Communication Disorders In Multicultural Populations

1
Communication Disorders In Multicultural
Populations
2
Introduction

• There are few reliable data on the general
  prevalence or incidence of communication
  disorders among CLD populations in the US.
• Estimates are based on projections from data
  founded on the mainstream population (Battle,
  2000).
• The National Health Interview Survey indicates
  that there is a greater prevalence of
  communication disorders among racial and ethnic
  minorities than among white individuals (Benson
  Marano, 1994).

3
Introduction

• ASHA estimates that 10 of the US population has
  a disorders of speech, hearing, or language
  unrelated to the ability to speak English as a
  native language (Cole, 1989).
• Provided that the prevalence of communication
  disorders among racial and ethnic minorities is
  consistent with that of the general population,
  it is estimated that 6.2 million CLD Americans
  have a communication disorder.
• The Individuals with Disabilities Education Act
  (IDEA) Amendments of 1997 required that states
  report by race and ethnicity the number of
  preschool and school-aged children served in each
  disability category.

4
Percentage of Children Ages 6-12 Served by
Racial/Ethnic Composition and Disability 2003
5
Fluency Disorders

• Like most disorders that affect the human
  condition, stuttering is not restrained by
  geographic demarcations.
• Stuttering appears on every continent, in every
  country, in every corner of the globe.
• Cultural groups that have been studied include
  Native Americans, African Americans, Asians,
  Hispanics, West Indians, and Africans.
• Results of these studies generally suggest that
  cultural differences influence speech fluency.
• There are differences in perceptions, beliefs,
  values, and norms about speech fluency and
  stuttering among various cultural groups.

6
Fluency Disorders

• With the increase in ethnically diverse
  populations, it is possible that SLPs may assess
  and treat clients who stutter from many
  culturally diverse backgrounds.
• These clients may have beliefs and attitudes that
  are different from the SLPs who treat them
  (Bebout Arthur, 1997).
• Gathering information about stuttering in
  multicultural populations is challenging because
  each cultural group does not have a standard set
  of beliefs.
• Many different ethnic and culturally diverse
  groups have individuals who maintain their own
  attitudes, beliefs, views, and perceptions about
  stuttering (Leith, 1986).

7
Stuttering Prevalence in Most Recently Studied
Populations

• Only a few authors have discussed prevalence
  rates, and perceptions about stuttering.
• Proctor, Yairi, Duff, and Zhang (2008)
  investigated the prevalence of stuttering in a
  sample of 3,164 preschoolers.
• 81 children (2.56) were identified as exhibiting
  stuttering.

8
Stuttering Prevalence in Most Recently Studied
Populations

• Of the 2,223 African American subset, 58 (2.60)
  stuttered and of the 941 European American
  subset, 23 (2.44) stuttered.
• A Chi-square test indicated no significant
  difference between the two racial groups although
  the ratio for males to females in both
  populations was 21.
• Among Hispanic Americans, prevalence estimates of
  .29 (Madding, 1995) to .84 (Leavitt, 1974) have
  been reported, a figure below the estimated 1 in
  the general population.

9
Research From the Middle East

• Among Arab speakers, consanguinity (blood
  relationships) contributes to a variety of
  communication disorders.
• In a survey of parents of Israeli Arab children,
  25 of the respondents indicated that their
  children had a speech and language disorders
  (Jaber, Nahmani, Shohat, 1997).
• After evaluation by a speech-language pathologist
  (SLP), 31 of children from consanguineous
  marriages were affected as compared with 22.4 of
  children from nonconsanguineous marriages.
• The problems noted in the disorders subgroup
  included errors in articulation (48.0), poor
  language (18), poor voice quality (15.9)
  stuttering (13.6), and other problems (4.5).

10
Multicultural Perspectives on Stuttering

• There is insufficient and often conflicting
  research about multicultural perceptions about
  stuttering.
• The available research has been conducted mainly
  on broad categories within these cultural groups
  (e.g., Hispanic American college students,
  African American middle and high school
  students).
• Although SLPs can glean some specific information
  about perceptions of stuttering from these
  studies, it is important for SLPs not to
  generalize these perceptions to all individuals
  within a culture.

