Turning to nature for rehabilitation

Can nature support physical and psychological wellbeing for adults with acquired brain injury (ABI) or long-term neurological conditions (LTNC)? Dr Anita Rose, consultant clinical neuropsychologist at Renovo, explores the issue.

“Being in nature is not only inspiring, it also has medical and psychotherapeutic potential. By experiencing nature, we place our body in the original functional circle made of humans and the environment from which we emerged. We put two matching puzzle pieces together – us and nature into one whole.” Clemens G. Arvay (Healing code of nature)

We can all find ourselves in stressful situations during our lifetime.  In fact, the whole of humankind has faced challenges and adversity during the recent pandemic. When we are facing crises it is natural to look for refuge, a safe environment, a place of healing.

In the narratives of history, we are shown the natural environments of gardens, pastoral landscapes, mountains, meadows and lakes as places of refuge and shelter. These are places we can hide from the distress we may be facing, places to find physical and mental restoration. 

Two years ago, I was diagnosed with cancer at the same time as my eldest daughter. As you can imagine this was a very stressful and fearful time. A time of asking “who am I?”, “is there hope?”. 

It was during this period I was able to access Nature Based Therapy via a local charity set up to help people living with cancer and life limiting conditions using complementary therapies. I recognised through this therapy that being out in nature helped keep me grounded and supported my psychological and physical wellbeing in a way that other medically based therapies didn’t.  

This experience led me on a journey to explore how we could utilise the natural rhythms and seasons of nature in supporting the healing journey of those with ABI and LTNC.

At the beginning of my journey, and being a neuropsychologist, I did what all psychologists do, went to the research databases.  My thought being there must be something there that that will help me understand the connection between nature and wellbeing, something that would explain my experience that I could then use to help my patients.

In the 19^th Century the Naturalist Henry David Thoreau commented that humans need “the tonic of wilderness” and John Muir, an activist and conservationist, “Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul” – yet there was nothing more of note until the mid-1990s when suddenly there was an explosion of studies.  These studies came from many different fields of research from landscaping and urban planning to environmental psychology all highlighting the effect nature can have on physical and emotional wellbeing.

Yet it took cancer to bring the importance of connection and impact of nature into my thinking and I found myself asking why this was.  

I then took time to reflect on my clinical practice, and as I did I realised that instinctively I had used nature in my work of rehabilitation of people who had suffered an acquired brain injury for many years. 

Among some of the things I was regularly doing included working with those who struggled to engage sitting face to face in an office in a talking therapy session suggesting we went out into the hospital gardens.  In doing this I would find they were more expressive of their struggles around self-identity following their brain injury and were also more receptive of interventions. 

I was conducting mindfulness sessions in the hospital grounds as this appeared to support both patients and staff in engaging with self-care. If a patient was very distressed, I would recommend sitting outside and using mindful breathing exercises or just talking them for a walk. We created nature tables in the hospital to show the changes in the seasons, the rhythms of the natural world such as the Solstices in order to orientate patients to the time of year and their surroundings. I used planting herbs in pots to enable patients in low awareness states to experience sensory touch and smells.  

I instigated and supported gardening clubs within the places I worked. I had even built grass boxes (turf laid into thin wooden boxes and allowed to grow) so that patients in wheelchairs could experience the feeling of grass under their bare feet. Following this reflection, I also found myself asking why it took my cancer diagnosis to bring to mind what I already instinctively knew, the importance of connection and impact of nature on physical and psychological wellbeing of my patients.

So back to the question I originally posed, can nature support physical and psychological wellbeing in those with ABI or long-term neurological conditions? Well, in my research exploration were very few studies looking at the impact of nature in these populations and what there were all concluded the same thing “it is possible nature can impact but more research is needed”.  Looking more generically at research using nature-based interventions the consensus is that using natural environments can promote positive changes in physical and psychological wellbeing. 

Considering my reflections of my personal experience and the anecdotal evidence of my clinical practice, albeit I was not consciously setting out to use nature based interventions, I believe the evidence suggests nature based interventions have the capacity to benefit those with an ABI or LTNC, regardless of severity.

So, the journey has started and what are the next steps? Research will always be an important part of understanding, planning and executing interventions, gaining funds and encouraging others to participate.

So, at Renovo Care where I currently work, we are planning a series of small studies to explore what in our natural surrounding we can use to benefit our patients. But more importantly I want to encourage others to recognise our connection to the natural world, to think outside the box (our buildings) and explore the environment around us. How can we bring the sense of hope that the natural world gives us and bring this to our patients (as well as to ourselves) to aid the feeling of a personal sense of hope for the future, whatever that may look like.

After all, “There is something infinitely healing in the repeated refrains of nature – the assurance that dawn comes after night, and spring after winter.” Racheal Carson