The effects of proprioceptive stimulation on cognitive processes in patients after traumatic brain injury

doi:10.1053/apmr.2002.27472

Archives of Physical Medicine and Rehabilitation

Volume 83, Issue 1, January 2002, Pages 115-121

https://doi.org/10.1053/apmr.2002.27472 Get rights and content

Abstract

Müller SV, Jarosch von Schweder A, Frank B, Dengler R, Münte TF, Johannes S. The effects of proprioceptive stimulation on cognitive processes in patients after traumatic brain injury. Arch Phys Med Rehabil 2002;83:115-21. Objective: To investigate the hypothesis that proprioceptive stimulation may be effective in the treatment of brain injury, using neurophysiologic and neuropsychologic measures. Design: Cohort analytic study. Setting: Patients recovering from traumatic brain injury (TBI) in a neurologic rehabilitation hospital were examined. Participants: Eleven patients with TBI (Glasgow Coma Scale score > 3) and 11 healthy control subjects matched for age and education. Interventions: Subjects were examined with the event-related potential (ERP) technique during a computerized choice–reaction-time task, in which they had to discriminate between even and odd digits. There were experimental runs with and without vibratory stimuli applied to the left forearm serving as proprioceptive stimulation. In addition, ERPs were recorded to vibratory stimuli without any additional task. Main Outcome Measures: Outcome measures included latencies and amplitudes of the P300 ERP component and of the late negative component. Results: In the passive vibration condition, both groups showed the same ERP distribution. In the choice–reaction-time task, latencies and amplitudes of the P300 differed between the 2 groups. The patient group showed longer P300 latencies, which were shortened by vibratory stimuli. In contrast, the control subjects were not affected by vibratory stimuli. Conclusion: Our findings support the hypothesis that pathologic cognitive processes after TBI can be improved by proprioceptive stimulation. Muscle vibration has positive effects on pathologically slowed cognitive processes but not in healthy subjects. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Subjects

Eleven patients who had suffered TBI and who were treated in a rehabilitation hospital participated in the experiment. Two patients had to be excluded from the choice–reaction-time experiment because they were not able to perform the test. The remaining subjects’ mean age was 32 years (range, 19-59yr), 2 were women, all were right-handed, and the mean duration of education was 12.8 years. All patients had initial Glasgow Coma Scale scores between 3 and 6 after the trauma. Careful examination by

Passive vibration

The vibration ERPs were separated as an early and a late negative component, which was the main focus of the current experiment. In keeping with data from Münte et al,²⁴ patients and control subjects produced nearly identical patterns of the late negative component. Figures 1A and 1B show this sustained negativity beginning at about 100ms and extending for several hundred milliseconds.

. Grand average passive vibration ERPs for (A) patients and (B) controls for all electrodes. Patients and control

Discussion

We found that muscle vibration affected ERPs in patients and controls. First, the behavior data showed that vibration sped up the detectability of targets and, second, enhanced the accuracy. These results were specified in detail by ERP data. Proprioceptive stimulation increased ERP latencies, but not amplitudes, and shortened reaction times, but did not increase hit rate. We found evidence for an undisturbed excitability by proprioceptive stimulation of cortical neuronal networks in TBI

Conclusion

TBI patients showed slowed target detection mechanisms and mild impaired executive processes. Vibratory stimuli elicited slow negative cortical potentials that did not differ between TBI patients and control subjects. These potentials represent the excitability of cortical neuronal networks and are an index of cortical activation beyond sensory areas. It was unchanged in TBI patients.

Vibratory stimuli sped up the target detection mechanisms in TBI patients but not in control subjects. This may

Acknowledgements

We thank Andreas Niesel, Jobst Kilian, and Hartmut Neiden for their support.

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In both the visual choice task and the continuous performance test, patients had significantly smaller P300 amplitudes compared to control subjects. Muller et al. (2002) used a visual P300 protocol to assess 11 TBI patients 3–9 months post-injury. GCS scores for these patients ranged between 3 and 6 immediately post-trauma.
Traumatic brain injuries are often associated with damage to sensory and cognitive processing pathways. Because evoked potentials (EPs) and event-related potentials (ERPs) are generated by neuronal activity, they are useful for assessing the integrity of neural processing capabilities in patients with traumatic brain injury (TBI). This review of somatosensory, auditory and visual ERPs in assessments of TBI patients is provided with the hope that it will be of interest to clinicians and researchers who conduct or interpret electrophysiological evaluations of this population. Because this article reviews ERP studies conducted in three different sensory modalities, involving patients with a wide range of TBI severity ratings and circumstances, it is difficult to provide a coherent summary of findings. However, some general trends emerge that give rise to the following observations and recommendations: 1) bilateral absence of somatosensory evoked potentials (SEPs) is often associated with poor clinical prognosis and outcome; 2) the presence of normal ERPs does not guarantee favorable outcome; 3) ERPs evoked by a variety of sensory stimuli should be used to evaluate TBI patients, especially those with severe injuries; 4) time since onset of injury should be taken into account when conducting ERP evaluations of TBI patients or interpreting results; 5) because sensory deficits (e.g., vision impairment or hearing loss) affect ERP results, tests of peripheral sensory integrity should be conducted in conjunction with ERP recordings; and 6) patients' state of consciousness, physical and cognitive abilities to respond and follow directions should be considered when conducting or interpreting ERP evaluations.
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^☆: Supported by the Kuratorium ZNS (grant no. 98011).

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

^★: Reprint requests to Sandra V. Müller, PhD, Dept of Neuropsychology, Otto-von-Guericke-University, Box 4120, 39016 Magdeburg, Germany, e-mail: [email protected].

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ArticlesThe effects of proprioceptive stimulation on cognitive processes in patients after traumatic brain injury☆,☆☆,★,★★,♢,♢♢

Abstract

Section snippets

Subjects

Passive vibration

Discussion

Conclusion

Acknowledgements

Arch Phys Rehabil

Neuropsychologia

Electroencephalogr Clin Neurophysiol

Neurol Clin

J Neurol Sci

Neuropsychologia

Brain Res

Neurosci Lett

Biol Psychol

Normative data for 538 head injury patients across seven time period after injury

J Clin Exp Neuropsychol

Storage and executive processes in the frontal lobes

Science

Reaction time indicators of attention deficits in closed head injury

J Clin Exp Neuropsychol

Event-related potentials as an index of cognitive function during recovery from severe closed head injury

J Head Trauma Rehabil

Event-related brain potentials reveal covert distractibility in closed head injuries

Neuroreport

Postraumatic movement disorders: a review

Mov Dis

Parallel organization of functionally segregated circuits linking basal ganglia and cortex

Ann Rev Neurosci

Dopamine projections and frontal systems function

Neuropsychological assessment

Effects of dopaminergic combination therapy for frontal lobe dysfunction in traumatic brain injury rehabilitation

Brain Inj

Articles
The effects of proprioceptive stimulation on cognitive processes in patients after traumatic brain injury☆,☆☆,★,★★,♢,♢♢