Aphasia is an acquired neurological disorder that impairs the ability to speak, understand spoken language, read, and write, and roughly one-third of stroke survivors acquire it, an estimated 11,000 people per day worldwide. Because the condition is frequently chronic, its toll extends well beyond language itself, eroding psychosocial well-being and quality of life in ways that can cascade into social isolation, depression, and shrinking participation in everyday activities. Contemporary rehabilitation frameworks, including the World Health Organization’s International Classification of Functioning, Disability and Health and the Life Participation Approach to Aphasia, therefore emphasize not only remediating language impairment but restoring communicative participation, belonging, and meaningful engagement in daily life.

The clinical stakes are considerable. Stroke is the third leading cause of adult disability globally, and the lifetime risk of stroke has increased more than 50 percent over the last 17 years, with incidence and prevalence projected to keep rising over the next quarter century. Some 84 percent of the global stroke burden is attributable to 23 modifiable risk factors such as high blood pressure, excess body weight, smoking, and physical inactivity, and unfavorable trends in these factors, coupled with rapid population aging, rising air pollution, and increasing global temperatures, threaten to overwhelm healthcare systems in the coming decades. Unequal access to high-quality prevention, acute care, and rehabilitation services compounds the problem.

Against this backdrop, an interdisciplinary team at the University of Montana, an avian ecologist from the W.A. Franke College of Forestry and Conservation working alongside speech, language, hearing, and occupational scientists, began in 2018 to weave bird-centered ecological engagement into the university’s Intensive Comprehensive Aphasia Program, a cohort-based, high-intensity rehabilitation model in which participants begin and end the program together while engaging in roughly 80 hours of aphasia rehabilitation over four weeks. The program’s structure, four days per week across four weeks, is participation-oriented and aligned with the WHO-ICF framework, and its defining features include interprofessional collaboration, community engagement, and a conceptualization of the person with aphasia and their communication partners as the unit of care. Graduate student clinicians in the speech-language pathology Master of Science program deliver therapy under faculty supervision while collaborators from other disciplines contribute expertise that supports real-world engagement.

Why birds? The authors argue that birds occupy a uniquely accessible position at the interface of ecological systems and human experience. They are among the most perceptually salient and widely encountered forms of biodiversity in human environments, readily detectable through both acoustic signaling and visual movement across urban and rural settings, exhibiting predictable temporal rhythms through migration and seasonal activity, and behaviorally interpretable by non-experts. Decades of research in environmental psychology and urban ecology have linked exposure to birds, particularly birdsong and visible avian diversity, to reduced stress, improved mood, attentional restoration, and enhanced life satisfaction, and experimental and longitudinal evidence suggests everyday encounters with birds can positively influence mood across socioecological contexts. Birds have even been shown to shape pro-environmental attitudes and place attachment, underscoring their behavioral and relational significance in human-dominated landscapes.

Yet, as the team notes, research on human-bird interactions has focused overwhelmingly on psychological well-being, mood restoration, and nature exposure outcomes, with comparatively little attention to how bird-centered experiences might be intentionally structured to support communication, participation, or rehabilitation in clinical populations. Birds and bird-related activities have been incorporated into broader eco-therapeutic and nature-based wellness practices, but these approaches have rarely been examined through the lens of clinical populations such as those in stroke rehabilitation. The authors contend that birds combine ecological accessibility, multisensory salience, behavioral dynamism, and recurring opportunities for shared interaction across everyday environments, creating opportunities for perception and interaction consistent with Gibson’s concept of ecological affordances, the idea that environments offer possibilities for action that organisms can perceive and use.

The paper’s central contribution is a conceptual framework in which bird-centered ecological engagement operates through three intersecting mechanisms. The first is the ecological grounding of shared attention. Birds provide dynamic, multisensory ecological stimuli that can be jointly perceived by multiple individuals simultaneously, and their movement, vocalizations, and intermittent appearance naturally draw visual and auditory attention while creating shared points of ecological reference around which interactions can emerge. Unlike traditional aphasia treatment approaches that explicitly target and require linguistic performance, bird-centered engagement can capture attention without requiring immediate verbal responses, creating a therapeutic context that reduces communicative pressure while sustaining active participation. For stroke survivors with aphasia, maintaining shared reference during typical conversation can be difficult because communication depends on rapidly processing a partner’s message and formulating a response in real time, and both linguistic processes may be impaired. Bird-centered engagement shifts social interaction away from linguistic performance toward a shared ecological experience, allowing participants to enter interactions through shared observation and multimodal responses such as gesturing, pointing, non-linguistic vocalizations, drawing, or referring to photographs rather than relying exclusively on verbal performance.

