Running head: RAISED THERAPY GARDEN

Raised Therapy Garden

Kristen D. Kincaid
Touro University Nevada

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2
Client Population

The raised therapy garden is beneficial for almost all client populations and can be
utilized in great benefit clients in long term nursing and rehabilitation facilities. Furthermore, it
can be constructed at the clients home to continue to work on therapeutic goals after discharge.
The raised therapy garden provides numerous opportunities for the occupational therapist (OT)
to address common issues in both long term nursing and rehabilitation facilities. Some of typical
goals of therapy in these settings focus on improved strength, endurance, ROM, activity
tolerance, cognition, and wellbeing.
Diagnosis
The raised therapy garden can be utilized with a wide range of client diagnoses. The
design of this garden is one that can be utilized in multiple settings, however; it is particularly
suited long term skilled nursing and rehabilitation facilities. Some diagnoses that may be seen in
these settings include: post-surgical, dementia, spinal injury, TBI, CVA, and MVA. The raised
therapy garden is beneficial in these settings because it allows for a multitude of possible
therapeutic interventions that can be tailored to address a clients specific needs, whether they are
cognitive, physical, psychosocial, or some combination of the prior.
Purpose of Device
The purpose of the raised therapy garden is to provide all clients the opportunity to
engage in the activity of gardening. The design of the garden is such that, with simple alterations
to the frame, the garden can be customized to fit any sized client. For example, the height can be
adjusted to better accommodate clients in a wheel chair. By raising the garden bed off the ground
level, the therapist removes barriers that may have prevented clients from engaging in this
activity. Typically, a client will need to be able to kneel, stoop, or squat to reach the ground level

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garden bed. This puts stress on the clients knees and back. Some clients are simply unable to
assume these positions. The raised therapy garden is a useful alternative to a ground based
garden because it allows the client to stand or sit while engaging in the activity.
Enhanced Functional Performance
Horticultural therapy is a treatment modality that uses plants and related activities to
improve the social, cognitive, physical, psychological and general health of the participant
(Simson & Straus, 1998). Gardening as a therapeutic activity can greatly enhance the functional
performance of a client in a long-term or rehabilitation facility. This device allows facilities to
build a cost effective and easy to assemble therapy garden for their clients and therapists to
utilize.
Fine Motor Skills
Gardening allows for a multitude of interventions that focus on fine motor skills. The
therapist can work on a clients pincer grasp by having the client plant seeds. The task can be
graded up by using smaller seeds and graded down by using larger seeds. In addition, the client
can remove old leaves by pinching them off. Hand strength can be improved by instructing the
client to mix compost into the soil. Furthermore, the therapist can have the client work on
pronation and supination by using a watering can to water the garden. This activity can be graded
up by adding more water and thus increasing the weight of the watering can. Conversely, the task
can be graded down by adding less water. Dexterity can be addressed by having the client plant
seedlings. This task can be graded up by using smaller seedlings that require more delicate
control, while it can be graded down by using larger seedlings that are less delicate. These are
just a small sampling of the many interventions that a therapist can do with a client while
utilizing the raised therapy garden.

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Dynamic Sitting or Standing Balance

One of the most impressive benefits of the raised therapy garden is its ability to be
customized to meet the demands of a client. By using the raised therapy garden, the therapist at a
long term nursing or rehabilitation facility is able to work on standing balance and endurance.
The client can stand directly in front of the garden, which would ideally be matched to their
height, with a wheelchair placed behind them for safety. This also can help the anxious client feel
more comfortable and secure standing because, in front of them, there is a solid surface to lean
on, while, behind them, there is the wheelchair. The feeling of security offered by this setup may
increase a fearful clients likelihood of standing to perform tasks. If gardening is an enjoyed
activity by the client, then they are more likely to become immersed in the activity, thereby
increasing the amounts of time spent standing. Furthermore, standing balance can be addressed
by directly the client to reach for items outside their BOS. Since these skills are addressed
through the use of an enjoyed activity, the client is more likely to stay engaged in therapy longer.
Dynamic sitting balance can be addressed in a similar manner, by placing gardening items
outside the clients direct reach. This will address the clients trunk control, strength, and
endurance.
Range of Motion (ROM)
The raised therapy garden has a trellis attached to the back of the unit that allows a plant
to grow up vertically. This trellis adds a beneficial feature to the unit as it allows for functional
flexion of the shoulder joint as a client reaches up to tend to the plants. The client can perform
tasks such as pruning dead leaves or securing new shoots to the trellis. This not only works on
ROM, but also addresses muscle strength and endurance. Other adaptations can be made to the
raised therapy garden that will allow for additional tasks that focus on ROM. For instance, hooks

