Rehabilitation in the Garden: Developing the Garden as a Tool to Achieve Functional Therapeutic...

8/4/2019 Rehabilitation in the Garden: Developing the Garden as a Tool to Achieve Functional Therapeutic Outcomes

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Outline for Friday, September 18, 2009 Session Confirmation #22284

Title:Rehabilitation in the Garden: Developing the Garden as a Tool to Achieve Functional TherapeuticOutcomes

Marketing Statement:Tour some urban healing gardens in healthcare and senior living environments and examine how theywork and what changes might help improve outcomes. Learn how therapists and activity professionalswork and about specific garden elements to support clinical applications and the intended therapeuticoutcomes.

Summary:Well-designed gardens provide functional, home-like settings for inpatient and outpatient therapies andresident activity programs. The relationship between the physical design of the therapeutic garden andthe rehabilitation programming is critical. While designing the garden landscape architects need tounderstand the type of therapy/program goals. The elements included in the therapeutic garden can

assist in achieving these therapy and activity goals. Landscape architects will be exposed to medicalterminology and the roles of key healthcare personnel, to assist them in designing successful gardens.In addition, different rehabilitation treatments are supported by certain design characteristics and howthey are applied in the garden is crucial. Whether a garden is providing and aiding the physical,cognitive or the emotional development, certain equipment, activities and spaces provide for thattherapy. Garden elements and accessories needed for individual applications ranging from senior careto acute care will also be explored including convincing research studies. In addition to the clinicalfocus, the role of plant material with its seasonal changes in the garden and the relationship to thepatients care will be discussed. How patients interact and are engaged in the outdoor setting canincrease or decrease their therapy outcome. Plant material selection also provides areas for education,restoration and social exchange. A well-designed garden will promote four seasons of sensorystimulation. After reviewing and understanding the tools needed for a successful therapeutic garden,the participants will tour three outstanding facilities in the Chicago-land area. The tour will include acontinuing care retirement community, a rehabilitation rooftop garden and a senior activity center.

Session Type:Field Session

Learning Objectives:1. Describe key garden elements and how they promote clinical programming applications forfunctional therapeutic outcomes in a variety of garden settings: senior living, rehabilitation units, acutecare, etc.2. Outline rehabilitation programming in the garden and aspects of design for four seasons.3. Compare and contrast the work of PT, OT, SLP, SW, HT, and other therapies in the garden.4. Identify and use appropriate medical terminology in design team collaboration.5. Given program goals, evaluate three gardens for effective qualities, areas for improvement andmissed opportunities.


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Outline:I. Benefits of Gardens in Rehabilitation Programs

A. The environment of care and customer satisfactionB. Well designed gardens provide functional, home-like settings for inpatient and outpatienttherapies and resident activity programsC. Gardens provide for movement, mild exercise and rehabilitation

D. Provide for a wide range of independent activities for all usersE. AHTA Therapeutic Garden Characteristics (TGC)F. TGC applied to Stenzel Healing Garden

II. Research studies to promote quality of life and rehabilitation in gardensA. Convincing evidence to help the designer educate the rehab team and administratorsB. Research for senior living

III. Medical Terminology for the DesignerA. Learn some of the more common medical and healthcare terms and abbreviations used indesign team workB. Identify medical terminology used by therapists to describe their program for the garden

IV. Garden Elements and Functional Patient Activities to Achieve Rehab GoalsA. The clientB. The designerC. The design team: a collaborative, interdisciplinary approach for quality and effectivenessD. Examine key features in the garden and how they support the clinical teams' work with

patientsResidential, homelikePlants, plants, and more plantsAccessibilityRaising some of the plant materialFour seasons of sensory stimulationBalance deciduous, evergreen, hardscape and plant materialNodes, privacy, gatheringGathering placeRamps, stairs, walking rails, benchesWalking surfacesView out the window

V. Role of the PT, OT, SLP, HT, RT, NSG in using the gardens for therapiesA. The rehabilitation teamB. Scope of goals for each therapyC. What are some of the activities that therapists use in the garden and whyD. How the garden elements help the therapist/client reach intended outcomes

VII. Goals in Senior LivingQuality of lifeFeeling of well-beingIncrease or maintain function: physical, cognitive, emotionalLifestyle choices for independence


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Adaptations for sensory deficits: visual, auditory, tactile, olfactory, gustatoryReminiscence and life review activities

VII ClosingA. Bibliography for Gardens in RehabilitationB. Evaluation tool for the field experienceC.

