Connecting with nature after brain injury

I'm Claire McDonald um and I work in independent practice and in um the not for profit organization neuro in nature so I am incredibly passionate about neuros psychology and about n your connection and so it is um heartwarming and you know a real privilege to be able to present today about Nature's benefit after brain injury so in terms of what I hope to be covering today um I'll talk a little bit about the history of Nature and human health and well-being and also introduce the practice of forest bathing for those who may not be aware of it I will talk about how nature benefits are um physical emotional and cognitive well-being um by talking about the research but also some of the theories um underpinning this and also specific research with people with acquired brain injury

I'll then be going on to talk about some of the challenges that exist around nature connection for people with acquired brain injuries but also some of the opportunities um that neuro rehab professionals and um individuals can connect with to support a better relationship with nature and then I'll just end on some top tips um with for nature connection as well okay so in terms of humans and nature um I think it's fair to say that our relationship with nature has really evolved over time um unfortunately this has been in the direction of disconnection rather than um than more connection so in ancient times um many cultures relied heavily on nature for healing practices we use plants and herbs to treat illnesses and injuries um and our our survival really depended on nature we we would have turned to nature for our diet we would have worked the land um and so we needed to really observe nature and respect it in order to survive but with the rise of

industrialization um we experienced many really incredible advancements in um medicine and healthc Care um um we adopted more pharmaceutical approaches to managing medicine and health um and what this meant particularly Western societies was that there was less focus on the health and healing properties of Nature and alongside this we experienced rapid urbanization so more and more people living within large towns and cities um working inside indoors less Physically Active um able to kind of ACCESS food from other sources um and this resulted in a real growing disconnection um with nature so we may have been living longer um but there seemed to be a real decline over time in our health and well-being and this is exactly what was observed in Japan um in the 1980s which prompted then the the establishing of forest bathing so in the 1980s in Japan there was a real Tech boom more and more people were spending time indoors behind screens um leading more sedentary

lifestyles on what the government and healthc Care Professionals observed was that there was a significant increase in physical and mental health problems um so things like autoimmune conditions cancers um depression mental health problems and increased suicide rates and this resulted in the Japanese government then coining the term shinin yuku which translates as Forest bathing and promoting this as the antidote to tech-based burn right as a way of trying to get people to reconnect with Japan's Amazon forests so what is Forest bathing so no nudity or undressing involved um it basically means immersing yourself in the forest air so what this looks like is a very slow and gentle walk in nature

so with the emphasis on slowing down and connecting with the environment through your senses so when people are on a forest bathing walk a guide would offer suggestions and prompts to help people direct their attention to the environment so looking at what they can see maybe all the colors looking at what they can touch the sensations smells um really important listening for signs um so in doing so what the guides are are trying to achieve is a shutting down of those opportunities to engage reminition um and kind of getting caught up in unhelpful thought processes so the the emphasis is really on being present in nature it's a very mindful activity

um it's not about doing or a physical activity or getting in the steps and it's not an intellectual Pursuit it's not about acquiring knowledge of trees or or of the environment it's about being present and really connecting with our senses and since the 1980s then this has led to a real explosion of more focused and scientific research really looking at the physical cognitive and emotional benefits of time um spent in nature um and the results really are quite breathtaking and these have been replicated all over the world um in sort of in from ancient Woodlands but also to kind of urban um Urban parks and also Gardens and and indoor settings as well and that's what I'll go on to talk a little bit more about now so in terms of the impact of nature on our bodies there is an abundance of high quality um

research systematic reviews and meta analysis looking at the physical health benefits um and some of the short-term positive changes that have been noted in include things like reduced Sal uh salivary cortisol so that's the uh stress hormone in our bodies reduced heart rate reduced blood pressure cholesterol improved heart rate variability and improvements and sleep and over the longer term connection and access to Nature then has um been associated with a reduction in chronic health conditions and illnesses so things like cardiovascular disease obesity um some cancers um and diabetes and a lot of that research uh more recently has focused on understanding the immune system benefits to time spent in nature um specifically the uh impact of fight insides so these are the natural oils that are released by certain kinds of trees so um Cedars Pine