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can be added to the trelliss support structure that house gardening tools and materials. The client
will then have to reach to secure and return these items. In addition, the therapist can have the
client perform gardening tasks at greater distances thereby addressing UE ROM.
Cognition
Providing therapy while using the raised therapy garden allows for a unique, functional
activity that can tax and train a variety of cognitive abilities. Retention and recall, decision
making, problem solving, verbal communication skills can all be successfully addressed during a
gardening activity. An example of an intervention that addresses the above mentioned skills is to
have the client identify plants that they are working with. The therapist can grade this task up by
using plants that look familiar. The task can be graded down by using plants that are in stark
contrast to each other.
Psychosocial and Emotional
By using the raised therapy garden in a long term skilled nursing or rehabilitation facility,
the client can immerse themselves in the activity of gardening. This immersion can act as a
diversion from illness or pain. Similarly, it may also help decrease the depression level of some
clients. Another benefit of using the raised therapy garden is that it focuses on the ability of the
client and what they can do. These meaningful and functional tasks embedded in the larger
activity of gardening can increase self-esteem and possibility assist with emotional regulation.
Description of the Item
The raised therapy garden is a customizable, portable gardening unit that can be used in
any setting with almost any clientele. It is a cost-effective design that allows for the use of
gardening as a therapeutic activity. Since the raised therapy garden utilizes a large plastic bin to
hold the soil and plant life, it can be used both indoors and outdoors. If used indoors watering of

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the plant life can be accomplished with a watering can during client intervention. The benefits of
having an indoor garden include avoidance of extreme environmental temperature; no additional
outdoor space needed and ease of accessibility. If used outdoors, the facility may also decide to
water the plant life with drip irrigation or a hose, in addition to a watering can. On the backside
of the raised therapy garden, there is a trellis that can be utilized to grown vines vertically. It
consists of support boards that are placed on each end of the raised therapy garden. Attached
between the boards is silver galvanized steel poultry netting. This serves as a support structure
for vining plants. Furthermore, this not only adds to the aesthetic design of the raised therapy
garden, but allows increased opportunities for therapeutic interventions.
Materials

Box of 2 deck screws (48 total)

Two 2x4x10 pressure-treated boards should yield:
o Four 37 boards
o Four 20 boards
Three 2x4x96 pressure-treated boards
o Four 33 boards
o Two 36 boards
Three 1x2x8 furling straps
o Five 36 boards
o Three 48 boards
Large all-purpose plastic bin 2x3
24-in x 50-ft Silver Galvanized Steel Poultry Netting
Additional Adaptive Equipment
The raised therapy garden can address many of the needs and goals of clients receiving

treatment in a long term skilled nursing or rehabilitation facility. However, because it is

appropriate for such a wide populace, it may be necessary to incorporate additional adaptive
equipment and tools into therapy. Some example include hand tools with a built up or
ergonomically placed handle, tools that attach to the forearm for increased control, and long

