Brief introduction about therapeutic gardens and some case studies.

1. Welcome
Welcome
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2. Credit seminarCredit seminar
Therapeutic GardenTherapeutic GardenTherapeutic GardenTherapeutic Garden
SHAMANTH.M.GSHAMANTH.M.G
AHM/14-07AHM/14-07
FLA DeptFLA Dept
Dr.Y.S.R.Horticultural University.Dr.Y.S.R.Horticultural University.
2014-20162014-2016
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3. Name Designation
Department/
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

4. Case StudiesCase Studies
Design GuidelinesDesign Guidelines
Types of therapeutic gardensTypes of therapeutic gardens
Therapeutic gardenTherapeutic garden
Topic division
History & IntroductionHistory & Introduction
conclusionconclusion
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5. The World Health Organisation defines health as
complete physical, mental and social well-being.
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6. 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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7. 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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8. • 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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9. 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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10. 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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11. 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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12. •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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13. • 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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14.  Medieval monastic cloister gardenMedieval monastic cloister garden
 Early example of restorative outdoor space for sickEarly example of restorative outdoor space for sick
patientspatients
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15. Raised BedsRaised Beds
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16. 16
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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17. 17
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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18. 18
• 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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19. Table 1: Responses from 143 garden users at four San Francisco
Bay Area hospitals
Healing Gardens in Hospitals
Cooper Marcus and Barnes, 1995
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20. 206969

