vocational rehabilitation outcomes for native american … · vocational rehabilitation outcomes...

Vocational Rehabilitation Outcomes for Native American and Alaskan Native Individuals with Traumatic Brain Injury

Presenters: Franklin J. Elliott (LU-Fellow)

Dr. Priscilla R Sanderson (Mentor) & Dr. Myra Rosen Reynoso (Mentor)

September 28-29, 2017 Atlanta Georgia

Franklin J. ElliottAssociate Professor: ECME (AS & BS)

Navajo Technical University: Chinle Instructional SiteFaculty Chair

Presentation Objectives

Establish a greater understanding of with is Traumatic Brain Injury (TBI).

Identify services, education, and training provided for Native Americans & Alaskan Natives.

Present historical data of TBI

LU-RRTC State-of-the-Science ConferenceSeptember 28-29,2017 Atlanta Georgia

BACKGROUND

LU-RRTC State-of-the-Science ConferenceSeptember 28-29, 2017, Atlanta Georgia

Research Questions

1. Is there a difference in reasons for unsuccessful closures for American Indian/Alaska Natives with TBI?

2. Is there a difference in acceptance rates for VR services among American Indian/Alaska Natives with TBI?

3. What are the obstacles in providing an effective VR?

LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia

METHOD

The focus of this analysis is on the Native American and Alaskan Native population with TBI.

A literature review was conducted in examining the breath of what is TBI.

A literature review was conducted to understand the process of neuroplasticity in relations to TBI.

Examination of Historical Data and Trends

An analysis of the RS-911 data to determine the Amount of VR Services Provided by Race/Ethnicity and Cross-tabulation of Race/Ethnicity by Reason of Closur


KEY INFORMANT CHARACTERISTICS Amount of VR Services Provided by Race/Ethnicity


KEY INFORMANT CHARACTERISTICS Amount of VR Services Provided by Race/Ethnicity)


Fuentes, M. M., Jimenez, N., Apkon, S. D., & Ravara, F. P. (2016). Functional outcomes during inpatient rehabilitation of American Indian and Alaska

Native children with traumatic brain injury. Journal of Pediatric Rehabilitation Medicine. DOI: 10.3223/PRM-160376.

KEY INFORMANT CHARACTERISTICS Cross-tabulation of Race/Ethnicity by Reason of Closure


Fuentes, M. M., Jimenez, N., Apkon, S. D., & Ravara, F. P. (2016). Functional

outcomes during inpatient rehabilitation of American Indian and Alaska Native

children with traumatic brain injury. Journal of Pediatric Rehabilitation Medicine.

DOI: 10.3223/PRM-160376.

KEY INFORMANT CHARACTERISTICS Demographic Information


Dillahunt-Aspillaga, C., Smith, T. J., Hanson, A., Ehlke, S., Stergiou-Kita, M., Dixon, C. G., & Quichocho, D. (2015). Exploring vocational evaluation practices following traumatic brain injury. Behavioural Neurology, doi:10.1155/2015/924027

KEY INFORMANT CHARACTERISTICS Demographic Information


Traumatic Brain Injury Among American Indians/Alaska Natives — United States, 1992–1996. (2002). Morbidity and Mortality Weekly Report, (14), 303.

External Cause:

Unspecified: Recreational, at home incidents, Others: unreported but later referred/reported

Regions:Indian Health Services Provided: Southwest Region

RESULTS

Type here


Research Question Identified Challenges

1. Is there a difference in reasons for unsuccessful closures for American Indian/Alaska Natives with TBI?

▪Return to work is identified as a complex and challenging process due to injury.

▪Although individuals are given support for rehabilitation•Employment rates are lower •Need to understand the key processes and relevant factors important for a thorough and rigorous vocational evaluations.

•Further research is needed to formally examine the success for the framework among a diverse group of vocational rehabilitation providers.

•Place on Physical Theory appointments and end after or partial visits completed.

•Referred by medical providers to SSDI

RESULTS (continued)

Research Question Identified Facilitators

2. Is there a difference in acceptance rates for VR services among American Indian/Alaska Natives with TBI?

Lack of FundingIndividual and Family

Lack of PreventionBy local, State, Federal agencies

Lack of IHS servicesrehabilitation & treatment

Lack of Agency Visibilitystate, Federal, National agencies

Lack of Culture and Spiritual Care for Brain Injury


Research Question Identified Facilitators

3. What are the obstacles in providing an effective VR?

▪ TBIs among AI/NA have serious consequences for patients, their family, and health-care delivery systems.

▪Number of hospital days with TBI▪Lost of quality of life▪Physical, cognitive, and psychosocial impairments that require long-term rehabilitation therapy.

▪Local medical services and rehabilitation service are limited/distance▪Transportation to and from treatment centers are limited▪Lack of TBI knowledge of the people and providers▪TBI hospitalizations among AI/AN might be underreported because of use of non-IHS or tribal facilities ▪Medicare, Medicaid, or private insurance might not cover▪Access to advanced emergency medical care due to rural areas – limit the chances of survival▪Risk taking behaviors (not all is seen or reported)▪Alcohol and Drug/substance abuse (meth)▪Suicide

RESULTS (continued)


Translations/Recommendations for Future Research Leaders


Strategies Translations/Recommendations

▪ Understand of Neuroplasticity

•The influence with sensory development and learning to reformat and reestablish neural pathways. Learn alternative functions & operations.

