RECREATION THERAPY TREATMENT PROGRAM PROTOCOL

Recreation Therapy Treatment Program Protocol

Horticultural Therapy

By: Michelle D. Muoz

LEI 4711 Fall 2016

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL

Purpose of Treatment Program

The Horticultural Therapy program focuses on increasing clients independence and
restoring functional skills through the use of horticulture and related activities. Horticultural
Therapy (HT) is a formal practice that uses plants, horticultural activities, and the garden landscape
to promote wellness for its participants (About Horticulture Therapy, n.d.). HT uses a goal oriented
approach with defined outcomes and assessment procedures (About Horticulture Therapy, n.d.). It
acknowledges the benefits of interaction between people and nature to improve cognitive,
physical, social, emotional, and spiritual wellness among individuals (About Horticulture Therapy,
n.d.). This type of therapy program incorporates meaningful and purposeful activities that offer
restoration and relief from debilitating conditions. It also encourages human growth and confronts
the individuals psychological needs and the connection to the natural world (Questions About
Horticultural Therapy, n.d.). Plants and plant-related activities will be used as treatment methods
to improve the clients well-being through active involvement (AHTA, 2007). Some benefits of
horticultural therapy include (AHTA, 2007):

Improves concentration

Alleviates depression

Increases self esteem

Increases sense of control

Reduces stress

Enhances social interactions

Improves mood

Promotes physical health

Decreases anxiety

Improves fine and gross motor

Improves coordination

skills

Staff Requirements/Competence
The horticultural therapy program will be implemented by a certified therapeutic recreation
specialist (CTRS), along with a registered horticultural therapist (HTR). The horticultural therapist

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is required to have obtained a bachelors degree from an accredited university, as well as a
certificate in horticultural therapy from the American Horticultural Therapy Association. The
CTRS is required to have a bachelors degree in therapeutic recreation or a related field and be
certified by the National Council for Therapeutic Recreation Certification.
Entrance Criteria/Diagnosis
The horticultural therapy program is designed for adults with traumatic brain injury (TBI).
A traumatic brain injury occurs when a sudden trauma causes damage to the brain (NINDS, 2016).
Symptoms can be unique for each individual and may range from mild to severe depending on the
extent of damage to the brain (NINDS,2016). An individual with TBI may experience impairment
in physical, cognitive, and social/emotional skills. They may find difficulty in once easy tasks and
in areas such as attention, concentration, memory, problem-solving, communication, balance,
coordination, and motor skills (Cognitive Problems after Traumatic Brain Injury, n.d). With the
use of horticultural therapy, individuals with TBI can regain lost skills and maximize their
independence. HT will provide goal oriented activities that can lead to improvements in the
individuals physical and cognitive skills. The group atmosphere provided in HT also increases
social interaction and can ultimately help the participants restore his/her social skills.
Exit Criteria
At the end of the horticultural therapy program, the client should be able to improve their
endurance and motor skills, restore cognitive function, and increase social interaction. The client
should also be able to maximize their independence and develop new leisure skills.
Safety Considerations
The horticultural therapy program will be conducted in a fully accessible therapeutic
garden. A therapeutic garden is carefully planned and created without any physical or attitudinal

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL

barriers where anyone can go to enjoy nature and engage in gardening (Larson, Hancheck &
Vollmar, n.d.). The therapeutic garden will use accessible garden tools and containers to eliminate
the risk of falls while participating in the activity. Raised beds will be used to make gardening
from a seated position more convenient. Adaptive garden tools with easy-grip and long reachers
will also be provided to increase participation and reduce the risk of injury.
Client Risks. Clients with TBI often experience persisting headaches (Treatment in
Headaches, n.d.). They may also suffer from fatigue and drowsiness which may be caused by
certain medications. The medications may cause side effects or have contraindications to be aware
of when participating in the horticultural therapy program (Simson & Straus, 1998). Individuals
with TBI also have problems with balance which may be caused by medications, drops in blood
pressure, or vision and hearing impairments. It is critical for the therapists monitor and understand
the clients risks in order to reduce the chance of injury during the activity and provide adequate
resources to prevent any accidents or harm.
Environmental Risks. The horticultural therapy program will be conducted outside in the
therapeutic garden. High temperatures may be an issue when working with individuals with TBI
and should be considered when planning sessions since strenuous activity is not recommended.
Therapists will provide break times, water for hydration, and shaded areas with fans to cool off
and reduce the risks of heat exhaustion. The therapeutic garden itself is fully accessible, with
leveled grounds and hand rails around the garden area. The garden also has shaded seating areas
where clients can sit down during their break times.
Facility and Equipment Required
The facility required to implement the horticultural therapy program is an outdoor
therapeutic garden that is fully accessible and meets the needs of the clients. The facility garden

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL

should provide seating/rest areas and nearby restrooms. An indoor dayroom may also be used for
art-related horticultural activities or when the weather conditions do not allow the program to be
performed outdoors. The indoor dayroom should be large enough for groups of up to 15 and have
tables and chairs to accommodate all participants.
The horticultural therapy program uses a variety of equipment to perform gardening
activities. Some equipment may include potting mix, gloves, shovels, seeds, watering cans, water
hose, digging forks, weeders, hand rakes, and planters. Adaptive tools may also be provided such
as lightweight tools, hand tools, and long handles. Raised beds and containers will also be used to
allow maximum participation and are useful for individuals who cannot easily kneel or bend or
are in a wheelchair (7 Adaptive Gardening Tools, n.d.). For art-related horticultural activities,
some equipment that may be used are scissors, paper, markers, tape, stones, and fabric.
Outcome Criteria
After the horticultural therapy program, individuals with TBI will have significant
improvements in physical, cognitive, and social/emotional health. Their outcomes will result from
active participation in horticulture and related activities. Horticultural therapy will help to improve
clients functional skills through activities that use fine and gross motor skills, memory and
decision making, and improve the clients confidence and satisfaction in life. Participation will
increase social interactions and build new relationships and also enhance independence by
developing new leisure skills.

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Planting Paperwhite Bulbs

Description: The Planting Paperwhite Bulbs horticulture activity is an easy planting project that
produces flowers within 3 to 6 weeks. This activity should be facilitated by a CTRS and HTR
and should consist of a group of 15 participants. The purpose of this activity is to plant
paperwhite bulbs and observe their growth over the 3 to 6-week time period.
Objectives:
1. Works on fine/gross motor skills and hand/eye coordination
2. Promotes cognitive stimulation
3. Provides sensory stimulation
Life Skills: Through this activity, participants will learn how to plant bulbs by filling pots with
soil and watering. They will learn about paperwhite bulbs and how to grow them. Participants
will be able to observe the growth of their bulbs which promotes curiosity, fascination, and hope.
A sense of accomplishment is achieved when the paperwhite bulbs flower.
Session Time: 45 to 60 minutes
Materials:

Paperwhite bulbs (3 per container)

Potting soil

6 pots

Watering can

Saucers

Plastic tray

Gloves

Hand shovel

Process:
1. Loosely fill pots with potting soil 1-2 inches from the top.
2. Place bulbs on top of the soil (3 bulbs in a 6 pot).
3. Add more soil to the container. Firmly press the soil around the bulbs without covering
them completely. Containers should then be placed on saucers and watered until it
drains through the bottom holes.
4. Do not allow the soil to dry, keep the soil moist.
5. Place near indirect sunlight to extend the length of the blooms.

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Content: Before planting, have participants analyze the bulbs. Get them to look at their color,
shape, and texture. Find the flat bottom, this is where the roots will develop once they are planted
and watered. Once planted, participants can care for and watch their bulbs flower. The
paperwhite bulbs produce clusters of fragrant small white flowers. Their fragrance is described
as being musky or spicy. Participants are encouraged to smell and touch their flowers which
provides sensory stimulation. At the end of the session, participants will be able to take home
their flowers and continue applying the knowledge they have learned through the horticultural
therapy program to care for their plants.

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Reference:
7 Adaptive Gardening Tools for Gardeners With Disabilities. (2016). Retrieved November 08,
2016, from https://www.verywell.com/gardening-with-disabilities-1094600
About Horticultural Therapy. (n.d.). Retrieved November 1, 2016, from
http://www.chta.ca/about_ht.htm
American Horticultural Therapy Association (AHTA). (2007). Retrieved October 28, 2016, from
http://ahta.org/sites/default/files/Final_HT_Position_Paper_updated_409.pdf
Cognitive Problems after Traumatic Brain Injury. (n.d.). Retrieved November 08, 2016, from
http://www.msktc.org/tbi/factsheets/Cognitive-Problems-After-Traumatic-Brain-Injury
Larson, J., Hancheck, A., & Vollmar, P. (n.d.). Accessible gardening for therapeutic horticulture.
Retrieved November 08, 2016, from http://www.extension.umn.edu/garden/yardgarden/landscaping/accessible-gardening-for-therapeutic-horticulture/
National Institute of Neurological Disorders and Stroke (NINDS). (2016). Retrieved November
08, 2016, from http://www.ninds.nih.gov/disorders/tbi/tbi.htm
Planting Paperwhite Bulbs. (2012). Retrieved November 08, 2016, from
http://www.gardentherapynotes.com/Planting-Paperwhite-Bulbs.html
Questions About Horticultural Therapy - Horticultural Therapy Institute. (n.d.). Retrieved
October 28, 2016, from http://www.htinstitute.org/questions-about-horticultural-therapy/
Simson, S., & Straus, M. C. (1998). Horticulture as therapy: Principles and practice. New York:
Food Products Press.
Treatment of Headaches and Dizziness in TBI Patients. (n.d.). Retrieved November 08, 2016,
from http://www.braininjurysupport.org/living-with-a-traumatic-brain-injury/physicalconsequences/