Nature-based rehabilitation—experiences from patients with acquired brain injury: an explorative qualitative study

Abstract

Purpose

Nature has been found to improve and promote health and prevent disease. Nature-based rehabilitation (NBR) delivered as part of neurorehabilitation is a developing approach. Yet to date the research is sparse. Following an acquired brain injury (ABI), people often experience impairments that cause limitations in activity and participation in daily life, which can impact the quality of life long-term. NBR delivered in neurorehabilitation has previously been explored from the perspective of occupational therapists and physiotherapists, however, to date patients’ experiences are yet to be explored. This study aims to explore patients’ experiences and perspectives of NBR delivered as part of standard neurorehabilitation.

Methods

This qualitative study had a constructivist and phenomenological design. Semi-structured focus group interviews were carried out across three healthcare settings in Denmark with 17 participants. Data was analysed using content analysis.

Results

The analysis generated three categories: 1. Outdoor versus indoor environment, 2. The natural environment as a co-therapist, and 3. Interrelatedness.

Conclusion

The study provides insight into participants’ experiences of NBR. They reported that interacting with the natural environment as part of neurorehabilitation enhanced activity. Moreover, being in nature increased their self-efficacy, sense of autonomy, community spirit, cooperation, and joy, and led to a feeling of peace.

IMPLICATIONS FOR REHABILITATION

• Nature-based rehabilitation (NBR) delivered as part of neurorehabilitation provides an alternative to indoor rehabilitation.

• The natural environment offers multisensory stimulation, sensory-motor training, and opportunities for mental restoration.

• NBR promotes social engagement, cooperation, and feelings of being in the same boat and may increase autonomy, self-efficacy, activity, and participation.

• NBR can be designed and delivered in a way where the natural environment and the intervention promote individual and group rehabilitation.

• The benefits of NBR in neurorehabilitation for patients appear to be an underexposed topic, and the intervention may provide an opportunity for improving rehabilitation for patients with acquired brain injury.

Keywords:

• Natural environment
• quality of life
• outdoor activities
• participation
• play
• self-efficacy
• cooperation

Acknowledgements

We would like to thank the participants and the health centres for their generous contribution to the study.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

The study was part of a larger regional NBR project, KOM UD funded by 15 June Foundation and The Danish Association of Occupational Therapists.