Bringing nature into neurorehabilitation - meet Dr Claire McDonald
Claire from the Neurons and Nature team provides an overview of how nature can help with neurorehabilitation
Dr Claire McDonald is one of the team behind the Neurons and Nature festival of connection happening in May 2024. In this blog post we’ll take a look at how nature interventions, such as forest based therapy can help with long-term neurological conditions.
Within the UK, the Neurological Alliance highlight that 1 in 6 of us are estimated to be living with a neurological condition; including “sudden onset” conditions like TBI or stroke, “intermittent” conditions such as epilepsy or migraine, “progressive conditions” like Parkinsons and dementia and “stable with changing needs” such as cerebral palsy . Despite the best efforts of healthcare professionals and services, access to neurorehabilitation services is often tricky, with long waiting times and disparities across UK locations. Alongside the physical and cognitive challenges these conditions can present, often the individuals and their carers experience high levels of psychological distress and social isolation (Lowe et al., 2021)
Is there a role for nature based interventions to help ?
Put simply, yes. As Claire explains, “It feels more important than ever therefore, that individuals and families living with neurological conditions are being informed of and supported to access any resource that may benefit their well-being, and there is compelling evidence that time spent in nature should be considered as one such resource”.
The role of nature in supporting people with a range of health conditions, as both a support and an aid to recovery, is not new. The benefits of hospital gardens and ensuring patients have access to natural views are recognised and well-evidenced practices, although unfortunately, in many UK healthcare settings these are still not always available or even considered a priority.
Our current understanding of how nature connection can benefit health is underpinned by the strong and compelling evidence around the use of forest bathing in Japan. During the 1980’s, as a response to rising levels of stress and illness across the population, a form of forest based therapy, Shinrin-Yoku, was introduced within which individuals were encouraged to engage and connect with the natural environment offered within woodlands and forest. Nature engagement is facilitated by focusing on each of the different senses and can include taking a slow, mindful walk through a green space. A large body of research has supported the psychological and physiological benefits this practice can provide (Yi et al., 2021),
A theoretical perspective
A number of psychological theories may account for the benefits nature can provide. Claire highlights two longstanding and key supportive theories, Stress Reduction Theory (Ulrich, 1981) and Attention Restoration Theory (ART) (Kaplan & Kaplan, 1989).
Ulrich’s theory suggests that we have an evolved connection with nature, often finding natural environments innately soothing and rewarding. His work included showing the benefits of seeing nature upon patient recovery after surgery. The theory indicates that a natural environment acts as an aid to the autonomic nervous system, the part of our nervous system which regulates body systems such as blood pressure and breathing rates.
Claire highlights research is supportive of this perspective. “For example, studies have demonstrated that time spent in a forest environment, such as walking through a forest and/or viewing the scenery can reduce levels of salivary cortisol, a stress hormone, blood pressure, pulse rate as well as increased parasympathetic nervous activity”. The parasympathetic nervous system is the part of the autonomic nervous system that is involved with rest and restoration.
ART suggests that in comparison to urban environments, the natural environment offers the chance to be away from everyday stress, experience expansive spaces, while engaging in activities linked to personal motivations and support less demanding cognitive processing, with nature offering “softly fascinating” stimuli. This is highly relevant to neuropsychological conditions, as Claire explained. “These opportunities are hypothesised to result in the replenishment of directed attention because we are less cognitively taxed in natural environments, leading to improved memory and attention”. Again research supports this, from studies where nature has been used to show increased concentration, focus and working memory performance.
“There is an increasing use of nature in the rehabilitation process among neurological therapists, particularly in the aftermath of the covid-19 pandemic” Claire says, although also highlights that “evidence base is limited and there is a lack of clarity around the specific benefits of nature-based interventions for individuals with longterm neurological conditions.” Where studies have been carried out on nature based interventions, benefits have been found, from psychological ones such as improvement in mood, stress, and sensory motor functioning, to social benefits such as engagement and proactivity.
The challenges faced by individuals with neurological conditions in accessing nature.
Claire highlights that accessing green spaces is “one of the biggest challenges for those with a neurological condition”, with research suggesting people with mobility issues visit green spaces much less than able bodied individuals. Access to nature via virtual means is one possibility to address this disparity, although this should be offered as part of a holistic treatment plan that also includes outdoor opportunities, with the treatment plan tailored to the needs and wishes of the individual. Indoor plants may also offer opportunities, with studies indicating that houseplants can support cognitive and mood improvements.
What does this mean for neurorehabilitation ?
As Claire sums up” In light of the available evidence, clinicians working within neurorehabilitation should be advocating for people with long term neurological conditions to increase their nature connection, and access nature based interventions like forest therapy alongside more traditional forms of rehabilitation.”
This is a key topic that will be discuss at the upcoming Neurons and Nature festival of connection, nature and neuropsychology in May 2024. Subscribe to hear more about the team and the speakers at the event in future posts.
Full details of the event can be found on our Eventbrite page.
References
Kaplan, R., & Kaplan, S. (1989). The experience of nature: A psychological perspective.Cambridge university press
Lowe, N., Crawley, L., Wilson, C., & Waldron, B. (2021). 'Lonely in my head': The experiences of loneliness in individuals with brain injury. British journal of health psychology, 26(2), 444–463. https://doi.org/10.1111/bjhp.12481
Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. (1991). Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology, 11(3), 201-230 https://doi.org/10.1016/S0272-4944(05)80184-7
Yi, Y., Seo, E., & An, J. (2022). Does Forest Therapy Have Physio-Psychological Benefits? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International journal of environmental research and public health, 19(17) https://doi.org/10.3390/ijerph191710512