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

1 Reframing human-bird interactions: from ecological stimulus to clinical application

Birds are among the most perceptually salient and widely encountered forms of biodiversity in human environments (Belaire et al., 2015). Across urban and rural environments, they are readily detectable through both acoustic signaling and visual movement, exhibit predictable temporal rhythms through migration and seasonal activity, and are behaviorally interpretable by non-experts. These characteristics make birds uniquely accessible ecological stimuli capable of capturing attention and structuring human perception in ways that few other taxa can. As a result, birds occupy a distinctive position at the interface of ecological systems and human experience.

Reflecting on these ecological characteristics, human–bird interactions have increasingly been examined as contributors to psychological well-being and human behavior. Studies in environmental psychology and urban ecology demonstrate that exposure to birds, particularly birdsong and visible avian diversity, is associated with reduced stress, improved mood, attentional restoration, and enhanced life satisfaction (e.g., Cox et al., 2017; Hammoud et al., 2022; Methorst et al., 2021; Shanahan et al., 2016). Experimental and longitudinal evidence further suggests that everyday encounters with birds can positively influence mood across socioecological contexts (Cox and Gaston, 2018; Hammoud et al., 2022). Beyond psychosocial wellbeing outcomes, birds have been shown to influence pro-environmental attitudes and place attachment, underscoring their behavioral and relational significance within human-dominated landscapes (Belaire et al., 2015; Soga and Gaston, 2016). Collectively, this literature positions birds as meaningful contributors to human well-being and behavior.

Despite this growing body of evidence, research on human–bird interactions has primarily focused on psychological well-being, mood restoration, and nature exposure outcomes, with comparatively less attention directed toward how bird-centered experiences might be intentionally structured to support communication, participation, or rehabilitation processes within clinical populations (Cox et al., 2017; Hammoud et al., 2022; Methorst et al., 2021). Although birds and bird-related activities have been incorporated into broader eco-therapeutic and nature-based wellness practices (Frumkin et al., 2017; Bratman et al., 2019), these approaches have rarely been examined through the lens of clinical populations such as those engaging in stroke rehabilitation. Birds may be uniquely positioned for this role because they combine ecological accessibility, multisensory salience, behavioral dynamism, and recurring opportunities for shared interaction across everyday environments. Collectively, these characteristics create opportunities for perception and interaction consistent with Gibson’s concept of ecological affordances (Gibson, 2015; original work published in 1979). However, little conceptual attention has been given to how these affordances might actively scaffold interaction, shared attention, or participation in therapeutic settings. This translational gap is particularly important because it leaves underexplored the possibility that birds may function not only as sources of psychological restoration, but as structured ecological stimuli capable of shaping and promoting communicative behavior and social participation in the context of neurological rehabilitation.

Stroke rehabilitation provides a compelling context in which to examine this translational gap. Stroke is the third leading cause of adult disability worldwide (Feigin et al., 2025) with the lifetime risk of having a stroke increasing more than 50% over the last 17 years. The incidence and prevalence of stroke is expected to continue to increase over the next twenty-five years (Bhattarai and Mohapatra, 2026; Ovbiagele, 2026; Shen et al., 2022). Importantly, 84% of global stroke burden is attributable to 23 modifiable risk factors (e.g., high blood pressure, excess body weight, smoking, and physical inactivity). Rapid growth of the aging population (Shreya et al, 2025) coupled with unfavorable trends in these major risk factors (Feigin et al., 2025) and global environment changes including rising air pollution and increased global temperatures (Zhu et al., 2024; Alahmad, et al., 2024) threatens to overwhelm global healthcare systems over the next decades. Unequal access to high-quality prevention, acute care, and rehabilitation services further complicates stroke rehabilitation.

