Effect of Chiropractic Care on Auditory Attention in Healthy Individuals: An Analysis of the P300 Event-Related Potentials Component
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Abstract
Background: The effect of chiropractic care on auditory attention, as measured by event-related potentials (ERP), has not been examined in healthy young adults. This study aimed to assess the impact of a single chiropractic session on auditory attention by analysing the amplitude and latency of the P300 ERP component within the auditory oddball paradigm in healthy adults.
Methods: Twenty-eight healthy adults participated in this chiropractic intervention study. ERP experiments were performed both before (pre-group) and one week after (post-group) a single chiropractic care session. During the experiments, a 64-channel electroencephalography (EEG)/ERP cap was used, and participants silently counted the target tone while disregarding standard tones. The amplitude and latency of the P300 ERP component were analysed using a standardised 10–20 EEG system across 19 electrode channels. A non-parametric Wilcoxon Signed-Rank Test (pairwise) was used to compare data groups.
Results: The topographic map distribution revealed a widespread pattern during standard stimuli and a more localised pattern during target stimuli in the post-group than in the pre-group. Significantly higher P300 amplitudes were observed at Cz (P = 0.013) and O1 (P = 0.012), along with a significantly shorter P300 latency at P7 (P = 0.042) in the post-group than in the pre-group.
Conclusion: Higher P300 amplitudes and shorter P300 latencies indicated improved attention. This evidence suggests that chiropractic care may enhance auditory attention in healthy individuals. However, its clinical importance remains uncertain. Therefore, it is premature to recommend chiropractic care as a treatment for boosting auditory attention.
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References
Amjad I, Niazi IK, Kumari N, Duehr J, Shehzad G, Rashid U, et al. The effects of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with attention deficit hyperactivity disorder: a pilot RCT. Front Psychol. 2024;15:1323397. https://doi.org/10.3389/fpsyg.2024.1323397
Haavik H, Niazi IK, Amjad I, Kumari N, Ghani U, Ashfaque M, et al. Neuroplastic responses to chiropractic care: broad impacts on pain, mood, sleep, and quality of life. Brain Sci. 2024;14(11):1124. https://doi.org/10.3390/brainsci14111124
Meyer AL, Amorim MA, Schubert M, Schweinhardt P, Leboeuf-Yde C. Unravelling functional neurology: does spinal manipulation have an effect on the brain? A systematic literature review. Chiropr Man Therap. 2019;27(1):60. https://doi.org/10.1186/s12998-019-0265-8
Navid MS, Niazi IK, Lelic D, Nedergaard RB, Holt K, Amjad I, et al. Investigating the effects of chiropractic spinal manipulation on EEG in stroke patients. Brain Sci. 2020;10(5):253. https://doi.org/10.3390/brainsci10050253
Navid MS, Niazi IK, Holt K, Nedergaard RB, Amjad I, Ghani U, et al. The effects of chiropractic spinal adjustment on EEG in adults with Alzheimer’s and Parkinson’s disease: a pilot randomised cross-over trial. J Integr Neurosci. 2024;23(5):98. https://doi.org/10.31083/j.jin2305098
Provencher B, Northon S, Gevers Montoro C, O’Shaughnessy J, Piché M. Effects of chiropractic spinal manipulation on laser-evoked pain and brain activity. J Physiol Sci. 2021;71(1):20. https://doi.org/10.1186/s12576-021-00804-2
Waterstone TS, Niazi IK, Navid MS, Amjad I, Shafique M, Holt K, et al. Functional connectivity analysis on resting-state electroencephalography signals following chiropractic spinal manipulation in stroke patients. Brain Sci. 2020;10(9):644. https://doi.org/10.3390/brainsci10090644
Haavik H, Özyurt MG, Niazi IK, Holt K, Nedergaard RW, Yilmaz G, et al. Chiropractic manipulation increases maximal bite force in healthy individuals. Brain Sci. 2018;8(5):76. https://doi.org/10.3390/brainsci8050076
Gevers-Montoro C, Provencher B, Northon S, Stedile-Lovatel JP, Ortega de Mues A, Piché M. Chiropractic spinal manipulation prevents secondary hyperalgesia induced by topical capsaicin in healthy individuals. Front Pain Res. 2021;2:702429. https://doi.org/10.3389/fpain.2021.702429
Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol. 2007;118(2):391–402. https://doi.org/10.1016/j.clinph.2006.09.014
Taylor HH, Murphy B. The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: a crossover study. J Manipulative Physiol Ther. 2010;33(4):261–272. https://doi.org/10.1016/j.jmpt.2010.03.004
Cebolla AM, PalmeroSoler E, Dan B, Cheron G. Frontal phasic and oscillatory generators of the N30 somatosensory evoked potential. Neuroimage. 2011;54(2):1297–1306. https://doi.org/10.1016/j.neuroimage.2010.08.060
Amodio DM, Bartholow BD, Ito TA. Tracking the dynamics of the social brain: ERP approaches for social cognitive and affective neuroscience. Soc Cogn Affect Neurosci. 2014;9(3):385–393. https://doi.org/10.1093/scan/nst177
Tivadar RI, Murray MM. A primer on electroencephalography and event-related potentials for organizational neuroscience. Organ Res Methods. 2019;22(1):69–94. https://doi.org/10.1177/1094428118804657
Pavarini SCI, Brigola AG, Luchesi BM, Souza ÉN, Rossetti ES, Fraga FJ, et al. On the use of the P300 as a tool for cognitive processing assessment in healthy aging: a review. Dement Neuropsychol. 2018;12(1):1–11. https://doi.org/10.1590/1980-57642018dn12-010001
Li Y, Hu Y, Liu T, Wu D. Dipole source analysis of auditory P300 response in depressive and anxiety disorders. Cogn Neurodyn. 2011;5(2):221–229. https://doi.org/10.1007/s11571-011-9156-y
Golob EJ, Ringman JM, Irimajiri R, Bright S, Schaffer B, Medina LD, et al. Cortical event-related potentials in preclinical familial Alzheimer disease. Neurology. 2009;73(20):1649–1655. https://doi.org/10.1212/WNL.0b013e3181c1de77
Olichney JM, Yang JC, Taylor J, Kutas M. Cognitive event-related potentials: biomarkers of synaptic dysfunction across the stages of Alzheimer’s disease. J Alzheimers Dis. 2011;26(s3):215–228. https://doi.org/10.3233/JAD-2011-0047
Correa-Jaraba KS, Lindín M, Díaz F. Increased amplitude of the P3a ERP component as a neurocognitive marker for differentiating amnestic subtypes of mild cognitive impairment. Front Aging Neurosci. 2018;10:19. https://doi.org/10.3389/fnagi.2018.00019
Waninger S, Berka C, Meghdadi A, Karic MS, Stevens K, Aguero C, et al. Event-related potentials during sustained attention and memory tasks: utility as biomarkers for mild cognitive impairment. Alzheimers Dement (Amst). 2018;10(1):452–460. https://doi.org/10.1016/j.dadm.2018.05.007
Miranda P, Cox CD, Alexander M, Danev S, Lakey JRT. Event-related-potential (ERP) markers of traumatic brain injury (TBI) severity and cognitive function: understanding how the brain works and thinks post TBI. J Syst Integr Neurosci. 2020;6(3). https://doi.org/10.15761/JSIN.1000225
Cavanagh JF, Wilson JK, Rieger RE, Gill D, Broadway JM, Story Remer JH, et al. ERPs predict symptomatic distress and recovery in sub-acute mild traumatic brain injury. Neuropsychologia. 2019;132:107125. https://doi.org/10.1016/j.neuropsychologia.2019.107125
Lowry E, Puthusseryppady V, Johnen AK, Renoult L, Hornberger M. Cognitive and neuroimaging markers for preclinical vascular cognitive impairment. Cereb Circ Cogn Behav. 2021;2:100029. https://doi.org/10.1016/j.cccb.2021.100029
Sur S, Sinha V. Event-related potential: An overview. Ind Psychiatry J. 2009;18(1):70–73. https://doi.org/10.4103/0972-6748.57865
Polich J. Updating P300: An integrative theory of P3a and P3b. Clin Neurophysiol. 2007;118(10):2128–2148. https://doi.org/10.1016/j.clinph.2007.04.019
Morlet D, Ruby P, André-Obadia N, Fischer C. The auditory oddball paradigm revised to improve bedside detection of consciousness in behaviorally unresponsive patients. Psychophysiology. 2017;54(11):1644–1662. https://doi.org/10.1111/psyp.12954
Blakey R, Ranlund S, Zartaloudi E, Cahn W, Calafato S, Colizzi M, et al. Associations between psychosis endophenotypes across brain functional, structural, and cognitive domains. Psychol Med. 2018;48(8):1325–1340. https://doi.org/10.1017/S0033291717002860
Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–1160. https://doi.org/10.3758/BRM.41.4.1149
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–191. https://doi.org/10.3758/BF03193146
Cooperstein R. Technique overview: Activator Methods Chiropractic Technique. Chiropr Tech. 1997;9(3):108–114.
