Craig Hospital in Denver is a hospital specializing in the neuro-rehabilitation and research for patients with spinal cord injury (SCI) and traumatic brain injury (TBI). Since 1982, the hospital has offered a horticultural therapy program among the many recreational therapy activities available to patients as part of their rehabilitation. In 1994, Susie Hall took over the program. Originally hired as a recreational therapist in 1988, she received her training at HTI and through a Master Gardener program.
Some basic information helps understand the patients at Craig Hospital. Spinal cord injury patients (50 to 55 beds) are 38 years old on average and 75% of them are men. Fifty percent of them have been in traffic accidents and the rest suffered falls or sports injuries. They arrive at the rehabilitation hospital on average 28 days after the accident and stay between two and four months. At the end of their stay, 90 % of them go home and 40% of them are back in a job or in school one year after their accident. There are fewer brain injury patients (25 to 30 beds). In addition, about fifty patients also attend Craig Hospital as a day hospital.
Adapting to new physical or cognitive limitations
The horticultural therapy program focuses on two main goals. “One approach is to offer patients a new hobby they can enjoy back home with their families or to allow them to start gardening with appropriate adaptations to their physical or cognitive limitations,” explains Susie Hall. The hospital encourages the involvement of families who have the opportunity to stay on site for one month (patients come from all over the United States and some come from abroad). “The more they do things together while the patient is here, the more the family understands how to help them when they go back home,” says the horticultural therapist.
“The other approach is therapeutic and the activity is done in collaboration with a physical therapist or an occupational therapist. For example, for patients with TBI who have vision problems, the goal may be to encourage them to learn to scan their environment. In the greenhouse, we position the plants on the left and ask them to move them to the watering faucet.” Here is another example. For a patient whose PT wants him to improve his ability to stand, an activity that requires him to stand at a table to repot plants provides incentive. It allows him to focus and forget his pain. “In a PT room, standing would have no purpose and would be boring. Here, the activity has meaning and he can make progress.”
The day I talked to her, Susie Hall was about to go work with a patient and his speech therapist. “Last week, he did an activity. We’ll see what he remembers and if he needs to refer to the instructions. We will ask him to explain what he is doing.” When a member of the team feels a patient is interested in gardening, Susie welcomes them with open arms as long as she knows their treatment goals in order to create “an environment that is positive and where they can succeed.”
In addition to individual sessions, Susie and a dozen volunteers lead gardening groups every two weeks. “It is open to all patients and to their families so they can see what they are capable of and how to implement the same thing back home.” The group’s activities are inspired by the seasons and holidays. ” For Valentine’s Day, we made topiaries with ivy. We talked about the plant and we bent the wire in the shape of a heart. This is a fun activity and participants can offer it to someone. For Easter, we will plant wheatgrass which grows in about a week. We can fill a basket where we then arrange flowers in test tubes.”
“When we can take care of something, we feel better”
According to the patient’s needs, Susie may be able to show them gardening tools tailored to their limitations such as scissors designed for quadriplegics who have limited mobility and strength. For patients with less severe TBI, the goal is to focus on an activity and group work, whether planting, propagating, watering in the greenhouse or drying flowers for a future project, for an hour.
Volunteers bring gardening activities to bedridden patients. “We bring plants and soil on a trolley and we work with them in their room. We put blankets on their beds and they can work with the soil,” explains Susie Hall. At the other end of the spectrum, some high-functioning patients go into town and visit nurseries or the botanical gardens where they can practice getting around with their wheelchair or cane.
For Susie, there are several positive aspects of focusing on plants for rehabilitation patients. “One goal is to work on their strength and on their cognitive abilities. The value of horticultural therapy is to provide a meaningful activity. The more they are interested, the longer they participate and the better the physical and cognitive outcomes are. When you put a plant in front of someone, they automatically reach out to touch it. The strong smell of geraniums will get them to make a face. There is a response to the plant. Instead of working with cubes that have no meaning, they can prune dead flowers off a plant. They work the same fine motor skills. The more creative you can be, the more you can improve the results.”
“Our patients have a lot of medical needs. What they are missing is to take care of something. Plants thrive when we take care of them and they are not judgmental. When we can take care of something, we feel better,” Susie concludes.