Q&A

Field Experience Description:Board bus to leave McCormick Place at 8:00 AM Arrive at Montgomery Place at

8:30 AM Educational session- Teresia Hazen 8:30 AM - 9:30AM Tour Montgomery Placefrom 9:30 - 10:30 AM. Montgomery Place is a Continuing Care Retirement Communitythat provides a high standard of living and included horticultural therapy as part of theongoing care of residents.

Load bus and travel to Schwab Rehabilitation Hospital Arrive and Tour 11:00-11:45AM.Schwab Rehabilitation Hospital utilizes a rooftop garden to provide a unique location for avariety of therapies including horticultural, sensory, and ambulatory.

Box Lunch delivered- eat lunch 11:45 - 12:45 PM

Load bus and travel to the Levy Center, Evanston Arrive and Tour the Levy Center 1:45-2:45PM. The Levy Center is home to the Hulda B. and Maurice L. Rothschild EnablingGarden which is used for therapy classes and special events.

Load buses at 3:00pm to return to McCormick Place by 4PM

Presenters:

Teresia M. Hazen, M.Ed., HTR, QMHP has been with Legacy Health since 1991. LHS is a not-for-profit integrated healthcare network including five hospitals and related services that promotes gardensin healthcare to create supportive environments of care for patients, families, visitors, staff andneighbors. It is the only health care system in the US to offer a horticultural therapy certificate programcertified by the American Horticultural Therapy Association (AHTA). Teresia is responsible forpioneering the horticultural therapy program and therapeutic gardens for Legacys long-term care andSNF patients. Today, she oversees nine therapeutic gardens and horticultural therapy work through theRehabilitation Institute of Oregon, Emanuel Childrens Hospital and the Oregon Burn Center. Hertraining in horticulture, special education, rehabilitation, addiction counseling and gerontology lendcredibility to design team work for gardens to meet a wide range of user needs.

Brian M. Slovacek, is Principal, Healthcare Studio Leader and Project Leader for Hitchock DesignGroup. Delivering quality design within challenging budgets, Brian is an outstanding advocate forclients land resources. This client-centric approach has helped Brian foster long-term relationshipsthroughout his career. As a Project Leader, he has coordinated complex consultant teams, beenengaged throughout the design and management process from client contact to construction closeout.This involvement in the design process from concept through construction has made Brian a skilled


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landscape architect at both macro-level planning and site-specific scales. A strong believer incontinuous education, Brian expanded his knowledge of therapeutic garden design by participating inan intense one-on-one workshop at the Rusk Institute at New York University Hospital.

Teresia Hazen, MEd, HTR, QMHPLegacy Health

Registered Horticultural TherapistCoordinator of Legacy Therapeutic Gardens & HT1015 NW 22nd Ave. Suite 529Portland, OR 97210T 503.413.6507 [email protected] search gardens

Brian M. SlovacekLandscape ArchitectPrincipal, Healthcare StudioHitchcock Design Group221 West Jefferson AvenueNaperville, Illinois 60540T 630.961.1787bslovacek@hitchcockdesigngroup.comwww.hitchcockdesigngroup.com
mailto:[email protected]:[email protected]://www.legacyhealth.org/http://www.legacyhealth.org/http://www.legacyhealth.org/mailto:[email protected]


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August 2009 Oregon Burn Center Garden Guest Book

Thank you so much for this little piece of heaven. My mother cannot walk to out here yet. But, justknowing that she can look out the window makes me feel good. J.

We are here with Josh. What a nice place. 40% of him is burned but he asked to come out here. It isso peaceful. Thanks.

8-9-09 Thank you Burn Center for all you do for me. Kathy Hamilton

July 30, 09 visiting Willis. A beautiful garden full of wonder and delight. Thank you!

