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Bringing Therapy Outdoors

Therapists at the NYU Medical Center's Rusk Institute for Rehabilitation Medicine are challenging traditional rehabilitation methods by taking their therapy outdoors into a custom designed PlayGarden where disabled children carry out the process of rehabilitation through play.

By Sonja Johansson, ASLA, landscape architect and principal of Johansson Design Collaborative

A sandbox is bordered by rocks and sheltered by morning glories and mandevillas that cling to a trellis. Robert Perless created the rainbow prism that spins above the trellis. Children learn about the power of the wind by watching the prism cast moving rainbows as it turns.

The therapeutic PlayGarden built outside the Rusk Institute for Rehabilitation Medicine in New York City was developed through a collaboration between landscape architects from the Johansson Design Collaborative (formerly Johansson & Walcavage) and Rusk therapists. Based on their extensive professional expertise, a Rusk team of physical, occupational, horticultural, recreational, and music therapists, pre-school teachers and other medical personnel developed a specialized program for the design of the outdoor rehabilitation space. Designing challenging, nature-oriented playgrounds is nothing new for these landscape architects (Sonja Johansson and her former partner Donna Walcavage designed the esteemed Rockefeller Park Playground in Battery Park City in New York).

A team of therapists, teachers and other medical professionals from the Rusk Institute for Rehabilitation Medicine collaborated with landscape architects to develop the design concept for the Rusk Children's PlayGarden where disabled kids approach rehabilitation as play. Their vision has been transformed into a unique physical space that includes a gently sloping grassy hill, a playhouse with an overhead ladder, a children's vegetable garden, a sand play hut, sensory gardens, an interactive water feature and custom designed play equipment. Plan by Johansson and Walcavage

Contributing our experience as landscape architects we [Johansson and Walcavage] conducted daylong meetings with the Rusk team in order to understand their perspective. The Rusk team told us that on their small lot on a busy, noisy, urban corner, they wanted a new kind of therapy to occur in a safe, nature-oriented, interactive outdoor environment. They wanted it to motivate children and provide opportunities for the children to explore and practice activities that would stimulate curiosity and promote independence, spontaneity and creativity in the physical, cognitive, social and sensory realms. Through a collaborative process several goals were developed including changing the perception of therapy as work into therapy as creative play.

A rendering of the Rusk Children's PlayGarden shows children rolling down a hill, running on the lawn, relaxing in a hammock, swinging in a glider swing, gardening and walking between play areas on a smooth pathway made of poured-in-place rubber safety surfacing. Landscape architects communicated their initial design ideas with therapists by drawing sketches (inset) depicting ways children would use the PlayGarden, like exercising by crawling up and rolling down a small grassy slope. Rendering by Thomas Schaller. Sketch by Vincent Chiu

In response to ADA regulations, landscape architects now design so that disabled people can maneuver within the built-environment as easily as possible. Playgrounds, however, are spaces that should encourage all children to try new and often difficult tasks. Because of the specialized rehabilitation needs of young patients, the therapeutic team specifically required that we safely integrate challenge into the PlayGarden to inspire the children to actively test their abilities and improve their developmental skills within a supportive environment.

The Process

One way the landscape architects communicated with the therapists was by drawing sketches illustrating the ideas from their therapy concepts. By viewing the sketches the therapists could visualize the design ideas and define how they would use the garden elements. This also allowed the therapists to make adjustments to the initial design concepts. The therapists told us things like "don't make it look like it is meant for disabled children" and "if wheelchairs can get under the table edge, use a regular table edge, not one with cutouts." From years of experience, the Rusk therapists presented helpful suggestions like the fact that surfaces with texture, such as grass, offer good, challenging rehabilitation opportunities because they can be difficult for some children to walk over. Another therapist commented that it was good exercise for children to walk up an incline like the slope of a slide, but that it was awkward for them to walk up their existing slide, because it was an orange plastic half-tube slide that bent their feet sideways as they tried to walk up. Our solution was to specify an incline ramp leading up to the top of their new slide.

