The multicultural movement in counseling and psychology has begun to provide scholars and practitioners with contextually relevant, systems-based ecological approaches to counseling as alternatives to the traditional theoretical models of human behavior and intervention that are based on Western dominant culture. This chapter provides awareness of the complexity of multicultural issues among individuals with disabilities and discusses culturally sensitive strategies to work with people with disabilities (PWDs). It reviews legislative mandates related to diversity and multiculturalism in rehabilitation and addresses the relationship between disability and culture in the scope of rehabilitation practice. The chapter introduces multiculturalism and multicultural counseling models as a therapeutic framework and provides guidelines to help psychologists increase their cultural sensitivity. It also provides strategies to work with individuals with disabilities from minority backgrounds.
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This chapter describes spirituality, religiousness, and indigenous/folk belief systems in a multicultural context. The majority of religion and health research to date has primarily focused on persons with life-threatening diseases and conditions, as persons facing death may use religion to help them accept their condition, come to terms with unresolved life issues, and prepare for death. In contrast, rehabilitation patients who suffer acute injuries or chronic progressive disorders may live for decades after the onset of their condition and use religious and spiritual resources to help them cope with their disability, give new meaning to their lives based on their newly acquired disabilities, and help them to establish new goals. The chapter then explains the different ways rehabilitation psychologists can address religious and spiritual beliefs with individuals from different faith traditions.
Rehabilitation providers who work with service members and veterans face significant cultural challenges that may impact the rehabilitation process. Part of this challenge is maintaining an awareness that any individual engaged in rehabilitation could have had prior military service that could impact rehabilitation care. This chapter provides an overview of military culture, including specific aspects of this culture that may affect the rehabilitation process, the various co-occurring disorders that are common in military/veteran populations, and resources and programs that are particularly useful when working with service members and veterans. Service members and veterans face unique challenges and stressors that are over and above some of the routine sources of stress that others face in the workplace. Stress can come from participating in combat, including exposure to traumatic events, risk of injury, and fears about deployment.
- Go to chapter: The Effects of Acculturation on Neuropsychological Rehabilitation of Ethnically Diverse Persons
This chapter explores the impact of acculturation on three diverse U.S. populations: Hispanics, represented by a specific focus on Mexican immigrants; African Americans; and Native Hawaiians. It reviews relevant acculturation theories developed to explain cultural and psychological changes occurring in racial and ethnic populations in the United States as a result of interactions with the majority racial/ethnic population. The chapter presents Berry’s model of acculturation in particular, as a helpful theoretical model for clinicians working in neuropsychological rehabilitation to use for understanding psychological issues related to acculturation pressures. It also highlights the unique historical context of acculturation for each ethnic group and its effect on their acculturation experience as well as mental and physical health outcomes. The chapter provides rehabilitation psychologists and counselors with culturally relevant assessment and intervention recommendations for working with ethnically diverse clients.
- Go to chapter: Cultural Variables and the Process of Neuropsychological Assessment in the Neurorehabilitation Setting After Brain Injury
Cultural Variables and the Process of Neuropsychological Assessment in the Neurorehabilitation Setting After Brain Injury
Neuropsychological assessment involves the administration of a battery of tests that assess a variety of cognitive domains to obtain a clinical picture of brain behavior relationships. Within the inpatient rehabilitation setting, neuropsychologists often perform various functions, including neuropsychological assessment, psychotherapy, and assistance with adjustment issues for patients and their families. This chapter discusses some of the common cultural issues that impact neuropsychology in an inpatient rehabilitation setting. It focuses on potential sources of bias that can threaten the validity of neuropsychological tests. The chapter also examines the process of the neuropsychological evaluation within the inpatient setting when working with individuals from diverse cultural backgrounds. It deals with a complex composite of sociodemographic factors that include education, socioeconomic status (SES), race, ethnicity, language, and worldview, all of which interact with one another to influence brain-behavior relationships.
