Brain Injury and Cultural Background

This neuropsychologist shares his experience and advice about culture, ethnicity, and brain injury rehab.

Transcript of this video.

There are certain senses and broad theoretical senses in which cultural differences don't make a big difference in how I teach rehab to home kinds of things, in the sense of certain principles. The sort of thing of the zone of recovery that I talked about before, the idea that we're working on the person gradually learning how to do things. Some cultures and some families are more readily oriented to that sort of thing than others, and we may have to go back to first principles and explain and work that through with people earlier, for more time. Also, people from certain cultures will have different explanations or different ideas as to what might have caused this problem and what is going to be helpful. And so we have to spend a lot of time, first learning about the culture in general that the person is coming from, and then understanding where that person and their family is, with respect to that culture of origin because many such people are immigrants in our country, and they're in a process. They're somewhere from in between their culture of origin and our host culture here. And where they are and what their goals are, in terms of their process of being here, is very different from one family to another, even within families. You may have a very common kind of thing, for instance, is that the parents have come too late to learn English very well, but the kids are picking up English quite easily. And so they're in two different positions with regard to their language, and acculturation and their understanding of how we do things here and so on, and maybe even in their own goals. We try find that out about each family member and where they are, so that what we do can be respectful of that and respectful of their understanding. Then we take that to see what their goals are going to be and where they want to-- what they're looking for in rehabilitation and try to tailor what we know how to do to help them arrive at what they want to arrive at. There are times when we might have to nudge that or massage that a bit to say to participate in that process acculturation, to say, "Well, yeah, we could do it this way, but that's not going to work here very well." (laughs) We may, to some small extent, be agents of cultural change when that is kind of part of the overall process of helping towards their goals that they may not be aware of. But that's not our job overall, only as it pertains to our rehabilitation goals. Certainly, we want to try to not just be respectful or tolerate of other cultures or perspectives, but to make use of and include and celebrate that in what we do. It's important for us to understand what are the community organizations, what are the activities that are really important to someone, and to work with them towards their goals of reincorporating into that. Now, that may include not only what they do to be able to fit in, but how they can understand how they fit there, and it may well include a reaching out to that community in a certain sort of way, so that setting, that can make a place for the person and allow them to function there. It may involve making a visit to the church, having a gathering of friends, going to the person's home and bringing other people around. Let me tell a story. I was working in the national rehabilitation hospital in Costa Rica, and a woman in the hospital who had an episode of anoxia, loss of oxygen, and she had 5 children, one of whom was a baby. She had returned home. She had a severe amnesia, and she had a severe lack of initiation. She just couldn't get herself going at things, which damage to a certain part of the brain can produce that. It wasn't depression. It wasn't that she didn't want to. It's that the starter was broken in the brain. It's like a car with a dead battery. What you can do with them is you can roll start them if you've got a standard transmission. You know--put it in gear, push it a little, and then pop the clutch, and then you get going, and that's the metaphor we often use for doing that. It's a kind of hard thing to grasp. We made a trip from the hospital, hospital bus, whole rehab team, 4-hour drive to her home, twice across the continental divide, and arrived at the home, and it was a kind of semi-rural neighborhood. Of course, they knew we were coming, when we got there. There was also a small rehab facility in the local town. We brought them over because they were going to do follow-up. There were about 15 or 20 of us professionals, and then the family and the neighbors started showing up. We had 30 people come, all squeezed into this living room. Everybody was part of the action. The extended family came from more of a distance and all of the neighbors who were going to be around. We gave explanations about this initiation and so on, and talked about what they could do to facilitate her being more active. Quite reasonably, in such a circumstance, they had hired someone to help out in the home. The person who was hired to help out in the home was on the model of--you know-- I'm a domestic servant. I'm here to do as much of the cooking and cleaning that I can to relieve her. We had to explain, "The more you can get her to do, the better," which is very much away from the model of what she thought she was hired to do, but, of course, her husband and the older kids were going to comment on this and the other family members had to know that we were talking about that, so that they didn't think that she was a bad employee. We demonstrated ways of doing that and what sorts of things would facilitate. Then we had local people that could follow-up with that instruction. But--you know--we got 30 people, a big community who were there, able to support her in that and those kinds of things. We never would've gotten 30 people to come 4 hours over the mountains to the hospital to learn all of those things. We might have tried to educate her husband and one or two other family members, so that they could say that, but it would've have come across with the same kind of authority for them and the same kind of impact for that family. Go there. Look at the context. See who you've got. When we were over there, we also learned some things that we might not have learned in the hospital, such as she would be sitting around all day doing nothing, and one day, there was thunder and a rainstorm starting to come. Suddenly, she jumped up out of the chair, ran outside to bring the laundry in off the line. We wouldn't learn that in the hospital, but their right stimulus was enough to get her moving and doing things. When you look at the context, when you go out and look at the context, you can learn things. You can collaborate until you arrive at something that is going to be more useful Take our knowledge, their knowledge, put it together.
Posted on BrainLine April 29, 2009.