Aug 5, 2009Visiting and staying here with my sixteen year old who was brought here to the Burn Center withsecond degree burns on face, arms and legs. What a great place, group of doctors and staff. Thisgarden is such a peaceful, relaxing place to get away from the craziness of the hospital room. I hopeall that are here visit and enjoy it. Thanks, to all that help in the care and recover. Mandi

This garden is pure BLISS.Matthew was here 8/7/09

Such a wonderful, peaceful, tranquil garden. Thank you! Bonnie(Picture) See Kathy H. to be featured in The American Gardener, the magazine of the AmericanHorticultural Society, Nov/Dec 2009.


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THERAPEUTIC GARDEN CHARACTERISTICS

(Adapted from American Horticultural Therapy Association Board of Directors, April 30, 1995)

Therapeutic gardens are featured in national publications and are being built with increasing frequency in health csettings. Among these new gardens, there is a high degree of correlation in physical design and programmintended to improve therapeutic benefits to garden visitors and participants. These identified factors interrelate wa vigorous plant dominated landscape to achieve restorative and horticultural therapy objectives and are likely toassociated with excellence in the design of therapeutic gardens. Some common characteristics are:

1. Scheduled and programmed activities: A horticultural therapy program guiding and promoting a programactivities and experiences in the garden is ideal. However, even in gardens designed for the passive/independ

enjoyment by visitors, special events increasing the number of visits, classes encouraging routine garden tasks, apublicizing activities of all kinds familiarize special populations, facility staff, families of clients or patients, anearby community residents with the garden.

2. Features modified to improve accessibility: Garden elements, features and equipment are all selectedmodified to provide accessible places, activities and experiences to the greatest extent possible. Each modificationthe therapeutic garden environment eases the task of gardening and or enhances the horticultural experience for visitor/gardener enabling them to see and even to study plants, to touch or smell them, to encounter the luxurigarden growth in their own way, on their own terms and at their own pace.

3. Well defined perimeters: Edges of garden spaces and special zones of activities within the garden are of

intensified to redirect the attention and the energies of the visitor to the components and displays within the garden

4. A profusion of plants and people/plant interactions: Therapeutic gardens introduce individuals to plannintensive outdoor environments in which the conscious provisions of spaces and places for restoration, horticulteducation, therapy, and for social exchanges are organized into legible and verdant, plant-dominated open spawith simple patterns of paths and workplaces. The garden promotes four seasons of sensory stimulation.

5. Benign and supportive conditions: Therapeutic gardens provide safe, secure and comfortable settings people. The avoidance of potentially hazardous chemicals such as herbicides, fertilizers, and insecticides, provision of shade and other protective structures, the flourishing plants, and the protected and protective naturethe therapeutic garden offer personal comfort and refuge to the garden user.


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6. Universal design: Therapeutic gardens are designed for the convenience and enjoyment for people with widest possible range of conditions. As practical and pleasurable landscapes for people of all ages and all abilitthese gardens commonly stimulate the full range of senses including memory, hearing, touch, smell and sometimtaste, as pleasurable alternatives to the visual experience of gardens. The therapeutic garden exploits the mcomplete range of people/plant interactions and experiences possible within its enclosures.

7. Recognizable placemaking: Therapeutic gardens are frequently simple, unified and easily comprehended placAn intensified recognition of garden patterns and garden experiences enhance the unique identity of a garden aspecial place for the people it serves. Placemaking, an important strategy in all landscape design efforts, heightthe visitors focus on plant-related sensuality, comfort, and independence experienced within a therapeutic garden

Resources:Legacy Health and Portland Community College Therapeutic Horticulture Certificate coursework. Next seriesbegins summer 2010. Inquire [email protected]. http://www.pcc.edu/gerontologyhttp://catalog.oregonstate.edu/OptionDetail.aspx?code=632&majorid=30

Legacy Gardens: Therapeutic Garden Design Workshop, October 19, 2009, 9:003:30 inquire [email protected] owww.legacyhealth.org and search gardens.

American Horticultural Therapy Association Annual Conference www.ahta.orgOctober 1-3, 2009 Pasadena, CA.