Approximately one-third of stroke survivors experience a condition called aphasia, with an estimated 11,000 people acquiring aphasia per day (e.g., Grönberg et al., 2022; Cruice, 2024; Bhattarai and Mohapatra, 2026; Simmons-Mackie and Azios, 2026). Aphasia is an acquired neurologic disorder that impairs language and communication functions including speaking, understanding spoken language, reading, and writing. Frequently, aphasia is a chronic condition, negatively impacting psychosocial well-being and quality of life which can then lead to social isolation, depression, and reduced participation in everyday life (e.g., Hilari et al., 2012). Recent systematic reviews and meta-analyses examining aphasia rehabilitation outcomes data provide evidence that the greatest recovery of language and communication function is associated with 20-50 hours of treatment (The RELEASE Collaborators, 2022). Furthermore, contemporary rehabilitation frameworks emphasize not only remediation of language impairment, but also restoration of communicative participation, psychosocial well-being, and meaningful engagement in everyday life (e.g., Abid et al., 2024; Chapey et al., 2000; WHO, 2001; Kagan et al., 2008; Simmons-Mackie and Azios, 2026). One innovative emerging service delivery model for aphasia rehabilitation, the Intensive Comprehensive Aphasia Program (ICAP), combines high-intensity language and communication therapy with cohort-based and participation-oriented activities, leading to improved outcomes relative to usual aphasia care (e.g., Rose et al., 2013; Rose et al., 2021; Worrall et al., 2024; Griffin-Musick et al., 2025). Because ICAPs are cohort-based and are designed to target life participation, they are uniquely positioned to integrate ecologically grounded experiences into the aphasia rehabilitation process.

Birds possess several characteristics that may make bird-centered engagement especially well-suited for aphasia rehabilitation contexts. Their movement, vocalizations, and seasonal rhythms naturally elicit shared attention, ecological observation, gesture, and narrative exchange, processes central to human communication and social interaction (Mundy and Newell, 2007). Because birds provide dynamic points of shared reference that place few demands on verbal performance, bird-centered engagement can create opportunities for interaction that reduce communicative pressure while supporting shared ecological experience. These properties suggest that bird-centered engagement provides a rich, supportive context for language and communication rehabilitation while reconnecting stroke survivors with aphasia to meaningful environmental and social participation contexts.

In this perspective, we draw on an interdisciplinary collaboration integrating bird-centered ecological engagement into an Intensive Comprehensive Aphasia Program that started in 2018 to examine how these interactions may support rehabilitation. We propose that bird-centered engagement represents a distinct class of ecological stimulus that can be intentionally structured to support communication, participation, and psychosocial well-being within stroke rehabilitation contexts. Rather than positioning birds solely as passive sources of restorative exposure, we conceptualize them as dynamic ecological referents capable of organizing attention, interaction, and participation across clinical and community settings.

2 Conceptual framework: bird-centered engagement as a clinical-ecological interface

We propose that bird-centered engagement represents a clinical-ecological interface linking ecologically salient stimuli with therapeutic processes that support communicative participation and social engagement (Figure 1) for stroke survivors with aphasia. The framework is informed by the World Health Organization’s International Classification of Function, Disability, and Health (WHO-ICF, 2001) and the Life Participation Approach to Aphasia (LPAA; Chapey et al., 2000), both of which position participation in meaningful life activities as a central rehabilitation goal.

We identify three intersecting mechanisms through which bird-centered engagement may influence communication and participation outcomes: 1) ecological grounding of shared attention, 2) communicative scaffolding, and 3) ecological participation and identity restoration.

2.1 Ecological grounding of shared attention

Bird-centered engagement may be particularly effective at organizing shared attention because birds provide dynamic, multisensory ecological stimuli that can be jointly perceived by multiple individuals simultaneously (Ratcliffe et al., 2013). The movement, vocalizations, and intermittent appearance of birds naturally draw visual and auditory attention while creating shared points of ecological reference around which interactions can emerge. Unlike traditional aphasia treatment approaches and associated activities that explicitly target and require linguistic performance (Crosson et al., 2019), bird-centered engagement can capture attention without requiring immediate verbal responses. This creates a novel therapeutic context that reduces communicative pressure while sustaining active participation and social engagement.

