87

87

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Credit seminar

Therapeutic
Therapeutic Garden
Garden
SHAMANTH.M.G
AHM/14-07
FLA Dept
Dr.Y.S.R.Horticultural University.
2014-2016
 Department/
  Name Designation
Major Field

Chairman Dr.R.Nagaraju Assistant professor Horticulture

Member Dr.K.Swarajya lakshmi Associate professor Horticulture

     
Member Dr.B.Govindarajulu  Principal scientist Pathology

Member Dr.D.Srinivas reddy Assistant professor     Entomology

 
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Topic division
Therapeutic
Therapeuticgarden
garden

History
History&&Introduction
Introduction

Types
Typesof
oftherapeutic
therapeuticgardens
gardens

Design
DesignGuidelines
Guidelines

Case
CaseStudies
Studies

conclusion
conclusion
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The World Health Organisation defines health as 

complete physical, mental and social well-being. 
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Healing:- 
•Process  that  promotes  overall  well-being  (Cooper  Marcus  & 
Barnes 1999). 
•In  particular,  it  is  a  process  that  the  body  restores  or  recovers 
both  physically  or/and  mentally.  Moreover,  it  is  a 
multidimensional  process  which  includes  physical,  mental, 
spiritual, emotional and social aspects. 
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82

Gardening  works  on  many 

different levels which makes 
it  a  powerful  and  flexible 
medium  for  improving 
health and quality of life. 
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• A  Therapeutic Garden is  an  outdoor  garden 

space  that  has  been  specifically  designed  to 
meet  the  physical,  psychological,  social  and 
spiritual needs of the people
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For  a  patient,  visitor,  or  member  of  staff, 

spending  long  hours  in  a  hospital  can  be  a 
stressful experience. 
Nearby access to natural landscape or a garden 
can enhance people’s ability to deal with stress 
and thus potentially improve health outcomes.
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A  therapeutic  garden  referred  to  different  garden 

features  that  have  the  ability  to  foster  restoration 
from  stress  and  also  have  other  positive  effects  on 
patients  staffs  and  visitors.  and  “should  contain 
prominent  amounts  of  real  nature  content  such  as 
green vegetation, flowers, and water.”
       
Ulrich, 1984
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History
• “The idea of healing garden is both ancient and modern”(Cooper 
Marcus & Barnes, 1999). 
• Historically, people have always used nature as a powerful healing 
source and as a resource for recovery (Cooper Marcus and Barnes, 
1999).
• Persian garden, the Japanese Zen garden and the Monastic 
Cloister gardens are some of examples of a healing environment 
which appeared throughout history in different parts of the world. 
• The Greeks created healing temples for their gods. The temple for 
the god Aesclepius (god of healing) was built in pastoral settings 
with mineral springs, bathing pools, gymnasiums, and healing 
gardens. Here people would come to worship, lodge, recreate, and 
heal.
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•In the 19th century, Dr. Benjamin Rush was first to document 
the positive effect working in the garden had on individuals with 
mental illness.
•In US, horticultural therapy blossomed after World War II, with 
homecoming soldiers in need of restorative therapy.
•Since the mid-1980s, research has indicated that gardens, parks 
and areas with natural greenery have beneficial effects on human 
health, well-being and capacity (Kaplan,R and Kaplan, S.1989).
 
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• Friends Asylum - first known example of psychiatric hospitals 
using gardening activities opening in 1813 in Philadelphia.
• In 1972, foundation teamed with the Horticulture Department 
at Kansas State University provided first horticultural therapy 
curriculum in the U.S.
• 1973 – NCTRH (National council for therapy and
rehabilitation)
• 1988 – AHTA (American Horticultural Therapy Association)
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 Medieval monastic cloister garden

 Early example of restorative outdoor space for sick
patients
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Raised Beds
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1673
INTRODUCTION
“Quality of life,” “well-being,” and “healing” are 
phrases  that  embody concepts being recognized 
with increasing importance in the 21st-century.

