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Allen BC, Cummer E, Sarma AK. Traumatic Brain Injury in Select Low- and Middle-Income Countries: A Narrative Review of the Literature. J Neurotrauma 2023; 40:602-619. [PMID: 36424896 DOI: 10.1089/neu.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Low- and middle-income countries (LMICs) experience the majority of traumatic brain injuries (TBIs), yet few studies have examined the epidemiology and management strategies of TBI in LMICs. The objective of this narrative review is to discuss the epidemiology of TBI within LMICs, describe the adherence to Brain Trauma Foundation (BTF) guidelines for the management of severe TBI in LMICs, and document TBI management strategies currently used in LMICs. Articles from January 1, 2009 to September 30, 2021 that included patients with TBI greater than 18 years of age in low-, low middle-, and high middle-income countries were queried in PubMed. Search results demonstrated that TBI in LMICs mostly impacts young males involved in road traffic accidents. Within LMICs there are a myriad of approaches to managing TBI with few randomized controlled trials performed within LMICs to evaluate those interventions. More studies are needed in LMICs to establish the effectiveness and appropriateness of BTF guidelines for managing TBI and to help identify methods for managing TBI that are appropriate in low-resource settings. The problem of limited pre- and post-hospital care is a bigger challenge that needs to be considered while addressing management of TBI in LMICs.
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Affiliation(s)
- Beddome C Allen
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Elaina Cummer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anand K Sarma
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Neurology, Division of Neurocritical Care, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
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Abedzadeh-Kalahroudi M, Fakharian E, Atoof F, Nooranipour V, Azadbakht J. The impact of tranexamic acid on brain contusion and intraparenchymal hemorrhage in patients with head injury. ARCHIVES OF TRAUMA RESEARCH 2022. [DOI: 10.4103/atr.atr_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kord Z, Alimohammadi N, Jafari Mianaei S, Riazi A, Zarasvand B. Clinical Guideline for Nursing Care of Children with Head Trauma (HT): Study Protocol for a Sequential Exploratory Mixed-Method Study. Pediatric Health Med Ther 2020; 11:269-275. [PMID: 32848495 PMCID: PMC7429226 DOI: 10.2147/phmt.s260720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Head trauma is a major health problem. Its primary complications happen at the time of trauma and are inevitable; thus, head trauma management is focused on the prevention and management of secondary complications. A clear clinical guideline for head trauma care can help nurses effectively prevent and manage secondary complications. This study aims to develop the clinical guideline for nursing care of children under 18 years with head trauma hospitalized in emergency departments, critical care units, and neurosurgery wards. METHODS This sequential exploratory mixed-method study will be conducted in three main phases as follows: qualitative, systematic review, and integration phases. In the qualitative phase, semi-structured interviews will be conducted to determine the care-related needs of children with head trauma. In the systematic review phase, a systematic review will be performed to find and then to review the most relevant articles, books, and the appropriate clinical guidelines. The quality of the retrieved guidelines will be assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. In the integration phase, the findings of the qualitative and systematic review phases were integrated, the draft of the guideline will be prepared, which will then be revised and validated through a nationwide Delphi survey. DISCUSSION The guideline for nursing care of children with head trauma can help to more effectively prevent, reduce, and manage the secondary complications of head trauma. Moreover, it reduces disability and mortality rates, improves nursing care quality, decreases healthcare costs, shortens hospital stay, and makes more rational clinical decisions.