American Society of Landscape Architects (ASLA) Therapeutic Gardens Professional Practice Network (PPN)http://host.asla.org/groups

Chicago Botanic Garden, Healthcare Garden Design Certificate Programhttp://www.chicagobotanic.org

Therapeutic Landscape Data Base http://www.healinglandscapes.org/contact.htmlhttp://tldb.blogspot.com/

2009 Gardens in Senior Living Workshop http://www.centerofdesign.org/pages/memorygarden.htm

Environment: Yale, Fall 2006, Nature in Humanities Habitathttp://environment.yale.edu/pubs/Environment-Yale-Fall-2006

Teresia Hazen, MEd, HTR, QMHP

Registered Horticultural TherapistCoordinator, Legacy Therapeutic Gardens & Horticultural TherapyLegacy Health1015 NW 22nd Ave. Suite 529Portland, Oregon 97210 503-413-6507 [email protected]

6/09


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Legacy Good Samaritan HospitalFranz R. Stenzel M.D. and Kathryn Stenzel Healing Garden

Date of Design Process: JuneAugust 1996Date of Construction Completion; June 1, 1997Designer: David Evans & Associates, Ron Mah, LA

Disciplines Involved: Physical, Occupational, Speech, Recreational and Horticultural Therapists,Rehabilitation Managers, Nursing, Current and Former Patients and Families, Horticultural TherapyVolunteers, Spiritual Care, Social Work, Facilities Staff, Major Donor, Landscape Architect andArchitect.

Goal of Design: Create a therapeutic garden to meet the needs of inpatient and outpatient rehabilitationtherapies, patient independent activity, visitors, staff and the neighborhood.

Populations Served: Acute care patients, acute care rehabilitation, outpatient rehab, day treatmentpatients, families, visitors, neighbors and staff, 24 hours daily. This is a public garden.

Significant elements as they relate to therapeutic garden design:1. Scheduled and Programmed Activities---Each rehabilitation therapy (PT, OT, HT, SLP, RT) uses the garden to help meet patient goals yearround, as weather permits. Plant signage and other educational devises provide information togarden visitors.Staff appreciation activities are scheduled year-round in the garden; hot chocolate in the autumn,strawberry shortcake in May, ice cream sundaes in August, etc. Horticultural Therapy Dept.

schedules Summer in the Garden a series of four six special community events each summerand fall including the Portland Art Museum Rental Sales Gallery, local nurseries and gardencenters, musicians, nature craft activities, summer employee bazaar, etc. The EmployeeRecognition Committee regularly schedules events and activities in the garden. HospitalAdministration organizes events in the garden like GO Red for Womens Heart Disease Awareness

and caramel corn in the garden to celebrate National Hospital Week.2. Features modified to improve accessibility----Rehabilitation therapies need various walking surfaces, stairs, ramps, inclines, and opportunitiesfor cognitive and physical activities. Some of the garden needed to be raised up to the patient toaccommodate wheelchair users and those unable to bend to the ground. Seating wallsaccommodate patients with decreased balance and decreased endurance. The area immediately

outside the lobby door is zero grade to accommodate the weak/frail patient. The incline to the westupper end of the garden provides challenge activities for patients as they rebuild endurance andgain wheelchair skills especially after brain injury or spinal cord injury. The garden in designed tosupport independent use by patients during unstructured time and families and visitors round theclock.3. Well defined perimeters---Themed garden areas included: Butterfly, Perennial, Fragrant, Rock, Hedge Demonstration,Drakes/ Monrovia Garden and two Northwest Gardens and direct the attention of the visitor to


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those components. Edges of garden spaces are defined by structures/buildings, and walkways.Privacy is provided to window rooms through the placement of plants.

4. A profusion of plants and people/plant interactions---This is a rich, lush intriguing botanical collection for four seasons of sensory stimulation.People/plant interactions are encouraged by botanical signage, plant placement for touch and smell

and regularly scheduled activities for patients and visitors. Simple patterns of paths, seatingoptions and workplaces for horticulture, therapy and socialization encourage people/plantinteractions.5. Benign and supportive conditions---The garden provides a safe, secure and comfortable setting for users. Patients and families chooseareas to meet privacy and social support needs. Visitors enjoy watching hummingbirds, butterfliesand birdlife in the garden. Pest and disease resistant plants are selected for the garden to avoid useof pesticides and chemicals. Shade is provided by some trees that have not reached maturity.More shade is needed in the garden during the sunniest months. This could be provided by betterplaced, wider branching trees and/or shade structures. The garden is in full shade September 6 toMarch 6, so it can be cool for some patients during these months.