21. Benefits of therapeutic gardening
• Psychological
• Social
• Physical
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22. 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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23. • Therapeutic landscape designed for people
with vision loss, outside London, England.
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24. 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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25. ElementsElements
 Familiar plantings
 Plants that attract birds and butterflies
 Ornamental plants
 Non-toxic and non-injurious plantings
 Annuals
 Soil
 Sunlight and natural shade
 Wind
 Precipitation
Natural elementsNatural elements
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26. Patio
Paved walking
Seatings
Landscape lighting
Raised beds
Shade
Water features
Electrical outdoor
outlet; for music and
related activities
Constructed garden elementsConstructed garden elements
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27. POTENTIAL
ACTIVITIES IN
A
THERAUPEUTIC
GARDEN
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28. Views through a windowViews through a window
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29. Sitting outsideSitting outside
Reading/Reading/
doing paper work outsidedoing paper work outside
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30. Walking &Walking &
RehabilitationRehabilitation
exercisesexercises
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31. Therapeutic garden characteristicsTherapeutic 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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32. 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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33. The key design principles
• Sustainability
• Orientation
• Accessibility
• Socialisation
• Meaningful activity
• Reminiscence
• Sensory stimulation
• Safety
AHTA, 2012
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34. 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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35. Orientation
•Locate gardens where they can be easily viewed from inside the
building
•Simple path system
AHTA, 2012
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36. 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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37. Socialisation
AHTA, 2012
•Enhance the quality of life
•Include elements that encourage interaction between
family members
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38. Meaningful activity
AHTA, 2012
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39. •Reminiscence
•Sensory stimulation
•Safety
AHTA, 2012
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40. Plants used..Plants used..
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41. Enhancing the sense of smell to relax
Scented flowers
Blue bottle (Centaurea cyanus L.)Stock (Mathiola incana L.)
Lavendula angustifolia Rosa damascena
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42. Scented Climbers
Star Jasmine Rangoon creeper Bower vine
Potato vineMadhvilataHoney suckle
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43. Glossy Abelia Cape Jasmine
Kamini Arabian Jasmine
Din ka Raja
Night-blooming jasmine
Scented Shrubs
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44. Lavandula angustifolia Ocimum sanctum Passion flower
(Passiflora sp.)
Rosemarinus officinalis
Balm mint
(Melissa officinalis)
Chamomile
(Matricaria recutita)
Anti-stress herbs
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45. Trees for shade (Tropical region)
Indian devil tree
(Alstonia scholaris)
Indian Beech Tree
(Pongamia pinnata)
Neem
(Azadirachta indica)
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46. Healing garden entrance with arbor at Cortesia’s Healing
Sanctuary in Oregon.
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47. • View of raised beds and work tables
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48. Case studies..Case studies..
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49. “EFFECT OF HEALING GARDEN USE ON
STRESS EXPERIENCED BY PARENTS OF
PATIENTS IN A PEDIATRIC HOSPITAL”
Toone (2008)
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50. • 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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51. Dell Children’s Medical Center in Austin.Dell Children’s Medical Center in Austin.
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52. Table 1- All Pre/Post Total Symptom Score and Emotional
Distress
Summery Scores
Table 1- All Pre/Post Total Symptom Score and Emotional
Distress
Summery Scores
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53. 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
Table 2- Descriptive Statistics of Change Scores Within GroupsTable 2- Descriptive Statistics of Change Scores Within Groups
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54. Table 3- Wilcoxon Signed Ranks TestTable 3- Wilcoxon Signed Ranks Test
Total
symptom
score
P
Emotional
Distress
Summery
Score
P
Garden .015 Garden .214
2 North .678 2 North .953
Surgery .161 Surgery .514
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55. Conclusion
participants experienced a greater decrease in
stress when sitting in the Healing Garden Courtyard
than when in either of the interior spaces.
Conclusion
participants experienced a greater decrease in
stress when sitting in the Healing Garden Courtyard
than when in either of the interior spaces.
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56. Healing at a Hospital Garden: Integration of
Physical and Non-Physical Aspects
Healing at a Hospital Garden: Integration of
Physical and Non-Physical Aspects
Asano, 2008
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57. Fig. 1. The garden design layout of the Kansai Rosai Hospital, Japan.
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58. Fig. 2. Minutes spent visiting the
Kansai Rosai Hospital garden.
Fig 3: Frequency of visits to the
Kansai Rosai Hospital garden
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59. Fig. 4. Reported use of the Kansai Rosai Hospital garden by
respondents of a survey (multiple answers).
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60. 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
garden, let children play with
peace, able to be private )
3
Unaware 1
No change 3
No answer 59
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61. Fig 5: Frequency of visit and if the hospital staff ever recommended the
garden responses by hospital staff
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62. Fig. 6. Kansai Rosai Hospital nurses response to the possibility
of rehabilitation or therapeutic use of the hospital garden
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63. Fig 7: A model demonstrating the design elements, purpose,
and programming of a healing landscape.
Fig 7: A model demonstrating the design elements, purpose,
and programming of a healing landscape.
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64. Landscape preference evaluation for hospital
environmental design
Petros and Georgi. 2011
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65.  The main goal of this study was to
investigate user’s attitudes towards landscape
design regarding the existing and future
improvements to outdoor grounds and spaces,
 The main goal of this study was to
investigate user’s attitudes towards landscape
design regarding the existing and future
improvements to outdoor grounds and spaces,
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66. Table 1: How satisfied are you with the current outdoor space area of the
hospital? (%)
Table 1: How satisfied are you with the current outdoor space area of the
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 2: Which part of the outdoor space of the hospital would you wish to increase? (%)Table 2: Which part of the outdoor space of the hospital would you wish to increase? (%)
Green
areas
Parking
areas
Rest areas Isolated
areas
Water
formations
Doctors 90 5 5 0 0
Nurses 50 4.2 37.5 8.3 0
Administrative
staff
63.6 18.3 13.6 0 4.5
Medical
students
52.8 13.9 25 8.3 0
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67. Table 3: Would you like a garden with trees and bushes in the outdoor space of the
hospital to exist? (%)
Table 3: Would you like a garden with trees and bushes in the outdoor space of the
hospital to exist? (%)
A lot A little Not at all
Doctors 90 10 0
Nurses 70.8 29.2 0
Administrative
staff
77.3 18.2 4.5
Medical students 80.6 16.6 2.8
Table 4: Do you believe that landscape design with green areas in the outdoor space of
the hospital would positively affect your psychologic status? (%)
Table 4: Do you believe that landscape design with green areas in the outdoor space of
the hospital would positively affect your psychologic status? (%)
Yes May be No
Doctors 95 5 0
Nurses 79.2 20.8 0
Administrative
staff
72.7 18.2 9.1
Medical students 91.7 8.3 0
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68. Table 5. Do you want to spend your rest time in a well-designed landscape
surrounding the hospital? (%)
Table 5. Do you want to spend your rest time in a well-designed landscape
surrounding the hospital? (%)
Yes No
Doctors 85 15
Nurses 95.8 4.2
Administrative staff 81.8 18.2
Medical students 94.4 5.6
Table 6. What kind of vegetation would you like to be planted in the hospital’s
garden? (%)
Table 6. What kind of vegetation would you like to be planted in the hospital’s
garden? (%)
High
trees
Medium
height trees
Small
trees
Bushes Trees+bushes
Doctors 5 15 15 15 50
Nurses 4.2 29.2 20.8 8.3 37.5
Administrative
staff
9.2 45 13.6 0 72.7
Medical
students
11.0 22.2 11.1 0 55.6
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69. Table 7. Do you wish for water features in the outdoor space of the
hospital? (%)
Table 7. Do you wish for water features in the outdoor space of the
hospital? (%)
Yes No
Doctors 70 30
Nurses 91.7 8.3
Administrative staff 50 50
Medical students 80.6 19.4
Table 8. What combination of colors would you like to see prevailing in the
hospital’s garden? (%)
Table 8. What combination of colors would you like to see prevailing in the
hospital’s garden? (%)
Monochromatic Limited number of
colors
Variegation
Doctors 10 50 40
Nurses 8.3 41.7 50
Administrative
staff
4.5 63.7 31.8
Medical students 8.3 47.3 44.4
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70. Table 9. What kind of activities would you wish to exercise in the hospital’s
garden? (%).
Table 9. What kind of activities would you wish to exercise in the hospital’s
garden? (%).
Rest Landscape
observation
Picnic Avoidance of
stressful
environment
Walking
Doctors 50 10 10 30 0
Nurses 41.7 8.3 8.3 29.2 12.5
Administrative
staff
36.4 9.1 22.7 31.8 0
Medical
students
61.1 0 19.4 16.7 28
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Table 10. Do you believe a garden would help the patients to recover? (%).Table 10. Do you believe a garden would help the patients to recover? (%).

