The patient, 73, was struggling to recover from surgery for the breast cancer that had spread into her bones. She had also suffered respiratory failure.
When the ventilator was turned down so she could breathe on her own, she battled anxiety.
The doctors at Atlanta’s Wesley Woods Geriatric Hospital decided she needed something to focus on to reduce her anxiety, so they called in Kirk Hines, a registered horticultural therapist.
Hines began working with her by asking her to pot some plant cuttings at her bedside. She was naturally right-handed, and now that she was able to use only her left hand after surgery, this was a difficult process.
But she was determined to regain her independence and go home to friends and family in South Georgia.
Little by little, they made progress. The potting sessions moved from her bedside to a chair and eventually to an outside table. Before she was discharged, she was off the ventilator entirely and walking to therapy on her own.
“Horticultural therapy worked because it allowed her to focus on something besides her anxiety,” Hines said.
An old idea, a new profession
Hines says he is one of just 270 registered horticultural therapists in the country. Their role is to work with cradle-to-grave rehabilitation teams and use the passive experience of the garden to achieve specific treatment goals, according to the American Horticultural Therapy Association.
The reason Hines is in such a select group is because horticultural therapy, while an ancient practice, is still emerging as a profession. It was first offered in the United States in 1973, Hines said.
It has been at Wesley Woods since 1993, when Hines was hired for the new position of horticultural therapist.
“Where do you see yourself in five years?” Hines recalls being asked during his job interview.
“In a greenhouse seeing patients,” he replied.
“We don’t have a greenhouse,” he remembers being told.
“If you hire me, you will,” he said.
Hines got the job. And Wesley Woods, which at the time had only one gardening tool, a plastic trowel with a cracked handle, got a greenhouse four years later.
Turning over a new leaf
Hines soon converted two courtyards from smoking areas into healing spaces.
One became a neuropsychiatry horticultural therapy garden. Hines designed it with hardscapes and plants as a place to treat patients with agitation associated with dementia.
The hardscapes include a circular walkway to prevent patients from feeling lost and a fountain to stimulate senses through sound.
He chose flowering and fragrant non-toxic plants such as gardenias, tea olives, Virginia sweet spire and camellias, using sight and smell to tap into long-term memory to treat confusion, agitation and anxiety. Stirring these senses can help patients remember plants around their homes when they were children.
Patients also perform single-step potting functions to help them feel a sense of success, not frustration.
The other enclosed courtyard is a horticultural therapy garden for the psychiatry unit. Hines created the garden as a safe place where patients with depression or mood disorders have control over such decisions as where to sit. Here, he also uses plants to rekindle or create interest in fun activities for patients with anhedonia, the loss of pleasure in enjoyable activities.
Greenhouse becomes a therapy room
Walkways in the garden by the greenhouse feature multiple surfaces. Together, these serve as a balance-ambulation confidence course.
Because the unusual space of the greenhouse facilitates conversation, Hines will meet individual patients with Parkinson’s disease there to help them improve their breathing. He does this in an exercise in which he engages them in conversation and asks them to talk louder.
He’ll also work with a speech and language pathologist in the greenhouse to help stroke patients with sequencing by giving them tasks such as transplanting or repotting that require specific steps. Sequential tasks help patients organize their thoughts and daily activities, Hines said.
Transplanting and repotting exercises also help patients regain motor skills. To build strength in their fingers, Hines uses small plants such as seedlings or cuttings; bonsai, which requires wiring; or orchids, which require patients to use their fingers to dig out old mix and dead roots. He’ll have patients scoop soil, pot large cuttings or water plants with a water wand or a misting bottle to rebuild strength in shoulders and arms.
A child’s garden of comfort
Horticultural therapy as a way to stimulate the senses, facilitate patient treatment and hasten recovery time has also gained acceptance among therapists in children’s hospitals and special-needs facilities.
Staff at a rehabilitation unit at Children’s Healthcare of Atlanta have discovered how the sights, sounds, smells and textures of the new organic vegetable garden at the Scottish Rite campus can help patients achieve the same health goals — reducing anxiety, developing motor skills, improving speech and ambulation –- as Hines is achieving with seniors.
The garden is also valuable for non-pharmacological pain management, said Lauren Meisenheimer, a child life specialist in the Comprehensive Inpatient Rehabilitation Unit. It reduces anxiety by stimulating senses that distract a child from physical pain, she said.
Different therapists use the garden for different therapy paths, she added.
Speech therapists, for instance, will use the garden to ask speech-impaired children to verbalize their feelings about colors they see or use the plants to treat aphasia –- the inability to verbalize thoughts, said Julie Hagar, a recreational therapist in the same unit.
Another therapist used the smells of herbs and the textures of soft fruits such as tomatoes to teach a child who had lost sight how to navigate, Hagar said.
Innovations for special needs
At the nearby Elaine Clark Center, therapists treating special-needs children from six weeks to 21 years old also report success using an organic sensory garden as part of their treatment program.
Speech therapist Karen Erlinger uses the garden to help children overcome feeding problems, as well as to teach language.
Other therapists use the garden to condition autistic children to the world around them or to help children with Down syndrome develop motor skills in jaws that are unstable.
The garden is also used to help blind children learn to navigate. On one occasion, when therapists gave a satiny-soft leaf of lamb’s ear to a blind and hearing-impaired toddler to help her walk on a path through the garden, she immediately lay down among the plants and rubbed them to her face.
Hidden therapy, visible results
Healing gardens have earned a reputation as hidden therapy because patients don’t associate plants with therapy. They also have hidden benefits for hospitals.
Facilities with healing gardens have better employee retention than hospitals that don’t have them, Hines said.
One reason for that may be that staff and doctors also use these green spaces as healing places.
At Wesley Woods, Hines said, it’s not unusual for him to find a doctor sitting quietly in a greenhouse, decompressing and listening to the doves in a glass aviary.
Tom Oder is an independent journalist who specializes in garden writing. He is a member of the American Garden Writers Association who writes on a variety of topics of horticultural interest and is a former senior editor with Cox Newspapers.