6. Universal design---The garden was designed and is programmed for the widest range of abilities. It accommodates theneeds of PTs for instructing patients in the use of power wheel chairs to childrens groups visiting

from local daycare programs to walking clubs from the Mac Club. The garden stimulates the fullrange of senses including memory, hearing, touch, smell, and taste by careful selection of plantmaterials, garden accessories and programmed activities.7. Recognizable placemaking---The design and plantings provide for a simple, unified and easily comprehended setting. Visitorsare focused on plant-related sensuality, comfort and independence in this therapeutic garden.

Funding Source: Good Samaritan Hospital FoundationSize: 13,000 sq. ft. Cost Sq. Ft.: $25.00 initial construction phaseMaintenance Plan:Directed by Coordinator of Therapeutic Gardens1. Eight hours paid HT Gardener weekly: grooming, pruning, planting and soil amendments.2. Fifteen hours HT Volunteers weekly: weeding, sweeping, watering and grooming.3. Irrigation repairs and annual power washing managed by Good Samaritan Facilities Dept.

Additions Pending:Three dining tables, umbrellas and chairs for the patio off the back door of lobby; April 07 complete.Long-term Needs:Activity pavilion for weather protection for garden users. Designed and in fundraising.Awards and Honors:

1998 AIA, Portland Chapter, Architecture + Energy Award. The garden a part of the MarshallStreet Addition was praised by the jurors for its value to patients, visitors, staff, wildlife andthe neighborhood.

1998 American Horticultural Therapy Association, Therapeutic Garden Award2005 United States Botanic Garden, Washington, DC. Stenzel Healing Garden picture is the

example for Therapeutic Gardens in the new permanent display Plants in Culture.

Teresia Hazen, MED, HTR, QMHPRegistered Horticultural Therapist, Coordinator, Legacy Therapeutic Gardens & Horticultural Therapy, Legacy Health, 503-413-6507


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RESEARCH ABSTRACTS TO SUPPORT HOSPITAL GARDENS

Compiled by Vi Hansen, LCSW, Legacy Cancer Services, Surgical Services and Teresia Hazen, MED,HTR, QMHP, Coordinator of Therapeutic Gardens, Legacy Health

1. Cimprich, Bernadine and Ronis, D.L. An Intervention to Restore Attention in Women with NewlyDiagnosed Breast Cancer. Cancer Nursing. 26 (4): 284-292 Aug 2003.

Cancer studies looked at how interaction with nature can increase cognitive functioning, the ability tofocus and the tendency to seek out new experiences. This dissertation by Cimprich, an RN, studiedrecovering breast-cancer patients engaged in gardening activity programs. Compared to anotherrecovering group who were not given such an opportunity, the patients who undertook nature activities

three times a week for ninety days had far less tendency to complain of mental fatigue, depression,marital problems or a general inability to cope. They scored significantly higher on tests of cognitiveacuity than their counterparts. They were far more likely to go back to work full-time and tackle newprojects, such as losing weight or learning a foreign language.

2. Cooper Marcus, Clare and Marni Barnes, 1995. Gardens in Healthcare Facilities: Uses,Therapeutic Benefits and Design Recommendations. Martinez, CA: The Center for Health Design.

Research sponsored by the Center for Health Design on the use and therapeutic benefits of hospitalgardens finds an overwhelmingly positive response from employees, patients, and their family andfriends. Of those who were observed and interviewed while in a garden, 95 percent reported a

therapeutic benefit. According to the study, this manifests itself in employees being more productive,patients feeling better and having more tolerance of medical procedures, and family and friends feelingrelieved of stress.

Four case studies (including user responses); typology of health facility outdoor spaces; and a set ofdesign recommendations for location, way finding, planting, and maintenance are included in thereport. Also included are a literature review and a brief historical overview of hospital gardens sincethe Middle Ages.

3. Cooper Marcus, Clare and Marni Barnes. Introduction: Historic and Cultural Overview. Chapter

1 in Healing Gardens: Therapeutic Benefits and Design Recommendations, Clare Cooper Marcus and

Marni Barnes, 1999. Wiley & Sons.

