Recreation Therapy Treatment Program Protocol 591h18

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL

1

Recreation Therapy Treatment Program Protocol Horticultural Therapy

By: Michelle D. Muñoz LEI 4711 Fall 2016

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL

2

Purpose of Treatment Program The Horticultural Therapy program focuses on increasing client’s 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 individual’s 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 client’s 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 ed horticultural therapist (HTR). The horticultural therapist

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL is required to have obtained a bachelor’s 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 bachelor’s 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

3

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. Client’s 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 client’s 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

4

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 client’s functional skills through activities that use fine and gross motor skills, memory and decision making, and improve the client’s confidence and satisfaction in life. Participation will increase social interactions and build new relationships and also enhance independence by developing new leisure skills.

5

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL

6

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.

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL 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.

7

RECREATION THERAPY TREATMENT PROGRAM PROTOCOL 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.braininjury.org/living-with-a-traumatic-brain-injury/physicalconsequences/

8