It is important to have a thorough understanding of the neuroepidemiology of central nervous system disorders to incorporate cultural diversity into the neurorehabilitation care of patients with these disorders. This chapter emphasizes traumatic brain injury and stroke two of the most common neurological disorders seen in neurorehabilitation facilities and services. It begins by reviewing existing neuroepidemiological studies that include representative samples of individuals from different cultures. 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.

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.

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 chapter explores multicultural variables to consider when providing neurorehabilitation services to inpatients in an acute neurorehabilitation center. It presents case studies of inpatients who have recently suffered brain injuries, strokes, and other conditions that have led to acute and/or chronic disability and potential cognitive changes. The acute and/or chronic disability and potential cognitive changes are in need of physical, occupational, and speech therapy to address declines in functioning due to cognitive changes and physical disability, as well as medical treatment to manage secondary conditions. The chapter then looks at several cases that involve clinicians working with patients and families from diverse backgrounds and of varying English-speaking abilities. It examines how culture, education, religion, and language may affect the clinical evaluations of patients in acute neurorehabilitation settings and at a clinician’s experience in providing multicultural neurorehabilitation.

Cultural beliefs have a tremendous influence on a person’s perception of disability. Viewing culture as a discrete system that encompasses interconnected components should enhance the cultural competence in rehabilitation centers. The manifold layers of culture include the: culture of origin, mainstream culture, brain injury culture, therapists’ culture, and the culture of the neurorehabilitation program. With the increased emphasis on cultural sensitivity, health care training programs have been focusing on enhancing the cultural sensitivity and competency of health care providers. These health care provider aspects also very much apply to the therapists in neurorehabilitation settings. The milieu-oriented neurorehabilitation program creates a unique culture that is different from other cultural influences encountered by an individual. Neuropsychologists in the Center for Transitional NeuroRehabilitation (CTN) milieu program play an important role in fostering a culturally sensitive and competent interdisciplinary team and in translating cultural considerations into concrete treatment approaches and goals.

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.

This chapter examines disability identity as a unique area in which the clinician working with individuals with brain injuries must become culturally competent. It begins with an overview of the disability rights movement and its influence on disability identity as a construct. Legislative and regulatory scaffolding for societal responsiveness to and acceptance of individuals with disability exists, but it requires further refinement. Social agencies have been created to support the process of adaptation to disability culture and are attempting to foster development of disability identity through networking resources for employment and socialization. The chapter then discusses critical issues in cultural competence and how these intersect with ethical practice in working with individuals and families with neurorehabilitation needs. It concludes with suggestions regarding cultural competence that transcend individual diagnoses.

This chapter explains the importance of using a certified medical interpreter and how to appropriately use this service in a hospital setting. An interpreter needs to understand cultural beliefs and be able to effectively communicate the information between two individuals who are likely from different cultures. The trained and culturally sensitive medical interpreter can communicate verbal information and serve as a cultural bridge between two individuals who could have very different beliefs about everyday interactions with others. Culturally competent medical translators pay close attention to both the verbal nuances of language and the nonverbal norms and customs that may be significant in a health care interaction. The chapter also discusses the importance of patient perception on follow-through of treatment, the idea of cultural competence, and how to appropriately communicate and use interpreter services. It provides some case examples of successful and unsuccessful interpretation.

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.

This chapter explores the concept of microaggressions in neurorehabilitation settings, describes their potential impact on the rehabilitation process, and offers recommendations on how to address and potentially mitigate infractions when they do occur. It illustrates different types of microaggressions that might transpire in neurorehabilitation settings. Providers in these settings may benefit from cultural competency training to develop a greater appreciation for how microaggressions may impact the quality of their work with ethnic minorities, detract from the working alliance, and limit therapeutic success. Increased familiarity with factors that might contribute to microaggressions may help providers better identify them and intervene in a timely and therapeutically helpful manner. However, given that a defining feature of microaggressions is their unintended nature, neurorehabilitation and other clinical settings would be well advised to establish policies that encourage critical self-examination and dialogue regarding specific issues of race, ethnicity, and culture without fear of harsh reprimand.