Stress Reduction and Access to Nature: A summary of three exploratory studies of the use and benefitof hospital gardens. Which specific qualities seemed to be helpful in triggering mood change? Morethan two-thirds of garden visitors mentioned elements of the plant world (trees, flowers, colors,seasonal change, greenery). More than half mention elements that stimulated auditory, olfactory andtactile senses such as birdsong, sound of water, fresh air and fragrances. Psychological or socialaspects were noted by 50% of participates. These include describers like peaceful, escape from work,openness/large, privacy/secret places, oasis, companionship, watching others, knowing it is there.


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Visual qualities other than relating to plant material were noted by 26% of respondents and 17% ofrespondents noted a list of practical features.

4. Ulrich, Roger, S. Effects of Gardens on Health Outcomes: Theory and Research. Chapter 2 in

Healing Gardens: Therapeutic Benefits and Design Recommendations, Clare Cooper Marcus andMarni Barnes, 1999. Wiley & Sons.

Stress as a major problem for patients, families and staff in healthcare settings is discussed. Alsopresented is a theory of supportive gardens developed by Dr. Ulrich. He proposes that gardens in

healthcare situations are important stress-mitigating resources for patients and staff to the extent thatthey foster: 1) A sense of control and access to privacy; 2) Opportunities for social support; 3) Physicalmovement, exercise and rehabilitation; 4) Access to the nature experience and other positivedistractions. (p.37) He advocates for the importance of continuing research----particularly sound andcredible research that shows that gardens can promote improved health outcomes, foster higherpatient/consumer satisfaction with healthcare providers and be acceptably cost-effective. (p. 31)

5. Ulrich, Roger S. Natural versus Urban Scenes: Some Psychophysiological Effects. Environment

& Behavior, 13(5): 523-556, Sept 1981.

Eighteen students, ages 20-27 years, viewed 60 color slides of each of three types: (1) nature withwater (2) nature dominated by vegetation and (3) urban environments without water or vegetation.The information rates of the three slide samples were equivalent. The effects of the slides on alphaamplitude, heart rate and emotional states were measured. The two categories of nature views hadmore positive influences on psychophysiological states than the urban scenes. Alpha was significantlyhigher while students viewed slides of vegetation or water than while they viewed urban scenes. Therewas also a consistent pattern for views of nature, especially water, to have more positive influences onemotional states. Water, and to a lesser extent vegetation views, held attention and interest moreeffectively than the urban scenes. Implications of the findings for theory development in

environmental aesthetics are discussed.

6. Ulrich, Roger, S. View through a Window May Influence Recovery from Surgery. Science. 224(April 1984): 420-1.

Medical records on recovery of patients after cholecystectomy (gall bladder surgery) in a suburbanPennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to aroom with window view of a natural setting might have restorative influences. Twenty-three surgicalpatients assigned to rooms with windows looking out on a nature scene of trees had shorterpostoperative hospital stays, received fewer negative evaluative comments in nursing notes and tookfewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick

building wall.

7. Wichrowski, Matthew HTR; Whiteson, Jonathan MD; Haas, Francois PhD; Mola, Ana RN, ANP;Rey, Mariano J. MD, Effects of Horticultural Therapy on Mood and Heart Rate in PatientsParticipating in an Inpatient Cardiopulmonary Rehabilitation Program., Journal of CardiopulmonaryRehabilitation., (September/October 2005): 25(5): 270-274


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PURPOSE: To assess the effects of horticultural therapy (HT) on mood state and heart rate (HR) inpatients participating in an inpatient cardiac rehabilitation program.

METHODS: Cardiac rehabilitation inpatients (n = 107) participated in the study. The HT groupconsisted of 59 subjects (34 males, 25 females). The control group, which participated in patienteducation classes (PECs), consisted of 48 subjects (31 males, 17 females). Both HT sessions and PEC

are components of the inpatient rehabilitation program. Each group was evaluated before and after aclass in their respective modality. Evaluation consisted of the completion of a Profile of Mood States(POMS) inventory, and an HR obtained by pulse oximetry.

