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Brandt-Rauf PW, Ayaz H. Occupational Health and Neuroergonomics: The Future of Wearable Neurotechnologies at the Workplace. J Occup Environ Med 2024; 66:456-460. [PMID: 38829949 DOI: 10.1097/jom.0000000000003080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Affiliation(s)
- Paul W Brandt-Rauf
- From the School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
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2
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Walia P, Fu Y, Norfleet J, Schwaitzberg SD, Intes X, De S, Cavuoto L, Dutta A. Brain-behavior analysis of transcranial direct current stimulation effects on a complex surgical motor task. FRONTIERS IN NEUROERGONOMICS 2024; 4:1135729. [PMID: 38234492 PMCID: PMC10790853 DOI: 10.3389/fnrgo.2023.1135729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
Transcranial Direct Current Stimulation (tDCS) has demonstrated its potential in enhancing surgical training and performance compared to sham tDCS. However, optimizing its efficacy requires the selection of appropriate brain targets informed by neuroimaging and mechanistic understanding. Previous studies have established the feasibility of using portable brain imaging, combining functional near-infrared spectroscopy (fNIRS) with tDCS during Fundamentals of Laparoscopic Surgery (FLS) tasks. This allows concurrent monitoring of cortical activations. Building on these foundations, our study aimed to explore the multi-modal imaging of the brain response using fNIRS and electroencephalogram (EEG) to tDCS targeting the right cerebellar (CER) and left ventrolateral prefrontal cortex (PFC) during a challenging FLS suturing with intracorporeal knot tying task. Involving twelve novices with a medical/premedical background (age: 22-28 years, two males, 10 females with one female with left-hand dominance), our investigation sought mechanistic insights into tDCS effects on brain areas related to error-based learning, a fundamental skill acquisition mechanism. The results revealed that right CER tDCS applied to the posterior lobe elicited a statistically significant (q < 0.05) brain response in bilateral prefrontal areas at the onset of the FLS task, surpassing the response seen with sham tDCS. Additionally, right CER tDCS led to a significant (p < 0.05) improvement in FLS scores compared to sham tDCS. Conversely, the left PFC tDCS did not yield a statistically significant brain response or improvement in FLS performance. In conclusion, right CER tDCS demonstrated the activation of bilateral prefrontal brain areas, providing valuable mechanistic insights into the effects of CER tDCS on FLS peformance. These insights motivate future investigations into the effects of CER tDCS on error-related perception-action coupling through directed functional connectivity studies.
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Affiliation(s)
- Pushpinder Walia
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Yaoyu Fu
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, United States
| | - Jack Norfleet
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, United States
| | - Steven D. Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Xavier Intes
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, United States
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Suvranu De
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Lora Cavuoto
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, United States
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
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3
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Caccianiga G, Mooney RA, Celnik PA, Cantarero GL, Brown JD. Anodal cerebellar t-DCS impacts skill learning and transfer on a robotic surgery training task. Sci Rep 2023; 13:21394. [PMID: 38123594 PMCID: PMC10733429 DOI: 10.1038/s41598-023-47404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
The cerebellum has demonstrated a critical role during adaptation in motor learning. However, the extent to which it can contribute to the skill acquisition of complex real-world tasks remains unclear. One particularly challenging application in terms of motor activities is robotic surgery, which requires surgeons to complete complex multidimensional visuomotor tasks through a remotely operated robot. Given the need for high skill proficiency and the lack of haptic feedback, there is a pressing need for understanding and improving skill development. We investigated the effect of cerebellar transcranial direct current stimulation applied during the execution of a robotic surgery training task. Study participants received either real or sham stimulation while performing a needle driving task in a virtual (simulated) and a real-world (actual surgical robot) setting. We found that cerebellar stimulation significantly improved performance compared to sham stimulation at fast (more demanding) execution speeds in both virtual and real-world training settings. Furthermore, participants that received cerebellar stimulation more effectively transferred the skills they acquired during virtual training to the real world. Our findings underline the potential of non-invasive brain stimulation to enhance skill learning and transfer in real-world relevant tasks and, more broadly, its potential for improving complex motor learning.
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Affiliation(s)
- Guido Caccianiga
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, 21218, USA.
