Occupational Therapy News OTnews January 2019 | Page 43

HORTICULTURAL THERAPY FEATURE Cipriani et al (2018) conducted a qualitative study to investigate the value and meaning of a horticultural therapy programme incorporated into occupational therapy interventions at an adult inpatient psychiatric facility (north-eastern United States), and its impact on recovery goals. Individual semi-structured interviews were conducted with occupational therapists (n=2) and programme participants (n=8) and analysed using a modified version of the empirical, phenomenological, psychological (EPP) method. Two main themes emerged, relating to the essence of the programme and the personal growth of participants. The authors explore the results, and identify a number of benefits of the programme including: opportunities for socialisation, development of work skills and experiencing a vocational role. benefits from a beautiful garden, landscaped by Tony Danford over 20 years ago, and still tended by him today. Since the ARU opened five years ago, the occupational therapy team has worked hard to establish occupation-based groups to support patients to engage in meaningful activities as part of their rehabilitation. From listening to our patients’ feedback on their leisure pursuits and self-identified goals, we developed a gardening group therapy session that appeals to both inexperienced and experienced gardeners. Led by our advanced rehabilitation assistant Joe Scoble, the group started as a simple table top session, with patients repotting plants, growing strawberries and tending to tubs, however we had dreams of turning it into something greater. The feedback we received from patients about the group was overwhelmingly positive, with reports that they enjoyed the opportunity to be outdoors, to gain confidence in completing gardening tasks as a wheelchair or prosthetic limb user and to learn new skills. The evidence in the literature that supports horticultural therapy as part of holistic rehabilitation is also widespread (Detweiler et al 2015; Wise, 2018), including both physical and psychological benefits to those who have sustained a traumatic or life changing event. In addition to the patient feedback and the evidence base, our rehabilitation assistant Joe also completed a horticultural therapy training course and this, coupled with his background in landscape gardening and rehabilitation expertise, helped us to put together a successful bid for charity funding to allow us to develop our table top gardening group into a bigger project. Since then, the garden group has evolved into the hub of the ARU for our patients. With support from gardener Tony, garden volunteers and patients supporting the design process, we have created a new vegetable and herb garden in a previously unused part of the garden, that is managed and tended by the ARU patients. The different height beds allows us to grade the activities being completed to meet the patients’ individual needs and abilities; our wheelchair users have access to beds for seated gardening tasks, while with our higher level prosthesis users can complete digging and heavy lifting while standing in the lower beds. For our upper limb patients, the group provides an opportunity to develop skills in gripping, grasping and manipulating objects, as well as to develop greater confidence to use their residual limb in functional ways previously not trialled. Projects so far have included planting, propagation and growing vegetables, herbs and salad plants, which we have begun to use in our cooking groups. We have seen that providing horticultural therapy as part of our rehabilitation programme offers our patients wide-ranging benefits. It gives them an opportunity to share experiences and form friendships, while also providing a space away from the ward re-connect with the outside world again and reflect after what has often been several months of being in the acute hospital environment. Cipriani J, Georgia J, McChesney M, Swanson J, Zigon J, Stabler M (2018) Uncovering the value and meaning of a horticulture therapy program for clients at a long-term adult inpatient psychiatric facility. Occupational Therapy in Mental Health, 34(3), 242–257 From a practical perspective, the therapy sessions also help patients to improve wheelchair skills and safety awareness, while also improving their dynamic balance and functional strength. The group also gives staff an opportunity to talk about the topic of health promotion, and encourages exercise, healthy eating and social interaction, all of which are vital in supporting the key NHS initiative of promoting self management and self care (www.england.nhs.uk/2017/11/encouraging-people-to-embrace- self-care-for-life/). We are able to use our garden as a tool for both learning and healing, and the ability to truly use occupation as rehabilitation has helped the occupational therapy team to reconnect with the core values of our profession. References Detweiler, MB, Self, JA, Lane S, Spencer L, Lutgens B, Kim DY, Halling MH, Rudder TC, Lehmann LP (2015) Horticultural therapy: a pilot study on modulating cortisol levels and indices of substance craving, post-traumatic stress disorder, depression, and quality of life in veterans. Alternative Therapies in Health and Medicine, 21(4): 36-41 Wise J (2018) Digging for victory: Horticultural therapy with veterans for post-traumatic growth. London: Routledge Sophie Cook, occupational therapist, and Joe Scoble, advanced rehabilitation assistant, Amputee Rehabilitation Unit. Email: [email protected] OTnews January 2019 43