conifers um and this is part of the trees's immune system response how it keeps itself well and protected from threats but this has a really complimentary effect on human immune systems and what the research has found is that exposure to these natural oils reduces inflammation within our bodies and promotes the activity of um cells called natural killer cells and these cells play a really important role in helping us to fight infections and um things like cancer cells and tumors as well and the results are so compelling and convincing that this has led to some countries like Japan um coming up with the idea of a an optimal nature dose or time spent in nature per month and um in Japan they recommend around two to three hours a month um but research has also highlighted that some of the significant physiological effects that we've noted just above um are experienced after just 20 minutes of nature connection per day

um but in terms of the psychological benefits the research also highlights that it's the quality of nature connection um that is really important and that's you know over and above time Spence so it's moments not minutes in nature um that really counts so I'll go on to talk about the mental health benefits now so again there is a huge body of research um you know a high number of systematic reviews exploring the psychological benefits um of nature connection and these extend across age groups across cultures um across socioeconomic status and across a wide range of clinical populations um there there are so many research papers now available um and what these papers highlight is that um nature connection results in a reduction of symptoms of anxiety stress

depression and reduces reminition processes um and reminition is kind of a a risk factor for the development of a whole range of mental health illnesses so things like psychosis Eating Disorders um and connection with nature seems to slow down and reduce this process as well as reducing unhelpful symptoms the research also highlights that nature can increase helpful uh mechanisms and uh experiences so research has found that um nature connection supports helpful emotional regulation skills and the experience of positive emotions so things like feelings of calm awe and wonder and self-reported feelings of well-being and reported uh quality of life as well and what's really nice is that the benefits

um seem to extend beyond the individual um to wider communities and relationships um so research has found improvements in feelings of Social connectedness and pro-social behavior towards others but also towards nature itself um and this is really really important given I suppose what we know about um concerns around climate issues and what's happening to the natural environment and certainly research from the University of Darby has sort of emphasized that The Closer the more closely we're connected to Nature the happier we are the more worthwhile life seems and the more willing we seem to be to take steps to protect nature and our wildlife and that's incred ibly important it's not just about taking from nature it's about that um that relationship with nature itself

okay so then moving on to the impact of Nature and our thinking skills um again there is a real growing body of evidence to highlight um the positive impact of nature connection on certain cognitive skills so particularly our attention working memory and cognitive flexibility and executive control and that has been noted on um kind of people's performance on cognitive assessments after exposure to Nature and it's not just about um actually being outdoors in nature um some studies such as that by Berto in 2005 highlighted that even viewing photos of resulted in performance or better performance on tasks of sustain and detention versus those who viewed images of kind of urban or builtup

environments um and these findings really complement um anecdotal and and qualitative findings um where people describe feeling that they feel more clarity after spending time in nature or that they feel that they're able to think differently about a situation or even feel more creative after spending time in nature and the research in particular has highlighted the importance of nature connection for children and the impact on their learning and well-being as well um so this paper by Taylor ad Alan highlighted that children living in urban areas who've had a Nature View from their from their uh living room windows seem to perform better on tasks of working memory uh impulse inhibition selective attention and concentration

compared to children who had sort of urban views or or didn't have that kind of view of Nature and I think within the education system it's fair to say that there's a real growing recognition of the positive impact of nature on a child's learning and well-being and more and more schools are beginning to introduce Forest therapy programs to kind of support connection opportunities within School settings and I think given I suppose the younger generation sort of increased time spent with screens and indoors this feels more important than ever so what's actually going on inside the brain during

connection

studies answer this question um by sort of comparing brain activity uh using fmri after uh walk in nature compared to an urban walk and the results are really really interesting so um this paper by sudak Al highlighted reduced activation of the amydala after a 60 Minute walk in nature so our amydala is our brain's kind of threat Control Center and it seemed that activity had reduced after um that time in nature and this was correlated with participants self-reports of feeling restored um similarly the paper by Bratman at Al um observed decreased blood flow to the prefrontal cortex so that's the area of the brain involved in kind of complex thought processes decision making and behaviors um and this correlated perhaps unsurprisingly

then with self-report decrease of rumination and getting caught up in thoughts um so it's really helpful you know more and more research is coming out that really helps us understand the powerful impact that nature has on our our brains our bodies and our emotional well-being um and I just want to kind of think a little bit more about the evidence based for people with acquired brain injury um because you know given the high rates of cogn difficulties of psychological distress in this population it feels like the evidence you know points to this being a really helpful um intervention for people living with acquired brain injuries and their family members as well um however as is often the case with acquired brain injury research there is not a huge body of of evidence just yet but what is there um is really promising and positive so this system atic review by uh vibal in 2020 um kind of identified seven high quality studies that looked at the impact of nature-based rehab