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, 70569, Germany.
| | - Ronan A Mooney
- Department of Physical Medicine and Rehabilitation, John Hopkins Medical Institute, Baltimore, 21218, USA
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, John Hopkins Medical Institute, Baltimore, 21218, USA
- Shirley Ryan AbilityLab, Chicago, 60611, USA
| | - Gabriela L Cantarero
- Department of Physical Medicine and Rehabilitation, John Hopkins Medical Institute, Baltimore, 21218, USA
| | - Jeremy D Brown
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, 21218, USA
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Galvin D, Toth AJ, O'Reilly B, O'Sullivan R, Campbell MJ. M1 transcranial direct current stimulation augments laparoscopic surgical skill acquisition. Sci Rep 2023; 13:13731. [PMID: 37612337 PMCID: PMC10447451 DOI: 10.1038/s41598-023-40440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
The acquisition of basic surgical skills is a key component of medical education and trainees in laparoscopic surgery typically begin developing their skills using simulation box trainers. However, despite the advantages of simulation surgical training, access can be difficult for many trainees. One technique that has shown promise to enhance the deliberate practice of motor skills is transcranial electric stimulation (tES). The purpose of this study was to assess the impact of transcranial direct current stimulation (tDCS) on training induced improvements and retention of traditional time and kinematic based laparoscopic surgical skill metrics. Forty-nine medical students were randomly allocated to a neurostimulation or sham group and completed 5 training sessions of a bead transfer and threading laparoscopic task. Participants in both the sham and stimulation groups significantly improved their time and kinematic performance on both tasks following training. Although we did find that participants who received M1 tDCS saw greater performance benefits in response to training on a bead transfer task compared to those receiving sham stimulation no effect of neurostimulation was found for the threading task. This finding raises new questions regarding the effect that motor task complexity has on the efficacy of neurostimulation to augment training induced improvement and contributes to a growing body of research investigating the effects of neurostimulation on the sensory-motor performance of laparoscopic surgical skill.
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Affiliation(s)
- Daniel Galvin
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Adam J Toth
- Lero, The Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland.
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
| | - Barry O'Reilly
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Ray O'Sullivan
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Mark J Campbell
- Lero, The Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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5
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Watanabe A, Sawamura D, Nakazono H, Tokikuni Y, Miura H, Sugawara K, Fuyama K, Tohyama H, Yoshida S, Sakai S. Transcranial direct current stimulation to the left dorsolateral prefrontal cortex enhances early dexterity skills with the left non-dominant hand: a randomized controlled trial. J Transl Med 2023; 21:143. [PMID: 36823635 PMCID: PMC9951449 DOI: 10.1186/s12967-023-03989-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The left dorsolateral prefrontal cortex (DLPFC) is involved in early-phase manual dexterity skill acquisition when cognitive control processes, such as integration and complexity demands, are required. However, the effectiveness of left DLPFC transcranial direct current stimulation (tDCS) on early-phase motor learning and whether its effectiveness depends on the cognitive demand of the target task are unclear. This study aimed to investigate whether tDCS over the left DLPFC improves non-dominant hand dexterity performance and determine if its efficacy depends on the cognitive demand of the target task. METHODS In this randomized, double-blind, sham-controlled trial, 70 healthy, right-handed, young adult participants were recruited. They were randomly allocated to the active tDCS (2 mA for 20 min) or sham groups and repeatedly performed the Purdue Pegboard Test (PPT) left-handed peg task and left-handed assembly task three times: pre-tDCS, during tDCS, and post tDCS. RESULTS The final sample comprised 66 healthy young adults (mean age, 22.73 ± 1.57 years). There were significant interactions between group and time in both PPT tasks, indicating significantly higher performance of those in the active tDCS group than those in the sham group post tDCS (p < 0.001). Moreover, a greater benefit was observed in the left-handed assembly task performance than in the peg task performance (p < 0.001). No significant correlation between baseline performance and benefits from tDCS was observed in either task. CONCLUSIONS These results demonstrated that prefrontal tDCS significantly improved early-phase manual dexterity skill acquisition, and its benefits were greater for the task with high cognitive demands. These findings contribute to a deeper understanding of the underlying neurophysiological mechanisms of the left DLPFC in the modulation of early-phase dexterity skill acquisition. TRIAL REGISTRATION This study was registered in the University Hospital Medical Information Network Clinical Trial Registry in Japan (UMIN000046868), Registered February 8, 2022 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053467.
