The Concept of Flow and Engagement in Aphasia Thomas Sather 1, 2, MS, Nickola Nelson 1, PhD, and Mary Beth Clark 2, MS 1 Western Michigan University PhD Program in Interdisciplinary Health Sciences, Kalamazoo, MI 2 Mayo Clinic Health System Department of Rehabilitation Services – Eau Claire, WI RESULTS INTRODUCTION DISCUSSION APHASIA CAMP BACKGROUND METHODS REFERENCES CONCLUSIONS and RECOMMENDATIONS Dalemans et al. 1 indicate that the degree and quality of engagement is more important to the people with aphasia (PWA) they studied than is the quantity of the activities they perform. The concept of engagement is complex and measuring engagement is difficult. Using the World Health Organization’s (WHO) ICF framework 2, it appears that Environmental Factors and Personal Factors influence engagement. In this pilot investigation, the concept of Flow 3 is explored and its utility as a measure of engagement in the population of aphasia is discussed. Flow is a concept coined by the psychologist Mihaly Csizksentmihalyi that describes optimal engagement and absorption in a task or activity. In this pilot investigation, adults with aphasia who were participating in a weekend aphasia camp rated their Flow experiences immediately and at the end of the camp. Mean S-FSS by Participant (0-5 Rating) (0 = Strongly Disagree; 5 = Strongly Agree) ) *Indicates significant at the p <.05 level ** indicates significant at the p <.01 level Participants in this study demonstrate a consistency in ratings both across measures (Short-Flow State Scale and Self-Ratings) as well across time (immediately following an activity and at the end of the camp weekend). Flow state ratings across participants are high Flow state ratings show limited variance From an Environmental Factors standpoint, the facilitory Camp environment may contribute to positive Flow ratings. Key Findings: A positive significant correlation is present between mean S-FSS score and Flow self-rating There is a significant association between self-rating and self-ranking These findings contribute to a sense of stability in perceived Flow ratings by PWA and support potential use of Flow indices as a meaningful tool for PWA Limitations: Relatively strict inclusion criteria, minimal normative Flow data in other settings/conditions, data gaps Recommendations: Further investigation into the validity of the Flow concept (rating Flow vs. enjoyment) Further investigation into the contribution of both Environmental Factors as well as Personal Factors on the Flow experience Further pursuit of Flow data in a variety of settings with PWA Further investigation of Flow as an objective measurement of the quality of engagement for PWA Further use of Flow concepts to evaluate and modify Environments and to influence the individual’s ability to achieve Flow 1.Dalemans, R., deWitte, L., Wade, D. & van den Heuvel, W. (2010). Social participation through the eyes of people with aphasia. International Journal of Language and Communication Disorders, 45 (5). 2.World Health Organization International Classification of Functioning, Disability and Health (ICF). Retrieved May, 2011 from 3.Csikszentmihalyi, M. (2008). Flow. The Psychology of Optimal Experience. New York. Harper Perennial. 4.Jackson, S., Eklund, B. and Martin A. (2010). The FLOW Manual: The Manual for the Flow Scales. Mindgarden, Inc. Secured online 12/7/10. ParticipantMean S-FSS Score Number of Activities Rated Std. DeviationVariance Participant Participant Participant Participant Participant Participant Participant Participant Total Mean SFSS Score Self Rating Mean SFSS Score Correlation Coefficient Sig. (1-tailed).042 N33 Self Rating Correlation Coefficient Sig (1-tailed).042 N33 Self Ranking Total Self Ranking Yes Self Ranking No Self Rating YesCount18725 Expected Count % within Self Rating72.0%28.0%100.0% % within Self Ranking85.7%38.9%64.1% % of Total46.2%17.9%64.1% Std. Residual Self Rating NoCount31114 Expected Count % within Self Rating21.4%78.6%100.0% % within Self Ranking14.3%61.1%35.9% % of Total7.7%28.2%35.9% Std. Residual ValueDfAsymp. Sig. (2-sided) Pearson Chi- Square Mean SFSS score is significantly correlated (utilizing Kendall’s Tau) to participant Flow Self Rating, τ =.25, (one-tailed), p <.05. A significant association was found between participants’ top three Self-Ranked activities and global Flow Self- Ratings χ 2 (1) = 9.24, p<.005. Self Rating x Self Ranking Chi Square Analysis Design: Correlative descriptive study to evaluate the usefulness of a scale for measuring Flow perceptions by PWA participating in activities they have chosen. Instruments: Short Flow State Scale (S-FSS) 4, a nine item questionnaire assessing participant perceptions of Flow components Global Flow self –ratings and self-rankings (top three) Sample: Eight participants meeting inclusion criteria completed Flow surveys on a total of 38 Camp activities. Inclusion criteria include: Score of > 4 on the ASHA NOMS Expressive and Receptive Language components Etiology of aphasia was secondary to a non-traumatic, non-tumorous cerebrovascular event. Moderate or less motor impairment (Score < 3 based on Wallace Motor Screening Scale (Wallace, 2010) Mean age = 57 years old (38 yrs. – 70 yrs.) Procedures: Flow information was presented to all campers in aphasia- friendly format and consent attained at the start Of the Camp weekend. Participants completed S-FSS ratings immediately after each activity and global Flow ratings and rankings at the end of the Camp weekend. Statistics: Non-parametric – Correlation and chi-square. Dr. Jon Lyon The Chippewa Valley Aphasia Camp and its participants Western Michigan University Interdisciplinary Health Sciences PhD program Mayo Clinic Health System – Eau Claire Department of Rehabilitation Services ACKNOWLEDGEMENTS Annual, participation-based weekend Camp for PWA and their families that began in 2003 Rustic setting in northwestern Wisconsin Average number of participants = 30 (PWA and family) Staffed by SLP’s and skilled professionals as well as trained community and student volunteers Premise of modifying the environment for success (Environmental and Personal Factors)