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  • Improvement of verbal fluency in patients with diffuse brain injury over time

    Final Number:

    Ana Luiza Zaninotto BA; Wellingson S. Paiva MD PhD; Almir F. Andrade MD, PhD; Robson Luis Amorim MD; Vinicius P Guirado MD; Leonardo Moura Sousa Jr MD; Iuri S Neville MD; Beatriz Baldivia BA; Monica Domiano Núñes BA; Mara Cristina Souza Lucia PhD; Manoel Jacobsen Teixeira

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic brain injury (TBI), is considered one of the most prevalent forms of primary neuronal injury in patients with severe TBI. Cognitive deficits induced by DAI can persist over time, especially following moderate or severe injuries. The aim of the present study was to compare verbal fluency performance at 6 and 12 months after the trauma in a same group of patients with diffuse axonal injury.

    Methods: Eighteen patients with moderate to severe DAI and 17 healthy volunteers were enrolled. All participants had sustained a TBI at least 6 months prior to the start of the study, were between 18-50 years, and had at least 4 years of education. The Verbal Fluency Test (VF) was administered within an extensive neuropsychological battery test. We evaluated the same patients at 6 months (DAI group) and 1 year (DAI2 group) and compared the results of neuropsychological tests with a control group of healthy volunteers who were matched for sex, age, and educational level.

    Results: In comparison to controls, an independent samples t-test revealed that the DAI1 group produced significantly fewer words. DAI 2 group produced significantly more semantic words than DAI 1 (p < 0.05), and demonstrated a trend towards the production of more clusters for letter A (p = 0.09) and total word generated in phonemicologic teste (p = 0.09). No significant differences were observed between DAI 2 and the control group in the total number of words generated in phonetic FAS or semantic fluency scores.

    Conclusions: The present findings may be useful in the construction of a management plan for long-term TBI rehabilitation that considers the trauma of each patient. Further, our results suggest the VF test is a suitable instrument for the assessment of cognitive difficulties following traumatic brain injury.

    Patient Care: Knowing the functional recovery of patients with LAD will be easier to establish therapeutic measures in acute and subacute trauma.

    Learning Objectives: Understanding changes in verbal fluency in patients with TBI and LAD assist in the management and recovery of patients.

    References: Vakil E. The effect of moderate to severe traumatic brain injury (TBI) on different aspects of memory: a selective review. J Clin Exp Neuropsychol. 2005 ;27(8):977-1021. Wilson BA, Watson PC, Baddeley AD, Emslie H, Evans JJ. Improvement or simply practice? The effects of twenty repeated assessments on people with and without brain injury. J Int Neuropsychol Soc. 2000;6(4):469-79. Bercaw EL, Hanks RA, Millis SR, Gola TJ Changes in neuropsychological performance after traumatic brain injury from inpatient rehabilitation to 1-year follow-up in predicting 2-year functional outcomes. Clin Neuropsychol. 2011;25(1):72-89. Dikmen SS, Machamer JE, Powell JM, Temkin NR. Outcome 3 to 5 years after moderate to severe traumatic brain injury.Arch Phys Med Rehabil. 2003;84(10):1449-57. Dikmen SS, Corrigan JD, Levin HS, Machamer J, Stiers W, Weisskopf MG. Cognitive outcome following traumatic brain injury. J Head Trauma Rehabil. 2009;24(6):430- 8

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