Nature in OT

Do you incorporate nature therapeutically in your practice?  Do you point out natural elements, make use of the seasons or treat your patients outside?  I do.  Natural materials make excellent creative play materials that make suggestions, but do not force the imagination.  The seasons provide an ever changing focus for teaching ADL’s and social interactions.  Exposure to the outdoors provides improved outcomes for patients in medical based settings (such as hospitals) and I believe the outdoors also helps outpatient pediatric therapy be more effective.  The calming and ever changing characteristics of the outdoors help children with both underactivity and hyperactivity.

Boy Swinging from TreeYet, what does it mean to incorporate nature therapeutically into your practice?  Does taking a child to the neighborhood park count?  How about facilitating a playdate in the backyard?  What aspects of nature would be therapeutic to your client?  Does playing in a fenced yard beside a highway benefit the child?  Does riding a bike in a parking lot help the teenager connect to nature?  Does learning about bird calls on an iPad incorporate nature?

Incorporating nature therapeutically into your practice means considering which ways nature can assist in facilitating the clients OT goals.  This means that the therapist has engaged in clinical reasoning to determine which aspects of nature should be included and which aspects may be less helpful.  There are many sensory, physical and attentional qualities to outdoor spaces.  The therapist is in charge of defining what aspects should be included in the session.  In addition, the therapist is responsible for making sure the scene is safe for the goal to be addressed.

A neighborhood park may be an excellent place to work on gross motor skills or to learn how to introduce oneself into a play situation.  Either of these goals may include or ignore the natural elements at the neighborhood park.  Does the park have safe natural obstacles to foster gross motor skills such as climbing in, over or on?  The therapist must have knowledge of what surfaces and opportunities the park would offer for gross motor skills.  The texture of grass could help a child improve their walking by going barefoot.  Nature could facilitate a better walking posture by walking over varied terrain.  A child could learn how to introduce himself and play with others in the park outside of nature.  However, the therapist could facilitate mud pie building allowing the child with special needs an easy and fun way to introduce themselves to other children.

Facilitating a playdate in the backyard could also incorporate nature by using sticks and pinecones found in the backyard and creating a play scheme around these objects.  Just as easily the therapist could be in the backyard with both children and never invite nature to the playdate.  The therapist defines how much and when to emphasize the roll that nature will play in the playdate.  Children naturally gravitate to natural play if allowed free play times.  The therapist may also decide that the lack of a fenced back yard would make the playdate unsafe to hold in the backyard.  The inclusion of nature needs to be considered prior to the session.

What if the backyard is fenced by a highway?  What therapeutic value does this space have?  Does the child play indoors all the time due to her location near a highway?  The therapist could determine that the fence is safe and the yard is safe.  The therapist could then introduce a container garden for the child to include a more natural version of the outdoors.  This may also encourage the child to go outside beyond the therapy sessions.  Perhaps, the therapist determines that the fast moving traffic is too disturbing for their client and that the outdoor environment would not be therapeutic.  The therapist may also try to facilitate a session that meets in a more conducive outdoor environment.

Riding a bike is an outdoor activity that people of all abilities engage in.  Learning to ride a bike in a parking lot may make the initial phases of learning to ride the bike easier through flat terrain and limited obstacles.  This wouldn’t necessarily connect this teenager to nature.  The connection to nature may come from riding his bike to a lake or nearby wooded area.  Without facilitation nature may not come into the bike riding conversation in a parking lot.  However, even the mention of the sun shining and the wind blowing may help that teenager make the connection.

Finally, teaching a child bird calls on an iPad may help a child with limited exposure to the outside connect with nature.  The iPad may be the link the child needs between the comfortable and the novel.  Some children appear afraid of large open spaces.  Learning to connect new sounds with birds may be a great activity prior to getting outside.  However, without getting outside the connection is abstract.  The connection to nature is virtual until the child goes outside and connects the learning with nature.

I hope to see more occupational therapist including nature in their practices.  I think the benefit that nature brings to my sessions is a catalyst to further learning and growth for me and my clients.