The second mechanism is communicative scaffolding. Because birds are jointly observable and behaviorally dynamic, they create recurring opportunities for interaction that are less dependent on verbal accuracy alone. A sudden bird call, the discovery of a nest, or the appearance of a raptor overhead can prompt shared noticing, emotional reaction, gesture, or collaborative interpretation, redistributing some of the communicative demand from individual speakers to the shared environment itself. Meaning can be jointly constructed through visual reference, shared listening, contextual inference, and multimodal communication strategies, allowing stroke survivors with aphasia to remain socially and communicatively engaged even when verbal output is limited. The third mechanism, ecological participation and identity reconstruction, addresses the way aphasia frequently narrows individuals’ social, communicative, and environmental worlds. Activities such as observing migration, identifying birds in neighborhood settings, revisiting nest sites, or participating in outdoor listening experiences situate communication within broader ecological and social systems, positioning individuals as active observers, interpreters, and contributors within shared environments rather than as patients defined primarily through communicative impairment. This shift away from illness-centered narratives toward shared curiosity, ecological knowledge, and environmental experience may foster a renewed sense of belonging by reconnecting individuals to their communities and the social relationships that give those experiences meaning.

The framework was not developed in the abstract but through successive iterations of the University of Montana program, and the paper traces an evolution from structured observation toward increasingly immersive, multimodal, and participation-oriented experiences. In 2021, an outdoor bird-centered activity on a campus patio focused on owls, selected in response to participant interests, with preserved specimens providing shared ecological reference points that supported low-pressure communication through pointing, yes-or-no responses, and choice-based participation when word-finding challenges limited spoken output. By 2023, engagement had expanded to a multi-session sequence combining classroom preparation on hawks and local raptors with structured outdoor observation of a Cooper’s hawk nest near campus, where participants were introduced to spotting scopes and binoculars while occupational therapists supported positioning, upper-extremity use, balance, and adaptive access to birding equipment, a critical consideration because many participants experienced post-stroke hemiparesis affecting mobility and upper-extremity function. In 2025, programming progressed to multisensory ecological immersion, with participants learning bird calls through audio exemplars paired with visual supports and later engaging in a full-day outdoor session at the university’s Lubrecht Experimental Forest co-facilitated with a sound artist and soundscape researcher, shifting ecological engagement toward deep listening and immersive soundscape participation during a hike, with physical therapy integrated throughout to facilitate safe mobility, pacing, endurance, and adaptive access.

Underpinning all of this was a commitment to communicative accessibility as foundational infrastructure rather than supplemental support. Speech-language pathologists coached the avian ecologists to use aphasia-friendly communication strategies grounded in supported conversation principles, which emphasize an adult-to-adult interactional stance that acknowledges competence while using structured techniques to support participation. Sessions supported communicative participation through deliberate pacing, reduced grammatical complexity, structured wait time, and ongoing verification of shared understanding, with information presented in manageable units that allowed participants to observe, respond, question, and collaboratively interpret ecological experiences. Stroke survivors were paired with trained communication partners, typically graduate student clinicians, who helped protect conversational turns, scaffold participation, and support repair when communication breakdowns occurred, allowing participants to remain active contributors during ecological interactions while the avian ecologists maintained content leadership. Over time, the avian ecologists increasingly internalized these strategies, resulting in more flexible, participant-led interaction with reduced reliance on direct clinician support, a progression that aligns with broader implementation research showing that supported communication approaches can be successfully integrated into non-clinician professional contexts when training and collaborative support structures are provided.

The flexibility of the approach became especially apparent during the COVID-19 pandemic, when the program shifted temporarily to remote delivery and activities emphasized audiovisual bird content, including bird calls, image-supported learning, facilitated ecological discussion, and home-based observation. As in-person participation resumed, bird-centered activities increasingly incorporated place-based immersion through parks, patios, field sites, and soundscape-oriented outdoor experiences, demonstrating that bird-centered ecological engagement could remain accessible and participation-oriented across multiple delivery modalities. The collaboration later expanded to include occupational and physical therapists, allowing bird-centered ecological engagement to be integrated with mobility support, environmental access, and adaptive equipment use during outdoor participation, and even when an avian ecologist was not physically present during the outdoor forest session, the ecological concepts, shared language, and communication-access strategies established earlier continued to structure participation through collaborative facilitation by the interdisciplinary team.