11
Multicultural Perspectives on Stuttering

• Other factors for SLPs to consider are age,
  education, acculturation, generation, gender, and
  length of stay in the United States.
• A few investigators have suggested that cultural
  variations in perceptions about stuttering exist
  among cultural groups.
• For example, Madding (1995) conducted a
  cross-cultural study with four ethnically diverse
  groups.
• He reported that Hispanic Americans have an
  overall relaxed and open feeling about stuttering.

12
Multicultural Perspectives on Stuttering

• African-Americans have gender differences in
  perceptions about stuttering.
• White non-Hispanics reported high levels of
  shame, fear, anger, rejection, and avoidance
  associated with stuttering.
• Asian-Americans were the least likely of the four
  cultural groups surveyed to marry or date a
  person who stutters.

13
Culturally Specific Perceptions

• Many different views about the causes of
  stuttering have been noted in the
  African-American culture.
• According to Robinson and Crowe (1998), some
  African Americans believe that stuttering may be
  caused if an infant looks in a mirror, a child
  gets a haircut before saying the first word, a
  child is bitten by a dog, a child is scared by a
  person or event, a child is tickled too much, a
  mother drops a baby, a mother sees a snake during
  pregnancy, or a mother eats improper foods while
  nursing.

14
Culturally Specific Perceptions

• Roesti and Tellis (2001) administered the
  Stuttering Inventory for African-American
  Students to African American middle and high
  school students and indicated that a majority of
  the respondents disagreed with many of the above
  perceptions.
• The African American students in this study also
  disagreed that scaring a person may cure
  stuttering and that after completing therapy a
  person who stutters should speak fluently.

15
Culturally Specific Perceptions

• A majority of the students, however, indicated
  that speech therapy may help a person who
  stutters and that the race of the SLP does not
  matter when treating African Americans who
  stutter.
• African American female students disagreed more
  than males about the causes of, cures for, and
  reactions to stuttering.
• Overall, African American middle and high school
  students indicated positive perceptions about
  persons who stutter.

16
Culturally Specific Perceptions

• Different views about stuttering have also been
  reported in the Hispanic American community.
• Madding (1995) indicated that some Hispanic
  Americans believe that stuttering could be caused
  by receiving the evil eye.
• Ness (1996) reported that some Hispanic American
  mothers
• believe that stuttering can be treated by seeing
  a curandero (folk healer), scaring a person,
  surgically cutting the tongue, putting a pencil
  under the tongue, putting a spoon in a persons
  mouth, seeking the help of a priest, and putting
  the persons head under water.

17
Culturally Specific Perceptions

• According to Tellis and Blood (2000), a majority
  of Hispanic American college students in their
  study disagreed with many of the previous
  results.
• Tellis and Blood also indicated that a majority
  of the Hispanic American students in their study
  disagreed that higher education is not as
  important for persons who stutter than for
  persons who do not stutter, persons who stutter
  should pursue careers that demand little
  speaking, parents should expect to see a lower
  level of performance in school from their
  children who stutter, and that stuttering is a
  bad habit that is learned in childhood.

18
Culturally Specific Perceptions

• The majority of the students also disagreed that
  stuttering could be caused by a severe fright,
  Gods will, bad luck or fate, parents putting
  pressure on their children to speak English as
  well as Spanish, switching from Spanish to
  English, and a lack of proficiency in English.
• Most of the students agreed, however, that
  stuttering could be caused by psychological
  problems and that speech therapy would help a
  person who stutters.
• There are limited data concerning Asian American
  perceptions about stuttering.

19
Culturally Specific Perceptions

• Bebout and Arthur (1992) indicated that some
  Chinese parents may not enroll their children who
  stutter in therapy because they believe that the
  child may not be trying hard enough and that the
  child may be less intelligent than other
  children.
• Bebout and Arthur (1997) also reported that some
  Chinese believe that persons who stutter can
  reduce the severity of stuttering by working
  harder in therapy.
• With the increase in this population in the
  United States, there is an acute need for more
  research within this population and other Asian
  American cultures.

20
Voice and Voice Disorders

• Voice is your acoustic identification (Aronson,
  1991).
• It is usually clearly identified in situations
  such as talking on the telephone and listening to
  others on the radio.
• Therefore, because of the distinctive acoustic
  identification of ones voice, a disorder in
  voice is easily and quickly identified.
• The acoustic identification differs from the
  voices of others of similar age, sex, and
  cultural groups.

