Nature-based rehabilitation for adults with acquired brain injury: a scoping review

Nature-Based Therapeutic Intervention for Individuals with Post-Concussion Symptoms

This study investigated the efficacy of a 10-session nature-based therapeutic intervention for people with post-concussion symptoms. The intervention involved physical and vestibular exercises, sensory training, relaxation, and psychoeducation, all of which were integrated with the natural environment in a forest therapy garden. This study was designed with a passive control period followed by the intervention (n = 30). The Mental Fatigue Scale (MFS) was the primary outcome measure. The secondary outcome measures were the Warwick-Edinburg Mental Wellbeing Scale and the short version of the Quality of Life after Brain Injury. A Likert scale was used to examine the mental strain of the sessions themselves. The MFS (primary outcome) exhibited a significant decrease with a medium-sized effect from before to after the intervention. The secondary outcomes exhibited significant increases from the beginning to the end of the intervention. All outcomes were sustained at follow-up ten weeks later. No significant difference was found from the control period. This study indicates that the described nature-based intervention is a feasible treatment for reducing prolonged post-concussion symptoms. However, it should be studied more in-depth to understand the impact of the natural environment and to validate the results on a larger representative population.

Nature-Based Design in Stroke Rehabilitation Environments: A Scoping Review

OBJECTIVE

To identify, examine, and map the characteristics of knowledge of nature-based design in stroke rehabilitation facilities, examine how research in this field has been conducted and identify gaps in knowledge.

BACKGROUND

Many stroke survivors have wide ranging impacts, resulting in long hospital stays to undertake rehabilitation. The physical environment can influence brain recovery; however, there is limited evidence to support the design of effective rehabilitation environments. Conversely, the health benefits available from connection with nature are well established. A nature-based design approach may have benefits and implications for the physical environment of inpatient stroke rehabilitation facilities; however, it is unclear what evidence exists in this field.

METHOD

This scoping review followed the JBI methodological guidance for the conduct of scoping reviews, with systematic searches of six databases.

RESULTS

Twenty-eight studies were included in the review. Aims and research methods varied widely. Investigations in 19 studies related to gardens and other designed outdoor nature-based environments. Other studies explored natural analogues, nature inside, inside/outside connections, and the natural environment. Findings from the studies were spread across the fields of design, use, exposure to, and engagement in nature-based environments.

CONCLUSION

The characteristics of knowledge underpinning nature-based design in stroke rehabilitation environments are highly diverse, and significant gaps exist in the evidence base. A framework developed during this review for mapping knowledge on the intentions and impacts for spaces and services in this field assisted to identify these gaps and may be applied to other areas of healthcare design research.

Nature-based rehabilitation-experiences from patients with acquired brain injury: an explorative qualitative study

PURPOSE

Nature has been found to improve and promote health and prevent disease. Nature-based rehabilitation (NBR) delivered as part of neurorehabilitation is a developing approach. Yet to date the research is sparse. Following an acquired brain injury (ABI), people often experience impairments that cause limitations in activity and participation in daily life, which can impact the quality of life long-term. NBR delivered in neurorehabilitation has previously been explored from the perspective of occupational therapists and physiotherapists, however, to date patients' experiences are yet to be explored. This study aims to explore patients' experiences and perspectives of NBR delivered as part of standard neurorehabilitation.

METHODS

This qualitative study had a constructivist and phenomenological design. Semi-structured focus group interviews were carried out across three healthcare settings in Denmark with 17 participants. Data was analysed using content analysis.

RESULTS

The analysis generated three categories: 1. Outdoor versus indoor environment, 2. The natural environment as a co-therapist, and 3. Interrelatedness.

CONCLUSION

The study provides insight into participants' experiences of NBR. They reported that interacting with the natural environment as part of neurorehabilitation enhanced activity. Moreover, being in nature increased their self-efficacy, sense of autonomy, community spirit, cooperation, and joy, and led to a feeling of peace.

Occupational therapists and physiotherapists experiences of using nature-based rehabilitation

BACKGROUND

Nature-based rehabilitation (NBR) is increasingly used within neurorehabilitation. The theoretical base is rooted in traditional neurorehabilitation professions, especially physiotherapy and occupational therapy, and relate to nature-based approaches.Objective: The objective was to explore the therapists' experiences of and rationale for applying NBR in neurorehabilitation when providing NBR to patients with acquired brain injury (ABI). Patients with ABI often experience severe consequences impacting their rehabilitation, activity, participation and quality of life.

