Horticultural therapists use gardening
to inspire memory, promote healing

By Lisa Marshall

From beneath the shade of her wide-brimmed hat, 93-year-old Winnie Klien raises a fresh-picked tomato to her lips and bites in, unleashing a flood of sweet juice – and memories.

After a long stretch of staring silently into the distance, she stirs. “I grew tomatoes, you know,” she says, smiling as the images come flooding back. “…and zucchini squash, and Irish potatoes…”

Nearby, Annie Borough, 78, rubs tow rose petals between her palms. Now in the late stages of dementia, she often keeps her eyes closed, a caregiver explains. But from time to time, the scent of the flowers seems to deliver her.

“Beautiful flowers,” Borough says, bright-eyed.

To the outside observer, it may appear just another lazy afternoon in the garden. But horticultural therapist Julie Mahoney believes this is strong medicine. Mahoney is one of thousands of practitioners in the burgeoning field of horticultural therapy, a health-care specialty that uses gardening to promote physical and emotional health.

She'll spend the afternoon clipping vegetables and watering flowers with the residents of the Anam Chara assisted-living home in hopes of jarring memories and sparking conversation among residents, many in the clutches of Alzheimer's disease.

“Most people of this generation had their own gardens and grew their own vegetables,” Mahoney says. “I think this helps tremendously to connect them with their lives.”

Thirty years after Kansas State University launched the first undergraduate curriculum for horticultural therapy, health-care workers are now using soil and spade to reach developmentally disabled kids, brain and spinal cord injury patients, mentally ill prison inmates and others

At least 17 colleges and universities provide horticultural therapy degrees, and the Denver-based American Horticultural Therapy Association is 800 strong and growing.

“I run into people who have actually heard of it now,” says Rebecca Haller who started one of the state's first horticultural therapy programs in 1981 at a Glenwood Springs facility for developmentally disabled kids. That program is thriving, and Haller, who now teaches classes at the Denver Botanic Gardens, has seen enrollment triple since 1997.

This fall, the city of Boulder's Exciting Programs Adventures and New Dimensions(EXPAND) program, for people with disabilities, will begin incorporating the therapy into its offerings. And one social worker with the Boulder Valley School District hopes to bring gardening into the classroom to promote socialization among special-needs kids.

“A lot of people in human services are looking for some different kinds of therapies that really work,” Haller says. “This works.”

Gardening for physical therapy

Susie Hall, a recreational therapist with Craig Rehabilitation Center in Denver, agrees.

Since 1982, the hospital has used gardening as a physical rehabilitation tool for spinal cord injury patients, helping to increase strength, endurance and fine motor skills. Hall also works one-on-one with brain injury patients, using gardening tasks to help them with identification, memory and problem-solving.

Patients are equipped with customized tools, and they work in garden beds raised to heights easily accessible from a wheelchair or walker.

“One lady could only stand for five minutes, but when she is out here in the garden, she can stand for 15 minutes,” Hall says. “It all has to do with doing something with a purpose.”

Instead of transferring woken pegs from one board to another to test motor skills, for instance, a brain injury patient might clip the dead heads of petunias and place them in a bowl on their lap.

For 60-year-old Joe Coranado, who crushed two vertebrae in a care accident June 6, harvesting Roma tomatoes from his wheelchair is an exercise in balance and motor coordination.

With each clutch of his specially adapted pruning tool, he strengthens one hand, while using the other to kelp him sit upright. It could be years, if ever, before he walks again, but he's already planning his garden at home.

Cindy Hayworth, 40, came to Craig from Peoria, Ill to recover from her spinal cord injury. To her, the garden is a place to gear up for the more grueling, and frustrating, indoor physical therapies.

“At home, I would sit for hours and mess around and plant. It just relaxed me and put me in the frame of mind to go to work,” she says, carefully balancing with her cane as she prunes a patch of marigolds. “It does the same for me here. It takes the edge off the therapy and makes things feel more normal.

“Just being out here makes you feel better,” she says.

Reviving an ancient proscription

The concept of gardening as therapy is nothing new.