However, over the last 50 years with the rapid 
growth   of  medical technology and economic 
pressure,  this ancient concept has been neglected.

Presently, Healthcare costs are climbing. Hence in 
hospitals and healthcare institutions often keep 
up extensive gardens and landscapes as an     
important part  of healing. 
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1772

Therapeutic  Gardens  can  be  found  in  a  variety  of 

settings, including but not limited to hospitals, skilled nursing 
homes,  assisted  living  residences,  continuing  care  retirement 
communities,  out-patient  cancer  centers,  hospice  residences, 
and other related healthcare and residential environments. 

The  focus  of  the  thereupetic  gardens  is  primarily  on 

incorporating  plants  and  friendly  wildlife  into  the  space  near 
to  hospitals  and  healthcare  centers  for  the  better  health 
outcomes of the peoples.
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1871

• The  Joint  Commission  for  the  Accreditation  of  Hospitals 

Organization  (JCAHO)  has  stated,  “Patients  and  visitors 
should  have  opportunities  to  connect  with  nature  through 
outside  spaces,  plants,  indoor  atriums,  and  views  from 
windows” (1999).
• There  is  significant  evidence  indicating  that  environmental 
exposures, such as contact with plants and animals, viewing  
landscapes, and participating in wilderness experiences, may 
have  positive  impact  on  mental  and  physical  health 
(Frumkin, 2001, 2004),
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Healing Gardens in Hospitals
Table 1: Responses from 143 garden users at four San Francisco 
Bay Area hospitals

Cooper Marcus and Barnes, 1995

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2069
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Benefits of therapeutic gardening

• Psychological

• Social 

• Physical
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 Facilitates  stress  reduction,  helps  body  reach  more 

balanced state
 Helps  person  summon  up  own  inner  healing 
resources
 Provide  a  setting  where  staff  can  conduct  physical 
therapy, horticultural therapy, etc. with patients
 Helps  patient  come  to  terms  with  incurable  medical 
condition
 Provide  a  relaxed  setting  for  patient-visitor 
interaction away from the hospital interior.
 Provides needed retreat for staff from stress of work
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• Therapeutic landscape designed for people

with vision loss, outside London, England.
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65
Types of Therapeutic Gardens
• Alzheimer's Gardens: adult day care programs and
dementia residences
• Healing Gardens: acute care hospitals, skilled nursing
facilities and other healthcare facilities
• Rehabilitation Gardens: rehabilitation hospitals
• Restorative Gardens: psychiatric hospitals
• Senior Community Gardens: assisted living, continuing
care retirement communities and other senior living
residences
• Cancer Gardens: chemotherapy facilities
• Enabling Gardens: vocational schools, arboretum
• Meditation Gardens: religious institutions and other
faith based settings
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Elements

Natural elements
 Familiar plantings
 Plants that attract birds and butterflies
 Ornamental plants
 Non-toxic and non-injurious plantings
 Annuals
 Soil
 Sunlight and natural shade
 Wind
 Precipitation
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Constructed garden elements

 Patio
 Paved walking 
 Seatings
 Landscape lighting
 Raised beds
 Shade
 Water features
 Electrical outdoor 
outlet; for music and 
related activities
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POTENTIAL
ACTIVITIES IN
A
THERAUPEUTIC
GARDEN
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61

Views through a window

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60

Sitting outside

Reading/
doing paper work outside
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59

Walking &
Rehabilitation
exercises
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58

Therapeutic garden characteristics

1.Scheduled and programmed activities
2.Features modified to improve accessibility 
3.Well defined perimeters
4.A profusion of plants and people interactions
5.Supportive conditions
6.Universal design 
7.Recognizable place making
                                                                                AHTA, 2015
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Design Principles in
Therapeutic Landscapes
 Before starting the design process it is important to
know the user groups.
 In designing a healing garden the focus should be on
the people who are going to use the garden.
 Depending on user groups there should be a balance
between the physical activities and just being and
experiencing the garden passively (Stigsdotter & Grahn
2002).
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The key design principles

