Outdoor Rehabilitation for Everyone at Unicare Bakke

The mission of the Outdoor Rehabilitation for Everyone program is to provide outdoor rehabilitation for all patients at the Unicare Bakke Rehabilitation Centre in Norway. Unicare Bakke hopes that, in the long run, this will help people with an impairment achieve the positive health outcomes and increased quality of life that time outdoors can provide. In Norway, hiking and being outdoors are deeply meaningful for many people. They often regard it as part of their soul and heritage. Providing rehabilitation that helps people achieve this function again is essential. 

The program provides outdoor rehabilitation tailored to the individual needs of the patients. Many patients have goals that include outdoor activities and therefore need to train in similar environments. The program also aims to show the health-promoting effects that outdoor environments and nature provide while helping patients feel safe outdoors with the new conditions their body has given them. In the long run, we hope that this will help patients get outdoors when they return home, achieving positive health outcomes and increasing their quality of life.

Program Description
The program offers weekly outdoor rehabilitation for all patients at Unicare Bakke. Every Wednesday afternoon, all patients have outdoor rehabilitation on their schedule. The number of staff that is present is usually about 10, divided between PT’s, OT’s and a rehabilitation assistant. The number of patients that participate every week varies, depending on weather and time of year. In the summer more than 40 patients might come out and at its lowest it might be 5-10. When outdoors, the staff works as a transdisciplinary team, everyone does what needs to be done, based on the goals and levels of functions of the patients. Since most of Unicare Bakke’s PT’s and OT’s are treating outside, the patients know and feel comfortable with them. As well, the therapists understand the patient’s goals and collaboratively with patients, help choose a suitable outdoor activity. When games and plays are the theme of the day, the PT’s and OT’s keep an extra eye on how the patients perform. Many games are excellent challenges when it comes to training on bearing weight on both legs and improving motor skills in the arm and hand, important for both for someone who has had a leg amputated or a stroke.

Services Offered
Walking is the most requested activity, so it is the one we offer the most. Since patients’ functions vary a lot, it’s important that we offer walks of different lengths and difficulty levels. Some people have a goal to complete the “walk around the mountain,” a quite demanding and difficult route, while others have a goal to walk a few metres. It's important for us to meet each patient’s individual needs. It's also important for us to present not only physical activities, but also the environmental-psychological effects of being outdoors, like activating all senses and just being. We always have coffee at the outdoor rehabilitation program and, from fall to spring, we light fireplaces where people can gather. The effects of drinking coffee together and gathering around  fireplaces should not be underestimated, as many meaningful conversations have started around the fire. 

Other services we offer are:

• Games like pétanque, spin ladder, croquet, mikado, and disc golf
• Garden activities like clearing weeds, watering, raking, and planting 
• Canoeing 
• Nordic walking 
• Mushroom picking 
• Swimming in the fjord 
• Outdoor cooking 
• Making a fire 
• Trying out aids like electric scooters and bikes 

Cost to Participate
Included in the cost for a stay at the rehabilitation centre
 

Contact Lotta Lundmark Alfredsson lotta@branak.se (+4) 670-322-5812

Populations Served
This program offers outdoor rehabilitation to approximately 50 inpatients at Unicare Bakke. The average age of patients is 61, but ages range from 18 to over 100. Staff at Unicare Bakke treat patients with the following diagnoses: 

• Leg amputation: Patients who have had a leg amputated recently or some time ago. Some of them are amputated on the lower leg, in the knee, above the leg, or in the hip.
   
• Stroke and traumatic brain injuries: Patients who have had a stroke or traumatic brain injury recently or some time ago.
   
• Orthopedic patients: Patients in this group have either undergone surgery or have problems with arthritis, pain, and/or mobility.
   
• Patients with a complex disease in need of rehabilitation after staying in a hospital: These are patients who need a little more time before they can move back home.
   
• Work-related rehabilitation: Patients in this group can have various diagnoses, but their common goal is to get back to work.

In relation to the The International Classification of Functioning, Disability and Health (ICF)’s four levels of function, Unicare Bakke has patients from levels 1-3: mild impairment to severe impairment. Many patients use a manual wheelchair, and some use a walker, crutches, or an electric wheelchair.  

Staff Composition
We have approximately 7-10 physiotherapists, 2 occupational therapists, and 1 occupational therapist assistant always present. When we are outdoors, everyone assists where needed. The occupational therapists are responsible for testing the electric scooters for those who need them.

The outdoor rehabilitation program at Unicare Bakke has been presented in many professional settings and to diverse audiences. The program was showcased at the outdoor rehabilitation conference in Valnesfjord in Norway 2018 and has been featured numerous times in different courses at the Swedish University of Agriculture (SLU). It has also been presented to architecture students at Chalmers in Sweden, at the national conference Djur, Natur, Hälsa 2018 in Sweden, to different municipalities in both Sweden and Norway, and to the Rehabilitation International World congress in 2020. The program is the subject of one of the chapters in the Swedish school book “Vård, Omsorg Och Rehabilitering Utomhus” and has been featured in two articles published in the magazines of the Swedish and the Norwegian Physiotherapy Associations.

Featured in the book: Vård, Omsorg Och Rehabilitering Utomhus (Translation: Outdoor care, nursing and rehabilitation)

Swedish Physiotherapy Association
Read: Fysioterapeutiska insatser i utomhusmiljö (Translation: Physiotherapy interventions in the outdoor environment)

Norwegian Physical Therapy Assocation
Read:  Åpne dørene for fysioterapeutiske tiltak utendørs! (Translation: Open the doors for outdoor physiotherapy measures!)