may not be routinely available in acute / post-acute settings, although staff reported ways of problem-solving some of these challenges. In our observations of therapy, medication and menu rounds staff can be seen to deploy various strategies as they give information or address patients’ queries and concerns. Material features of the setting are enrolled or referred to for particular purposes (Heath & Hindmarsh, 2002), whether it is clarifying an activity sequence for Bob; medication information for Joan; or Jim’s menu choices; these are supported by gesture, embodied information (demonstration) coupled with co-ordination of eye-gaze or touch. As & Damico (2007) underline, these phenomena are complex, requiring “rapid local management of … behaviours and their interpretations” (p. 93). Where patients with moderate-severe aphasia initiate inquiries or comments, staff involved in the consecutive delivery of therapy or care are naturally challenged to address these in timely and sensitive ways; they may capitalise on the local ecology, material resources, activity context and patient’s verbal / non-verbal contributions, effectively represent the patient’s voice (Simmons-Mackie & Damico, 2007; Simmons-Mackie et al., 2004; Goodwin, 1995); but equally, may decide (consciously or unconsciously) to curtail these sequences using a strategic division of labour where involvement of the aphasic person is reduced or rendered passive (Simmons-Mackie et al., 2004; Goodwin, 1995). Hedberg et al. (2007) found that patients were not invited to freely give their perspective. Here – within an admittedly limited sample – we found that opportunities for patients to ask, comment or be actively involved in their care arose frequently; importantly, these opportunities may have been opened up by staff, but also equally quite swiftly closed down or passed by unrecognised. Patient active participation has the potential to promote engagement, and increase the efficiency and effectiveness of rehabilitation interventions.
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