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Affiliation(s)
- Zeynab Kord
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Critical Care Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soheila Jafari Mianaei
- Children Care Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Riazi
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Pediatric Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Zarasvand
- Department of Neurosurgery, Dezful University of Medical Sciences, Dezful, Iran
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Mehrolhassani N, Movahedi M, Nazemi-Rafi M, Mirafzal A. Persistence of post-concussion symptoms in patients with mild traumatic brain injury and no psychiatric history in the emergency department. Brain Inj 2020; 34:1350-1357. [PMID: 32772732 DOI: 10.1080/02699052.2020.1802659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To elucidate the predictive factors for persistent post-concussion symptoms at 1 and 3 months following minor traumatic brain injuries (mTBIs) in patients with no psychiatric history. METHODS This was an observational study in an academic trauma centre including adult patients with a history of mTBI and no psychiatric history. Exclusion criteria were missing the follow-up phone calls, radiologic abnormalities, simultaneous injuries and refusal to participate. Outcomes were post-concussion syndrome according to the international classification of diseases (ICD)-10 (ICD-PCS) and persistence of more than one mTBI related symptoms at 1 and 3 months post-injury. RESULTS From 364 enrolled patients, 16 (4.4%) developed ICD-PCS, whereas 28 (7.6%) and 8(2.1%) reported more than one symptom at one and three months, respectively. Multivariable analysis showed associations between ICD-PCS with more than one initial symptom in the emergency department (ED) and the non-motor vehicle collision (non-MVC) impact mechanism with area under curve of 0.77. The former variable was associated with the persistence of more than one post-concussion symptom at one and three months. CONCLUSION More than one symptom in the ED and the mechanism of injury not related to MVCs (sports, violence or fall injuries) may predict symptom persistence. Early treatment and follow-up strategies may be beneficial for vulnerable patients.
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Affiliation(s)
- Narges Mehrolhassani
- Department of Emergency Medicine, Kerman University of Medical Sciences , Kerman, Iran
| | - Mitra Movahedi
- Department of Emergency Medicine, Kerman University of Medical Sciences , Kerman, Iran
| | - Masoomeh Nazemi-Rafi
- Department of Emergency Medicine, Kerman University of Medical Sciences , Kerman, Iran
| | - Amirhossein Mirafzal
- Department of Emergency Medicine, Kerman University of Medical Sciences , Kerman, Iran
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Yousefzadeh-Chabok S, Kapourchali FR, Ramezani S. Determinants of long-term health-related quality of life in adult patients with mild traumatic brain injury. Eur J Trauma Emerg Surg 2019; 47:839-846. [DOI: 10.1007/s00068-019-01252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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Reza A, Riahi E, Daneshi A, Golchini E. The incidence of traumatic brain injury in Tehran, Iran. Brain Inj 2018; 32:487-492. [DOI: 10.1080/02699052.2018.1429658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ahadi Reza
- Department of Anatomical Science, Iran University of Medical Science, Tehran, Iran
| | - Esmail Riahi
- Department of Physiology, School of Medicene, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolhadi Daneshi
- Department of Neurosurgery, Iran University of Medical Science, Haft-e-Tir Hospital, Tehran, Iran
| | - Ehsan Golchini
- Anatomy Department, School of Medicine, Iran University of Medical sciences, Tehran, Iran
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Incidence, Demographics, and Outcome of Traumatic Brain Injury in The Middle East: A Systematic Review. World Neurosurg 2017; 107:6-21. [DOI: 10.1016/j.wneu.2017.07.070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
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Fakharian E, Abedzadeh-Kalahroudi M, Atoof F. Effect of Tranexamic Acid on Prevention of Hemorrhagic Mass Growth in Patients with Traumatic Brain Injury. World Neurosurg 2017; 109:e748-e753. [PMID: 29074420 DOI: 10.1016/j.wneu.2017.10.075] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intracranial hemorrhage is a common complication of traumatic brain injury (TBI). The purpose of this study is evaluation of the effect of tranexamic acid (TXA) on hemorrhagic mass growth in TBI patients. PATIENTS AND METHODS In this randomized, double-blind clinical trial, 149 patients with TBI and any kind of blood on their computed tomography scan enrolled in the study and were randomly allocated to receive TXA or placebo. After 24 hours, computed tomography scan was repeated for assessing the changes in hemorrhage, new bleeding, and mass effects of blood on brain tissue. The primary outcome was growth of the hemorrhagic lesion. Data were analyzed by SPSS software using Fisher exact, chi-square, and Mann-Whitney U tests, as well as linear and logistic regression models. FINDINGS The incidence of hemorrhagic lesion growth was 20.5% in the TXA group and 22.7% in the placebo group. The difference was not significant (P = 0.87, RR = 0.89). The mean (standard deviation) of hemorrhagic lesion growth was 9.4 (15.3) in the TXA group and 10.2 (10.1) in the placebo group without significant difference (P = 0.27). The frequency of deaths (2.7% vs. 4%), adverse outcome at discharge (10.8% vs. 17.3%), and 3 months later (6.8% vs. 14.7%) in the TXA group were lower than the placebo, but the difference was not statistically significant. No side effect was observed with the administration of TXA. CONCLUSION Administration of a short dose of TXA does not lead to significant prevention of growth of posttraumatic hemorrhagic lesion or improvement of clinical outcomes.
