NeuroRehabilitation - Volume 24, issue 1

Authors: Arango-Lasprilla, Juan Carlos

Article Type: Editorial

DOI: 10.3233/NRE-2009-0448

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 1-3, 2009

Authors: Arango-Lasprilla, Juan Carlos | Ketchum, Jessica M. | Gary, Kelli | Hart, Tessa | Corrigan, John | Forster, Lauren | Mascialino, Guido

Article Type: Research Article

Abstract: Objective: To determine differences in life satisfaction at 1-year post-TBI among Caucasian, African American, Hispanic, and Asian individuals with TBI, after adjusting for covariates that significantly differ between ethnic groups and/or affect the Satisfaction with Life Scale (SWLS) at one year post-injury. Design: Retrospective study. Setting: Longitudinal dataset of the TBI Model Systems National Database. Participants: 3,368 individuals with moderate to severe TBI (2478 Caucasian, 629 African American, 180 Hispanic, and 81 Asian/Pacific Islander) hospitalized between 1989 and 2005. Main Outcome Measures: Satisfaction with Life Total score at 1 year post injury. …Results: African Americans had 3.21 units lower SWLS scores one year post-injury than Asian/Pacific Islanders (95% CI = 0.61–5.81) and 1.99 units lower SWLS scores than Caucasians (95% CI = 0.97–3.00) after controlling for marital status, employment at admission, cause of injury, FIM at discharge, and LOS in acute care. Conclusions: African Americans have poorer self-reported life satisfaction than Caucasians and Asians one year after TBI. This effect is not due to pre-injury marital or employment status, cause of injury, nor injury severity or functional status. Further research on the factors which might explain these differences is warranted, so that targeted rehabilitation programs can be designed and implemented that enhance quality of life for all individuals who have suffered a TBI. Show more

Keywords: Satisfaction with life, TBI, Race/ethnicity

DOI: 10.3233/NRE-2009-0449

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 5-14, 2009

Authors: Sander, Angelle M. | Pappadis, Monique R. | Davis, Lynne Cole | Clark, Allison N. | Evans, Gina | Struchen, Margaret A. | Mazzei, Diana M.

Article Type: Research Article

Abstract: The purpose of the current study was to determine the contribution of race/ethnicity and income to community integration at approximately 6 months following traumatic brain injury (TBI). Participants were 151 persons with mild to severe TBI (38% Black; 38% Hispanic; 24% White) recruited from consecutive admissions to the Neurosurgery service of a county Level I trauma center. A large number of participants had low income and low education. Community integration was assessed using the Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique – Short Form (CHART-SF), and Community Integration Measure (CIM). Results of analysis of covariance (ANCOVA) indicated …that, after accounting for injury severity, age, education, and income, race/ethnicity contributed significantly to the variance in CIQ Total score, Home Integration Scale, and Productive Activity Scale scores. Blacks had lower CIQ Total scores compared to Whites. Black and Hispanic participants had lower scores than Whites on the Home Integration Scale, and Blacks had lower scores than Whites and Hispanics on the CIQ Productive Activity Scale. Low income (⩽ $20,000) was related to lower scores on the CIQ and CHART-SF Social Integration Scales, and scores on the CIM Total, Belonging, and Independent Participation scales. These results indicate that racial/ethnic differences in community integration exist, even after accounting for income. However, income was more predictive than race/ethnicity for certain aspects of community integration, indicating that it should be accounted for in all studies investigating racial/ethnic differences in outcomes. Show more

Keywords: Traumatic brain injury, race/ethnicity, income, community integration

DOI: 10.3233/NRE-2009-0450

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 15-27, 2009

Authors: Mascialino, Guido | Hirshson, Chari | Egan, Mathew | Cantor, Joshua | Ashman, Teresa | Tsaousides, Theodore | Spielman, Lisa

Article Type: Research Article

Abstract: Previous studies that used objective measures of community integration found that in the first year after injury, minority groups with traumatic brain injury (TBI) exhibit lower levels of community integration than White participants. The objective of this study was to determine if this discrepancy persists beyond one year post injury, and if assessing subjective components of community integration helps understand these differences. Participants were 360 community dwelling adults with TBI including 29% from minority backgrounds. Mean time post injury was 8.66 years (SD = 9.94). Main outcome measure utilized was the Participation Objective Participation Subjective (POPS). Multiple regression indicated …that minority status predicted levels of transportation use (p < 0.01), with white participants reporting less use, after controlling for demographic and injury variables. When looking at subjective indicators, minority status predicted levels of dissatisfaction with community, civic, life and leisure participation (p < 0.01), and total levels of participation (p < 0.0125), with White participants reporting significantly less dissatisfaction. Findings indicate that differences between minorities and white participants in objective aspects of community integration after one year post-injury are only evident in levels of transportation use. However, when looking at subjective indicators differences between groups are present in other areas. These findings underscore the importance of considering the consumer's subjective experience when providing services to minorities in a rehabilitation setting. Show more