Across iterations, the authors identified recurring principles that may inform future integration of bird-centered ecological engagement in rehabilitation contexts. Communicative accessibility functioned as foundational infrastructure, and ecological participation depended not only on the activity itself but on interactional structures that allowed participants with aphasia to remain active contributors within shared ecological experience. Ecological engagement remained most effective when it preserved intellectual and participatory complexity rather than simplifying interaction into passive exposure or recreational distraction, with participants responding most strongly when ecological observation involved shared interpretation, curiosity, and collaborative meaning-making. The evolution across classroom-type sessions, outdoor observation, remote audiovisual participation, and immersive soundscape experiences also demonstrated that ecological participation can remain meaningful across multiple settings and delivery modalities, a flexibility that may be particularly important for adapting accessibility within rehabilitation and community contexts.

The authors are candid about the limitations of their work. The perspective does not report controlled outcome data from stroke survivors with aphasia, and the integration of bird-centered ecological engagement into the program is described from a programmatic and implementation perspective rather than as a formal experimental evaluation. Although observations across cohorts suggest meaningful engagement and participation, systematic measurement of communicative, behavioral, or psychosocial outcomes was beyond the scope of the paper, and future research employing controlled designs, standardized participation measures, and longitudinal follow-up will be necessary to evaluate the magnitude and durability of effects. The proposed mechanisms, including ecological grounding of shared attention, communicative scaffolding, and ecological participation, remain theoretically inferred rather than empirically isolated, and future studies will need to operationalize and directly test these mechanisms across rehabilitation contexts and delivery modalities. Ethical and ecological considerations also remain essential, and the authors caution that expanding bird-centered ecological engagement within therapeutic settings must remain attentive to wildlife disturbance, habitat integrity, and species-specific stress responses, with collaboration between avian ecologists and conservation practitioners important to ensure that rehabilitation-oriented ecological engagement does not inadvertently compromise avian welfare.

Even so, the reframing the authors propose is ambitious. Rather than positioning birds solely as passive sources of restorative exposure, they conceptualize them as dynamic ecological referents capable of organizing shared attention, shaping interaction, and supporting participation across communicative and social contexts. Birds are highly detectable across environments through movement, sound, and visual salience, while their behavioral unpredictability and ecological rhythms create recurring opportunities for shared noticing and interaction. Unlike many therapeutic stimuli that focus on performance, birds support forms of engagement organized around co-observation, environmental participation, and collaborative interpretation, properties that allow the ecological experience itself to function as a communicative resource. The framework also expands how participation is conceptualized within rehabilitation, positioning nature not as passive enrichment or therapeutic backdrop but as the medium through which participation emerges, connecting communication, mobility, observation, listening, and environmental relationship.

Looking forward, the authors call for future studies examining how different forms of bird-centered ecological engagement, including sound-based immersion, neighborhood observation, adaptive birding, and field-based participation, shape communicative interaction, social participation, and psychosocial well-being across clinical and non-clinical populations. Comparative work across modalities, settings, and accessibility approaches may help clarify how ecological participation can remain communicatively meaningful across different forms of engagement, and the framework opens opportunities for interdisciplinary research at the intersection of avian ecology, rehabilitation science, accessibility, and human-environment interaction. More broadly, the perspective suggests that birds may be understood not only as indicators of ecological quality but as active participants in relational systems linking ecological experience, communication, and human well-being, a proposition that, if borne out by future research, could reshape how both bird science and rehabilitation sciences conceptualize human-environment relationships and expand the role of birds within research on health, accessibility, and social belonging.

Subject of Research: Bird-centered ecological engagement: reframing human-bird interaction in stroke rehabilitation

Article Title: Bird-centered ecological engagement: reframing human-bird interaction in stroke rehabilitation

Article References: Dreitz, V. J., Griffin-Musick, J., Everett, A., & Off, C. A. (2026). Bird-centered ecological engagement: reframing human-bird interaction in stroke rehabilitation. Frontiers in Bird Science, 5, Article 1953932. https://doi.org/10.3389/fbirs.2026.1953932

Image Credits: AI Generated

DOI: 10.3389/fbirs.2026.1953932

Keywords: Bird-centered, ecological, engagement, reframing, human-bird, interaction, stroke, rehabilitation, scientific research