Abstract
Stroke survivors undergo a thorough cognitive diagnosis that often involves administration of multiple standardized tests. However, patient’s narrative discourse can provide clinicians with additional knowledge on patient’s subjective experience of illness, attitude toward current situation, and motivation for treatment. We evaluated the methods of analyzing thematic content and story types in relationship to cognitive impairment in stroke survivors with no aphasia (including 9 left hemisphere damage – LHD patients, and 16 right hemisphere damage – RHD patients). Cognitive impairment was evaluated in comparison to a group of 25 patients with orthopaedic injury not involving the brain. Our findings primarily show that higher elaboration on own cognitive problems, physical ailments or coping strategies in LHD patients and cognitive problems, emotional issues and circumstances of illness onset in RHD patients is related to deficits in executive functions and retrieval of information from memory. Furthermore, RHD patients who use more chaos story type show lower executive functioning. However, these results did not survive the significance threshold of p < 0.05 after Bonferroni adjustment for multiple comparisons. In conclusion, this study provides preliminary evidence that stroke survivor’s narrative can constitute an additional source of clinically-relevant information regarding patient’s experience of illness and attitude toward recovery. This knowledge can aid clinicians and nurses in everyday interactions with the patients and support individualized strategy to treatment. Still, the current results need be confirmed with future studies in a larger cohort of stroke patients.
Highlights
Conversation between the clinician and the patient should be the entry point for neurorehabilitation (Christensen et al, 1989)
This study provides preliminary evidence that a stroke survivor’s narrative can constitute an additional source of clinically relevant information regarding patient’s experience of illness and attitude toward recovery
Our data show that this knowledge can be unfolded with the use of discourse analyses methodologies such as the thematic framework of illness narratives (Pluta et al, 2015) and the story typology (Frank, 1995)
Summary
Conversation between the clinician and the patient should be the entry point for neurorehabilitation (Christensen et al, 1989). The aim of assessing narrative ability and structural aspects is to display intricate microand macrolinguistic impairments as well as preserved aspects of language function in stroke survivors (Marini, 2012) This method helps to build a clinical portrait of the abilities of the stroke survivor to organize information and communicate it in a coherent and informative manner (Marini, 2012). This aim is radically different from analyzing narrative discourse in order to uncover a patient’s subjective perspective, experiences, attitudes, or beliefs. This type of analysis of patient discourse can be a useful tool for clinicians to understand patient’s state of knowledge related to illness and socio-psychological state and may help in planning the course of rehabilitation (Pluta et al, 2015)
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