Existing Site

The existing urban site, at East 34th Street and First Avenue, was a tiny corner play area next to the hospital's greenhouse. The neighborhood is surrounded by high-rises and busy, noisy streets. The original Rusk play area was built in the 1970s with metal swings and massive concrete and timber structures that overwhelmed and darkened the area. It had gone unused for years.

Major Design Elements

Our goal was to create an outdoor environment where children would be motivated to do the hard work needed for their therapy. We wanted it to be an enjoyable experience; we wanted to find them laughing as they played.

The Rusk PlayGarden functions as an active space that challenges disabled children to engage in play activities that mimic rehabilitation exercises, such as swinging (ABOVE) or climbing up steps to a slide (BELOW). Photo courtesy of Sonja Johansson

Photo courtesy of the rusk institute

Photo courtesy of Sonja Johansson

Four main concepts emerged that were integrated into the PlayGarden design: nature, variety and challenge, interactivity and scale. Kids need to be surrounded by nature and natural play activities, like running up and rolling down a grassy hill. Children require a variety of choices and challenges. Building a slide that offers two access choices, with a ramp on one side of the slide and steps on the other, accommodates and challenges kids with different ability levels. Interactive features include sandboxes and gardens that are easily accessible. These are places where kids can kneel or sit and work on their coordination and strength while they dig, plant and water flowers and vegetables. Colorful garden elements like a large play hammock and swings with both mesh and hard seats are a popular destination because they challenge children and stimulate movement.

Design Concept--Built to Challenge

The scope of what we wanted to achieve for the Rusk PlayGarden was large and diverse, while the actual site space was limited to a small area. When children walk out of the medical center and into the garden they are greeted by a wide open sky and are immediately faced with a magnificent variety of colorful places, activities and challenges to explore. They can play, and sing and be noisy--all things that would be hard to do inside hospital walls. The PlayGarden motivates children to play in ways that stimulate the rehabilitative therapy they would normally practice indoors.

Walls built of fieldstone hold a water feature filled with small movable stones that allow children to create their own waterfalls. The wall starts at wheelchair height and slopes down and under the bridge where it's level with the walking surface. This allows children to easily enter and stand in the water. Photo courtesy of michael rogol

Rehabilitation activities that usually seem like work, like practicing walking up steps, suddenly seem like less effort when children can see the slide that they'll get to at the top of the steps.

We changed the topography of the new play area to create a more interesting and interactive space. While the entire area is handicapped accessible, it is designed for therapeutic work rather than ease of access. A key design solution was to add low retaining walls both at the perimeter fence and inside. This created a multi-level space of visual interest and physical challenge, changing the existing small, flat site to a lush naturalistic environment with an undulating lawn and pathways that allow children a choice of many routes throughout the garden.

A grassy hill is a focal point that the children flow around. Children exercise by tumbling down and doing the hard job of climbing up again. They do it again and again because it's fun--not because their therapists have told them to do it.

Custom Play Equipment

We custom designed the play equipment and then worked with a playground manufacturer to have them fine-tune the engineering and manufacture the equipment. Structures that offer safe, challenging play options include a custom playhouse with window boxes that the children have planted with flowers they eagerly watch and tend. The playhouse is made of perforated metal, which gives the therapists a clear view to observe the children without getting too close and inhibiting their play. The playhouse roof has overhead rungs that serve as an upper body exerciser. The rear wall has chinning bars to climb on.

Kids can manually turn on frog sprays to cool off and play on a hot day. A bridge with handrails offers a smooth, safe crossing for all kids--even those in wheelchairs--to navigate over the stream. Photo courtesy of the rusk institute

Swings are a popular destination spot that offer a reward for the difficult walk across the lawn. A sand box improves coordination by encouraging kids to dig. The children immerse themselves in the soil while planting flowers and vegetables. They care for the plants and practice coordination while watering. (In the garden, spilling is never a "mistake".) Kids hide among the shrubs; they inspect the flittering butterflies and watch their tomatoes turn from green to red.

Children learn about the seasons in real time by raking the leaves in the autumn. One pre-school child planted a donated baby fig tree; he dug a hole big enough for a large oak, refilled all the soil he had piled to the side and every day watered it and measured it to see if it had grown taller than he was.