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Affiliation(s)
- Akihiro Watanabe
- grid.39158.360000 0001 2173 7691Graduate School of Health Sciences, Hokkaido University, Sapporo, 060-0812 Japan
| | - Daisuke Sawamura
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, 060-0812, Japan.
| | - Hisato Nakazono
- grid.443459.b0000 0004 0374 9105Department of Occupational Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, 814-0001 Japan
| | - Yukina Tokikuni
- grid.39158.360000 0001 2173 7691Graduate School of Health Sciences, Hokkaido University, Sapporo, 060-0812 Japan
| | - Hiroshi Miura
- grid.39158.360000 0001 2173 7691Graduate School of Health Sciences, Hokkaido University, Sapporo, 060-0812 Japan
| | - Kazuhiro Sugawara
- grid.263171.00000 0001 0691 0855Department of Physical Therapy, Sapporo Medical University, Sapporo, 060-8556 Japan
| | - Kanako Fuyama
- grid.412167.70000 0004 0378 6088Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, 060-8648 Japan
| | - Harukazu Tohyama
- grid.39158.360000 0001 2173 7691Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido 060-0812 Japan
| | - Susumu Yoshida
- grid.412021.40000 0004 1769 5590Department of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu, 061-0293 Japan
| | - Shinya Sakai
- grid.39158.360000 0001 2173 7691Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido 060-0812 Japan
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D'Ambrosia C, Aronoff-Spencer E, Huang EY, Goldhaber NH, Christensen HI, Broderick RC, Appelbaum LG. The neurophysiology of intraoperative error: An EEG study of trainee surgeons during robotic-assisted surgery simulations. FRONTIERS IN NEUROERGONOMICS 2023; 3:1052411. [PMID: 38235463 PMCID: PMC10790934 DOI: 10.3389/fnrgo.2022.1052411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2024]
Abstract
Surgeons operate in mentally and physically demanding workspaces where the impact of error is highly consequential. Accurately characterizing the neurophysiology of surgeons during intraoperative error will help guide more accurate performance assessment and precision training for surgeons and other teleoperators. To better understand the neurophysiology of intraoperative error, we build and deploy a system for intraoperative error detection and electroencephalography (EEG) signal synchronization during robot-assisted surgery (RAS). We then examine the association between EEG data and detected errors. Our results suggest that there are significant EEG changes during intraoperative error that are detectable irrespective of surgical experience level.
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Affiliation(s)
- Christopher D'Ambrosia
- College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Cognitive Robotics Laboratory, Department of Computer Science and Engineering, Contextual Robotics Institute, University of California, San Diego, La Jolla, CA, United States
| | - Eliah Aronoff-Spencer
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Estella Y. Huang
- Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Nicole H. Goldhaber
- Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Henrik I. Christensen
- Cognitive Robotics Laboratory, Department of Computer Science and Engineering, Contextual Robotics Institute, University of California, San Diego, La Jolla, CA, United States
| | - Ryan C. Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Lawrence G. Appelbaum
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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Subramaniam A, Liu S, Lochhead L, Appelbaum LG. A systematic review of transcranial direct current stimulation on eye movements and associated psychological function. Rev Neurosci 2022; 34:349-364. [PMID: 36310385 DOI: 10.1515/revneuro-2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
Abstract
The last decades have seen a rise in the use of transcranial direct current stimulation (tDCS) approaches to modulate brain activity and associated behavior. Concurrently, eye tracking (ET) technology has improved to allow more precise quantitative measurement of gaze behavior, offering a window into the mechanisms of vision and cognition. When combined, tDCS and ET provide a powerful system to probe brain function and measure the impact on visual function, leading to an increasing number of studies that utilize these techniques together. The current pre-registered, systematic review seeks to describe the literature that integrates these approaches with the goal of changing brain activity with tDCS and measuring associated changes in eye movements with ET. The literature search identified 26 articles that combined ET and tDCS in a probe-and-measure model and are systematically reviewed here. All studies implemented controlled interventional designs to address topics related to oculomotor control, cognitive processing, emotion regulation, or cravings in healthy volunteers and patient populations. Across these studies, active stimulation typically led to changes in the number, duration, and timing of fixations compared to control stimulation. Notably, half the studies addressed emotion regulation, each showing hypothesized effects of tDCS on ET metrics, while tDCS targeting the frontal cortex was widely used and also generally produced expected modulation of ET. This review reveals promising evidence of the impact of tDCS on eye movements and associated psychological function, offering a framework for effective designs with recommendations for future studies.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | - Sicong Liu
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Liam Lochhead
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Lawrence Gregory Appelbaum
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
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8
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Patel R, Suwa Y, Kinross J, von Roon A, Woods AJ, Darzi A, Singh H, Leff DR. Neuroenhancement of surgeons during robotic suturing. Surg Endosc 2022; 36:4803-4814. [PMID: 34724587 PMCID: PMC9160107 DOI: 10.1007/s00464-021-08823-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The initial phases of robotic surgical skills acquisition are associated with poor technical performance, such as low knot-tensile strength (KTS). Transcranial direct-current stimulation (tDCS) can improve force and accuracy in motor tasks but research in surgery is limited to open and laparoscopic tasks in students. More recently, robotic surgery has gained traction and is now the most common approach for certain procedures (e.g. prostatectomy). Early-phase robotic suturing performance is dependent on prefrontal cortex (PFC) activation, and this study aimed to determine whether performance can be improved with prefrontal tDCS. METHODS Fifteen surgical residents were randomized to either active then sham tDCS or sham then active tDCS, in two counterbalanced sessions in a double-blind crossover study. Within each session, participants performed a robotic suturing task repeated in three blocks: pre-, intra- and post-tDCS. During the intra-tDCS block, participants were randomized to either active tDCS (2 mA for 15 min) to the PFC or sham tDCS. Primary outcome measures of technical quality included KTS and error scores. RESULTS Significantly faster completion times were observed longitudinally, regardless of active (p < 0.001) or sham stimulation (p < 0.001). KTS was greater following active compared to sham stimulation (median: active = 44.35 N vs. sham = 27.12 N, p < 0.001). A significant reduction in error scores from "pre-" to "post-" (p = 0.029) were only observed in the active group. CONCLUSION tDCS could reduce error and enhance KTS during robotic suturing and warrants further exploration as an adjunct to robotic surgical training.