• Sustainability
• Orientation
• Accessibility
• Socialisation
• Meaningful activity
• Reminiscence
• Sensory stimulation
• Safety
AHTA, 2012 
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Sustainability

 Understanding of its therapeutic value, 
activity programs and maintenance regime

 Garden’s success very much depends 
upon the staff’s understanding of the design

AHTA, 2012 
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54

Orientation

•Locate gardens where they can be easily viewed from inside the 
building
•Simple path system

AHTA, 2012 
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53
Accessibility

Ensure garden accessible with people by removing the physical and 
mental barriers  
Ensure there is plenty of shade 
Offer a range of garden beds at differing heights for ease of access
AHTA, 2012 
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52

Socialisation

•Enhance the quality of life

•Include elements that encourage interaction  between 
family members

AHTA, 2012 
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51

Meaningful activity

AHTA, 2012 
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50

•Reminiscence

•Sensory stimulation

•Safety 

AHTA, 2012 
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49

Plants used..
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48
Enhancing the sense of smell to relax
Scented flowers

Lavendula angustifolia Rosa damascena

Stock (Mathiola incana L.) Blue bottle (Centaurea cyanus L.)

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47
 Scented Climbers 

Honey suckle Madhvilata Potato vine

Star Jasmine  Rangoon creeper Bower vine

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46
 Scented Shrubs

Glossy Abelia Cape Jasmine Din ka Raja

Kamini Arabian Jasmine Night-blooming jasmine

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Anti-stress herbs

Lavandula angustifolia Ocimum sanctum Passion flower

(Passiflora sp.)

Balm mint Chamomile
Rosemarinus officinalis
(Melissa officinalis) (Matricaria recutita)
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Trees for shade (Tropical region)

Indian Beech Tree

(Pongamia pinnata)

Indian devil tree Neem

(Alstonia scholaris) (Azadirachta indica)
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43

Healing garden entrance with arbor at Cortesia’s Healing

Sanctuary in Oregon.
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• View of raised beds and work tables

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Case studies..
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40

“EFFECT OF HEALING GARDEN USE ON

STRESS EXPERIENCED BY PARENTS OF
PATIENTS IN A PEDIATRIC HOSPITAL”

Toone (2008)
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39

• Dell Children’s Medical Center in Austin.

• To test the hospital healing garden had an effect on
the on stress levels of parents of pediatric hospital
patients.
• 27 participants, equating 9 to group.
• Data was collected in the form of surveys and
behavioral observation.
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38

Dell Children’s Medical Center in Austin.

Table
Table1-1- All
AllPre/Post
Pre/PostTotal
TotalSymptom
SymptomScore
Scoreand
andEmotional
Emotional 37
37
Distress
Distress
Summery
SummeryScores
Scores
 36
36

Table
Table2-
2-Descriptive
DescriptiveStatistics
Statisticsof
ofChange
ChangeScores
ScoresWithin
WithinGroups
Groups

Total Symptom Score

Setting N Range Minimum Maximum Mean
Garden 9 22.83 -1.67 21.17 7.333
2 North 9 34.67 -28.17 6.50 -1.796
Surgery 8 8.83 -3.33 5.50 1.222

Emotional Distress Summery Score

Setting N Range Minimum Maximum Mean
Garden 9 30.75 -6.50 24.25 5.722
2 north 9 30.25 -24.00 6.25 -2.361
Surgery 8 10.50 -3.50 7.00 1.055
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35

Table
Table3-
3-Wilcoxon
WilcoxonSigned
SignedRanks
RanksTest
Test

Total Emotional
symptom P Distress P
score Summery
Score
Garden .015 Garden .214

2 North .678 2 North .953

Surgery .161 Surgery .514

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34

Conclusion
Conclusion

participants
participants experienced
experienced aa greatergreater decrease
decrease in
in
stress
stress when
when sitting
sitting in
in the
the Healing
Healing Garden
Garden Courtyard
Courtyard
than
than when
when inin either
either of
of the
the interior
interior spaces.
spaces.
 33
33