RESULTS: Changes in the POMS total mood disturbance (TMD) score and HR between preintervention and post intervention were compared between groups. There was no pre-session differencein either TMD score (16 +/- 3.6 and 19.0 +/- 3.2, PEC and HT, respectively) or HR (73.5 +/- 2.5 and 79+/- 1.8, PEC and HT, respectively). Immediately following the intervention, the HT TMD wassignificantly reduced (post-TMD = 1.6 +/- 3.2, P < .001), while PEC TMD was not significantlychanged (TMD = 17.0 +/- 28.5). After intervention, HR fell in HT by 4 +/- 9.6 bpm (P < .001) but wasunchanged in PEC.

CONCLUSION: These findings indicate that HT improves mood state, suggesting that it may be auseful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease,these findings support the role of HT as an effective component of cardiac rehabilitation.

(C) 2005 Lippincott Williams & Wilkins, Inc.

10/05


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Basic Medical Terminology for the Designer

JACHO Joint Commission on the Accreditation of Healthcare OrganizationsCARF Committee on the Accreditation of Rehabilitation Facilities

RT Recreational TherapistCTRS Certified Therapeutic Recreation SpecialistRT Respiratory TherapistSLP Speech and Language Pathologist (ST speech therapy)PT Physical TherapistPTA Physical Therapy AssistantOT Occupational TherapistOTR/L Registered and licensed OT

COTA Certified Occupational Therapy AssistantHTR Registered Horticultural Therapist

SW Social WorkerMSW Masters SWLCSW Licensed Clinical SWChildlife Therapist Psychosocial + Activity needs

MHP Mental Health ProfessionalQMHP Qualified Mental Health Professional (Masters psych equivalent)

NSG NursingRN Registered NurseLPN Licensed Practical NurseCAN Certified Nursing Assistant

Physiatrist Rehab physician

Pts Patients in hospital, psych, rehab or SNF (Skilled Nursing Facility)Residents Live in a facilityClient Person served by a program

BH Behavioral Health, psychiatry unitNICU Neo natal intensive care unitICU Intensive care unitNICU Neonatal intensive care unitPICU Pediatric intensive care unitAcute Care Inpatient hospital nursing care


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SNF Skilled Nursing Facility, step down from acute care, usually in the community facilityversus within hospital

LTC Long term care, nursing home, 24-hour nursing careCCRC Continuing Care Retirement Community---Senior Ctr, Adult Day Program, Retirement

Facility, Assisted Living, SNF, NH, Dementia Unit, Hospice for continuum of careservices

TBI Traumatic Brain InjuryCVA Cerebral Vascular Accident---strokeMS Multiple Sclerosis, progressive disease of nervous systemSCI Spinal Cord InjuryMR Mental RetardationSMR Severe Mental Retardation

Chronic Conditions Long term, leaving residual disabilityArthritisCHF congestive heart failureCOPD congestive obstructive pulmonary disease

Clinical Assessment in the areas of:MobilityCognitionPhysical/perceptualEmotional/psychologicalSocialSpiritual

ADLs Activities of Daily Living---activity performed daily, like dressing, grooming, bathing,eating, etc.

Ambulation Walking with or without assistive deviceROM Range of MotionEndurance Ability to sustain activity over a specified period of time

MOB Medical Office BldgPOB Physicians Office Bldg

Teresia Hazen, MED, HTRCoordinator, Legacy Therapeutic Gardens,[email protected] 2/15/05
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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The Rehabilitation Team

Team Members Major Functions

Rehabilitation Nurse

(RN & LPN)

Assists patient in achieving

maximum independence 24hours/day, 7 days/week

*Performs activities that maintain & restore function & prevent complications of further loss*Provides direct care*Directs carryover of skills taught & practiced during therapies

*Coordinates daily schedule & team activities*Provides therapeutic environment*Provides patient & family education*Acts as patient & family advocate

Rehabilitation CNA *Performs activities that maintain & restore function & prevent complications of further loss*Provides direct care*Reinforces skills taught & practiced during therapy*Provides therapeutic environment*Reinforces patient & family education

Physiatrist

Rehabilitation Physician

*Establishes medical diagnosis and prognosis*Recommends or prescribes treatments, medications & therapeutic aids*Guides progress of rehabilitation treatment plan