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Affiliation(s)
- Ronak Patel
- Deparment of Surgery and Cancer, Imperial College London, London, UK.
| | - Yusuke Suwa
- Deparment of Surgery and Cancer, Imperial College London, London, UK
| | - James Kinross
- Deparment of Surgery and Cancer, Imperial College London, London, UK
| | | | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Ara Darzi
- Deparment of Surgery and Cancer, Imperial College London, London, UK
| | - Harsimrat Singh
- Deparment of Surgery and Cancer, Imperial College London, London, UK
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Chinzara T, Buckingham G, Harris D. Transcranial direct current stimulation (tDCS) and sporting performance: A systematic review and meta-analysis of tDCS effects on physical endurance, muscular strength, and visuomotor skills. Eur J Neurosci 2021; 55:468-486. [PMID: 34904303 DOI: 10.1111/ejn.15540] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has been linked with a range of physiological and cognitive enhancements relevant to sporting performance. As a number of positive and null findings have been reported in the literature, the present meta-analysis sought to synthesise results across endurance, strength, and visuomotor skill domains to investigate if tDCS improves any aspect of sporting performance. Online database searches in August 2020 identified 43 full-text studies which examined the acute effects of tDCS compared to sham/control conditions on physical endurance, muscular strength, and visuomotor skills in healthy adults. Meta-analysis indicated a small overall effect favouring tDCS stimulation over sham/control (standardized mean difference (SMD)=0.25, CI95%[0.14;0.36]). Effects on strength (SMD=0.31, CI95%[0.10;0.51]) and visuomotor (SMD=0.29, CI95%[0.00;0.57]) tasks were larger than endurance performance (SMD=0.18, CI95%[0.00;0.37]). Meta-regressions indicated effect sizes were not related to stimulation parameters, but other factors such as genetics, gender, and experience may modulate tDCS effects. The results suggest tDCS has the potential to be used as an ergogenic aid in conjunction with a specified training regime.
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Affiliation(s)
- Trish Chinzara
- Department of Sport and Health Science, University of Exeter, UK.,Goldsmiths University of London, London, UK
| | - Gavin Buckingham
- Department of Sport and Health Science, University of Exeter, UK
| | - David Harris
- Department of Sport and Health Science, University of Exeter, UK
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10
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Hadi Z, Umbreen A, Anwar MN, Navid MS. The effects of unilateral transcranial direct current stimulation on unimanual laparoscopic peg-transfer task. Brain Res 2021; 1771:147656. [PMID: 34508672 DOI: 10.1016/j.brainres.2021.147656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Efficient training methods are required for laparoscopic surgical skills training to reduce the time needed for proficiency. Transcranial direct current stimulation (tDCS) is widely used to enhance motor skill acquisition and can be used to supplement the training of laparoscopic surgical skill acquisition. The aim of this study was to investigate the effect of anodal tDCS over the primary motor cortex (M1) on the performance of a unimanual variant of the laparoscopic peg-transfer task. METHODS Fifteen healthy subjects participated in this randomized, double-blinded crossover study involving an anodal tDCS and a sham tDCS intervention separated by 48 h. On each intervention day, subjects performed a unimanual variant of laparoscopic peg-transfer task in three sessions (baseline, tDCS, post-tDCS). The tDCS session consisted of 10 min of offline tDCS followed by 10 min of online tDCS. The scores based on the task completion time and the number of errors in each session were used as a primary outcome measure. A linear mixed-effects model was used for the analysis. RESULTS We found that the scores increased over sessions (p < 0.01). However, we found no effects of stimulation (anodal tDCS vs. sham tDCS) and no interaction of stimulation and sessions. CONCLUSION This study suggests that irrespective of the type of current stimulation (anodal and sham) over M1, there was an improvement in the performance of the unimanual peg-transfer task, implying that there was motor learning over time. The results would be useful in designing efficient training paradigms and further investigating the effects of tDCS on laparoscopic peg-transfer tasks.
