The Role of Culture in TBI Rehabilitation. Denise Krch NABIS September 21, 2013
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1 The Role of Culture in TBI Rehabilitation Denise Krch NABIS September 21, 2013
2 Outline What is culture? Intersection between culture and rehabilitation in TBI Incorporating culture into treatment
3 What is culture? Outline
4 Disease/Injury Characteristics Awareness Learning & Memory Working Memory Processing Speed Cognitive Outcome Visuospatial Processing Executive Function Attention Cognitive Reserve Culture Emotional Functioning
5 What is Culture? Shared, learned system of values, beliefs, attitudes, and behaviors
6 What is Culture? Cultural Diversity Race Ethnicity Gender Class Sexuality Age Religion Disability
7 Worldview Shapes how you see cultural differences
8 The World According to Americans
9 The World According to Scots
10 The World According to Texans
11 The World According to San Franciscans
12 World-View Goal of training for cultural competence is to develop ethnorelative thinking
13 Ethnocentric Ethnorelative Cultural sensitivity awareness Cultural competence translation of awareness into credible behaviors
14 Ethnocentric Ethnorelative
15 Outline Intersection between culture and rehabilitation in TBI
16 How is Culture Relevant to Rehab? Dana, R. (1993). Multicultural assessment perspectives for professional psychology
17 Worldview Impacts Presentation of symptoms Perception of illness and disability Expectation for recovery Use of rehabilitation services Potential for cognitive improvement
18 Attribution Error Socially undesirable behaviors One s own group: external situation Other groups: internal disposition
19 Rehab Environment Rehab professional 19 y/o African-American man from projects
20 Rehab Environment Benign, clean, safe environment Dedicated committed professionals with best interest of welfare of patient who promote rehabilitation from injury White-collar setting with higher norms and expectations for language and social behavior Hospital stay isolates patient from social support, provoking fear, anxiety, abandonment
21 Attitude Toward Therapy Rehab professional 28 y/o Cuban man sustains TBI; family present 24/7
22 Attitude Toward Therapy Patient is lazy, unmotivated, codependent Family is enabling Presence of family eases patient s burden Self care less important when family will care for patient at discharge Love and concern are demonstrated through care and attention
23 Rehab professional Emotional Functioning 22 y/o Chinese woman sustains TBI; shows limited emotion
24 Emotional Functioning Patient exhibits alexithymia Lack of emotional engagement in adjustment to disability is abnormal Patient says how she feels does not matter. Chinese culture has few verbal expressions for concepts of emotions and expression of dysphoria and grief
25 Emotional Functioning -2 Rehab professional 30 y/o Mexican woman learns child was killed in MVA. Exhibits yelling, chest pounding, asks God to take her instead; husband joins in behavior
26 Emotional Functioning - 2 Patient is emotionally labile, agitated symptom of TBI; husband overly dramatic, agitating pt Sedate patient, remove husband Affect is openly accepted and highly valued Expression of emotion is therapeutic and promotes group cohesion Dramatic physical gestures are not unusual
27 Pain Rehab professional 42 y/o Korean man sustains TBI; severe polytrauma, yet limited pain complaints
28 Pain Patient must not be experiencing pain Patient suffered in pain because not vocal Koreans have fewer affective descriptors for pain (relative to European Americans), but experience similar intensities of pain
29 Rehab professional Cognitive Deficits 35 y/o Mexican man with significant cognitive impairments; refuses to see vocational counselor, denies deficits
30 Cognitive Deficits Patient presents with anogagnosia Refusal to see therapist is self-preservation Patient is undocumented and fearful of deportation
31 Attitude Toward Discharge Rehab professional 39 y/o Japanese man with TBI who had worked as attorney prior to injury
32 Attitude Toward Discharge Patient should accept change in abilities and consider new career Patient is extremely shamed at inability to return to premorbid career, feels like he has failed his family; doesn t cooperative with discharge plans
33 Symptoms Decreased appetite, restlessness, fatigue, withdrawal, somatic complaints Postconcussion syndrome with PTSD? Susto caused by fright or traumatic experience?
34 Symptoms -2 Headaches, crying, irritability, restlessness, vomiting, diarrhea, fever Acute brain injury? Mal ojo caused by having been looked upon by person with evil eye?
35 Symptoms - 3 Headaches, sleep difficulties, nervousness, easy tearfulness, dizziness, tingling Brain injury sequela? Nervios?
36 Outline Incorporating culture into treatment
37 Emic vs Etic? Emic unique to patient s culture Etic common across many cultures
38 Culture and Treatment Patient who doesn t want to attend therapy
39 Culture and Treatment 19 y/o African-American man from projects
40 Culture and Treatment 28 y/o Cuban man with family present 24/7
41 Culture and Treatment 22 y/o Chinese woman, limited emotional expression
42 Culture and Treatment 30 y/o Mexican woman, strong emotional expression
43 Culture and Treatment 42 y/o Korean man with polytrauma, limited pain complaints
44 Culture and Treatment 35 y/o Mexican man with significant cognitive impairments; denies deficits
45 Culture and Treatment 39 y/o Japanese man who had worked as attorney
46 Culture and Treatment Susto, mal ojo, nervios
47 Expectations for Assessment and Treatment Consider Race Ethnicity Gender Class Sexuality Age Religion Disability
48 Worldview
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