This book focuses on the key issues surrounding multicultural neurorehabilitation for a wide range of health care professionals. The study of traumatic brain injury has seen a clear evolution in the sophistication, breadth, and depth of findings concerning neuroepidemiology as it affects racial and ethnic minorities. As large-scale epidemiological studies increasingly include and distinguish individuals of color and linguistic minorities together with religion, sexual orientation, physical disabilities, place of residence, and key socioeconomic variables that interact with race/ethnicity, more information will be available to make changes in policy, training, and clinical service delivery. Neuropsychological assessment involves the administration of a battery of tests that assess a variety of cognitive domains to obtain a clinical picture of brain behavior relationships. Within the inpatient rehabilitation setting, neuropsychologists often perform various functions, including neuropsychological assessment, psychotherapy, and assistance with adjustment issues for patients and their families. The book discusses some of the common cultural issues that impact neuropsychology in an inpatient rehabilitation setting. Considerations of race and ethnicity, disability culture, military and veteran culture, and cultural aspects of religiousness and spirituality are all considered in the book. The authors in the book wrote from their own perspectives as clinicians and researchers, representing diverse cultural backgrounds and neurorehabilitation contexts and roles. Hopefully, the book will generate more discussion, research, and literature on multicultural neurorehabilitation.
Psychiatric disability refers to a psychiatric disorder associated with functional limitations that prevent achievement of age-appropriate goals. The nomenclature and diagnostic criteria for psychiatric disabilities vary widely, however, across the mental health, rehabilitation, and social security disability systems. Common mental disorders refer to psychiatric disorders that are less disabling than serious mental illness but still impact role functioning. Depression is probably the widest-ranging psychiatric disorder in terms of severity and duration. Substance abuse disorder is among the most common co-occurring disorders in all psychiatric disabilities, affecting 50" of people with psychiatric disabilities at some point in their lifetime. Anxiety disorders are highly comorbid with other psychiatric diagnosevs, including other anxiety disorders, mood and eating disorders, and schizophrenia spectrum disorders. Victimization of people with psychiatric disabilities is a serious public health problem, as they are 11 times more likely to be victimized by violence and crime than the general population.
This chapter addresses the medical, physical, neurological, psychological, social, and vocational aspects of spinal cord injury (SCI) medicine. SCI is often associated with risk-taking behavior. The prevalence of alcohol abuse is high when compared with that of the general population. Injuries involving the cervical and thoracic spinal cord have a deleterious effect on the respiratory system. As ventilatory demand increases with activity, accessory muscles, innervated by segments of the thoracic and cervical cord, are recruited to aid in inhalation and exhalation. A spinal cord injury below the twelfth thoracic vertebrae may damage the defecation reflex and cause paralysis of the anal sphincter muscle. Through proper medical management, psychosocial support, and rehabilitation therapies as well as the patient’s motivation and family/caregiver’s participation, it is possible for a person with SCI to pursue a productive and satisfying life.
The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.
Neuromuscular disorders are a complex and heterogeneous group of disorders that ultimately impair the general function of the skeletal muscles. Neuromuscular disorders include disorders of the peripheral nerves, plexuses, spinal roots, motor neurons, neuromuscular junctions (NMJs), and muscles. The cornerstone of management for patients with neuromuscular disorders is rehabilitation. An effective rehabilitation program is critical not only for maintaining a patient’s quality of life but also for optimizing one’s physical and psychosocial function. Botulism is a presynaptic disorder of neuro-muscular transmission. There is a variety of therapeutic and cosmetic uses of botulinum toxin. In neuromuscular disorders it is frequently used to treat spasticity and sialorrhea. Neuromuscular electrical stimulation (NMES) is widely used in rehabilitation to prevent disuse atrophy and recover muscle mass and function in immobilized patients. There is growing evidence of safety and benefit of NMES use in many of the inherited myopathies.