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handled watering sticks or garden tools. In addition, some common therapy materials can be used
to assist with gardening tasks. For example, a common dowel can be utilized by the client to
decrease the dexterity needed to poke holes for seed planting.
Literature Review
According to the study published in Psychiatry Investigation Journal, preliminary studies
indicate that therapeutic gardening results in a reduction of pain, improvement of attention and
memory, a lessening of stress, modulation of agitation, a decrease in the amount of as needed
medication, and a reduction of falls (due to less medication). In addition, it is also thought to help
clients learn new skills and to regain lost skills. Furthermore, it provides a sense of responsibility
and social interaction to clients. All of these benefits are hard with few to no side effects. These
findings are important due to the fact that, as a client ages, they are more likely to need
rehabilitation for acute and chronic problems including: cognitive decline, altered mental status,
stroke, heart attack, and surgical procedures. Additional preliminary studies indicate that postsurgical and post trauma patients that are allowed exposure to natural settings have improved
treatment outcomes. The study concluded that, in the future, controlled clinical trials need to be
completed. Most evidence that exists for therapeutic gardening is drawn from descriptive case
studies and did not usually include control patients (Detweiler et al., 2012)
A study published in Pediatric Rehabilitation found that one important benefit of
horticulture therapy is that the patient can continue the occupation of gardening at home using
adaptive techniques learned during therapy sessions. Furthermore, gardening activities were cited
as easy to vary and adapt to a clients level of ability. In the study, 72 patients who suffered from
a brain injury (stroke, hemorrhage, or brain trauma) participated in a gardening group for 9
months. Each client had individualized goals and the therapeutic interventions were designed to

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meet the specific goals. It is important to note that the effectiveness of the therapy was not
assessed in this study. Therefore, concrete conclusions about the use of therapeutic gardening
with this population cannot be made. Goals that were addressed while gardening were to:
improve mobility, increase muscle strength and balance, increase gross and fine motor skills,
increase ROM, improve ability to cross mid-line and improve hand-eye coordination. In
addition, gardening also allowed therapists to address client goals of cognitive re-organization by
encouraging clients to systematically learn a new way to perform an activity. The major
limitation of the study was that it lacked a final measure to assess whether the therapeutic
gardening was beneficial. In future studies, an assessment tool must be utilized pre and post
treatment to discern whether treatment resulted in statistically significant improvements of client
function (Soderback, Soderstrom, & Schalander, 2004).
Cost Analysis
The costs of the materials to construct the raised therapy garden were below sixty dollars.
This makes this a very cost effective assistive device to incorporate into a long term skilled
nursing or rehabilitation facility. Since the cost is acceptable for this device, multiple versions
can be built to address the different sizes and abilities of the clients. Some examples of
variations of the raised therapy garden include those that are built higher for taller clients or
those who are on spinal precautions, or build to meet needs of a client who uses a wheelchair.
Large All Plastic Bin
Blue Hawk 24-in x 50-ft Silver
Galvanized Steel Poultry Netting
Two 2x4x10 Pressure Treated
Lumber
Three 2x4x10 Pressure Treated
Lumber
Three 1x2x8 Furring Strip
Grip-Rite #8 2-1/2 in. Phillips
Bugle-Head Wood Screws (1 lb.-

$13.97
$8.97
$4.47 x 2
$2.82 x 3
$1.13 x 3
$8.47

RAISED THERAPY GARDEN

Pack
8.97
Blue Hawk 24-in x 50-ft
Silver Galvanized Steel
Poultry Netting
$56.21
Total Cost (with sales tax)

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References

Detweiler, M. B., Sharma, T., Detweiller, J. G., Murphy, P. F., Lane, S., Carman, J., ...Chudhary,
A. S. (2012). What is the evidence to support the use of therapeutic gardens for the
elderly? Psychiatry Investigation Journal, 9, 100-110. doi:10.4306/pi.2012.9.2.100
Simson, S., & Straus, M. (1998). Horticulture as Therapy: Principles and Practices.
Binghamton, NY: Haworth Press.
Soderback, I., Soderstrom, M., & Schalander, E. (2004). Horticultural therapy: the
healing garden and gardening in rehabilitation measures at Danderyd Hospital
Rehabilitation Clinic, Sweden. Pediatric Rehabilitation, 7, 245-260.
doi:10.1080/13638490410001711416