How Does Brain Injury Impact American Indian and Alaska Native Children?

For years, researchers and medical professionals have studied the outcomes of brain injury care in order to identify critical factors that influence a patient’s recovery. Two such factors that have been examined to contribute to this include race and culture. Previous studies have shown that race may influence treatment outcomes post injury. This can be caused by service quality and quantity disparities, comprehension of injury and treatment processes, cultural expectation discrepancies, and differing perspectives about the impact of a health condition and its impact on an individual. In many studies, American Indian and Alaska Native populations are excluded or grouped into other racial categories, causing little to be known about the impact of traumatic brain injury (TBI) in these communities. Because of this, these populations have not been able to receive the same level of care as other groups. 

New Types of Therapy

There is a growing need for culturally competent therapy. One study involving Canadian First Nations elders found cultural differences in TBI treatment approach that may influence treatment outcomes. A person’s worldview of a disease or disorder may impact their expectations of treatment, which can impact their experience of disability in regards to their condition. For American Indian and Alaskan Native people, studies reveal that there are differing cultural expectations for service and treatment from the Western approach to TBI intervention. Because of these cultural differences experienced by adults, researchers believe such differences may be apparent for children. If children are not obtaining proper care, this can make recovery more challenging in both the short and long term. 

One study consisting of 114 American Indian and Alaskan Native children and 7,267 White children who had suffered a TBI examined the developmental functional quotients for the motor and cognitive domains of the FIM and WeeFIM assessments. Researchers used regression analysis to compare the two different cohorts of children. Factors examined included duration of the loss of consciousness, age, gender, year of discharge from rehabilitation, length of stay, developmental functional quotient, insurance coverage, and race. 

Race and Developmental Functions

Researchers found that race was not significantly associated with discharge developmental functional quotients. American Indian and Alaskan Native children with TBI did have significant differences in comparison to white children in regards to duration of the loss of consciousness, year of discharge from rehabilitation, length of stay, developmental functional quotient, and insurance coverage type. If children were discharged closer to the end of the study period, American Indian and Alaskan native children displayed higher cognitive functioning post discharge than white children. Further, researchers observed that the female gender was associated with higher cognitive functioning at discharge for white children but not for American Indian or Alaskan Native children. With a small sample size available for American Indian and Alaskan Native children, it is difficult to adequately compare this group of children to the general population. However, researchers hypothesize that American Indian and Alaskan Native children who experience more severe injuries may have limited support in regards to the distance of the location of clinical care in respect to their home, cultural factors, and potential lack of access to resources that may facilitate communication with family members. 


What does this mean for rehabilitation and other clinical professionals? Considering cultural attitudes towards therapy, disease and disorder, along with expectations of care can help you better serve your patients of diverse racial and cultural backgrounds. This is beneficial for patients of all ages, not just children. Access to healthcare and treatment remains a prevalent issue for certain cultures in society as well. Examining factors such as a patient’s home distance from treatment, the patient’s support system, and utilizing resources and education regarding their condition can also benefit your treatment approach with your patient. It is important to consider culture when treating patients, as cultural factors may impact the delivery and reception of care. 


Fuentes, M. M., Jimenez, N., Apkon, S. D., & Rivara, F. P. (2016). Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury. Journal of pediatric rehabilitation medicine, 9(2), 133–141.

Dustin Luchmee

Dustin was HappyNeuron's Product Specialist. With research experience in stroke, Dustin learned how a stroke can change someone's life. He also learned how different kinds of therapists can work together to help a person get better. He is passionate about neuro-rehabilitation and finding the active ingredients for effective therapy.

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