Occupational Therapy Interventions in Natural Environments for Children With Neurodevelopmental Disorders: A Health Promotion Perspective

This paper examines the contribution of pediatric occupational therapy in natural environments for children with neurodevelopmental disorders (NDDs). Occupational therapy, as a health profession focused on meaningful occupations, aims to enhance a child’s autonomy and functionality, utilizing play as an important therapeutic medium. While occupational therapy interventions can be conducted in structured indoor settings, nature emerges as a dynamic "partner" in rehabilitation, offering rich sensory stimuli and opportunities for risk-taking and creativity. The research questions of this study focus on identifying the main motor, cognitive, social, and emotional outcomes reported following occupational therapy interventions in nature for children with neurodevelopmental disorders, as well as investigating the occupational therapy models used when applied in natural settings. The methodology was based on a systematic review of international literature in the databases Scopus and PubMed for the period 2015–2025. Two camp-based studies reported positive changes in individualized occupational performance goals, assessed through parent ratings or adolescent self-ratings using the COPM. Particular emphasis is placed on environments such as therapeutic camps, where integrated occupational therapy may support participation. However, the research highlighted limited empirical evidence on occupational therapy interventions in natural environments; the included studies do not establish comparative model effectiveness or the specific contribution of nature. From a health promotion perspective, nature-based occupational therapy may support children’s meaningful participation in everyday life. Its potential contribution to functional autonomy and psychosocial well-being warrants further investigation within inclusive, person-centred approaches connecting occupational therapy, child health promotion and environmental health.