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Affiliation(s)
- Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Fatemeh Atoof
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Rostami R, Salamati P, Yarandi KK, Khoshnevisan A, Saadat S, Kamali ZS, Ghiasi S, Zaryabi A, Ghazi Mir Saeid SS, Arjipour M, Rezaee-Zavareh MS, Rahimi-Movaghar V. Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial. Chin J Traumatol 2017; 20:278-282. [PMID: 28552331 PMCID: PMC5831269 DOI: 10.1016/j.cjtee.2016.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/06/2016] [Accepted: 11/30/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE There are some studies which showed neurofeedback therapy (NFT) can be effective in clients with traumatic brain injury (TBI) history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NFT on continuous attention (CA) and short-term memory (STM) of clients with moderate TBI using a randomized controlled clinical trial (RCT). METHODS In this preliminary RCT, seventeen eligible patients with moderate TBI were randomly allocated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition (WMS-IV) test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project. RESULTS Eight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants' age were (26.75 ± 15.16) years and (27.60 ± 8.17) years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups (p ≥ 0.05). CONCLUSION Based on our literature review, it seems that our study is the only study performed on the effect of NFT on TBI patients with control group. NFT has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different protocols are recommended.
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Affiliation(s)
- Reza Rostami
- Department of Psychology, Tehran University, Tehran, Islamic Republic of Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Kourosh Karimi Yarandi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alireza Khoshnevisan
- Department of Neurosurgery, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Zeynab Sadat Kamali
- Department of Psychology, Tehran University, Tehran, Islamic Republic of Iran
| | - Somaie Ghiasi
- Department of Psychology, Kharazmi University, Tehran, Islamic Republic of Iran
| | - Atefeh Zaryabi
- Department of Clinical Psychology, Allame Tabatabaei University, Tehran, Iran
| | - Seyed Shahab Ghazi Mir Saeid
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mehdi Arjipour
- Department of Neurosurgery, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saeid Rezaee-Zavareh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran,Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran,Corresponding author. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.Sina Trauma and Surgery Research CenterTehran University of Medical SciencesTehranIslamic Republic of Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Jokar A, Ahmadi K, Salehi T, Sharif-Alhoseini M, Rahimi-Movaghar V. The effect of tranexamic acid in traumatic brain injury: A randomized controlled trial. Chin J Traumatol 2017; 20:49-51. [PMID: 28209450 PMCID: PMC5343096 DOI: 10.1016/j.cjtee.2016.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients. METHODS This single-blind randomized controlled trial was conducted on patients with traumatic ICH (with less than 30 ml) referring to the emergency department of Vali-Asr Hospital, Arak, Iran in 2014. Patients, based on the inclusion and exclusion criteria, were divided into intervention and control groups (40 patients each). All patients received a conservative treatment for ICH, as well as either intravenous TA or placebo. The extent of ICH growth as the primary outcome was measured by brain CT scan after 48 h. RESULTS Although brain CT scan showed a significant increase in hemorrhage volume in both groups after 48 h, it was significantly less in the TA group than in the control group (p = 0.04). The mean total hemorrhage expansion was (1.7 ± 9.7) ml and (4.3 ± 12.9) ml in TA and placebo groups, respectively (p < 0.001). CONCLUSION It has been established that TA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. Larger studies are needed to compare the effectiveness of different doses.
