Extended tests for evaluating post-traumatic brain injury deficits in resource-limited settings: methods and pilot study data.
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INTRODUCTION: Traumatic brain injury (TBI) is one of the leading causes of all injury-related deaths and disabilities in the world, especially in low to middle-income countries (LMICs) which also suffer from lower levels of funding for all levels of the health care system for patients suffering from TBI. These patients do not generally get comprehensive diagnostic workup, monitoring, or treatment, and return to work too quickly, often with undiagnosed post-traumatic deficits which in turn can lead to subsequent incidents of physical harm. METHODS: Here, we share methods and results from our research project to establish innovative, simple, and scientifically based practices that dramatically leverage technology and validated testing strategies to identify post-TBI deficits quickly and accurately, to circumvent economic realities on the ground in LMICs. We utilized paper tests such as the Montreal cognitive assessment (MoCA), line-bisection, and Bell's test. Furthermore, we combined modifications of neuroscience computer tasks to aid in assessing peripheral vision, memory, and analytical accuracies. Data from seventy-one subjects (51 patients and 20 controls, 15 females and 56 males) from 4 hospitals in Ethiopia are presented. The traumatic brain injury group consists of 17 mild, 28 moderate, and 8 severe patients (based on the initial Glasgow Comma Score). Controls are age and education-matched subjects (no known history of TBI, brain lesions, or spatial neglect symptoms). RESULTS: We found these neurophysiological methods can: 1) be implemented in LMICs and 2) test impairments caused by TBI, which generally affect brain processing speed, memory, and both executive and cognitive controls. DISCUSSION: The main findings indicate that these examinations can identify several deficits, especially the MoCA test. These tests show great promise to assist in the evaluation of TBI patients and support the establishment of dedicated rehabilitation centers. Our next steps will be expansion of the cohort size and application of the tests to other settings.
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Acknowledgements: We want to thank all staff and National Institute for Health Research (NIHR) Global Health Research Group members on Neurotrauma, especially Natalia Budohoska, for her unlimited support and commitment to this project. Our heartfelt gratitude goes to our site partner Nasrin Abdulsattar, without whose dedication and assistance, none of this work would be possible. We deeply thank Glen Duncan, whom we sadly lost recently, for designing and making our custom keyboard. We thank all hospitals and their staff for all support, from IRB approval to daily assistance with data gathering. We want to acknowledge Temesgen Beyene, Biruk Getachew, Ayalew Zewdie, Mulualem Wondafrash, Bethelhem Yesehak, Moti Belay, Mekdes, Salahadin, Abera, Gemechu, Eyerusalem Bergene, and Simbo Mitiku and staff and nurses including Afrah and Amira. Goldberg’s precious time spent on detailed editing, proofreading repeatedly and constructive criticism of the manuscript made for a tremendous improvement. Our gratitude also goes to Glenn Wolther and Nicholas Foley for the manuscript editing support.
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1664-2295