Healing
Healing at
at aa Hospital
Hospital Garden:
Garden: Integration
Integration of
of
Physical
Physical and
and Non-Physical
Non-Physical Aspects
Aspects

Asano, 2008
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32

Fig. 1. The garden design layout of the Kansai Rosai Hospital, Japan.
 31
31

Fig. 2. Minutes spent visiting the Fig 3: Frequency of visits to the

Kansai Rosai Hospital garden. Kansai Rosai Hospital garden
 30
30

Fig. 4. Reported use of the Kansai Rosai Hospital garden by

respondents of a survey (multiple answers).
 29
29
Table 1. Changes reported by patient visitors to a hospital garden.

N=142 n
Relaxed 43
Refreshed 24
Enjoyable 8
Healed 5
Other (feels like my own 3
garden, let children play with
peace, able to be private )
Unaware 1
No change 3
No answer 59
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28

Fig 5: Frequency of visit and if the hospital staff ever recommended the
garden responses by hospital staff
 27
27

Fig. 6. Kansai Rosai Hospital nurses response to the possibility

of rehabilitation or therapeutic use of the hospital garden
 26
26

Fig
Fig7:
7: AAmodel
modeldemonstrating
demonstratingthe
thedesign
designelements,
elements,purpose,
purpose,
and
andprogramming
programmingof ofaahealing
healinglandscape.
landscape.
 25
25

Landscape preference evaluation for hospital

environmental design

Petros and Georgi. 2011

 24
24

 The
The main
main goal
goal of
of this
this study
study was
was to
to
investigate
investigate user’s
user’s attitudes
attitudes towards
towards landscape
landscape
design
design regarding
regarding the
the existing
existing and
and future
future
improvements
improvements to to outdoor
outdoor grounds
grounds and
and spaces,
spaces,
 23
23
Table
Table1:1:How
Howsatisfied
satisfiedare
areyou
youwith
withthe
thecurrent
currentoutdoor
outdoorspace
spacearea
areaof
ofthe
the
hospital?
hospital?(%)
(%)
A lot A little Not at all
Doctors 5 45 50
Nurses 12.5 75 12.5
Administrative staff 13.6 63.7 22.7
Medical students 8.3 75 16.7

Table
Table2:2:Which
Whichpart
partof
ofthe
theoutdoor
outdoorspace
spaceof
ofthe
thehospital
hospitalwould
wouldyou
youwish
wishtotoincrease?
increase?(%)
(%)

Green Parking Rest areas Isolated Water

areas areas areas formations
Doctors 90 5 5 0 0
Nurses 50 4.2 37.5 8.3 0
Administrative 63.6 18.3 13.6 0 4.5
staff
Medical 52.8 13.9 25 8.3 0
students
Table
Table3:
3:Would
Wouldyou youlike
likeaagarden
gardenwith
withtrees
treesand
andbushes
bushesin
inthe
theoutdoor
outdoorspace
spaceof
ofthe
the
hospital
hospitalto
toexist?
exist?(%)
(%)

A lot A little Not at all

Doctors 90 10 0
Nurses 70.8 29.2 0
Administrative 77.3 18.2 4.5
staff
Medical students 80.6 16.6 2.8

Table
Table4:
4:Do
Doyou
youbelieve
believethat
thatlandscape
landscapedesign
designwith
withgreen
greenareas
areasin
inthe
theoutdoor
outdoorspace
spaceof
of
the
thehospital
hospitalwould
wouldpositively
positivelyaffect
affectyour
yourpsychologic
psychologicstatus?
status?(%)
(%)