Two girls in leg braces performed their therapy session by swinging in the glider where they laughed and sang songs as they swung. Then they got off and walked along the paths, where there are many interesting things to do and see. Imagine the alternative: indoors the children would spend part of their therapy time in a hospital hallway walking up and down the hallway.

Unifying the PlayGarden is a pathway system built with colorful, poured-in-place rubber safety surfacing that aids in orientation as it curves around the grassy slope and gardens and continues under arbors and rises over bridges. The play structures offer activities that are therapeutic, but children also gain strength while walking along the paths from one activity to another.

Children Choose to Play--Which Promotes Healing

Each area of the garden lets children choose different therapeutic learning experiences within an interactive journey through flower and vegetable gardens, arbors, waterfalls, streams, lawn and play equipment. The PlayGarden offers a safe environment in which children can independently carry out activities, explore, experiment, make decisions and play. It instills an awareness of, and appreciation for, the natural world and aids in the development of critical thinking and science skills. In addition, the garden supports positive socialization between children of different abilities and between children and adults.

The therapists who work at Rusk everyday can attest to the fact that children have more fun and perform their therapy better outside in the PlayGarden than they do when restricted to indoor therapy rooms. The complaints therapists often hear– "I'm too tired", "I can't" and "I won't"–disappear as the children play outdoors without being completely aware that they are achieving their therapy and growing strong.



Play equipment manufactured by Playground Environments International,

Frog Water Spray by Kenneth Lynch and Sons,

Grass Mat by Mat Factory, Inc.,

Vitriturf rubber safety surface by Vitricon, Inc.,

Wheelchair-accessible glider swing by WhisperGLIDE,


Project Cost, Scope and Details

Photo courtesy of Sonja Johansson

Client: The Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center

Design Process: Design began in 1993. Construction was completed in 1998.

Cost: $450,000

Theme and Scope: Transformed a 5,000-square-foot urban lot into an exciting and educational multi-level environment for physically disabled children.

Population: Patients, families, staff and neighborhood residents as well as visiting landscape architects, doctors, therapists and other medical personnel.



  • 1999 AIA Certificate of Merit, Architecture for Education Design Award for Exemplary Learning Environment
  • 2000 NYC ADA Achievement Award, honorable mention
  • 2002 BSLA Merit Award
  • 2003 Adaptive Environments "Excellence in Universal Design, Great Places Fit for People Award"
  • Jury selection for Healthcare Design magazine, November 2001


FIRM HISTORY: Johansson Design Collaborative Inc.,
Sonja Johansson, ASLA, Principal

Johansson Design Collaborative (JDC) is a continuation of the Massachusetts office of Johansson & Walcavage Landscape Architects LLP founded in 1978 by Sonja Johansson and Donna Walcavage. Sonja Johansson, ASLA, is a registered landscape architect in Massachusetts and New York with over 38 years of experience. Her firm has purposely stayed small--today JDC has three employees located in an office in Massachusetts.

To continue her education Sonja regularly attends conferences including annual ASLA meetings and healthcare design conferences. Log onto the JDC's website at



  • Sonja Johansson, ASLA, principal-in-charge, Johansson Design Collaborative Inc., Landscape Architecture (formerly Johansson & Walcavage)
  • Donna Walcavage, ASLA, (formerly with Johansson & Walcavage, now Donna M. Walcavage, PC)
  • Various staff formerly with Johansson & Walcavage including Kirk Jaskoviak, ASLA; Terry Johnson; Richard Anderson, ASLA and other staff
  • Rusk team of horticultural, recreational, music, physical and occupational therapists, teachers and other medical personnel, including ongoing communications with horticultural therapists Nancy Chambers, HTR and Gwenn Fried, HTR
  • Fred Druck, Playground Environments International, engineered the play equipment--Druck is currently working at PlayWorx, the custom division of Gametime
  • Padilla Construction Services
  • Robert Perless, artist, created the prism that sits on the sand hut structure
  • Vincent Chiu, sketch artist

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December 6, 2019, 1:26 pm PDT

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