CREATIVE
Design of Rehabilitation Landscapes
Project Type:
Research Publication
Published as: Joyce, K. & Shepley, M. Affordances of outdoor environments for physical and occupational therapy. In Pasha, S. & Shepley, M. (in press) Design of Physical Medicine and Rehabilitation Facilities. Routledge.
Also contributing to: Joyce, K., & Shepley, M. (in review). Exploring the benefits and challenges of outdoor therapy environments: Integrating perspectives from rehabilitation and design professionals. Health and Place.
While demand for physical and occupational therapy services continues to rise alongside growing recognition of nature's health benefits, the intersection of these fields remains under-explored. This study investigated how outdoor environments can uniquely support rehabilitation goals through in-depth examination of therapeutic affordances and benefits, as well as practical implementation challenges. By integrating perspectives from 23 rehabilitation professionals and environmental designers across the United States, our research identifies key affordances, critical design features, and implementation pathways for outdoor therapy spaces, essential knowledge for clinicians, designers, and healthcare administrators seeking to leverage the therapeutic potential of nature while addressing practical barriers to adoption.
Outdoor rehabilitation space typologies and setting types identified during interviews
Approach and Learnings
Methods:
Using thematic analysis of semi-structured interviews and visual documentation provided by participants, we examined both the theoretical foundations and practical applications of outdoor rehabilitation environments. Each interview explored professional experiences, perceived benefits and challenges, design considerations, and observations about trends in outdoor therapeutic spaces. This interdisciplinary approach allowed us to examine not just what makes outdoor therapy beneficial, but also how these environments can be effectively designed and implemented across diverse healthcare contexts.
Key Findings:
Key Affordances of Outdoor Therapy Environments:
Graduated Challenges - Varied terrain and environmental diversity create natural progression of difficulty levels
Enhanced Motivation - Multisensory nature experiences and real-world contexts increase patient engagement
Motor Skill Development - Manipulatable elements (tools, loose parts, natural materials) foster fine and gross motor skills
Environmental Typologies:
Publicly Owned, Dispersed Sites - Community trails, parks, and public spaces that offer authentic integration but less control
Privately Owned, Centralized Facilities - Purpose-designed therapeutic gardens and dedicated spaces with greater environmental control
Benefits and Challenges:
Holistic Health Impacts - Improvements in mood, autonomy, and overall wellbeing for both patients and staff
Real-World Activities as Therapy - Everyday tasks become meaningful therapeutic interventions that better prepare patients for daily life
Control-Choice Paradox - Less controlled environments paradoxically expand therapeutic options and patient choice
Environmental Hazards - Weather extremes, insects, allergens create barriers but also therapeutic learning opportunities
Logistical Barriers - Billing structures, liability concerns, and maintenance needs present implementation challenges