Yes May be No
Doctors 95 5 0
Nurses 79.2 20.8 0
Administrative 72.7 18.2 9.1
staff
Medical students 91.7 8.3 0 22
22
 21
21
Table
Table5.5.Do
Doyou
youwant
wanttotospend
spendyour
yourrest
resttime
timein
inaawell-designed
well-designedlandscape
landscape
surrounding
surroundingthe
thehospital?
hospital?(%)
(%)

Yes No
Doctors 85 15
Nurses 95.8 4.2
Administrative staff 81.8 18.2
Medical students 94.4 5.6

Table
Table6.6.What
Whatkind
kindof
ofvegetation
vegetationwould
wouldyou
youlike
liketo
tobe
beplanted
plantedin
inthe
thehospital’s
hospital’s
garden?
garden?(%)
(%)
High Medium Small Bushes Trees+bushes
trees height trees trees
Doctors 5 15 15 15 50
Nurses 4.2 29.2 20.8 8.3 37.5
Administrative 9.2 45 13.6 0 72.7
staff
Medical 11.0 22.2 11.1 0 55.6
students
Table 20
20
Table7.7.Do
Doyou
youwish
wishfor
forwater
waterfeatures
featuresin
inthe
theoutdoor
outdoorspace
spaceof
ofthe
the
hospital?
hospital?(%)
(%)
Yes No
Doctors 70 30
Nurses 91.7 8.3
Administrative staff 50 50
Medical students 80.6 19.4

Table
Table8.8.What
Whatcombination
combinationofofcolors
colorswould
wouldyou
youlike
liketo
tosee
seeprevailing
prevailingin
inthe
the
hospital’s
hospital’sgarden?
garden?(%)
(%)

Monochromatic Limited number of Variegation

colors
Doctors 10 50 40
Nurses 8.3 41.7 50
Administrative 4.5 63.7 31.8
staff
Medical students 8.3 47.3 44.4
 19
19

Table
Table9.9.What
Whatkind
kindof
ofactivities
activitieswould
wouldyou
youwish
wishto
toexercise
exercisein
inthe
thehospital’s
hospital’s
garden?
garden?(%).
(%).

Rest Landscape Picnic Avoidance of Walking

observation stressful
environment
Doctors 50 10 10 30 0

Nurses 41.7 8.3 8.3 29.2 12.5

Administrative 36.4 9.1 22.7 31.8 0

staff

Medical 61.1 0 19.4 16.7 28

students
 18
18

Table 10.Do
Table10. Doyou
youbelieve
believeaagarden
gardenwould
wouldhelp
helpthe
thepatients
patientsto
torecover?
recover?(%).
(%).
 17
17

Conclusion
Conclusion
All
All doctors
doctors responded
responded toto the
the survey
survey gave
gave aa possibility
possibility of
of
improving
improving the
the physiologic
physiologic status
status of
of the
the patients
patients with
with outdoor
outdoor
gardens.
gardens.


The
The staff
staff understood
understood toto aa large
large extent,
extent, the
the importance
importance of
of having
having aa
green
green landscape
landscape forfor improving
improving the the psychology
psychology and and healing
healing of
of
patients.
patients.
 16
16

Impact
Impact of
of Gardening
Gardening Activities
Activities on
on Special
Special
Children:
Children: aa Case
Case Study
Study

Riaz et al., 2012

 15
15

Table:
Table:1-
1-Distribution
Distributionof
ofchildren
childrenaccording
accordingto
toage,
age,gender
genderand
and
living
livingplace.
place.
 14
14

Figure:
Figure: 1.
1. Nature
Nature of
of impairment
impairment in
in special
special
children.
children.
 13
13

Figure:
Figure: 2.
2. Places
Places to
to be
be used
used byby children
children for
for
gardening
gardening activities.
activities.
 12
12

Figure:
Figure:3.
3.Opinion
Opinionof
ofrespondents
respondentsabout
aboutgardening
gardeningas
as
aameans
meansfor
foraacloser
closerrelationship
relationshipbetween
between
parents
parentsand
andchildren.
children.
 11
11