interventions and there were a number of different interventions presented in the papers so things like Horticultural therapy so growing things gardening projects Forest bathing that we talked about before um and also Outdoor Adventure therapies so that involved kind of doing things like camping going on um kind of uh sort of rock climbing or rafting Expeditions um and looking at the the impact on individuals um so what these papers highlighted was that nature based rehab improved the impact of acquired brain injury and this included benefits to sensory motor functions I nitive functions um there were reported improved uh uh motivation proactivity and engagement in Rehabilitation and with rehab goals improved mood and emotion regulation um and self-reported increased positivity and I guess proactive and helpful views around coping after brain injury um and a sense of positive identity formation

um and it was really interesting to note that one of these studies looked at the brain activity um of the participants and Horticultural therapy so a project uh based around Growing Seeds and planting and kind of seeing these through to harvesting um actually uh appeared to result in Improvement or changed activity in certain brain areas that tend not to be activated through um normal or traditional stroke rehabs and these were the sort of visual and color processing areas uh assoc association areas and sensory motor areas of the brain which was quite an interesting result just that it brings something different to

rehab and then uh Corson Al um worked with people who had a diagnosis uh of postconcussion syndrome and offered a an 8 we nro based intervention incorporating um I guess creative activities and outdoor-based mindfulness and Forest therapy and what people reported was a reduction in mental fatigue increased quality of life and even though they found some of the tasks challenging in terms of um sometimes feeling overwhelmed with the sensory information and and stimulation of being in those environments they experience the tasks and the activities as really motiv and meaningful and they were willing to tolerate some of that sort of discomfort around uh sensory stimulation in order to experience those benefits and within the UK um there are some really creative and wonderful um projects and interventions being offered so Gibbs Dal in

2022 um have published a qualitative uh paper on experiences of surf therapy after acquired ABI so this is based down in Swansea and Wales um and the themes of This research really highlighted the opportunities for um positive change and acceptance that people experienced through that nature connection so there are lots of really interesting and creative nature based projects happening and it's so important that when we do this we we kind of are committed to sharing and Publishing um those results so what is going on why why are these benefits kind of occurring um so there are a couple of key theories that help us to understand a little bit more about this um and the first is stress reduction theory which was proposed by rri um in the early 80s um so this Theory suggests that connecting with nature directly impacts and influences

our nervous system so resulting in decreased sympathetic nervous system activity so this is our fight flight response it turns the volume down on that an increased parasympathetic uh nervous system activity so that's our rest and digest uh system and it turns the volume up on that which enables us to recover from stressful experiences heal and also experience mood and psychological benefit benefits um so you know hopefully the research that we've kind of just covered in the previous slides you can really see how that fits and and gives Credence to this um this Theory but rck himself completed some really inter in research um in the 1980s that kind of shipped

um how people design hospitals and Health healthc Care environments um so what he did was he looked at the hospital notes of bile surgery patients and compared those who had a view of a tree out of a window in the hospital bed compared to those who had a view of a wall um and interestingly those who had the nature of view had shorter hospital stays fewer complications and required fewer doses of moderate and strong uh pain medication and he concluded from this that this was evidenced to support that nature views promoted healing um and as I say it's been quite influential in shaping um the design of of Health healthc Care and uh rehab settings um even today so the second key um theory that I want to discuss um looks

at understanding the cognitive benefits of nature connection um and this series proposed by Kaplan and kapan in the late 80s so what they suggest is that busy Urban environments are so highly stimulating um and they require much more of what they called our directed and voluntary attention capacities so even looking at this image on the screen it's so busy there's so much happening um and obviously what our our voluntary attention capacity is a finite resource and over time this becomes fatigued and we struggle to sustain our concentration particularly on tasks that have a a low motivational appeal so you know on a nice sunny day when other people seem to be out in a bite it feels really hard to sit down and do the paperwork that we need to do um so we experience that uh attention fatigue and this impacts our ability to perform cognitive tasks and also our decision meing processes as well so in contrast to Urban