In ancient Egypt, court physicians prescribed walks in the palace gardens for members of the royalty who were deemed “mentally disturbed.”

In 1879, the Pennsylvania Friends Asylum for the Insane (today known as Friends Hospital) built the first patient greenhouse.

But as land has become more urbanized and society has become more removed from natural settings, reintroducing plants into the health care environment has become a challenge.

Plants, raised beds and tools can be expensive, and insurance seldom covers horticultural therapy, so facilities that provide it must absorb the cost.

“We don't charge for it, “Hall says. “For a facility to actually justify its value and its worth can sometimes be a stumbling block.”

The people-plant connection

In hopes of lending more credibility to their profession, members of the American Horticultural Therapy Association would like to find out why people react to plants the way they do, and what that response entails.

The association now meets annually and publishes a yearly journal to share new research.

“So many people are aware of their need for plants in their won environment that the logic of using it with patients is increasing tremendously,” says Diane Relf, who holds a doctorate in horticultural therapy and helped found the American Horticultural Therapy Association.

But research on the subject is quite limited, she says.

One researcher at the University of Delaware compared patients recovering from gall bladder surgery and found those with views of landscapes spent less time in the hospital than those patients looking out on a brick wall. They required less-potent and fewer drugs to remain comfortable.

In another study, at the Sloan-Kettering Institute in New Your, women recovering from breast cancer surgery found that walks in the garden helped restore their ability to concentrate and reduced depression

One study of college students documented physiological changes, including lower blood pressure and reduced muscle tension, after visual contacts with plants.

Theories abound as to why being around plants can be beneficial to the health.

Researcher Richard Ulrich maintains that in a world where our senses are bombarded with noise, movement and visual complexity, a plant-dominated environment offers simplicity, thus reducing stress. In the “Biophilia Hypothesis,” a series of essays published in 1933, other researchers contend that our response to plants is genetically programmed, a product of survival instincts established thousands or millions of years ago.

“Since we evolved in environments comprised primarily of plants, we have a psychological and physiological response to them,” Relf writes.

Gardening is also good exercise. According to one study, you can burn as many calories in 45 minutes of gardening as in 30 minutes or aerobics. One hour of weeding burns 300 calories.

And a growing body of research indicates that plants and their soil micro-organisms may naturally absorb potentially toxic chemicals from the air.

But advocates don't envision a day anytime soon when horticultural therapy on its own will be broadly embraced by the medical community, or insurance companies.

Instead, predicts Mahoney, occupational, vocational and physical therapists will incorporate it into their work.

“I just don't think it is going to be something that is really well-funded,” Mahoney says.

Growing interest

The concept is catching on nonetheless.

Seventy health care workers from 19 states and three countries flew into Denver earlier this month for a four-day introductory class in horticultural therapy.

Jean Derr, a nurse who worked in home health care for years, now volunteers at the Denver Botanic gardens, leading groups of developmentally disabled adults, blind children and elderly people through the Sensory Garden.

Each plant there is carefully chosen for its pungent smell or taste, its unusual feel or sound.

Derr urges visitors to rub their hands through the soft red ruby grass, put a bundle of thyme to their nose, take a taste of wild chives or just listen to the quaking aspen above.

“We've had people who were non-verbal for years leave here and say,

‘Thank you,' or ‘pretty,' ” Derr says.

Qualife Wellness Community, a day facility for cancer patients in Denver, recently constructed a therapy garden. And the Colorado Department of Corrections has hired a horticultural instructor to work with mentally ill inmates at two Pueblo correctional facilities.

For Mahoney, seeing is believing.

On a recent afternoon at Anam Chara 92-year-old Wanda Lapari tucked a marigold bead over her left ear as she chatted cheerfully with Mahoney.

“Just moments ago, she was agitated. She didn't even want to come outside,” Mahoney says.

Nearby Winnie Klien kicks back in a chair on the porch, one plump red tomato tucked safely into the basket on her walker.

“We'll have that one for dinner,” Klien says.

From the Boulder Daily Camera of September 25, 2000, by Lisa Marshall