For stroke survivors living with aphasia, maintaining shared reference during typical conversation or other communication exchanges can be difficult because communication depends on rapidly processing a communication partner’s message and formulating a response in real time (Sacks et al., 1974; Indefrey and Levelt, 2004). Both linguistic processes may be impaired for stroke survivors with aphasia, significantly reducing their ability to meaningfully participate in fast-paced conversations (Wilkinson et al., 2003; Leaman and Archer, 2022; Rotherham et al., 2025). Bird-centered engagement shifts the social interaction away from linguistic performance-focused communication toward a shared ecological experience. Because attention is directed toward a jointly perceived bird sighting, vocalization, or environmental event, stroke survivors can enter social interactions through shared observation and multimodality responses (e.g., gesturing, pointing, using non-linguistic vocalizations, drawing, referring to photographs) rather than relying exclusively on verbal performance (Archer et al., 2021; Killmer et al., 2022).This shared ecological reference stabilizes attention in ways that support sustained participation and shared engagement with little communicative pressure. A bird in flight, a distinctive call, or the appearance of a nest creates immediate opportunities for shared noticing and co-attention. Birds may be especially well-suited for this role because they combine ecological unpredictability with perceptual accessibility. Their intermittent movement, acoustic signaling, and visibility across indoor and outdoor settings sustain curiosity and orient responses without overwhelming sensory demand. Bird-centered engagement may therefore function not simply as environmental enrichment, but as an ecological scaffold for sustained interpersonal attention and communicative participation.

2.2 Communicative scaffolding

Bird-centered engagement may also function as a form of communicative scaffolding by organizing interaction around shared ecological reference rather than speaker-driven linguistic performance. In many conversational settings, interaction is structured around rapid verbal exchange and speaker-generated communication (Leaman and Archer, 2022; Rotherham et al., 2025). Bird-centered interaction shifts communicative focus toward jointly experienced ecological events, redistributing some of the communicative demand from individual speakers to the shared environment itself.

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. Communication therefore emerges through shared experiences during an ecological event rather than through speaker performance alone.

We propose that this ecological scaffolding can serve an important role in aphasia rehabilitation because it expands the range of communicative participation contexts available for social engagement. Meaning can be jointly constructed through visual reference, shared listening, contextual inference, and multimodal communication strategies (e.g., gesturing, writing, drawing, using smart devices), thereby allowing stroke survivors with aphasia to remain socially and communicatively engaged even when verbal output is limited. In this way, bird-centered engagement supports social interaction that is flexible, socially reciprocal, and grounded in shared environmental experience.

2.3 Ecological participation and identity reconstruction

Aphasia frequently narrows individuals’ social, communicative, and environmental worlds, reducing participation in public spaces and limiting opportunities for meaningful interaction beyond clinical or caregiving contexts (Chapey et al., 2000; Simmons-Mackie and Azios, 2026). Bird-centered ecological engagement has the potential to improve social and communicative participation by reconnecting individuals with shared ecological experiences that extend into community and everyday life. 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 rather than within interpersonal or clinical performance alone.

Importantly, this bird-centered participation is not merely recreational. Bird-centered engagement positions individuals as active observers, interpreters, and contributors within shared environments, supporting autonomy, environmental mastery, and renewed forms of social participation (Mundy and Newell, 2007; Hammoud et al., 2022). Bird-centered engagement also need not to depend on access to remote or high biodiverse environments; opportunities may range from observing common birds through windows or listening for vocalizations in a neighborhood to participating in more immersive outdoor experiences. The specific opportunities available will vary with geographic location, habitat, season, and individual mobility, but this flexibility allows bird-centered engagement to be adapted to different ecological and accessibility contexts, extend opportunities for participation beyond formal rehabilitation settings.

Bird-centered activities may additionally support identity reconstruction by shifting interaction away from illness-centered narratives and toward shared curiosity, ecological knowledge, and environmental experience (Meyerson and Zuckerman, 2025; Strong and Shadden, 2020). Rather than being defined primarily through communicative impairment, individuals participate as observers, learners, community members, and ecological participants. In this way, bird-centered engagement may foster broader sense of belonging by reconnecting individuals to their communities, their environments, and the social relationships that give those experiences meaning (Harmon et al., 2025).

Together, these three mechanisms suggest bird-centered engagement may influence communication and participation across multiple relational scales, from shared attention and communicative interaction to broader experiences of ecological participation and belonging. By supporting shared attention, reducing communicative pressure, and reconnecting individuals with meaningful environmental and social contexts, bird-centered activities may positively influence communicative participation, psychosocial well-being, and stroke-related quality of life.

