Most of us take for granted the surfaces we walk on each day and our ability to get from one location to another. But for many rehabilitation patients—many of whom have undergone a dramatic change in the way they live daily life—each surface is now an obstacle course.

Due to that fact, a growing and critical part of their rehabilitation is taking place outside hospital walls, in terrain parks and agility courses designed to both challenge and aid patients in regaining independence.

Simply stepping up onto a curb, an action that most people do without even thinking, has become for many rehabilitation patients a complex operation. Agility courses at today’s rehab facilities provide an arena to practice navigating obstacles—including ramps, raised platforms, speed bumps, stairs, and simulated obstacles such as street curbs and train thresholds—until the actions become second nature again.

Surface courses—small patches of varied materials—help patients learn to navigate the many surfaces they’ll encounter, such as gravel, cobblestone, turf, sand, brick, concrete, and tire shreds.

Gardens are another essential component of terrain parks. Horticultural gardens serve as therapy, both physical and spiritual. Planter boxes at various heights allow patients to work with nature as part of their healing process while practicing maneuvering. Knee walls with handrails and varied-height benches with grab bars provide horizontal surfaces so patients using assisted devices can sit and enjoy the gardens while practicing transfers.

But physical and occupational therapy isn’t the only reason to incorporate gardens in a rehab facility. Healing gardens provide respite for rehab patients, who typically require an extended length of stay, ranging up to six months.

This landscape as therapy concept is being fully optimized at a large rehabilitation hospital in California, currently in design. The entire hospital campus is being transformed into an outdoor recovery zone, extending rehabilitation far beyond the walls of the hospital. Existing buildings and hardscape are being replaced with new, dual-purpose outdoor spaces, healing gardens and terraces, and large plazas and amphitheaters that will also serve as physical therapy and terrain parks. In this replacement project, large sliding doors line the entire wall of the outpatient therapy gyms helping to blur the boundary between inside and out.

By seamlessly connecting the indoor and outdoor spaces, the project allows patients to learn to adapt to the external conditions they will face when they leave the hospital by literally opening their doors to the landscape.

Terrain parks achieve a two-part goal: overcoming both the physical and psychological challenges of living life outside a rehab hospital. They’re the perfect framework for patients to tackle these challenges in a safe environment, and any number of small details can shape their success.


Brenna Costello, AIA, EDAC, is a principal with SmithGroupJJR (Phoenix). She can be reached at