21
Voice and Voice Disorders

• Voice quality change can occur with medical
  problems such as laryngitis, pharyngitis,
  allergies, sinus congestion, reflux of gastric
  acid into the larynx, shortness of breath due to
  chronic obstructive pulmonary disease, asthma,
  CVA or other neurological abnormalities,
  mechanical interventions (i.e., prolonged
  ventilator support), or various types of oral and
  laryngeal cancer.
• Voice quality change can occur after yelling at a
  ball game, cheering, or by excessive talking.
• Voice quality even changes, as you become older.

22
Voice and Voice Disorders

• Voice problems are not always visible
  abnormalities in the larynx.
• Voice disorders occur when the vocal folds
  present abnormal growths, movements, weaknesses,
  muscular tension and spasms, or inflammations due
  to a variety of underlying causes.
• Incidence of all vocal cord disorders among
  minority groups in the US is difficult to
  ascertain because no studies currently exist that
  are cross-sectional for race or ethnicity.

23
Incidence of Laryngeal Pathologies

• We can examine the incidence of laryngeal cancer
  in the US with a focus on AA and white adults,
  and the incidence of laryngeal pathologies in
  Asian, AA, and white children.
• Yang, Thomas, and Davis (1989), reported the
  incidence of laryngeal cancer by subsite for
  adult blacks and whites across gender, with ages
  ranging from less than 29 years to 29 years.
• Compared with white men, black men had a higher
  incidence of all subsite laryngeal cancers, most
  notably cancer of the glottis.

24
Incidence of Laryngeal Pathologies

• Similarly, black women had a higher incidence
  than white women of all subsite laryngeal
  cancers, except for the glottis.
• Recent national statistics also show that AA and
  American Indian women are at a greater risk for
  laryngeal cancer and have a lower 5-year survival
  rate than white women.
• The incidence of laryngeal pathologies in
  children was investigated by Dobres and
  colleagues (1990).
• Asian children constituted .02 of the subjects,
  black children 5, and white children 79.

25
Incidence of Laryngeal Pathologies

• Overall, the incidence of laryngeal pathologies
  was greater among the boys than the girls.
• Asian male to female incidence ratio was the
  greatest at 4.3 to 1.0, whites had the second
  greatest 1.8 to 1.0, and blacks had the lowest
  1.4 to 1.0.
• For all groups, the occurrence of subglottic
  stenosis was the highest.
• Vocal nodules were more prevalent in white boys
  as compared with white girls.

26
Incidence of Laryngeal Pathologies

• Vocal nodules were only slightly more prevalent
  in Asian boys than Asian girls.
• Among black children, girls showed a higher
  incidence of vocal nodules as compared to black
  boys.
• In the care of laryngomalacia, the incidence was
  higher among white boys than girls, but in blacks
  the pattern was reversed.
• Laryngomalacia was equally dispersed among Asian
  boys and girls.

27
Cleft Lip, Cleft Palate, Cleft Lip and Palate

• Vanderas (1987) examined the epidemiological data
  from both international and US studies to
  determine the incidence of cleft lip, cleft
  palate, and cleft lip and palate in blacks,
  American Indians, Chinese, and Japanese.
• The incidence of cleft palate in the US per 1,000
  population was highest for Chinese (4.04),
  second highest for American Indians
  (0.79-3.62), third highest for Japanese
  (0.82-2.41) and fourth highest for blacks
  (0.80-1.67).
• For Filipino births in Hawaii, the incidence was
  2.45 per 1,000.

28
Cleft Lip, Cleft Palate, Cleft Lip and Palate

• Puerto Ricans and Mexicans showed an incidence
  rangning from 0.42 to 2.27 with Puerto Ricans
  showing slightly greater incidence than Mexicans.
• Among blacks, the incidence of cleft palate
  tended to be greater than that of cleft lip and
  cleft palate, or that of cleft lip alone.
• For American Indians , Chinese, and Japanese, the
  incidence of cleft lip and palate tended to be
  grater than the incidence of cleft lip alone or
  cleft palate alone.
• The gender ratios for each racial group revealed
  that boys tend to have higher incidence of cleft
  palate than girls.