3 Bird-centered ecological engagement within ICAP

The conceptual framework described above was developed through the integration of bird-centered ecological engagement within an Intensive Comprehensive Aphasia Program (ICAP). The following sections describe the rehabilitation context in which these activities were implemented, the communication strategies that supported participation, and the evolution of bird-centered engagement across multiple ICAP sessions over several years.

3.1 Overview of ICAP

The University of Montana (UMT) operates a summer ICAP for adults living with aphasia following stroke. The ICAP service delivery model is cohort-based, high-intensity, comprehensive aphasia rehabilitation program in which participants begin and end the program together while engaging in multiple hours of rehabilitation activities per day over several weeks (Rose et al., 2013; Rose et al., 2021; Monnelly et al., 2024). The UMT ICAP typically operates four days per week across four weeks, providing approximately 80 hours of aphasia rehabilitation. The program is participation-oriented and aligned with the WHO-ICF framework (WHO-ICF, 2001) and the Life Participation Approach to Aphasia (LPAA; Chapey et al., 2000). The aim of the UMT ICAP is to support language recovery, and improve functional communication, communicative confidence, and meaningful participation in everyday life for people living with aphasia.

A defining feature of the UMT ICAP is its integration of interprofessional collaboration and a focus on community engagement. Graduate student clinicians enrolled in the speech-language pathology Master of Science program provide aphasia rehabilitation under faculty supervision, while collaborators from other disciplines contribute expertise that supports participation-oriented outcomes that include real-world engagement. The UMT ICAP conceptualizes the person with aphasia and their care/communication partner(s) as the unit of care, integrating communication strategy training and participation-focused support throughout rehabilitation activities. Within this innovative aphasia rehabilitation context, an avian ecologist collaborated with rehabilitation experts to design ecologically grounded experiences that support communication, participation, and social engagement.

The cohort-based and participation-oriented structure of UMT ICAP creates conditions in which shared ecological experiences can be intentionally integrated into rehabilitation and communicative interaction. Within this context, bird-centered engagement functions not as supplemental enrichment, but as meaningful context for participation, communication, and shared ecological experience.

3.2 Making ecological engagement communicatively accessible

Bird-centered engagement can only function therapeutically when ecological participation is communicatively accessible. Because aphasia affects the ability to express and interpret language in real time, participation in shared ecological experiences depends not only on the activity itself, but on the interactional supports that structure communication throughout the experience. In the context of delivering bird-centered ecological experiences to individuals with aphasia, communication accessibility functions as the implementation infrastructure that determines whether participants can genuinely engage in shared attention, learning, and dialogue. Accordingly, the approach described here was grounded in supported communication principles consistent with Supported Conversation for Adults with Aphasia (SCA; Kagan et al., 2001), which emphasizes an adult-to-adult interactional stance that acknowledges competence while using structured techniques to support participation and conversational engagement.

As bird-centered ecological engagement evolved within the UMT ICAP, speech-language pathologists (SLPs) coached the avian ecologist(s) to use aphasia-friendly communication strategies that supported participation during ecological engagement. This training emphasized both the interpersonal stance and communication practices that supported comprehension, expression, and conversational repair during bird-centered activities. The avian ecologists communicated directly with participants using natural adult tone while maintaining a communicative approach that emphasized competence, curiosity, and substantive dialogue rather than passive or superficial exchange. Sessions supported communicative participation through deliberate pacing, reduced grammatical complexity, structured wait time, and ongoing verification of shared understanding (Kagan et al., 2001). Information was presented in manageable units while allowing participants opportunities to observe, respond, question, and collaboratively interpret ecological experiences. Over time, the avian ecologist(s) increasingly internalized these communication strategies, resulting in more flexible, participant-led interaction with reduced reliance on direct SLP support. This progression aligns with broader implementation research demonstrating that supported communication approaches can be successfully integrated into non-SLP professional contexts when training and collaborative support structures are provided (Jensen et al., 2014).

Bird-centered ecological engagement is inherently multimodal because birds can be experienced through sound, movement, visual observation, and shared environmental reference. To support participation, the avian ecologist(s) supplemented spoken discussion with written key words, visual materials, and multimodal communication supports (e.g., whiteboards, smart devices) when needed. Importantly, these supports were intended to preserve participants’ agency in meaning-making rather than compensate for communication on their behalf. The goal was not to simplify ecological engagement, but to broaden the range of communicative participation available during interaction. By supporting shared observation, multimodal response, and collaborative interpretation, bird-centered activities allowed participants to remain engaged in meaningful ecological and social interaction even when verbal precision was limited.