METHODS

Qualitative focus group interviews with therapists were conducted at two Danish rehabilitation hospitals, Hammel Neurorehabilitation and Research Center (HNRC) (Hospital 1) and Vejlefjord Rehabilitation (VFR) (Hospital 2). These are highly specialized neurorehabilitation hospitals for patients in the acute-subacute and subacute-chronic phases. HNRC has several sensory gardens and VFR has a park and an inlet nearby. Content analysis was employed to analyze the interviews.

RESULTS

An occupational perspective of health was a frame to analyze and conceptualize the results. The analysis produced two main categories: What does nature offer - approach and rationale; Therapeutic rationale for conducting NBR.

CONCLUSION

The therapists applied known theories and methods; they perceived the natural environment as an extended room for training and activity, as a means for targeted rehabilitation and beneficial to the patients.

Engaging with nature and the outdoors: A scoping review of therapeutic applications in contemporary occupational therapy

Introduction:

Engagement with the natural outdoors is recommended for public health and wellbeing. Occupational therapists are well-placed to promote these therapeutic benefits, yet limited evidence exists of the scope of such applications.

Methods:

A scoping review was conducted informed by the Joanna Briggs Institute framework. A systematic search was undertaken across five databases, and 64 sources were included following screening. Data were extracted using deductive content analysis, and themes identified through thematic analysis.

Findings:

Three themes were identified: occupation-based applications; occupation-focused applications; and occupational therapy’s contribution. Whilst current applications were evident, most literature explored potential or emerging practice. Outdoor engagement was found to be a complex, therapeutic occupation with the potential to promote mental health and restoration; quality of life and wellbeing; and healthy lifestyles through connection to nature; others; and self .

Conclusion:

Occupational therapists enable outdoor engagement through occupation-focused and occupation-based interventions across a range of practice contexts. Occupational science may offer a valuable contribution to the evidence base, through considering being in nature as a meaningful occupation and outdoor accessibility as a matter of occupational justice. However, evidence of current practice is limited. Further research is recommended to strengthen the evidence-base and inform routine consideration within practice.

Effects of forest bathing (shinrin-yoku) on individual well-being: an umbrella review

The aim of this review was to outline the most relevant benefits of forest bathing for well-being promotion. This study was designed as an umbrella literature review. Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, Google Scholar, Scopus, PsycINFO, CINAHL and the DOAJ were systematically searched for relevant reviews up to February 2021. After article selection, 16 systematic reviews met inclusion criteria. Overall, the best available evidence supports the use of forest bathing as a complementary practice for the promotion of psychophysical well-being, whereas evidence for its use as a therapeutic practice for the improvement of organic diseases needs to grow before clear and specific clinical indications can be formulated. The positive impact of forest bathing on individual quality of life, along with its favorable cost-effectiveness profile, may justify its possible adoption for public health strategies of well-being promotion. Further investigations on the topic are advised.

What Competencies Does a Community Occupational Therapist Need in Neurorehabilitation? Qualitative Perspectives

More than three million people in Chile suffer from neurological conditions, and many of these become permanent users of health services with a community approach. In this way, disciplinary competencies in this area are relevant. We seek to characterize the competencies for community occupational therapy intervention in neurorehabilitation. Using a qualitative approach, interviews were conducted with eighteen professionals and were analyzed using content analysis. The main results are associated with the competencies of knowledge associated with theoretical biomedical and community elements. Skills range from health evaluation and intervention on micro- and macrosocial levels. Attitude is also an important skill, stemming from personal and relational spheres. These findings suggest that interventions are essentially on a personal and microsocial level, focusing first on pathology and treatment, and later comprehending the interactions with a patient's close social environment, such as family, schoolmates, and workmates and their physical environment at home, school, and the workplace. Although the final objective of community intervention is present in the discourse as being able to generate structural changes that favor well-being and social inclusion, concrete competencies are not appreciated on a macrosocial level.