29
Cleft Lip, Cleft Palate, Cleft Lip and Palate

• Black boys showed a greater incidence for all
  cleft types than black girls.
• American Indian boys had a greater incidence for
  cleft lip with palate and cleft palate alone than
  American Indian girls.
• Both showed an equal incidence of cleft lip
  alone.
• The Chinese showed an unclear ratio on gender
  differences for cleft lip with palate, but boys
  showed a greater incidence of cleft palate alone
  than girls.
• Japanese boys showed a greater incidence of cleft
  lip and palate, but girls had a greater incidence
  of cleft palate alone.

30
Cleft Lip, Cleft Palate, Cleft Lip and Palate

• The prevalence of cleft palate and cleft lip with
  or without cleft palate was also studied in
  Israeli Arabs (Jaber, Nahmani, Shohat, 2002).
• In the sample of 1281 respondents, comprised of
  siblings and members of the parental generation,
  the overall prevalence rate for all 26 affected
  individuals was 1.6/1000.
• Four of these individuals had cleft palate only
  (0.24/1000) and 22 had cleft lip with or without
  cleft palate (1.36/1000)
• This study showed that the prevalence of facial
  clefting in an Israeli Arab community is
  consistent with that in the general population
  worldwide.

31
Voice Disorders and Health-Related Conditions

• According to the National Cancer Institute,
  overall cancer incidence rates are higher in men
  than women.
• Known risk factors for cancer include tobacco,
  alcohol, certain diet ingredients, and
  carcinogenic substances in the workplace.
• The breakdown by gender and racial grouping per
  100,000 population can be seen in the table that
  follows.

32
Voice Disorders and Health-Related Conditions
33
Hearing and Hearing Disorders

• According o the National Institute on Deafness
  and Other Communication Disorders (NIDCD, 1999),
  approximately 28 million individuals in the US of
  both genders and all races have a hearing
  disorders.
• According to the Gallaudet Research Institute
  (1999), 54.2 of deaf and heard of hearing
  children are racial and ethnic minorities.
• Hispanics constitute 20.4 of the children.
• Seventeen percent are African American, 4.2
  Asian and Pacific Islander, .08 American Indian,
  and another 3 are other or multiethnic.

34
Etiology of Hearing Impairments

• For more than 30 years The Gallaudet Research
  Institute has conduced an annual survey to
  collect data about the etiology of hearing loss.
• For more than 10 years, heredity, meningitis, and
  prematurity have been identified as the three
  primary causes of hearing loss across all racial
  and ethnic groups.
• African American and Latino children have been
  disproportionately represented the categories of
  prematurity and meningitis.
• African American children have been
  disproportionately represented also among case of
  cytomegalovirus.

35
Etiology of Hearing Impairments

• Lower birth weight has been found to be directly
  related to a higher prevalence of bilateral
  sensorineural hearing loss, although the
  prevalence rates of hearing impairment for normal
  birth weight and borderline normal birth weight
  African American males was consistently higher
  than those for white children of both genders and
  African American females.
• For half of all infants born with
  severe-to-profound hearing loss, the hearing loss
  is due to hereditary factors, or it is genetic.

36
Etiology of Hearing Impairments

• The etiology of deafness was studied in 51
  families of 74 children attending classes for the
  deaf in the United Arab Emirates (UAE)
  (Al-Gazali, 1998).
• In 19 of the cases, deafness was part of a
  syndrome complex, whereas in the other 81 of the
  cases, only deafness was present.
• Overall there was a high prevalence of autosomal
  recessive deafness in both groups (92) with
  autosomal dominant deafness constituting 7 and
  sporadic deafness 1 of the deafness cases.

37
Etiology of Hearing Impairments

• The level of consanguinity in the study group was
  74.
• Moreover, 86 of the affected children had a
  positive family history for hearing loss.
• 54 of those had affected siblings, 50 of which
  had more than one affected sibling.
• However, almost all the parents were not aware
  that the deafness in their children was genetic
  in origin.
• Differences have been found in the incidence of
  otitis media among racial groups (National Center
  for Health Statistics, 1986).

38
Etiology of Hearing Impairments

• American Indians, Alaskan Eskimos, and Aborigines
  have the highest incidence rates, and African
  Americans have the lowest incidence rate among
  racial groups.
• The differences in the incidence of otitis media
  may be due in part to differences in the
  structure and function of the eustachian tube
  among racial groups.
• The shorter, straighter eustachian tube of
  American Indians is thought to be associated with
  a higher incidence of chronic middle ear disease,
  although not all American Indian tribes have the
  same incidence rates of otitis media nor do all
  people of African descent.