Stroke survivors with aphasia were paired with a trained communication partner, typically aa graduate student clinician in speech-language pathology clinician (GSC) who supported communication during bird-centered activities while the avian ecologist(s) maintained content leadership. GSCs helped protect conversational turns, scaffold participation, and support repair when communication breakdowns occurred, allowing participants with aphasia to remain active contributors during ecological interactions. This supported communication model was important because the therapeutic value of bird-centered engagement depended on more than passive exposure to environmental stimuli. Supported communication strategies allowed participants to engage in complex, interest-driven ecological interaction while maintaining autonomy, participation, and shared meaning-making.

3.3 Evolving bird-centered engagement within the UMT ICAP

Bird-centered ecological engagement within UMT ICAP evolved through iterative collaboration between avian ecologists and speech-language pathologists beginning in 2018. From the onset, bird-centered experiences were positioned not as supplemental enrichment, but as contexts for shared attention, supportive conversation, ecological observation, and values-based participation (e.g., being outdoors, learning something complex and meaningful).

Across successive ICAP iterations, bird-centered engagement became progressively more immersive, multimodal, and participation-oriented while remaining grounded in communication-access principles that supported ecological participation for individuals living with aphasia. Early activities emphasized structured outdoor observation and shared ecological discussion, while later iterations increasingly integrated skill-building, adaptive equipment use, multisensory listening experiences, and immersive outdoor participation. This 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.

The flexibility of bird-centered ecological engagement became especially apparent during the COVID-19 pandemic, when the UMT ICAP shifted temporarily to remote delivery. During this period, 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. Together, these shifts demonstrated that bird-centered ecological engagement could remain accessible and participation-oriented across multiple delivery modalities.

4 Illustrative cases of bird-centered engagement in the UMT ICAP

The following vignettes illustrate how bird-centered ecological engagement evolved across successive ICAP iterations (Figure 2) and demonstrate how the proposed mechanisms operated in practice. Bird-centered ecological engagement became progressively more immersive, multimodal, and participation-oriented while remaining grounded in communication-access principles that supported ecological participation for individuals living with aphasia. Together, these examples demonstrate how interdisciplinary collaboration between avian ecologists and rehabilitation clinicians supported accessible, meaningful, and ecologically grounded communicative participation within aphasia rehabilitation contexts.

Vignette 1: Early outdoor ecological observation and interest-led engagement

In 2021, an outdoor, bird-centered ecological activity was introduced (Figure 2) using a patio space on the UMT campus. Content focused on owls, selected in response to participant interests expressed during earlier ICAP conversations. The session was structured around guided ecological observation and shared discussion, during which avian ecologists introduced owl characteristics and behaviors while participants engaged through observation and supported interaction. Physical artifacts, including preserved specimens and related materials, were introduced to provide shared ecological reference points that supported attention and interaction, creating multiple low-pressure communication opportunities for pointing, yes/no responses, and choice-based participation when word-finding challenges limited spoken output. The communication environment emphasized deliberate pacing, structured pauses, and ongoing verification of shared understanding.

This early implementation primarily illustrates ecological grounding of shared attention, with bird-centered observation supporting low-pressure interaction, shared focus, and communicative participation. It also demonstrated that bird-centered ecological engagement could support meaningful interaction within relatively low-demand outdoor contexts. Rather than requiring sustained verbal performance, participation emerged through shared observation, ecological curiosity, and co-attention to avian stimuli within the environment. This early implementation established a foundation for later ICAP iterations by demonstrating that ecological experiences could be intentionally structured to support communication, participation, and accessible outdoor engagement simultaneously.

Vignette 2: Multi-modal observation, skill-building, and adaptive participation

By 2023, bird-centered ecological engagement expanded from a single outdoor experience to a multi-session sequence that combined classroom-based preparation with an accessible outdoor experience. The first session introduced foundational concepts related to hawks and local raptors, including ecological behaviors, visual identification features, and relevant terminology. Aphasia-accessible supports were embedded throughout the activity, including printed visuals, written key words, structured comprehension checks, and deliberate opportunities for participants to ask questions and share prior knowledge. These preparatory sessions also reinforced shared communication strategies that participants could later apply during real-time ecological observation.