Delorme A, Makeig S. EEGLAB: an open source toolbox for analysis of singletrial EEG dynamics including independent component analysis. J Neurosci Methods. 2004;134(1):9–21. https://doi.org/10.1016/j.jneumeth.2003.10.009
LopezCalderon J, Luck SJ. ERPLAB: an opensource toolbox for the analysis of eventrelated potentials. Front Hum Neurosci. 2014;8:213. https://doi.org/10.3389/fnhum.2014.00213
Luck S. New software package: ERPLAB Studio – ERP Info. [Internet]. United States: ERP Info; 2024. [Retrieved 2025 Aug 14]. Available at: https://erpinfo.org/blog/2024/6/11/erplab-studio
Fiel Peres F. Effect sizes for nonparametric tests. Biochem Med (Zagreb). 2025;36(1):010101. https://doi.org/10.11613/BM.2026.010101
Didoné DD, Garcia MV, Oppitz SJ, da Silva TFF, dos Santos SN, Bruno RS, et al. Auditory evoked potential P300 in adults: reference values. Einstein (São Paulo). 2016;14(2):208–212. https://doi.org/10.1590/S1679-45082016AO3586
Demirayak P, Kıyı İ, İşbitiren YÖ, Yener G. Cognitive load associates prolonged P300 latency during target stimulus processing in individuals with mild cognitive impairment. Sci Rep. 2023;13(1):15956. https://doi.org/10.1038/s41598-023-43132-8
Medvidovic S, Titlic M, Maras‑Simunic M. P300 evoked potential in patients with mild cognitive impairment. Acta Inform Med. 2013;21(2):89–92. https://doi.org/10.5455/aim.2013.21.89-92
Rodríguez‑Labrada R, Velázquez‑Pérez L, Ortega‑Sánchez R, Peña-Acosta A, Vázquez-Mojena Y, Canales-Ochoa N, et al. Insights into cognitive decline in spinocerebellar ataxia type 2: a P300 event‑related brain potential study. Cerebellum Ataxias. 2019;6(1):3. https://doi.org/10.1186/s40673-019-0097-2
Van Dinteren R, Arns M, Jongsma MLA, Kessels RPC. P300 development across the lifespan: a systematic review and meta‑analysis. PLoS One. 2014;9(2):e87347. https://doi.org/10.1371/journal.pone.0087347
Begum T, Reza F. Auditory cognitive function assessment during pregnancy: an event‑related potential and neuropsychological study. Bangladesh J Med Sci. 2021;20(3):608–617. https://doi.org/10.3329/bjms.v20i3.52803
Cade AE, Turnbull PRK. Effect of chiropractic intervention on oculomotor and attentional visual outcomes in young adults with long‑term mild traumatic brain injury: a randomized controlled trial. J Manipulative Physiol Ther. 2024;47(1–4):1–11. https://doi.org/10.1016/j.jmpt.2024.08.003
Reza F, Begum T. Mild cognitive impairment in mild brain injury (MBI) patients: an event‑related potential (ERP) and neuropsychology study. Bangladesh J Med Sci. 2019;18(3):557–566. https://doi.org/10.3329/bjms.v18i3.41626
Brehmer Y, Westerberg H, Bäckman L. Working‑memory training in younger and older adults: training gains, transfer, and maintenance. Front Hum Neurosci. 2012;6:63. https://doi.org/10.3389/fnhum.2012.00063
Ye L‑l, Xie H‑x, Cao L, Song W‑q. Therapeutic effects of transcranial magnetic stimulation on visuospatial neglect revealed with event‑related potentials. Front Neurol. 2022;12:799058. https://doi.org/10.3389/fneur.2021.799058
Li K, Mo D, Yu Q, Feng R, Li Y. Effect of repetitive transcranial magnetic stimulation on post‑stroke comorbid cognitive impairment and depression: a randomized controlled trial. J Alzheimers Dis. 2024;101(1):337–352. https://doi.org/10.3233/JAD‑240505
Kirby ED, Jones CB, Fickling SD, Pawlowski G, Brodie SM, Boyd LA, et al. Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study. Front Hum Neurosci. 2023;17:1209480. https://doi.org/10.3389/fnhum.2023.1209480
Morand‑Beaulieu S, O’Connor KP, Richard M, Sauvé G, Leclerc JB, Blanchet PJ, et al. The impact of a cognitive‑behavioral therapy on event‑related potentials in patients with tic disorders or body‑focused repetitive behaviors. Front Psychiatry. 2016;7:81. https://doi.org/10.3389/fpsyt.2016.00081