Keywords: Traumatic brain injury, community integration, minorities, minority status

DOI: 10.3233/NRE-2009-0451

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 29-36, 2009

Authors: Arango-Lasprilla, Juan Carlos | Ketchum, Jessica M. | Stevens, Lillian Flores | Balcazar, Fabricio | Wehman, Paul | Forster, Lauren | Hsu, Nansy

Article Type: Research Article

Abstract: Objective: To examine differences in employment outcomes among Hispanics and Caucasians with Spinal Cord Injuries at one year post-injury. Design: Retrospective study. Setting: Longitudinal dataset of the SCI Model Systems. Participants: 11,424 Individuals diagnosed with spinal cord injury (1369 Hispanics and 10055 Caucasians) that were enrolled in the National Spinal Cord Injury Statistical Center (NSCISC) database and interviewed during their scheduled one-year post-injury follow-up evaluation between 1975 and 2006. Main Outcome Measures: Employment status (competitively employed, unemployed and other). Results: After adjusting for age, gender, marital status, education level, employment …status at admissions, cause of injury, category of neuro-impairment, and ASIA impairment scale, race/ethnicity has a significant effect on employment status at 1 year post-injury. Specifically, the odds of unemployment versus employment were 1.864 times greater for Hispanics than for Caucasians (95% CI = 1.478, 2.349) and the odds of unemployment versus other were 1.980 times greater for Hispanics than for Caucasians (95% CI = 1.625, 2.413). Conclusions: Racial disparities do exist in successful employment after 1 year post SCI, particularly between Caucasians and Hispanics. Future research should focus on what factors contribute to this disparity, along with forming new education and rehabilitation strategies to improve return-to-work outcomes for Hispanics after SCI. Show more

Keywords: Spinal cord injury, minorities, and employment

DOI: 10.3233/NRE-2009-0452

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 37-46, 2009

Authors: Krause, James S. | Saladin, Lisa K. | Adkins, Rodney H.

Article Type: Research Article

Abstract: Objective: To identify disparities and changes in subjective well-being, participation, and health over a 6-year period as a function of race-ethnicity and gender in persons with spinal cord injury (SCI). Methods: Stratified sampling was used to maximize inclusion of women and racial-ethnic minorities. Three model SCI systems participated, representing the Southeastern, Western, and Mountain regions of the United States. 250 participants completed measures on two occasions. Similar portions of Caucasians (n = 62), African-Americans (n = 61), American-Indians (n = 56), and Hispanics (n = 71) participated. Women made up approximately 43.1% of the …sample. Three sets of outcome measures assessed: (a) subjective well-being and depressive symptoms, (b) participation, and (c) health. Results: MANOVA indicated significant effects for race-ethnicity (between subjects effect) and time (within subjects effect) but not for gender or the interaction effects. A Bonferroni correction was used to compare outcomes as a function of race-ethnicity and time. Five outcomes were significantly related to race-ethnicity, whereas no items were significantly related to the time effect after the Bonferroni correction. Caucasians reported best subjective well-being scores in several domains followed by African-Americans. Caucasians also reported more hours out of bed than either African-Americans or Hispanics. Conclusion: Over a 6-year period, race-ethnicity continued to be related to differences in subjective well-being and participation but not health. Disparities in outcomes did not systematically increase or diminish over time, suggesting that once developed, such disparities are unlikely to change in the absence of intervention. Show more

Keywords: Spinal cord injury, disparities, depression, health, quality of life

DOI: 10.3233/NRE-2009-0453

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 47-56, 2009

Authors: Saladin, Lisa K. | Krause, James S.

Article Type: Research Article

Abstract: Objective: To compare the prevalence of pressure ulcer (PU) and barriers to treatment in the event of PU development as a function of race-ethnicity in persons with spinal cord injury (SCI). Methods: Interview data were collected from three rehabilitation hospitals each of which was designated as a model SCI system of care by the United States Department of Education. There were 475 participants with similar portions of each racial-ethnic group (African-American n = 121, American-Indian n = 105, Caucasians n = 127, Hispanics n = 122). Results: The lowest prevalence rates for …pressure ulcers were reported by Hispanics followed by Caucasians. Logistic regression revealed racial-ethnic differences in the odds of developing a PU within the past 12 months. Social support and injury severity were also associated with risk of PU while age, gender, years since injury, and education were not. Significant racial-ethnic differences were also observed in 5 of 9 barriers to the treatment of PUs. Conclusion: Results suggest that variability in social support and barriers to treatment may contribute to the racial-ethnic differences in prevalence rates for PU that were observed. Future research in this area could lead to the development of strategies to enhance prevention and treatment targeted at the elimination of any racial-ethnic disparities. Show more

Keywords: Spinal cord injury, disparities, pressure ulcers, health, quality of life

DOI: 10.3233/NRE-2009-0454

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 57-66, 2009

Authors: Onukwugha, E. | Weir, M.R.