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Affiliation(s)
- Abolfazl Jokar
- Department of Emergency Medicine, Arak University of Medical Science, Arak, Iran
| | - Koorosh Ahmadi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Tayyebeh Salehi
- Department of Emergency Medicine, Arak University of Medical Science, Arak, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author. Sina Trauma and Surgery Research Center, Sina Hospital, Hassan-Abad Square, Imam Khomeini Ave, Tehran, 11365-3876, Iran. Fax: +98 216 6757009.Sina Trauma and Surgery Research CenterSina HospitalHassan-Abad SquareImam Khomeini AveTehran11365-3876Iran
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Fakharian E, Mohammadzadeh M, Behdadmehr S, Sabri HR, Mirzadeh AS, Mohammadzadeh J. Repetitive Traumatic Brain Injury in Patients From Kashan, Iran. Trauma Mon 2016; 21:e23869. [PMID: 28180123 PMCID: PMC5282941 DOI: 10.5812/traumamon.23869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a worldwide problem, especially in countries with high incidence of road traffic accidents such as Iran. Patients with a single occurrence of TBI have been shown to be at increased risk to sustain future TBI. Objectives The aim of this study was to present the incidence and characteristics of repeated TBI (RTBI) in Iranian patients. Patients and Methods During one year, all admitted TBI patients with prior TBI history were enrolled into the study. In each patient, data such as age, gender, past medical history, injury cause, anatomic site of injury, TBI severity, clinical findings and CT scan findings were collected. Results RTBI comprised 2.5% of TBI cases (41 of 1629). The incidence of RTBI per 100,000 individuals per years was 9.7. The main cause of RTBI was road traffic accident (68.3%); 9.7 % of cases had preexisting seizure/epilepsy disorder; 36.6% of patients with RTBI had pervious ICU admission due to severe TBI. Ten patients had Glasgow coma scale (GCS) ≤ 13 (24.4%). Seizure was seen in seven patients (17.1%). Thirty-nine percent of patients with RTBI had associated injuries. Eleven patients had abnormal CT scan findings (26.9%). Conclusions Considering the high incidence of trauma in developing countries, RTBI may also be more common compared with that of developed countries. This mandates a newer approach to preventive strategies, particularly in those with a previous experience of head injury.
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Affiliation(s)
- Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mahdi Mohammadzadeh
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mahdi Mohammadzadeh, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155620634; +98-9132632168, E-mail:
| | - Shirin Behdadmehr
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Hamid Reza Sabri
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | | | - Javad Mohammadzadeh
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Ghayoumi Z, Yadegari F, Mahmoodi-Bakhtiari B, Fakharian E, Rahgozar M, Rasouli M. Persuasive discourse impairments in traumatic brain injury. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e21473. [PMID: 25798418 PMCID: PMC4360602 DOI: 10.5812/atr.21473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/08/2014] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
Background: Considering the cognitive and linguistic complexity of discourse production, it is expected that individuals with traumatic brain injury (TBI) should face difficulties in this task. Therefore, clinical examination of discourse has become a useful tool for studying and assessment of communication skills of people suffering from TBI. Among different genres of discourse, persuasive discourse is considered as a more cognitively demanding task. However, little is known about persuasive discourse in individuals suffering from TBI. Objectives: The purpose of this study was to evaluate the performance of adults with TBI on a task of spoken persuasive discourse to determine the impaired linguistic measures. Patients and Methods: Thirteen TBI nonaphasic Persian speaking individuals, ranged between 19 to 40 years (Mean = 25.64 years; SD = 6.10) and 59 healthy adults matched by age, were asked to perform the persuasive discourse task. The task included asking the participants to express their opinion on a topic, and after the analysis of the produced discourse, the two groups were compared on the basis of their language productivity, sentential complexity, maze ratio and cohesion ratio. Results: The TBI group produced discourses with less productivity, sentential complexity, cohesion ratio and more maze ratio compared the control group. Conclusions: As it is important to consider acquired communication disorders particularly discourse impairment of brain injured patients along with their other clinical impairments and regarding the fact that persuasive discourse is crucial in academic and social situations, the persuasive discourse task presented in this study could be a useful tool for speech therapists, intending to evaluate communication disorders in patients with TBI.
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Affiliation(s)
- Zahra Ghayoumi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation, Tehran, IR Iran
| | - Fariba Yadegari
- Department of Speech Therapy, University of Social Welfare and Rehabilitation, Tehran, IR Iran
- Corresponding author: Fariba Yadegari, Department of Speech Therapy, University of Social Welfare and Rehabilitation, Tehran, IR Iran. Tel: +98-2122180043, Fax: +98-2122180043, E-mail:
| | | | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences,Tehran, IR Iran
| | - Mehdi Rahgozar
- Department of Biostatistics and Computer, University of Social Welfare and Rehabilitation, Tehran, IR Iran
| | - Maryam Rasouli
- Department of Pediatrics, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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