The second session transitioned from classroom-based ecological learning to accessible outdoor participation through structured observation of a Cooper’s hawk nest located near UMT’s campus. During this outdoor session, participants were introduced to spotting scopes and binoculars, shifting engagement from guided observation toward active ecological participation. Occupational therapists (OTs) were integrated to support positioning, upper-extremity use, balance, and adaptive access to birding equipment. Because many participants experienced post-stroke hemiparesis affecting mobility and upper-extremity function, these supports were important for meaningful participation in ecological observation and shared outdoor engagement. Introducing adaptive birding equipment allowed participants to collaboratively locate, track, and discuss birds within the environment in real time rather than functioning as passive observers.

Across these sessions, SLPs provided ongoing guidance to the avian ecologist(s) to support accessible questioning, response flexibility, structured wait time, and conversational repair strategies during ecological interaction. Relative to earlier ICAP iterations, this year reflected a transition toward increasingly immersive and participation-oriented ecological engagement characterized by repeated exposures, adaptive participation, interprofessional collaboration, and greater opportunities for participant-led interaction linked to real-time observation.

This iteration illustrates communicative scaffolding in practice, as repeated ecological exposure, adaptive participation, and shared ecological reference supported increasingly complex interaction and participant-led engagement.

Vignette 3: Multisensory ecological immersion and distributed participation

In 2025, bird-centered programming progressed to a more immersive and multisensory model that extended beyond conventional bird observation to include structured listening and sound-based ecological participation across multiple sessions. The first session introduced participants to bird calls using audio exemplars paired with visual supports to scaffold recognition, discussion, and shared ecological interpretation. Aphasia-accessible interaction supports, including slowed pacing, repetition, verification of meaning, and multiple modes of response, supported participation in shared listening and meaning-making around sound.

Later in the ICAP, participants engaged in a full-day outdoor session at UMT’s Lubrecht Experimental Forest co-facilitated with a sound artist and soundscape researcher. This experience shifted ecological engagement toward “deep listening” and immersive soundscape participation within a natural environment on a hike. Physical therapy was integrated throughout the outing to facilitate safe mobility, pacing, endurance, and adaptive access during outdoor participation.

Although an avian ecologist was not physically present during the outdoor session, the ecological concepts, shared language, and communication-access strategies established during the first session continued to structure participation through collaborative facilitation by the interdisciplinary ICAP team. In this way, bird-centered ecological engagement remained conceptually coherent across facilitators, settings, and modalities while still grounded in avian ecological observation and shared environmental experience.

This iteration most strongly reflects ecological participation and identity reconstruction, as engagement extended beyond structured sessions into embodied environmental experience. Rather than functioning solely as therapeutic activities, bird-centered ecological experiences became shared forms of environmental participation that connected communication, mobility, listening, and ecological observation within a broader social and ecological context.

5 Emerging principles of bird-centered ecological engagement

Across successive ICAP iterations, bird-centered ecological engagement evolved from relatively structured observational activities toward increasingly immersive, multimodal, and participation-oriented ecological experiences. This iterative development process revealed several recurring principles that may inform future integration of bird-centered ecological engagement within rehabilitation contexts.

One consistent lesson across iterations was that communicative accessibility functioned as foundational infrastructure rather than supplemental support. 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.

A second lesson was that ecological engagement remained most effective when it preserved intellectual and participatory complexity rather than simplifying interaction into passive exposure or recreational distraction. Participants responded most strongly when ecological observation involved shared interpretation, curiosity, and collaborative meaning-making.

The evolution of bird-centered engagement 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. This flexibility may be particularly important for adapting accessibility within rehabilitation and community contexts.

Together, these lessons reinforce the idea that bird-centered ecological engagement functions not merely as environmental enrichment, but as communicative and participatory framework through which ecological experience can support interaction, belonging, and meaningful participation following aphasia.