Article Type: Research Article

Abstract: Introduction: Predictors of hospital discharges against medical advice (AMA), including race/ethnicity, have been examined previously. However, the predictive effect of an admission for rehabilitative care has not been examined in an inpatient stroke population, nor has the impact of race/ethnicity on this relationship been reported. Methods: Live hospital discharges with a primary diagnosis of stroke from 2000–2005 were identified in a longitudinal dataset. The outcome of interest was a discharge AMA. A hierarchical logistic model was estimated to examine the effect of race/ethnicity and rehabilitative care on the outcome while controlling for patient and hospital characteristics. …Results: A total of 569 of the 79,561 stroke admissions (0.7%) ended in a discharge AMA. There were 1,565 admissions for rehabilitative care and 32% of patients were non-Caucasian. Among Caucasians, adjusted odds of a discharge AMA were higher for patients with an admission for rehabilitative care (AOR = 3.83, p < 0.0001). Among those not admitted for rehabilitative care, non-Caucasian patients were more likely to leave AMA (AOR = 1.4; p = 0.0005). Conclusions: This study identifies dependence between race/ethnicity, rehabilitative care, and discharges AMA. More research is needed to understand the implications of differential rates of discharges AMA among race/ethnic groups and across patient care settings. Show more

Keywords: Discharges against medical advice, stroke, rehabilitation, ethnicity

DOI: 10.3233/NRE-2009-0455

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 67-74, 2009

Authors: Marquez de la Plata, Carlos | Arango-Lasprilla, Juan Carlos | Alegret, Montse | Moreno, Alexander | Tárraga, Luis | Lara, Mar | Hewlitt, Margaret | Hynan, Linda | Cullum, C. Munro

Article Type: Research Article

Abstract: Neuropsychological evaluations conducted in the United States and abroad commonly include the use of tests translated from English to Spanish. The use of translated naming tests for evaluating predominately Spanish-speakers has recently been challenged on the grounds that translating test items may compromise a test's construct validity. The Texas Spanish Naming Test (TNT) has been developed in Spanish specifically for use with Spanish-speakers; however, it is unlikely patients from diverse Spanish-speaking geographical regions will perform uniformly on a naming test. The present study evaluated and compared the internal consistency and patterns of item-difficulty and -discrimination for the TNT and two …commonly used translated naming tests in three countries (i.e., United States, Colombia, Spain). Two hundred fifty two subjects (136 demented, 116 nondemented) across three countries were administered the TNT, Modified Boston Naming Test-Spanish, and the naming subtest from the CERAD. The TNT demonstrated superior internal consistency to its counterparts, a superior item difficulty pattern than the CERAD naming test, and a superior item discrimination pattern than the MBNT-S across countries. Overall, all three Spanish naming tests differentiated nondemented and moderately demented individuals, but the results suggest the items of the TNT are most appropriate to use with Spanish-speakers. Preliminary normative data for the three tests examined in each country are provided. Show more

DOI: 10.3233/NRE-2009-0456

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 75-85, 2009

Authors: Marquez de la Plata, C. | Lacritz, L.H. | Mitschke, R. | Van Ness, P. | Agostini, M. | Diaz-Arrastia, R. | Cullum, C.M.

Article Type: Research Article

Abstract: There is relatively little research pertaining to neuropsychological assessment of Spanish-speaking individuals with intractable temporal lobe epilepsy (TLE). The current study examined verbal and visual memory performances in 38 primarily Spanish-speaking patients with TLE (Right = 15, Left = 23) of similar epilepsy duration to determine if lateralizing differences can be found using verbal and nonverbal memory tests. On a test specifically designed to assess auditory learning and memory among Spanish-speaking individuals, the Spanish Verbal Learning Test (SVLT), patients with left TLE performed significantly worse than patients with right TLE. In contrast, no significant differences in story or visual memory …were seen using common memory tests translated into Spanish. Similar to what has been found in English speakers, these results show that verbal memory differences can be seen between left and right sided TLE patients who are Spanish-speaking to aid in providing lateralizing information; however, these differences may be best detected using tests developed for and standardized on Spanish-speaking patients. Show more

Keywords: Temporal lobe epilepsy, memory, Spanish-speakers

DOI: 10.3233/NRE-2009-0457

Citation: NeuroRehabilitation, vol. 24, no. 1, pp. 87-93, 2009