Community Integration Research: Traumatic Brain Injury & Ethnic Differences

Perceptions of Community Integration in an Ethnically Diverse Sample.

Sander AM, Pappadis MR, Clark AN, Struchen MA.  Department of Physical Medicine and Rehabilitation, Baylor College of Medicine (Drs Sander, Clark, and Struchen); Harris County Hospital District (Dr Sander); Brain Injury Research Center, TIRR Memorial Hermann (Drs Sander, Clark, and Struchen and Ms Pappadis); and Graduate College of Social Work, University of Houston (Ms Pappadis), Houston, Texas.  J Head Trauma Rehabil. 2010 Jul 13. [Epub ahead of print]

OBJECTIVE: To investigate the meaning of community integration in an ethnically diverse sample.

DESIGN: Prospective study using mixed qualitative and quantitative methods.

SETTING: County level I trauma center.

PARTICIPANTS: Fifty-eight blacks, 57 Hispanics, and 52 whites with traumatic brain injury living in the community 6 months postinjury.

MAIN MEASURES: Open-ended interview questions and a questionnaire assessing perceived importance of community integration activities.

RESULTS: Resulting themes indicated that feeling part of the community was related to type and quality of community relationships, perceived safety and security, active involvement, feeling included and respected, and familiarity with the community. Themes regarding barriers included the following: environmental and social barriers; injury-related cognitive and physical changes; dissimilarities to others; relocation; and financial issues. Blacks and Hispanics placed more emphasis on domestic activities than did whites.

CONCLUSIONS AND IMPLICATIONS: Feeling integrated into the community relates to aspects of the environment, as much as to involvement in specific activities. Environmental barriers can be just as important as injury-related changes. Different racial/ethnic groups place different value on participation activities. The results emphasize the importance of assessing subjective aspects of community integration, individualizing rehabilitation goals, and intervening in the environment to facilitate participation.

Racial and ethnic disparities in functional, psychosocial, and neurobehavioral outcomes after brain injury.

Arango-Lasprilla JC, Kreutzer JS.  Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23219, USA.  J Head Trauma Rehabil. 2010 Mar-Apr;25(2):128-36.

Because of the growing minority population in the past 3 decades in the United States and the increasing numbers of individuals who sustain a traumatic brain injury (TBI), researchers and clinicians have started to pay more attention to the role of race and ethnicity in outcomes after TBI, with the goal of better serving this population. The aim of this article is to review the literature on the influence of race/ethnicity on functional, psychosocial, and neurobehavioral outcomes after TBI. Specifically, the following 8 areas of outcomes will be examined: (1) treatment outcomes, (2) neuropsychological outcomes, (3) employment/productivity, (4) functional outcomes, (5) community integration, (6) marital status, (7) quality of life/life satisfaction, and (8) emotional/neurobehavioral outcomes. To conclude this review, suggestions for improvements in professional competency, research, systems of care, and training are proposed.

Objective and subjective assessment of long-term community integration in minority groups following traumatic brain injury.

Mascialino G, Hirshson C, Egan M, Cantor J, Ashman T, Tsaousides T, Spielman L.  Mount Sinai School of Medicine, Department of Rehabilitation Medicine, New York, NY, USA.  NeuroRehabilitation. 2009;24(1):29-36.

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.