Challenges and Solutions for Gardening Therapy | Occupational Therapy Practice

The Gardening Hype

The pandemic and the lockdowns have changed how many people do their occupations for leisure and even work. Many have taken to growing plants (including me) to help cope with staying indoors due to either required mandates or for personal safety reasons.

Gardening Therapy

Gardening for therapy is nothing new and has been proposed for its health benefits. A meta-analysis found gardening to beneficial to our health, mental and physical.[1]Soga, M., Gaston, K. J., & Yamaura, Y. (2017). Gardening is beneficial for health: A meta-analysis. Preventive medicine reports, 5, 92-99. Gardening can help to manage depression, mood, even one’s BMI, which makes sense as it can be very physical such as with weeding and the high MET values required up to METs or more.[2]https://golf.procon.org/met-values-for-800-activities/

Meaning of Gardening to People

“When I am out in the garden among everything that’s growing
I get a magnificent feeling of wellbeing … speeding up the
whole process of recovery”

“It is really satisfying to do things when the result is visible, it
is the best form of rehabilitation.”

Gardening as an Occupation

In my anecdotal experience working with patients, especially older adults, often a common activity that is meaningful to them is gardening. Gardening often comes up during my evaluations and many patients participate in outdoor gardening which has additional benefits of fresh air, sun and being out in nature.

Gardening does not just involve the task of gardening at home itself, but also shopping for plants and tools or even visiting gardens concerning community access and mobility like the beautiful Atlanta botanical garden that I recently visited.

“We enjoyed the fruits of our labours – we ate our own
school-grown tomatoes.”

Gardening even crosses over into other occupations such as ADLs when you factor in how it can result in the production of foods – vegetables, fruits, herbs, and grains from our residential gardens.

Barriers to Gardening

But outdoor gardening poses many challenges and barriers to patients. Activity analysis of gardening involves cognitive skills in order to maintain and optimize the health of plants, balance, fine motor skills to use gardening tools, gross motor skills, and strength to work with larger plants and move things soil and dirt (which can be very heavy), complex movements and positions such as crouching and kneeling, and even risks, such as slipping after watering plants. I remember going to a nursery to look at some new plants and I remember the ground being wet with even puddles of water as the workers just watered their plants.

Role and Implications of OT in Gardening

As occupational therapists, our goal is to maintain or promote or modify our patient’s participation in gardening. So it is well within our scope of practice to address gardening for our patients. Occupational therapists can address the mental, physical, and spiritual components holistically for patients who wish to continue or begin gardening either for leisure or even for work. You can even make money gardening such as working in a nursery, selling plants as a business, or entering your harvests into competitions.

According to the article, the implications include:

  1. Gardening is a beneficial occupation, which is established through evidence that the natural environment, use of gardening activities, the social group, opportunities to redefine personal identity and roles through a nurturing process, and skill development increase wellbeing. Despite this, activity analysis and grading, and accessibility of the environment, remain considerations.
  2. Professionals working within a gardening setting are able to harness the personal and social agents of change and to work to establish and maintain links to the wider community. This promotes social inclusion and the push toward community development as a determinant of health.
  3. Occupational therapists should collaborate with organizations operating within the voluntary and community sectors in order to use their unique services.[3]York, M., & Wiseman, T. (2012). Gardening as an occupation: a critical review. British Journal of Occupational Therapy, 75(2), 76-84.

Activity Barriers and Solutions

Safety and Balance

Gardening is a great way to practice one’s balance, but safety needs to be addressed due to concerns such as uneven terrain, fall hazards, slip hazards, and injury (e.g., thorns). Patients who anticipate independently gardening should have a means of calling for help in case of an emergency, e.g., falls such as having a fall alert system or encouragement to have a phone on them.