39
Etiology of Hearing Impairments

• Sickle cell disease (SCD) affects people of
  African descent in the US, African and the
  Caribbean.
• It also affects Israeli Arabs, Saudis, Turks,
  Greeks, Sicilians, Cypriots, and other races from
  areas adjacent to the Mediterranean Sea and
  Indian Ocean.
• SCD is a genetically inherited abnormality of the
  hemoglobin molecule.
• One in 375 American of African ancestry is born
  with sick cell anemia, and another 1 in 12
  carries one copy of the sickle cell gene.

40
Etiology of Hearing Impairments

• One of the clinical manifestations of the disease
  is that sickle shaped cells form clumps that
  occlude smaller veins and capillaries, possibly
  including those supplying blood to the cochlea.
• Forty states, Puerto Rico, and the Virgin Islands
  have a sickle cell screening program for newborn
  infants.
• There is evidence of peripheral and central
  auditory dysfunction in children with SCD.
• Permanent peripheral dysfunction is most likely
  to manifest itself as a high-frequency
  sensorineural hearing impairment.
• A large portion of individuals with HIV has head
  and neck symptoms.

41
Etiology of Hearing Impairments

• The most common otologic and audiologic
  manifestations of HIV and AIDS include Kaposis
  sarcoma of the ear, otitis caused by Pneumocystis
  carinii, eustachan tube obstruction caused by
  nasopharyngeal mass, serous otitis media,
  abnormal auditory response in the brain stem,
  sensorineural hearing loss, and facial palsy.
• A hearing impairment associated with HIV and AIDS
  is generally viewed as a secondary disorder
  arising from one of three primary etiologies
• effects of immunosuppression caused by HIV and
  direct infection of the hearing mechanism by HIV
  itself

42
Etiology of Hearing Impairments

• Other opportunistic infections that attach the
  hearing mechanism and
• Damage to the hearing mechanism due to toxic side
  effects of medications used to treat the HIV or
  any associated opportunistic infections.
• Lalwani and Sooy (1992) estimated that
  sensorineural hearing loss in HIV-positive and
  AIDS clients ranged from 20.9-49.
• The NIDCD (1989) estimated that 75 of adult AIDS
  clients and 50 of AIDS-related Complex (ARC)
  clients had clinical auditory system
  abnormalities.

43
Adult Neurogenic Disorders

• Stroke is lay term for describing a sudden
  diminution or loss of consciousness, sensation,
  and voluntary motion usually thought to be caused
  by the rupture or obstruction (as by a clot) of
  an artery of the brain.
• Cerebrovascular accident (CVA) is the medical
  term applied to a neurological event that has a
  vascular or circulatory origin.
• Each year, about 700,000 people experience a
  stroke.
• About 500,000 of these are first attacks, and
  200,000 are recurrent attacks.
• About 4.7 million stroke survivors (2.3 million
  men, 2.4 million women) are alive today.

44
Adult Neurogenic Disorders

• In 2002, stroke killed 275,000 people in 2002 and
  accounted for about 1 of 16 deaths in the United
  States.
• 28 of people who experience a stroke in a given
  year are under the age of 65 years.
• For people over age 55, the incidence of a stroke
  more than doubles in each successive decade.
• The chance of having a stroke before age 70 is 1
  in 20 for both genders.
• Stroke is more common in men than in women.
• In most age groups, more men than women will have
  a stroke in a given year.
• At older ages, the incidence is higher in women
  than in men.

45
Adult Neurogenic Disorders

• At all ages, more women (61.5) than men (38.5)
  die of stroke.
• Compared with Whites, young African Americans
  have 2-3 times the risk of stroke, and
  African-American men and women are more likely to
  die of stroke.
• Death rates by race/ethnicity were
• 87 for black males
• 78 for black females
• 60 for white males
• 59 for white females
• 52 for Asian/Pacific Islanders.
• 40 for Hispanics and
• 40 for American Indians/Alaska Natives.

46
Adult Neurogenic Disorders

• African-Americans are twice as likely as
  Euro-Americans to experience lacunar
  strokesthrombotic strokes in small blood
  vessels.
• For men age 20 and older, the age-adjusted
  prevalence of stroke is
• 2.2 for non-Hispanic white men
• 2.5 for non-Hispanic black men
• 2.3 for Mexican-American men
• For women age 20 and older, the age-adjusted
  prevalence for stroke is
• 1.5 for non-Hispanic whites,
• 3.2 for non-Hispanic blacks
• 1.3 for Mexican-Americans.