Physical Therapist (PT) *Addresses ROM, strength, reflexes, tone, posture, gait, splint & brace fit and function &sensorimotor performance*Uses Heat, cold, hydrotherapy, electrical stimulation, massage, joint mobilization and exerciseas treatment modalities*Trains patient in walking, bed and wheelchair mobility

Occupational Therapist

(OTR/L)

*Assists with ADLs and independent living skills*Addresses joint function, protection, coordination, endurance, body mechanics & positioning*Guides use of adaptive equipment, splints & braces*Evaluates home management and social skills*Participates in adaptation of physical & social environment

Speech & Language

Pathologist (SLP)

*Treats disorders of verbal & written language*Treats comprehension, memory & cognitive limitations

*Directs treatment plan for patients with swallowing problems*Guides development of augmentative communication systems

Social Worker (LCSW) *Assesses coping style and adaptation to disability*Assesses family and social support networks*Addresses housing, living arrangements & education issues*Coordinates financial resources and transportation issues*Facilitates discharge planning

Neuro Psychologist (PhD) *Assesses cognition, emotional status of patient & family*Facilitates adaptation to disability

Recreational Therapist (CTRS) *Involves patient in functional recreational & leisure activities to restore function & promoteoptimal level of independence

*Utilizes a variety of leisure interventions to promote physical, cognitive & emotional healingassociated with illness, injury or chronic disability*Facilitates community integration and awareness of community resources

Horticultural Therapist (HTR) *Involves patient in functional horticulture activities to restore function & promote optimallevel of independence*Provides practice/application setting for PT, OT, SLP, RT goals, as determined by co-therapists*Assists patient with goal setting & problem solving for indoor and/or outdoor adaptivegardening in the discharge setting for year-round activity


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Gardens in RehabilitationBibliography

Cooper Marcus, C. (2003). Healing Havens. Landscape Architecture, August, pp. 84-88,104-109.

Cooper Marcus, C. and M. Barnes. (1995). Gardens in Health Care Facilities: Uses, TherapeuticBenefits, and Design Considerations. Martinez, CA: The Center of Health Design.

Cooper Marcus, C. and M. Barnes (Eds.). (1999). Healing Gardens: Therapeutic Benefits and DesignRecommendations. New York: John Wiley & Sons.

Francis, C. and C. Cooper Marcus. (1992). Restorative Places: Environment and Emotional Well-Being. In Proceedings of 24th Annual Environmental Design Research Association Conference.Boulder, CO; EDRA.

Hartig, T., M. Mang, and G. W. Evans. (1991). Restorative Effects of Natural Environment

Experiences. Environment and Behavior, Vol. 23, pp. 3-36.

Horsburgh, C. R. (1995). Healing by Design. The New England Journal of Medicine, Vol. 11, No.333, pp. 735-740.

Jackson, J. (2001). What Olmstead Knew, National Center for Environmental Health, Centers forDisease Control and Prevention Emory University, Atlanta GA. Websites cited:

Rebuilding the Unity of Health and Environment: a new Vision of Environmental Health forthe 21st Century: Institute of Medicine.National Academy Press. Washington, DC, 2001.

Obesity reference:http://www.cdc.gov/nccdphp/dnpa/obesity/

Physical activity reference:http://www.cdc.gov/nccdphp/sgr/summ.htm

Diabetes reference:http://www.cdc.gov/diabetes/statistics/

National Institute on Aging, Exercise and Physical Activity: Your Everyday Guide from the NationalInstitute on Aginghttp://www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide/01_getready.htm

Singleton D. (1994). Two Community Hospital Gardens: A Therapeutic Assessment. In

M. Francis, P. Lindsey, and J.S. Stone (Eds.), The Healing Dimensions of People-Plant Relations:Proceedings of a Research Symposium. Davis, CA: Center for Design Research, University ofCalifornia, Davis, pp. 269-282.

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Consumer Satisfaction. Journal of Environmental Psychology, Vol. 21, pp. 301-314.

Teresia Hazen, MED, HTR, QMHP

Registered Horticultural TherapistCoordinator, Legacy Therapeutic Gardens & Horticultural TherapyLegacy Health1015 NW 22

ndAve. Rm. 529

Portland, OR [email protected] 503-413-6507 FAX 503-413-8103
mailto:[email protected]:[email protected]:[email protected]

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