Positioning

Gardening may involve getting very low to the ground, which can be a difficult position for patients with conditions such as arthritis, hemiparesis, generalized weakness, poor proprioception and other sensory deficits such as vision. To overcome the challenge of crouching and kneeling, raised flower beds and planters can be used. If patients are not a danger sitting on the ground, it is even a good opportunity to practice floor recovery and transfers. For those with back pain and poor lower extremity function, sitting on the ground may be a viable alternative to crouching. For those with back pain, a soft cushion or pad on the ground will help to increase the duration that patients can sit on the ground to do gardening. Small pots can be used and placed on surfaces such as tables, such as seated on outdoor patio furniture to participate in indoor planting while outside such as propagation, increasing pottery size, or watering.

Low Vision

Gardening can be challenging due to low vision or just in general, things often have low contrast such as dirt and seeds. Other objects such as rocks may resemble seeds. While most plants are green and flowers often have highly saturated colors, it may be difficult to differentiate between different plants. Furthermore, sunlight may add glare and pose additional challenges. Setting up an umbrella or providing shade by relocating may be an option. The timing of day will affect the location of the sun as well as the temperature and heat, e.g., to avoid heat stroke. Patients can purchase tools or modify them to add contrast or change colors to help differentiate them, e.g., avoid purchasing green-colored or black-colored tools and water hoses.

Watering Risks: Assistive Technology and Adaptive Equipment

As watering plants may have safety risks, automation may be a solution such as with automated irrigation systems or even smart home devices that can remotely manage the watering of plants via a smartphone.

By nature of gardening, we often use tools already, but these may pose additional challenges due to poor fine motor skills, arthritis, or other chronic issues. These tools often require a cylindrical grasp and squeeze motion such as shears and to hold tools. Larger built-up handles may help if the tool is already small. Electric tools may be more effective and can save on energy demands, but pose additional dangers such as injury.

Find the balance of safety and function, but also consider safety and try to go low tech first before high due to costs and safety concerns with operating machinery. Patients with cognitive deficits such as memory and planning may benefit from written cues, supervision, and task simplification. Adaptive techniques can help remind patients to water their plants such as alarms or calendars or the mentioned, automated watering systems.

Pest Management

Pets are a natural part of gardening which can result in the death of plants and invasion of one’s garden. Handling of pest management products carries risks due to potential chemical exposure, if not irritations to skin. Opt for products that have multiple uses that can manage multiple pests such as systematic insecticides. Avoid the use of sprays compared to sprinkling on applications as this simplifies the need for additional tools and activity demands.

Tall Plants and Ladders

Naturally, some plants and trees will grow very tall and patients may often be inclined to climb on a ladder for gardening. I recently purchased a long-handled pruning tool that allows me to prune back my tree from ground level. While an added expense, educating patients about fall safety is paramount to maintaining their participation in gardening on a larger long-term scale. Hiring help or asking for help may be another good idea. For example, my elderly neighbor has a well-kept garden that is many orders larger than most in size. She does the watering but has weekly or bi-weekly gardeners and landscapers come by to help with managing her gardening. Patients may also benefit from downsizing their garden or changing the variety of plants to facilitate easy management of gardening such as those that require less watering, have slower growth, or have fewer needs such as sunlight.

Advocacy

Not every facility such as in the hospital may have an outdoor garden. Sometimes it may be present but is managed professionally by hired workers. Talk with your team and bring up the idea to leadership to propose starting a community-maintained garden that allows for patient participation. As there may be legal concerns, be sure to ask for permission from leadership before you have a patient work on the garden which may be the property of the organization. If not, an indoor garden or small potted plants is always a viable alternative, as long as your facility has some windows with adequate sunlight.

See my other post for an overall guide to gardening for occupational therapy practitioners.

References

References
1 Soga, M., Gaston, K. J., & Yamaura, Y. (2017). Gardening is beneficial for health: A meta-analysis. Preventive medicine reports, 5, 92-99.
2 https://golf.procon.org/met-values-for-800-activities/
3 York, M., & Wiseman, T. (2012). Gardening as an occupation: a critical review. British Journal of Occupational Therapy, 75(2), 76-84.
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.