6 Expanding the scope of human-bird interaction research

Research on human-bird interactions has largely demonstrated associations between avian presence and improved psychological well-being, including reduced stress, and enhanced mood, and attentional restoration (Hammoud et al., 2022; Cox et al., 2017; Ratcliffe et al., 2013). These findings have been foundational in establishing birds as meaningful contributors to human health within biodiversity and environmental psychology research. However, much of this work has focused on passive exposure or correlational relationships between bird presence and well-being outcomes.

This perspective extends this literature by proposing that bird-centered ecological engagement can be intentionally structured to support communicative, participation, and psychosocial well-being within rehabilitation contexts. Rather than conceptualizing birds solely as sources of restorative exposure, we position them as dynamic ecological referents capable of organizing shared attention, shaping interaction, and supporting participation across communicative and social contexts.

Several characteristics may make birds especially well-suited for this role. Birds are highly detectable across environments through movement, sound and visual salience, while their behavioral unpredictability and ecological rhythms create recurring opportunities for share 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. These properties allow the ecological experience itself to be a communicative resource.

Importantly, this framework also expands how participation is conceptualized within rehabilitation contexts. Bird-centered ecological engagement does not position nature as passive enrichment or therapeutic backdrop. Instead, participation emerges through shared ecological experience that connects communication, mobility, observation, listening, and environmental relationship. In this way, bird-centered engagement may support not only communicative participation, but broader experiences of environmental belonging and re-engagement with community life following aphasia.

The proposed framework also raises broader questions for future human-bird interaction research. Future studies could examine 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. More broadly, this perspective suggests that birds maybe be understood not only as indicators of ecological quality, but also as active participants in relational systems linking ecological experience, communication, and human well-being.

7 Limitations of this perspective

This perspective advances a conceptual and practice-informed reframing of human–bird interactions within a clinical rehabilitation context. Several limitations warrant acknowledgment.

First, the present work does not report controlled outcome data from stroke survivors with aphasia. Integrating bird-centered ecological engagement into the UMT ICAP 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 this perspective. Future research employing controlled designs, standardized participation measures, and longitudinal follow-up will be necessary to evaluate the magnitude and durability of effects.

Second, the proposed mechanisms, including ecological grounding of shared attention, communicative scaffolding, and ecological participation, remain theoretically inferred rather than empirically isolated. Future studies will need to operationalize and directly test these mechanisms across rehabilitation contexts and delivery modalities.

Finally, ethical and ecological considerations remain essential. Expanding bird-centered ecological engagement within therapeutic settings must remain attentive to wildlife disturbance, habitat integrity, and species-specific stress responses. Collaboration with avian ecologists and conservation practitioners will be important to ensure that rehabilitation-oriented ecological engagement does not inadvertently compromise avian welfare.

Taken together, these limitations underscore that this perspective is intended as a conceptual and translational framework rather than definitive evidence of clinical efficacy. By articulating plausible mechanisms and describing implementation approaches, we aim to support future interdisciplinary research examining how structured bird-centered ecological engagement may influence communication, participation, and psychosocial well-being across rehabilitation contexts.

8 Future directions

Bird-centered ecological engagement offers a novel interface between ecological systems and clinical practice. By situating rehabilitation within shared environmental experience, this framework expands how both bird science and rehabilitation sciences conceptualize human–environment relationships. Rather than positioning birds solely as passive sources of psychological restoration, this perspective suggests that birds may function as dynamic ecological referents capable of shaping attention, interaction, participation, and environmental belonging across clinical and community contexts.

Future research should examine how different forms of bird-centered ecological engagement, including sound-based immersion, adaptive birding, neighborhood observation, and field-based ecological participation, shape communicative interaction and psychosocial well-being across diverse populations and rehabilitation settings. Comparative work across modalities, settings, and accessibility approaches may also help clarify how ecological participation can remain communicatively meaningful across different forms of engagement.

More broadly, this framework opens opportunities for interdisciplinary research at the intersection of avian ecology, rehabilitation science, accessibility, and human–environment interaction. Examining how ecological experiences can be intentionally structured to support participation and communication may expand the role of birds within research on health, accessibility, and social belonging.

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Footnotes

Edited by: Tina Phillips, Cornell University, United States

Reviewed by: Funmi Akindejoye, University of Tasmania, Australia