The Concept of Flow and Engagement in AphasiaThomas 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, MI2Mayo Clinic Health System Department of Rehabilitation Services – Eau Claire, WI

RESULTSINTRODUCTION 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 framework2, it appears that Environmental Factors and Personal Factors influence engagement. In this pilot investigation, the concept of Flow3 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 andabsorption 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 http://www.who.int/classifications/icf/en/

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.

Participant Mean S-FSS Score Number of Activities Rated

Std. Deviation Variance

Participant 1 4.98 5 .05 .002

Participant 2 4.53 6 .45 .205

Participant 3 4.69 4 .28 .077

Participant 4 4.61 4 .11 .012

Participant 5 4.69 4 .25 .061

Participant 6 4.13 6 .58 .338

Participant 7 4.04 5 .56 .312

Participant 8 4.61 4 .48 .235

Total 4.51 38 .48 .231

  Mean SFSS Score

Self Rating

Mean SFSS Score

Correlation Coefficient

1.000 .250

  Sig. (1-tailed)   .042  N 33  

Self Rating

Correlation Coefficient

.250 1.000

  Sig (1-tailed) .042    N 33 33

Self Ranking

TotalSelf Ranking

YesSelf Ranking

NoSelf Rating Yes Count 18 7 25

Expected Count 13.5 11.5 25.0% within Self Rating 72.0% 28.0% 100.0%% within Self Ranking 85.7% 38.9% 64.1%% of Total 46.2% 17.9% 64.1%Std. Residual 1.2 -1.3  

Self Rating No Count 3 11 14Expected Count 7.5 6.5 14.0% within Self Rating 21.4% 78.6% 100.0%% within Self Ranking 14.3% 61.1% 35.9%% of Total 7.7% 28.2% 35.9%Std. Residual -1.7 1.8  

Value Df Asymp. Sig. (2-sided)Pearson Chi-Square

9.235 1 .002

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 χ2 (1) = 9.24, p< .005.

Self Rating x Self Ranking Chi Square Analysis

http://digitalnative.wordpress.com/2012/01/26/flow/

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 campersin 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)