▪Education of family and friends on TBI and recovery procedures.

•Provide training to understand what TBI is and how to cope with training and rehabilitation at home on a daily basis.

Translations/Recommendations for Future Research Leaders


Strategies Translations/Recommendations

▪ Understand of TBI •Further research is needed to formally examine the success

▪Preventive Measures •Alcohol /Substance Abuse•Suicide

▪Examine sensory development processes

•Central nervous system compensation linked to improved rehabilitation •(triggers compensatory neural plasticity)

Knowledge Translation Resources & Deliverables

TBI Research

Catroppa, C., Anderson, V. A., Morse, S. A., Haritou, F., & Rosenfeld, J. V. (2008). Outcome and Predictors of Functional Recovery 5 Years Following Pediatric Traumatic Brain Injury (TBI). Journal Of Pediatric Psychology, 33(7), 707-718. doi:10.1093/jpepsy/jsn006

Dillahunt-Aspillaga, C., Smith, T. J., Hanson, A., Ehlke, S., Stergiou-Kita, M., Dixon, C. G., & Quichocho, D. (2015). Exploring vocational evaluation practices following traumatic brain injury. Behavioural Neurology, doi:10.1155/2015/924027

Fuentes, M. M., Jimenez, N., Apkon, S. D., & Ravara, F. P. (2016). Functional outcomes during inpatient rehabilitation of American Indian and Alaska Native children with traumatic brain injury. Journal of Pediatric Rehabilitation Medicine. DOI: 10.3223/PRM-160376.

Peach, R. K. (2013). The cognitive basis for sentence planning difficulties in discourse after traumatic brain injury. American Journal Of Speech-Language Pathology, (2), 285. doi:10.1044/1058-0360(2013/12-0081)

Traumatic Brain Injury Among American Indians/Alaska Natives — United States, 1992–1996. (2002). Morbidity and Mortality Weekly Report, (14), 303.

Whitfield, H. W., & Lloyd, R. (2008). American Indians/Native Alaskans with Traumatic Brain Injury: Examining the Impairments of Traumatic Brain Injury, Disparities in Service Provision, and Employment Outcomes. Rehabilitation Counseling Bulletin, 51(3), 190-


References (continued)

Brain Injury Research

Finnanger, T. G., Olsen, A., Skandsen, T., Lydersen, S., Vik, A., Evensen, K. I., & ... Indredavik, M. S. (2015). Life after adolescent and adult moderate and severe traumatic brain injury: self-reported executive, emotional, and behaviouralfunction 2-5 years after injury. Behavioural Neurology, doi:10.1155/2015/329241

Hsieh, T., Kang, J., Lai, J., Huang, Y., Rotenberg, A., Chen, K., & ... Peng, C. (2017). Relationship of mechanical impact magnitude to neurologic dysfunction severity in a rat traumatic brain injury model. Plos ONE, 12(5), 1-18. doi:10.1371/journal.pone.0178186

Massenburg, B. B., Veetil, D. K., Raykar, N. P., Agrawal, A., Roy, N., & Gerdin, M. (2017). A systematic review of quantitative research on traumatic brain injury in India. Neurology India, 65(2), 305-314. doi:10.4103/neuroindia.NI_719_16

McInnes, K., Friesen, C. L., MacKenzie, D. E., Westwood, D. A., & Boe, S. G. (2017). Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. Plos ONE, 12(4), 1-19. doi:10.1371/journal.pone.0174847

Patel, A., Vieira, M. C., Abraham, J., Reid, N., Tran, T., Tomecsek, K., & ... Staton, C. A. (2016). Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review. Plos ONE, 11(9), 1-17. doi:10.1371/journal.pone.0161554


References (continued)


Brain Injury Research

Roy, A., Bernier, R. A., Wang, J., Benson, M., Jr.French, J. J., Good, D. C., & Hillary, F. G. (2017). The evolution of cost-efficiency in neural networks during recovery from traumatic brain injury. Plos ONE, 12(4), 1-26. doi:10.1371/journal.pone.0170541

Wilson, N. M., Gurney, M. E., Dietrich, W. D., & Atkins, C. M. (2017). Therapeutic benefits of phosphodiesterase 4B inhibition after traumatic brain injury. Plos ONE, 12(5), 1-30. doi:10.1371/journal.pone.0178013

von Steinbüchel, N., Real, R. L., Sasse, N., Wilson, L., Otto, C., Mullins, R., & ... Gibbons, H. (2017). German validation of Quality of Life after Brain Injury (QOLIBRI) assessment and associated factors. Plos ONE, 12(5), 1-22. doi:10.1371/journal.pone.0176668

FUNDING AGENCY ACKNOWLEDGEMENT

The contents of this presentation were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RT5024-01-00). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this presentation do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

Contact Information

Rehabilitation Research and Training Center (RRTC)

On Research and Capacity Building for Minority Entities

6700 N. Martin Luther King Ave.

Oklahoma City, Ok. 73111

Phone: (855) 497-5598

Fax: (405)962-1638

RRTC email: [email protected]

RRTC Website: www.langston.edu/capacitybuilding-rrtc

mailto:[email protected]

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