environments what Kaplan and Kap suggest is that natural environments draw on involuntary attention um and so they are softly fascinating they are less demanding of our cognitive resources and time spent in nature then because it uses this more effortless attention it allows us to replenish and restore our voluntary attention capacities and results in this improved cognitive um functioning and they also highlighted that just by view of us feeling less stressed in nature this also has a positive impact on our uh cognitive abilities so again if we're less caught up in unhelpful rumination and thought processes this actually gives more cognitive space and capacity to focus on the things that we want to do to achieve the goals that we want to achieve so again a lot of the the kind of cognitive research appears to to support this Theory also um

so as well as you know feeling really passionate about the um the stats and the numbers and the data I am really really passionate about um hearing people's lived experiences and stories of nature connection and I feel this can be really powerful in bringing to life what the theories suggest and also what the research papers um highlight as well so I want to just share the experience of someone that I've worked with for um I guess over a year now who experienced a traumatic brain injury and with with his consent James very kindly drafted um this narrative for me so I'll just read this um read this now so since my accident I really struggle walking and have per memory shortterm memory is definitely what where I struggle the most it really frustrates me and leaves me confused unsure of where I'm going what I'm doing and where I put

things this is probably why nature and reserves are so important to me you can put as little or as much time into it as you want or can as long as you enjoy your time doing it like a nice walk alone or simply sitting outside and watching various Birds zip about you're already winning even with a little food be it nuts or seeds You' be surprised how much will come to you even in the most unlikely of places birds of all kinds and squirrels then you can build it up for there from there you might find yourself becoming interested in the birds trees mushrooms Etc you might have the best or worst knowledge of nature it doesn't matter you can dip in and out of this or even carry this interest on at home by reading about it or looking at things

online basically by being outside in nature I can relax I don't feel rushed because I can do as much or as little as I want and I don't need to think about I don't need to be or think about somewhere else this calms me down and frees up my mind to only think about or focus on what I want and ways I can achieve things within my new post accident limits um so I'm really grateful um to James for sharing this experience and I think it really does capture everything that has been identified on the previous slides in terms of the cognitive benefits but the emotional benefits but it also Al highlights that you know even for people who are experiencing mobility issues and cognitive challenges that actually it is still possible and highly beneficial to connect with nature um so that's just what I want to to kind of present a little bit about now

um so access to Green Space across the UK is not equal um even though the benefit um you know will will be applicable to to everyone um so some of the barriers to n connection um identified are um those living in very urban areas um those from lower socioeconomic statuses people from ethnic minority groups people with um physical um or sensory disability and um gender and sexuality so people who identify as being from the LGB uh T community and also females tend to feel less safe um accessing local green spaces and there's a lot of fear around um risks uh around heat crimes and violence in these settings um and this is you know it's it's really really challenging um and is a a kind of an issue that local authorities the government and public bodies have a real duty to invest um in in managing um we need to advance the equality of n connection opportunities as these are the populations that will benefit most

um from connecting with nature but what I want to kind of share a little bit about is these issues not with withstanding how can we support people to access nature perhaps in adapted ways or or not involving going um to local parks or or green spaces even though this is very much the ideal um so there is an incredible body of research that highlights the positive impact on our minds and bodies um from indoor n connection opportunities and when particular or individual senses have been isolated so whether that's visual sense whether that's nature signs nature smells um and some of the research is really really interesting so um a paper by uh okay at Al um highlighted that viewing a bonsai treat for just one minute resulted in really positive psychological and physiological effects in patients with spinal cord injury um so there was a reduced prefrontal cortex

activity um and increased positive feelings and reduced negative emotions and this was also replicated in elderly adults undergoing rehab and even in those with a diagnosis of dementia as well so just one minute with a lovely little bonsai tree um really sounds incredible and similarly um mchan at Al has completed um a number of studies looking at the impact and acceptability of virtual Forest bathing um so using online over Zoom looking at kind of detailed images of nature um and this was F to improve mood and decrease rumination processes um and symptoms of long covid and the study was also replicated in patients with l energy conditions and spinal cord injuries and Ms in Canada and again that qualitative feedback was incredibly positive um although it was highlighted that um