47
Adult Neurogenic Disorders

• The annual rates per 1,000 population of new and
  recurrent strokes for men ages 65-74 are
• 14.4 for non-blacks
• 11.9 for blacks
• 15.2 for American Indians
• The annual rates per 1,000 population for new and
  recurrent strokes for women ages 65-74 are
• 6.2 for non-blacks
• 16.1 for blacks
• 7.9 for American Indians
• Annual rates per 1,000 population of new and
  recurrent strokes for men and women ages 75-84
  are
• 24.6 for non-black men and 22.7 for non-black
  women
• 17.5 for black males and 22.4 for black women

48
Adult Neurogenic Disorders

• Annual rates per 1,000 population of new and
  recurrent strokes for men and women ages 85 and
  older are
• 27.9 for non-black men and 30.6 for non-black
  women
• 40.8 for black men 0.0 for black women
• Annual rates per 1,000 population of stroke in
  Japanese-American men also increases with
  advancing age. At ages 45-49 years, the
  incidence is
• 2.1 for total stoke
• 1.5 for thromboembolic stroke
• .04 for intracerebral hemorrhage
• At ages 65-68 years, the incidence is
• 8.2 for total stroke
• 6.6 for thromboembolic stroke
• 1.0 for intracerebral hemorrhage.

49
Adult Neurogenic Disorders

• An comparative epidemiological study of stroke,
  stroke patterns, clinical presentation, and risk
  factors in Saudis and non-Saudis was undertaken
  on patients admitted at King Abdul Aziz
  University from January 1997- January 2000 (Qari,
  2000).
• A total of 71 patients were admitted with stroke
  during the period of the study for an incidence
  of 3 of total admission to the medical unit.
• The mean age was 63 years with male female ratio
  of 3.41.

50
Adult Neurogenic Disorders

• Cerebral infarction was recorded in 80 of the
  cases.
• The most common presentation of stroke in Saudis
  was ischemia in 77 of the cases and hemorrhage
  in 20.5 of the cases. In non-Saudis, ischemia
  was diagnosed in 85 of the cases and hemorrhage
  in 7 of the cases.
• Of those hemorrhagic cases, 15 were
  intracerebral and 1 were subarachnoid attributed
  to aneurysm diagnosed by cerebral angiogram.
• Hypertension was the most important risk factor
  for ischemic and hemorrhagic stroke.

51
Adult Neurogenic Disorders

• Other risk factors were hyperlipidemia, diabetes
  mellitus, ischemic heart disease, atrial
  fibrillation and smoking.
• The pattern of stroke was judged to be similar to
  that reported for other parts of Saudi Arabia and
  other Arab countries.
• There are 5500 TBIs a day, and 137 resulting
  deaths.
• Head injury is the leading causes of death and
  disability in children and young adults in the
  U.S.
• It represents an estimated 13 of all injuries
  nationwide.

52
Adult Neurogenic Disorders

• Conservative estimates claim over 2 million
  individual experience a TBI each year.
• About 500,000 to 750,000 head injuries each year
  are severe enough to require hospitalization.
• About 75,000 to 100,000 result in death.
• The populations most likely to be affected by TBI
  are young children, young adults, and the
  elderly, who fall and suffer elder abuse.
• Throughout the world, the median age of TBI is
  18.

53
Adult Neurogenic Disorders

• Males are twice as likely as females to
  experience head injuries.
• The most frequently injured group of individuals
  is males between the ages of 15 and 24,
  constituting 50 of all head injury cases.
• Deaths due to head injuries represent 2 of all
  deaths, and 26 of all injury deaths.
• There is little information regarding the
  relationship between race and head injury.

54
Adult Neurogenic Disorders

• Generally, nonwhites are 49 more likely to have
  a head injury than whites.
• Incidence rates are as follows
• 209 per 100,000 whites
• 278 per 100,000 blacks
• 262 per 100,000 Hispanics
• Car crashes account for 50 of all TBIs.
• Alcohol plays a significant role in head injury
  accidents.
• About 56 of head injury survivors have a
  documentable blood alcohol level at the time of
  their accident.

