Gardening as a Meaningful Occupation in Initial Stroke Rehabilitation
Rationale: Following a stroke, individuals may experience feelings of uncertainty about their health and future life. It is important for participants to engage in meaningful occupations that promote health and improve quality of life during this time. Garden-related activities have been used for therapeutic purposes for many population groups in the field of occupational therapy. Garden-related activities have shown to promote mental healing, learning new recreational occupations, social integration, sensory enrichment and integration, cognitive reorganization, sensory motor training, assessment and training of prevocational skills, and assessment and training of ergonomic bodily positions.
Methods: This qualitative study analyzed notes written by occupational therapists who worked in stroke rehabilitation during a 6 month-period. The notes reflected their observations and descriptions after sessions with a gardening group. The therapists were trained in stroke rehabilitation and offered two sessions with gardening groups per week. The patients participated in horticultural activities, such as propagating plants from seeds or cuttings, potting, planting, watering, composting, harvesting plant material, and preserving the material for tea or decorative purposes. They also made food or handicraft items using materials obtained from outdoors.
Results:
Six themes were revealed through qualitative thematic analysis:
1. Possibilities for skills training:
Occupational therapists commented on how the patients worked on the functioning of their hands and feet to perform the tasks and meet the rehabilitation goals. The notes described how the patients’ capacities, such as strength, balance and coordination, gross and fine motor skills, and cognitive and sensory skills, were challenged.
2. Engagement in the occupation
Engaging in garden-related activities and surrounding themselves with the smell and taste of plants and garden products made the patients aware of their sensory capacity. For instance, one patient used lavender to explore whether their sense of smell was still intact. Furthermore, gardening as an occupation led to enjoyment and satisfaction from making a specific product, and through this, the gardening contributed to the patients’ increased sense of wellbeing and self-esteem.
3. Mastery of the activity
Occupational therapists described the patients’ experience of mastery when participating in the gardening group. Patients expressed satisfaction when doing an occupation that was adapted to their functional level, and their satisfaction was particularly enhanced when they managed tasks that were of interest to them. The occupational therapists considered the use of gardening in stroke rehabilitation as both a context and an occupation in which the patients themselves could recognize their own progress, experience mastery in functioning, and look for new ways to challenge themselves.
4. Finding mental rest
Many of the gardening sessions introduced occupations that helped patients to become calmer and to gain mental rest. The therapists also described how seeing plants grow and develop over time could help patients to unwind and be less impatient concerning the rate of their rehabilitation progress:
5. Connection to past experiences
In some circumstances, patients related gardening to past experiences and experienced gardening as a familiar and preferred context and occupation. They observed that the patients could thus experience gardening as personally meaningful and as a reflection of their identity and preferences.
6. Shared experiences and hope
The occupational therapists described the gardening group as an opportunity for patients to meet and work together. They considered the social environment as supportive and noted that the patients shared their experiences and own stories about gardening, their health challenges and worries, and their views and hopes for the future.
Conclusions and Implications for OT:
Occupational therapists found that gardening provided clinical opportunities for skills training and health resources. As a group-based, common occupation, gardening may provide a complementary approach in stroke rehabilitation. In addition, the findings indicate that therapists saw possibilities for individual patient’s adaptation through everyday, common gardening activities, which also led to engagement, mastery, mental rest, connection to past experiences, and connection with others.
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