being able to access their own plants and look out a window at the same time as doing the online or virtual um intervention seemed to really support uh the benefits as well um and one of my kind of favorite papers is uh by Le Al so he somehow managed to convince a group of Japanese businessmen to spend 24 hours in a windowless hotel room and he pumped in some of these uh Woodland essential oils that we talked about earlier containing fightan sides and spending time in this environment and absorbing those Woodland oils significantly enhanced that NK cell activity and the benefits persisted um like I say up to up to a month um and this was reported alongside just adrenaline levels and uh mood improvements as

well so what can neural rehab professionals do to support nature connection after acquired brain injury I think it's really important to identify and think about what opportunities are available um throughout someone's rehab Journey um from being in a hospital setting you know is there access to a garden is the person getting opportunity to to kind of look out out of a window um you know can they be looking at photos or kind of doing activities as part of their their Rehab on award um to support nature connection and just being curious what was their pre-injury relationship with nature like as well and and can they be supported to reconnect with that if that's something of importance to them

but I think just offering information and education about the health benefits of nature connection is really important I think we all intuitively know that you know spending time or connecting with nature is good for us but the evidence and the Neuroscience behind it really is incredible and I I think that people don't necessarily see it as you know sort of as important as taking tablets or or kind of other interventions but it really is and the the research kind of supports that but also you know and I think your rehab professionals are great at problem solving and thinking about adjustments and so we can work with individuals and families to problem solve around some of the accessibility

barriers and support someone's confidence in accessing local green spaces or spending time Outdoors if that's what they want to do um so we can you know offer to meet someone at their local Green Space and kind of look at the you know any adjustments or equipment that they may need but we can also consider options for indoor nure connection as well but also thinking about how I guess NHS Services can maybe Link in and work collaboratively with um third sector organizations and Charities that might already be offering nature based projects um and I think you know neuro rehab professionals can support the people running those projects to have a really good understanding of the needs of individuals with acquired brain injuries and any adjustments that um can be put in place to support that engagement and

accessibility but also you know not just supporting the people that we're working with but thinking about your own um connection with nature and your own well-being are you taking time to kind of connect with nature yourself and can you wave this into your um kind of Day-Day activities in order to yeah just support that work life balance a little bit more which means that you know we're we're more able to support the people that we're working with so similar to that then so in keeping with that then I've just listed some small tips for nich connection um so one starting small I really hope that I've emphasized it doesn't have to be a huge physical or knowledge based Endeavor to connect with nature it just starts with noticing what's already around you looking out the window looking up to the sky opening the wind you know spring is such a an incredible season to do this what's around us already um and just taking the time to notice that and then perhaps

developing developing a bit of a routine so that habit forms around this so maybe when you're having your morning coffee just sitting by the window or opening the door so that you can hear some of those nature signs or maybe you know as you're driving to somewhere or doing errands just you know looking for particular trees and and and noticing these connecting with your senses so what can you see what can you hear what can you smell what can you touch and what can you taste um this is how our brain and body knew and and kind of pick in that information from our environment um so you know many many time in previous years I would have gone for a walk in the park so getting in my steps but my head would have been completely somewhere else thinking about something else or head in a phone or listening to a podcast and connecting with your senses means just stepping away from the screens just for a minute and really slow going down and being present with what's

there for as I say invite nature inside so you know think about introducing house plants you know if you don't have these already um you know even looking at Nature images there are some really beautiful high quality images online um and even online virtual forest beathing videos that people can access on YouTube you can also buy those Woodland essential oils so things like Cypress Oil to kind of burn and release in your house so that you're gaining those benefits as well and finally um creating an emotional bond with nature so really noticing how you feel when connected with nature noticing those feelings of calm awe or wonder and these are the feelings that are going to reinforce and help us to repeat and build on that nature

connection um so just some Tech home messages then um so yeah I I hope um I've been clear and highlighting that nature connection offers an abundance of opportunities for physical mental and cognitive well-being and these benefits go beyond the individual level to Pro social and Community benefits but also in terms of of sort of sustainability resulting in pro- environmental actions as well and that's so important

um in terms of how we can support people with acquired brain injury we should be providing people with information about the benefits of n connection and this should and could be easily Incorporated within the context of someone's Rehabilitation

Journey um and it doesn't have to be a timec consuming or physically or cognitively demanding task we can weave these opportunities into daily life um just be beginning with simply notic what's there so yeah just please give it a go see see what you can notice and yeah how how that feels for you um so yeah that's that's my techh home messages and the end of my presentation