Latinos no reciben eficiente cuida de rehabilitación
Latinos may get less intense stroke rehab

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Dr. Marcie Bockbrader adjusts an external brain stimulator on stroke survivor Debbie Hall at The Ohio State University Wexner Medical Center. Bockbrader is conducting a study with the device, known as NexStim, to see if stimulating the brain just before physical therapy can help improve a stroke patient`s response to rehab. See how it works here: bit.ly/1xf4e8j

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Según los resultados de un estudio, los sobrevivientes de un ataque cerebral de origen latino tienden a recibir una rehabilitación menos intensa en realación con los blancos. Ese hallazgo explica por qué los latinos tienden a ser más afectados después de un ataque cerebral.

Las estadísticas de los Centros para el Control y la Prevención de Enfermedades, el ataque cerebral es la cuarta causa de muertes entre los latinos y la la tercera causa de muertes entre negros y asiáticos y personas oriundas en las islas del Pacífico. Es la quinta causa de muertes en blancos estadounidenses, y representa al país un costo anual de aproximadamente $34 mil millones.

A relación con la mayoría de otros grupos culturales, los méxico-americanos que representan el grupo étnico más grande, tienen un estado de salud más deficiente y sus condiciones crónicas y múltiplese aumentan el riesgo a sufrir un ataque cerebral como los diabéticos y los que sufren presión arterial alta.

El neurólogo Salvador Cruz-Flores, M.D., fue el autor principal de un informe en 2011 donde señala que ataque cerebral impacta de forma distinta a los grupos raciales y étnicos, pero que no existen muchos estudios que abordan el tema de acceso a la rehabilitación. Desde la publicación del documento, los investigadores de ataque cerebral han hecho un esfuerzo en identificar esas diferencias, y entender por qué existen, dijo Cruz-Flores, quien no participó en el nuevo estudio. Pero dijo que se necesita más investigación centrada en formas de disminuir las disparidades.

“Hay una tendencia a que minorías –en este caso hispanos– tienen menos acceso a rehabilitación en el hospital, lo cual tiene implicaciones con respecto a la recuperación”, dijo Cruz-Flores, director de neurología de la Texas Tech University Health Sciences Center School of Medicine en El Paso.

El mensaje para los pacientes de ataque cerebral y sus familiares es que deben colaborar cercanamente con sus médicos para escoger el cuidado correcto de rehabilitación, dijo Morgenstern. En cuanto al cuidado después de un ataque cerebral, dijo, no existe una solución universal para todos.

English

Life after a stroke can be marred by significant impairments, with survivors having to relearn how to speak, walk or carry out day-to-day activities such as cooking and getting dressed. That’s why stroke rehabilitation is recommended to aid the recovery of hundreds of thousands of Americans who survive a stroke each year.

But Mexican Americans may be getting inferior rehab services compared with whites, a recent study suggests. It may explain why that ethnic group is harder hit by stroke’s long-term effects, researchers said.

Among those receiving rehab, 73 percent of white patients got inpatient rehab — a more intensive recovery program — whereas only 30 percent of Mexican Americans did. Mexican American patients were much more likely to receive their rehabilitation care at home or outpatient location, the results show.

A big difference between home-based and inpatient care is the time allotted for services, said the study’s lead author Lewis B. Morgenstern, M.D., a professor of neurology and director of the stroke program at the University of Michigan Medical School and School of Public Health.

But the study doesn’t prove Mexican American stroke survivors would recover more cognitive and motor skills if they received aggressive rehab, Morgenstern said. Because this was a small preliminary study, “you have to take these results with kind of a grain of salt — or a boulder of salt,” he said.

Compared with most of their cultural peers, Mexican Americans — who by far make up the largest Hispanic ethnic group — tend to be in worse health and have multiple chronic conditions, such as diabetes and high blood pressure, that can increase stroke risk. Mexican American participants in the Corpus Christi study had higher rates of diabetes, high blood pressure and smoking compared with their white peers.

Neurologist Salvador Cruz-Flores, M.D., was the lead author of a 2011 report that said stroke impacts racial and ethnic groups differently, but there were few studies addressing racial and ethnic differences in rehabilitation. Since the report, stroke researchers have made an effort to identify those differences and understand why they exist, said Cruz-Flores, who was not involved in the new study. But more targeted work is needed to find ways to reduce the disparities, he said.

The takeaway from the recent study for doctors, Cruz-Flores said, is that not all stroke patients have the same access to rehabilitation services.

The message for stroke patients and their families is to work closely with their doctors in choosing the right type of rehabilitative care, Morgenstern said. When it comes to post-stroke care, he said, one size does not fit all.