Targeted isometric force impulses in patients with traumatic brain injury reveal delayed motor programming and change of strategy.

The capability of quickly (as soon as possible) producing fast uncorrected and accurate isometric force impulses was examined to assess the motor efficiency of patients with moderate to severe traumatic brain injury (TBI) and good motor recovery at a clinical evaluation. Twenty male right-handed patients with moderate to severe TBI and 24 age-matched healthy male right-handed controls participated in the study. The experimental task required subjects to aim brief and uncorrected isometric force impulses to targets visually presented along with subjects' force displays. Both TBI patients and controls were able to produce force impulses whose mean peak amplitudes varied proportionally to the target load with no detectable group difference. Patients with TBI, however, were slower than controls in initiating their responses (reaction times [RTs] were longer by 125 msec) and were also slower during the execution of their motor responses, reaching the peak forces requested 23 msec later than controls (time to peak force: 35% delay). Further, their mean dF/dt (35 kg/sec) was slower than that of controls (53 kg/sec), again indicating a 34% impairment with respect to controls. Overall, patients with TBI showed accurate but delayed and slower isometric force impulses. Thus, an evaluation taking into account also response time features is more effective in picking up motor impairments than the standard clinical scales focusing on accuracy of movement only.