72. Conclusion
All doctors responded to the survey gave a possibility of
improving the physiologic status of the patients with outdoor
gardens.
The staff understood to a large extent, the importance of having a
green landscape for improving the psychology and healing of
patients.
Conclusion
All doctors responded to the survey gave a possibility of
improving the physiologic status of the patients with outdoor
gardens.
The staff understood to a large extent, the importance of having a
green landscape for improving the psychology and healing of
patients.
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73. Impact of Gardening Activities on Special
Children: a Case Study
Impact of Gardening Activities on Special
Children: a Case Study
Riaz et al., 2012
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74. Table: 1- Distribution of children according to age, gender and
living place.
Table: 1- Distribution of children according to age, gender and
living place.
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75. Figure: 1. Nature of impairment in special
children.
Figure: 1. Nature of impairment in special
children.
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76. Figure: 2. Places to be used by children for
gardening activities.
Figure: 2. Places to be used by children for
gardening activities.
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77. Figure: 3. Opinion of respondents about gardening as
a means for a closer relationship between
parents and children.
Figure: 3. Opinion of respondents about gardening as
a means for a closer relationship between
parents and children.
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78. Figure: 4. Opinion of special children about
having fountains around.
Figure: 4. Opinion of special children about
having fountains around.
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79. Figure: 5. Kinds of plants in which special children were
interested at school and home.
Figure: 5. Kinds of plants in which special children were
interested at school and home.
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80. Figure: 6. Suggestion of respondents about
gardening to be used as part of a
school curriculum.
Figure: 6. Suggestion of respondents about
gardening to be used as part of a
school curriculum.
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81. Figure: 7. Teachers having discussion of
gardening with students in class.
Figure: 7. Teachers having discussion of
gardening with students in class.
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82. Figure: 8. Mode of involvement of children in
garden activities.
Figure: 8. Mode of involvement of children in
garden activities.
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83. Figure: 9. Satisfaction level of parents about
gardening facilities at school.
Figure: 9. Satisfaction level of parents about
gardening facilities at school.
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84. ConclusionConclusion
The results of this study show the positive impacts
of gardening for the children with special needs in
respect to mental, social and all allied benefits and
outcomes that are needed for their betterment.
Teachers and parents of such children observed
gardening as a very important activity for their
physical and psychological health along with the
other trainings and education at schools.
The results of this study show the positive impacts
of gardening for the children with special needs in
respect to mental, social and all allied benefits and
outcomes that are needed for their betterment.
Teachers and parents of such children observed
gardening as a very important activity for their
physical and psychological health along with the
other trainings and education at schools.
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85. OrganizationsOrganizations
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
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86. The therapeutic garden is a preceding concept, it is being
revived in modern times because of the comprehensive
therapeutic benefits.
It is a natural method to reduce stress, tension, fatigue, pain,
sadness, depression and anxiety. It increases positive mood,
energy and feeling of calm and encourage human-nature
interactions.
The significance of the discipline and the contribution it can
make to advancing health and well being has just begun to be
understood. Continued research studies will help contribute
to evidence based research and further implementation of best
practices.
The therapeutic garden is a preceding concept, it is being
revived in modern times because of the comprehensive
therapeutic benefits.
It is a natural method to reduce stress, tension, fatigue, pain,
sadness, depression and anxiety. It increases positive mood,
energy and feeling of calm and encourage human-nature
interactions.
The significance of the discipline and the contribution it can
make to advancing health and well being has just begun to be
understood. Continued research studies will help contribute
to evidence based research and further implementation of best
practices.
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Conclusion

87. 22
Doubts…???Doubts…???

88. “We are not ourselves when nature
being oppressed, commands the
mind to suffer with the body”
Shakespeare
11