Analysis of Narrative Functionality: Toward Evidence-based Approaches in Managed Care Settings

Abstract

The advent of managed health care has challenged rehabilitation professionals to guide their clients toward functionally meaningful outcomes in the least amount of time possible and to justify the evidence base for their intervention approaches. The ability to relate personal narratives in everyday contexts lies at the core of communicative functionality, but feasible clinical assessment of narrative has proven elusive. The purpose of this article is to offer an evidence-based framework for guiding assessments of the personal narratives of adults with aphasia, within a managed care model of service delivery. A literature-based model of narrative functionality is proposed, and a targeted set of criterion-referenced measures and behavioral observations derived from this model are suggested as potential metrics of narrative functionality. The authors do not intend to prescribe exact methods of narrative evaluation, but rather to suggest possible directions for professionals to develop evidence-based clinical narrative analysis tailored to the functional assessment needs of their clients across a variety of service settings.

Keywords

Narrative - assessment - aphasia - managed care

• References

• 1 Murray L, Clark HM. Modern health care and the future of neurogenic language disorders. Chapter 12. In: Murray L, Clark HM, eds. Neurogenic Disorders of Language: Theory Driven Clinical Practice. Clifton Park, NY: Delmar; 2006
• 2 Kiser LJ, Lefkovitz PM, Kennedy LL eds. The Integrated Behavioral Health Continuum: Theory and Practice. Washington, DC: American Psychiatric Publishing; 2001
• 3 Norrick NR. Conversational Narrative: Storytelling in Everyday Talk. Amsterdam, The Netherlands: John Benjamins Publishing; 2000
• 4 Tomblin JB. Perspectives on diagnosis. In: Tomblin JB, Morris HL, Spriestersbach DC, eds. Diagnosis in Speech-Language Pathology. San Diego, CA: Singular Publishing; 2002: 3-33
• 5 World Health Organization (WHO). Towards a Common Language for Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization; 2002. Available at: http://www.who.int/classifications/icf/training/icfbeginnersguide.pdf Accessed October 1, 2011
• 6 Labov W. Some further steps in narrative analysis. J Narrat Life Hist 1997; 7: 395-415
• 7 Murray L, Clark HM. Neurogenic Disorders of Language: Theory Driven Clinical Practice. Clifton Park, NY: Delmar; 2006: 400-409
• 8 Holland AL, Fridriksson J. Aphasia management during the early phases of recovery following stroke. Am J Speech Lang Pathol 2001; 10: 19-28
• 9 Ulatowska HK, Allard L, Chapman SB. Narrative and procedural discourse in aphasia. In: Joanette Y, Brownell HH, eds. Discourse Ability and Brain Damage: Theoretical and Empirical Perspectives. New York, NY: Springer-Verlag; 1990: 180-198
• 10 Holland AL. Lessons from a clinical life in aphasia. Top Stroke Rehabil 2010; 17: 13-19
• 11 Haynes WM, Pindzola RH. Diagnosis and Evaluation in Speech Pathology, 8th ed. Upper Saddle River, NJ: Pearson; 2012: 52-
• 12 Olness GS, Ulatowska HK. Personal narratives in aphasia: coherence in the context of use. Aphasiology 2011; 25: 1393-1413
• 13 McCauley RJ. Familiar strangers: criterion-referenced measures in communication disorders. Lang Speech Hear Serv Sch 1996; 27: 122-131
• 14 Westby CE, StevensDominguez M, Oetter P. A performance/competence model of observational assessment. Lang Speech Hear Serv Sch 1996; 27: 144-156
• 15 Longacre RE. The Grammar of Discourse, 2nd ed. New York, NY: Plenum Press; 1996
• 16 Labov W. Language in the Inner City: Studies in the Black English Vernacular. Philadelphia, PA: University of Pennsylvania Press; 1972
• 17 Armstrong E, Mortensen L, Ciccone N, Godecke E. Expressing opinions and feelings in a conversational setting. Semin Speech Lang 2012; 33: 16-27
• 18 Armstrong E. Expressing opinions and feelings in aphasia: linguistic options. Aphasiology 2005; 19: 285-295
• 19 Grice HP. Logic and conversation. In: Cole P, Morgan JL, eds. Syntax and Semantics 3: Speech Acts. New York, NY: Academic Press; 1975: 41-58
• 20 Mandler JM. Stories, Scripts and Scenes: Aspects of Schema Theory. Hillsdale, NJ: Lawrence Erlbaum Associates Inc; 1984
• 21 Labov W, Waletzky J. Narrative analysis: oral versions of personal experience. In: Helm J, ed. Essays of the Verbal and Visual Arts: Proceedings of the 1966 Annual Spring Meeting of the American Ethnological Society. Seattle, WA: University of Washington Press; 1967: 12-44
• 22 Berman R. Narrative theory and narrative development: the Labovian impact. J Narrat Life Hist 1997; 7: 235-244
• 23 Polanyi L. Telling the American Story: A Structural and Cultural Analysis of Conversational Storytelling. Cambridge, MA: MIT; 1989
• 24 Ulatowska HK, Olness GS. Pragmatics in discourse performance: insights from aphasiology. Semin Speech Lang 2007; 28: 148-158
• 25 Bachorowski JA, Owren MJ. Vocal expressions of emotion. In: Lewis M, Haviland-Jones JM, Barrett LF, eds. Handbook of Emotions, 3rd ed. New York, NY: Guilford Press; 2008: 196-210
• 26 Olness GS, Matteson SE, Stewart CT. “Let me tell you the point”: how speakers with aphasia assign prominence to information in narratives. Aphasiology 2010; 24: 697-708
• 27 Olness GS, Englebretson EF. On the coherence of information highlighted by narrators with aphasia. Aphasiology 2011; 25: 713-726
• 28 Och E, Capps L. Living narrative: creating lives in everyday storytelling. Cambridge, MA: Harvard University Press; 2001
• 29 Martin JR, White PRR. The Language of Evaluation: Appraisal in English. New York, NY: Palgrave Macmillan; 2005
• 30 van Dijk TA. Discourse and interaction in society. In: van Dijk TA, ed. Discourse and Social Interaction. London, UK: Sage; 1997: 1-37
• 31 Armstrong L, Brady M, Mackenzie C, Norrie J. Transcription-less analysis of aphasic discourse: a clinician’s dream or a possibility?. Aphasiology 2007; 21: 355-374