55
Adult Neurogenic Disorders

• For children under 1 year of age, the most common
  etiology of head injury is abuse.
• Between the ages of 1 and 4 years, falls from 2'
  or more (windows, steps, trees, playground
  equipment) are most common.
• Ages 5-9 years experience the most car-pedestrian
  injuries.
• Ages 9-14 years experience the most
  sports-related injuries.
• For boys, the most dangerous sports are football
  and soccer.
• For girls, field hockey, basketball, and
  volleyball.

56
Adult Neurogenic Disorders

• Ages 15-19 years experience the most motor
  vehicle crashes (MVCs) due to poor judgment,
  alcohol, and/or drug use.
• In the USA only, violence from assaults and
  recreational beatings account for the highest
  statistics of head injury in the 10 largest
  cities in the US.
• Approximately 5 to 10 of the adult population
  age 65 years and older is affected by a dementing
  disorder with the prevalence doubling every five
  years after the age of 65.
• The largest group affected by dementia is over 85
  years of age with prevalence in this group
  reaching 50.

57
Adult Neurogenic Disorders

• Alzheimers Disease is the most common disorder
  causing cognitive decline in the elderly and
  accounting for 50-60 of all dementias.
• Dementia is also a component in 30 of person's
  with Parkinson's disease.
• Vascular or multi-infarct dementia accounts for
  15-20 of dementia patients.
• Primary risk factors for Alzheimers Disease are
  age and family history.

58
Adult Neurogenic Disorders

• Susceptibility genes, previous head injury with
  loss of consciousness, female sex and lower
  education level have also been implicated.
• Approximately 4 million Americans have
  Alzheimers disease.
• Approximately 19 million Americans say they have
  a family member with Alzheimers, and 37 million
  know someone with the disease.
• The Alzheimers Association also noted that the
  number of African Americans entering into age of
  risk (65 and older) is growing rapidly.

59
Adult Neurogenic Disorders

• This has considerable implications for the
  increased prevalence of Alzheimers disease among
  African Americans, largely attributed to the
  higher rate of diabetes and vascular disease in
  this population (Alzheimers Association, 2002).
• Several studies of the incidence of dementia and
  the prevalence of dementia of the Alzheimers
  type (DAT) and vascular dementia (VaD) have been
  conducted in persons over age 60 years from Wadi
  Ara, an inbred Arab community in northern Israel
  (Bowirrat, Friedland, Korczyn, 2002 Farrer,
  Bowirrat, Friedland, Waraska, Korczyn, Baldwin,
  2003).

60
Adult Neurogenic Disorders

• The incidence of dementia in this group was found
  to be 26 of individuals over aged 60 years.
• The prevalence rate of VaD was 5.9 as compared
  to that of 20.5 for DAT.
• Family studies revealed that more than one-third
  of the DAT cases are members of one hamula
  (tribal group) within Wadi Ara.
• Male gender, hypertension, and illiteracy were
  more common among VaD cases.

61
Adult Neurogenic Disorders

• Old age, female gender and lack of education were
  risk factors for the development of DAT
  (Bowirrat, Friedland, Farrer, Baldwin, Korczyn,
  2002).
• The rate of institutionalization and health
  status of nursing home (NH) type patients was
  studied in the Al-Ain Medical District of the
  United Arab Emirates (Margolis Reed, 2001).
• NH-type patients were defined as people aged 60
  years and older who were admitted to a hospital
  or a long-term institutionalized setting for at
  least 6 weeks.

62
Adult Neurogenic Disorders

• The study sought to determine the clinical,
  functional, cognitive, and nutritional status of
  these NH-type patients living in the Middle East.
• In total, 47 NH-type patients were identified and
  evaluated.
• The rate of institutionalization was 7.0-14.0 per
  1,000 people aged 65 or older.
• The age distribution was 30 (60-74 years), 49
  (75-84 years), and 21 (85 years).
• The length of stay was 3.8 years.
• The femalemale ratio was 1.6.

63
Adult Neurogenic Disorders

• All except 1 had a neurological disorder, and 89
  had dementia.
• The cognitive deficits were severe with only 61
  alert, 41 able to speak, 17 orientated in
  place, and 15 orientated in time.
• The functional status was also poor 98 received
  assistance with all instrumental activities of
  daily living, 85 received assistance with five
  activities of daily living, and 94 were bed
  bound.
• Overall nutritional status was also impaired.