Riding the wave into wellbeing: A qualitative evaluation of surf therapy for individuals living with acquired brain injury

Nature has long demonstrated the capacity to facilitate wellbeing. Interventions involving the natural environment such as surf therapy, are increasingly being used to facilitate aspects of wellbeing in clinical populations. However, explorations of how nature-based interventions such as surf therapy may be used to promote wellbeing in the context of neurorehabilitation are missing from the peer-reviewed literature. Here we characterize the experience of a five-week surfing intervention involving fifteen adults living with the psycho-social and cognitive sequelae of acquired brain injury. Insights were analysed using reflexive thematic analysis, which highlighted the importance of seven overarching themes, including: 1) Connection to Nature, 2) Facilitating Trust and Safety, 3) Managing and Accepting Difficult Emotions, 4) Facilitating Positive Emotion, Meaning and Purpose, 5) Building Community through Social Connection, and 6) Positive Change. Barriers and opportunities (theme 7) were also identified as components on which clinical services may be improved. We present a theoretical model for the benefits of surf therapy in people living with acquired brain injury (ABI) based on these themes and reflections on findings from the wider literature. Findings emphasise the importance of leveraging community partnerships to augment the holistic model of neurorehabilitation and potential implications for service redesign are discussed, focusing on recent developments in wellbeing science.

The Psychological and Physical Effects of Forests on Human Health: A Systematic Review of Systematic Reviews and Meta-Analyses

BACKGROUND

The aim of this systematic review of systematic reviews was to identify, summarise, and synthesise the available evidence of systematic reviews (SRs) and meta-analyses (MAs) on the preventative and therapeutic psychological and physical effects of forest-based interventions. Methods: Both bibliographic databases and grey literature sources were searched for SRs and MAs published until May 2020. Eight databases were searched for relevant articles: MEDLINE, Embase, Web of Science, Cochrane Library, PsycInfo, CiNii, EBSCO, and Scopus. Grey literature was sourced from Google Scholar and other web-based search tools. SRs and MAs that included randomised controlled (RCT), non-randomised controlled (NRCT), and non-controlled trials (NCT) on health-related effects of forest-based interventions were eligible if they had searched at least two databases. The methodological quality of eligible reviews was assessed by AMSTAR-2. Results: We evaluated 11 systematic reviews covering 131 different primary intervention studies, mostly from Asian countries, three of which included supplementary meta-analyses. The quality assessment resulted in moderate confidence in the results of two reviews, low confidence in six, and critically low confidence in three. The results of the eight moderate and low-rated reviews indicated that forest-based interventions are beneficial to the cardiovascular system, immune system, and mental health (in the areas of stress, depression, anxiety, and negative emotions). Evidence for the effectiveness of forest-based interventions on metabolic parameters in adults, the severity of atopic dermatitis in children and adolescents, and social skills and sociality in healthy primary school children was weak. Discussion/Conclusions: Evidence suggests beneficial therapeutic effects of forest-based interventions on hypertension, stress, and mental-health disorders, such as depression and anxiety. Changes in immunological and inflammatory parameters after forest therapy should be verified in bio-geographically native forests. In the future, more attention should be paid to careful planning, implementation, and reporting of primary studies and to systematic reviews on the effects of forest-based interventions.

Are Community Gardening and Horticultural Interventions Beneficial for Psychosocial Well-Being? A Meta-Analysis

Recent literature has revealed the positive effect of gardening on human health; however, empirical evidence on the effects of gardening-based programs on psychosocial well-being is scant. This meta-analysis aims to examine the scientific literature on the effect of community gardening or horticultural interventions on a variety of outcomes related to psychosocial well-being, such as social cohesion, networking, social support, and trust. From 383 bibliographic records retrieved (from 1975 to 2019), seven studies with a total of 22 effect sizes were selected on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analytic findings on 11 comparisons indicate a positive and moderate effect of horticultural or gardening interventions on psychosocial well-being. Moderation analysis shows a greater effect size in individualistic than collectivistic cultures. A greater effect size was also observed in studies involving community gardening compared to horticultural intervention. Nevertheless, an effect of publication bias and study heterogeneity has been detected. Despite the presence of a large number of qualitative studies on the effect of horticulture/gardening on psychosocial well-being, quantitative studies are lacking. There is a strong need to advance into further high-quality studies on this research topic given that gardening has promising applied implications for human health, the community, and sustainable city management.