Chapter 13: Neurological System

Background

Neurological diseases, disorders, and injuries can be catastrophically life-changing for individuals and their families. When individuals survive traumatic neurological accidents, they may require lifelong, expensive support and treatments. Individuals with a lower socioeconomic status will undoubtedly struggle far worse than those from middle- and upper-class families.

Social Determinant Considerations and Culturally Responsive Practice Points for Health Care Providers

Cerebral Vascular Accidents

In 2020, cerebral vascular accidents (CVAs) were determined to be the fifth leading cause of death in both Canada and Saskatchewan (Government of Saskatchewan, 2022). The risk factors for CVAs include hypertension, diabetes mellitus, dyslipidemia, cardiac disease, obesity, family history, alcohol use, and cigarette smoking. Certain racialized groups are at a higher risk of experiencing a stroke due to a higher prevalence of risk factors. In their study, Owolabi et al. (2022) found that stroke patients of African descent had a significantly higher prevalence of hypertension and diabetes mellitus. This study also found that stroke patients of European descent had higher frequencies of alcohol consumption, cigarette smoking, and physical inactivity (Owolabi et al., 2022).

The World Health Organization (WHO, 2015) stated that 80% of premature heart attacks and strokes are preventable. According to the WHO (2015), health care providers (HCPs) can work with patients in the community and hospital settings to discuss prevention techniques such as:

• eating a balanced diet
• participating in regular physical activity
• avoiding tobacco use
• monitoring blood pressures on a semi-regular basis
• accessing annual health checks to monitor lab values such as blood sugar and blood lipid levels

Spinal Cord Injuries

The WHO (2013) stated that up to 500,000 people suffer from spinal cord injuries (SCIs) globally each year. Most SCIs occur following preventable events such as motor vehicle accidents, falls, and violence (WHO, 2013). Patients who suffer from SCIs are more likely to die prematurely, and individuals of lower socioeconomic status have even worse survival rates (WHO, 2013).

• A Saskatchewan study carried out by Ahmed et al. (2020) found that Indigenous Peoples are more likely to experience traumatic SCIs. They are also more likely to have extended hospital stays and fewer community supports upon discharge. Indigenous patients have extensive barriers to discharge, including a lack of funding, lack of access to care (especially on reserves), and minimal support for home modifications (Ahmed et al., 2020).
• Another important disparity that Ahmed et al. (2020) discovered in their study is that injuries of Indigenous people often occur in more remote locations. Therefore, acute care treatment is often delayed. The delay in detection, management, and surgical treatment of Indigenous patients is a concerning trend (Ahmed et al., 2020).
• The study by Ahmed et al. (2020) also states that individuals of a lower socioeconomic status also experience higher levels of isolation, as they have less access to resources to pursue leisure activities, join clubs, order specialized equipment, and arrange wheelchair transportation. Furthermore, financial strain paired with SCIs is consistently related to struggles with mental health.
• The study by Khazaeipour et al. (2015) found that patients who have a lower socioeconomic status are at a higher risk of experiencing depression following a spinal cord injury resulting in para or quadriplegia. Furthermore, patients who are cared for by family other than a spouse have a higher instance of depression (Khazaeipour et al., 2015).

The WHO (2013) suggested the following measures for improving the survival, health, and participation for individuals with SCIs:

• timely pre-hospital management
• quick recognition of SCIs, with appropriate stabilization of injuries
• timely access to acute care and surgical treatment
• access to ongoing health care, education, and products to reduce infection risk and improve quality of life
• access to skills rehabilitation centers
• provision of mental health services to treat the psychological aspects of the injuries, such as post-traumatic stress disorder and depression
• access to assistive devices to improve independence and quality of life

Brain Injuries

Each year in Saskatchewan, approximately 2,200 individuals sustain an acquired brain injury (ABI). Approximately 150 of these will require lifetime support for their injuries (Government of Saskatchewan, n.d.). Traumatic brain injuries (TBIs) are generally caused by accidents such as falls, motor vehicle accidents, and violent events (Saadi et al., 2021). Incidences of TBIs are higher among men than women, but racial differences are unfortunately less studied (Saadi et al., 2021). However, emerging research shows that racial and ethnic minorities do have a greater incidence of TBIs than White individuals (Brenner et al., 2020).

• In a study by Brenner et al. (2020), it was determined that more Black individuals sustained moderate to severe traumatic brain injuries.
• Brenner et al. (2020) also determined that White individuals were more likely to have better support in place after experiencing a traumatic brain injury. They were also more likely to have their disabilities recognized, regardless of functional deficit. There are discrepancies noted in the prevalence, study, and treatment of TBIs in White versus non-White individuals (Brenner, et al., 2020).

More research is needed to better understand the racial differences in incidents of TBIs. It is imperative to understand these connections in order to improve the care provided to all patients.

References

Ahmed, S. U., Humphreys, S., Rivers, C., Jeffrey, M., & Fourney, D. R. (2020). Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study. Canadian Journal of Surgery, 63(3), E315. DOI: 10.1503/cjs.012819

Brenner, E. K., Grossner, E. C., Johnson, B. N., Bernier, R. A., Soto, J., & Hillary, F. G. (2020). Race and ethnicity considerations in traumatic brain injury research: incidence, reporting, and outcome. Brain Injury, 34(6), 801–810. https://doi.org/10.1080/02699052.2020.1741033

Government of Saskatchewan (2022, April 13). Government increases commitment to supporting stroke awareness campaign [Press release]. https://www.saskatchewan.ca/government/news-and-media/2022/april/13/government-increases-commitment-to-supporting-stroke-awareness-campaign

Government of Saskatchewan (n.d.). Acquired brain injury services. https://www.saskatchewan.ca/residents/health/accessing-health-care-services/health-services-for-people-with-disabilities/acquired-brain-injury-services

Khazaeipour, Z., Taheri-Otaghsara, S. M., & Naghdi, M. (2015). Depression following spinal cord injury: Its relationship to demographic and socioeconomic indicators. Topics in Spinal Cord Injury Rehabilitation, 21(2), 149–155. DOI: 10.1310/sci2102-149

Owolabi, M., Sarfo, F., Howard, V. J., Irvin, M. R., Gebregziabher, M., Akinyemi, R., . . . & Howard, G. (2017). Stroke in indigenous Africans, African Americans, and European Americans: Interplay of racial and geographic factors. Stroke, 48(5), 1169–1175. DOI: 10.1161/STROKEAHA.116.015937.

Saadi, A., Bannon, S., Watson, E., & Vranceanu, A. M. (2021). Racial and ethnic disparities associated with traumatic brain injury across the continuum of care: a narrative review and directions for future research. Journal of Racial and Ethnic Health Disparities, 1–14. https://doi.org/10.1007/s40615-021-01017-4

World Health Organization (2013). Spinal cord injury [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury