime, simply by caring for plants. “When a patient can [grow] plants to decorate their rooms, the common areas of their facility or make a gift for someone, it gives back some control and autonomy in their lives,” Wichrowski says.

While the stress-reducing effects of HT are obvious, it can also have potentially far-reaching benefits as an aid to recovery for cardiac patients. Wichrowski’s 2005 Journal of Cardiopulmonary Rehabilitation study, “Effects of Horticulture Therapy on Mood and Heart Rate in patients participating in an inpatient Cardiopulmonary Rehabilitation Program,” demonstrates cardiac rehabilitation patients “showed significant reductions in blood pressure and significantly improved mood.”

He says HT improves the patient’s mood, suggesting that is may be a useful tool for stress reduction. “To the extent that stress contributes to coronary heart disease, these findings support the role of HT as an effective component of cardiac rehabilitation.”

Integrating HT
For patients with anxiety disorders or who are easily over-stimulated, creating positive associations in nature can help teach self-soothing techniques.

Garden features, such as water fountains, soft sounding wind chimes, fragrant plants and various plant textures “are wonderful calming influences, particularly when combined with relaxation and breathing exercises to increase stress reduction potential,” Wichrowski says.

He encourages therapists to suggest parents or caretakers take both adult and pediatric patients into the garden or on nature walks because of the “the calming sensory qualities present in gardens and nature.”

“As we begin to associate relaxation with the garden room or outside garden space, we can become conditioned to relax in the garden environment,” Wichrowski says. “This can become a self-soothing activity once they have become accustomed to the exercise.”

For therapists who would like to integrate HT into the classroom or clinic, it simply requires gardening materials, a few tools and a window. Even if a windowsill or light cart is all you have available, HT is simple to implement in almost any setting.

When patients see the plants they have carefully tended on their therapists’ windowsill, it boosts self-confidence and creates a feeling of accomplishment. Therapists can adapt their planting activities to whatever growing space is available, and according to Wichrowski, “beautifying their own rooms or public spaces within various types of healthcare facilities is a great way to utilize plant materials created by HT work.”

Click here to read a behind the scenes blog from the author.

Kate DeBevois is the staff writer for Therapy Times. Questions or comments can be directed to kdebevois@valleyforgepress.com.