Figure:
Figure: 4.
4. Opinion
Opinion of
of special
special children
children about
about
having
having fountains
fountains around.
around.
 10
10

Figure:
Figure:5.
5.Kinds
Kindsof
ofplants
plantsin
inwhich
whichspecial
specialchildren
childrenwere
were
interested
interestedat
atschool
schooland
andhome.
home.
 99

Figure:
Figure: 6.
6. Suggestion
Suggestion of
of respondents
respondents about
about
gardening
gardening to
to be
be used
used as
as part
part of
of aa
school
school curriculum.
curriculum.
 88

Figure:
Figure: 7.
7. Teachers
Teachers having
having discussion
discussion of
of
gardening
gardening with
with students
students in
in class.
class.
 77

Figure:
Figure: 8.
8. Mode
Mode of
of involvement
involvement of
of children
children in
in
garden
garden activities.
activities.
 66

Figure:
Figure: 9.
9. Satisfaction
Satisfaction level
level of
of parents
parents about
about
gardening
gardening facilities
facilities at
at school.
school.
 55

Conclusion
Conclusion


The
The results
results of
of this
this study
study show
show thethe positive
positive impacts
impacts
of
of gardening
gardening for
for the
the children
children with
with special
special needs
needs in
in
respect
respect to
to mental,
mental, social
social and
and all
all allied
allied benefits
benefits and
and
outcomes
outcomes that
that are
are needed
needed forfor their
their betterment.
betterment.


Teachers
Teachers andand parents
parents of
of such
such children
children observed
observed
gardening
gardening as as aa very
very important
important activity
activity for
for their
their
physical
physical and
and psychological
psychological health
health along
along with
with the
the
other
other trainings
trainings and
and education
education atat schools.
schools.
 44
Organizations
Organizations

American horticulture therapy association www.ahta.org

Canadian horticultural therapy association www.chta.org
City farm www.resourcecentrechicago.org
Gardening leave www.gardeningleave.org
Farming for health www.farmingforhealth.com
Garden partners www.gardenpartners.org
German association for horticulture and therapy
Horticultural therapy institute www.htinstitute.org
Human issues in horticulture- horticultural therapy, Hawaii
Michigan horticultural therapy association www.michiganhta.org
Thrive www.thrive.org.uk
Trellis www.trellisscotland.org.uk
Urban meadows www.urbanmeadows.org
ASHA foundation trust www.ashafoundation.org
 33
Conclusion
The
Thetherapeutic
therapeuticgarden
gardenisisaapreceding
precedingconcept,
concept,ititisisbeing
being
revived
revivedin
inmodern
moderntimes
timesbecause
becauseof
ofthe
thecomprehensive
comprehensive
therapeutic
therapeuticbenefits.
benefits.

ItItisisaanatural
naturalmethod
methodtotoreduce
reducestress,
stress,tension,
tension,fatigue,
fatigue,pain,
pain,
sadness,
sadness,depression
depressionand
andanxiety.
anxiety.ItItincreases
increasespositive
positivemood,
mood,
energy
energyand andfeeling
feelingof
ofcalm
calmand
andencourage
encouragehuman-nature
human-nature
interactions.
interactions.

The
Thesignificance
significanceof
ofthe
thediscipline
disciplineand
andthe
thecontribution
contributionititcan
can
make
maketo toadvancing
advancinghealth
healthand
andwell
wellbeing
beinghas
hasjust
justbegun
begunto tobe
be
understood.
understood.Continued
Continuedresearch
researchstudies
studieswill
willhelp
helpcontribute
contribute
to
toevidence
evidencebased
basedresearch
researchand
andfurther
furtherimplementation
implementationof ofbest
best
practices.
practices.
 22

Doubts…???
 11

“We are not ourselves when nature

being oppressed, commands the
mind to suffer with the body”
Shakespeare