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Affiliation(s)
- Zaeem Hadi
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan; Brain and Vestibular Group, Neuro-otology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, UK
| | - Aysha Umbreen
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Muhammad Nabeel Anwar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Muhammad Samran Navid
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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11
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Walia P, Kumar KN, Dutta A. Neuroimaging Guided Transcranial Electrical Stimulation in Enhancing Surgical Skill Acquisition. Comment on Hung et al. The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials. Brain Sci. 2021, 11, 707. Brain Sci 2021; 11:1078. [PMID: 34439698 PMCID: PMC8395024 DOI: 10.3390/brainsci11081078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 01/02/2023] Open
Abstract
Surgical skill acquisition may be facilitated with a safe application of transcranial direct current stimulation (tDCS). A preliminary meta-analysis of randomized control trials showed that tDCS was associated with significantly better improvement in surgical performance than the sham control; however, meta-analysis does not address the mechanistic understanding. It is known from skill learning studies that the hierarchy of cognitive control shows a rostrocaudal axis in the frontal lobe where a shift from posterior to anterior is postulated to mediate progressively abstract, higher-order control. Therefore, optimizing the transcranial electrical stimulation to target surgical task-related brain activation at different stages of motor learning may provide the causal link to the learning behavior. This comment paper presents the computational approach for neuroimaging guided tDCS based on open-source software pipelines and an open-data of functional near-infrared spectroscopy (fNIRS) for complex motor tasks. We performed an fNIRS-based cortical activation analysis using AtlasViewer software that was used as the target for tDCS of the motor complexity-related brain regions using ROAST software. For future studies on surgical skill training, it is postulated that the higher complexity laparoscopic suturing with intracorporeal knot tying task may result in more robust activation of the motor complexity-related brain areas when compared to the lower complexity laparoscopic tasks.
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Affiliation(s)
- Pushpinder Walia
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14260, USA;
| | - Kavya Narendra Kumar
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260, USA;
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260, USA;
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12
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The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials. Brain Sci 2021; 11:brainsci11060707. [PMID: 34071756 PMCID: PMC8229080 DOI: 10.3390/brainsci11060707] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/15/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
The application of transcranial direct current stimulation (tDCS) to targeted cortices has been found to improve in skill acquisition; however, these beneficial effects remained unclear in fine and complicated skill. The aim of the current meta-analysis was to investigate the association between tDCS application and the efficacy of surgical performance during surgical skill training. We included randomized controlled trials (RCTs) investigating the efficacy of tDCS in enhancing surgical skill acquisition. This meta-analysis was conducted under a random-effect model. Six RCTs with 198 participants were included. The main result revealed that tDCS was associated with significantly better improvement in surgical performance than the sham control (Hedges’ g = 0.659, 95% confidence intervals (95%CIs) = 0.383 to 0.935, p < 0.001). The subgroups of tDCS over the bilateral prefrontal cortex (Hedges’ g = 0.900, 95%CIs = 0.419 to 1.382, p < 0.001) and the primary motor cortex (Hedges’ g = 0.599, 95%CIs = 0.245 to 0.953, p = 0.001) were both associated with significantly better improvements in surgical performance. The tDCS application was not associated with significant differences in error scores or rates of local discomfort compared with a sham control. This meta-analysis supported the rationale for the tDCS application in surgical training programs to improve surgical skill acquisition.
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Patel R, Rai A, Thornton-Wood F, Wilkinson A, Darzi A, Singh H, Leff DR. Neuroenhancement of future surgeons - Opinions from students, surgeons and patients. Brain Stimul 2021; 14:616-618. [PMID: 33789167 DOI: 10.1016/j.brs.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ronak Patel
- Department of Surgery and Cancer, Imperial College London, UK.
| | - Amar Rai
- Department of Surgery and Cancer, Imperial College London, UK
| | | | - Aimee Wilkinson
- Department of Surgery and Cancer, Imperial College London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, UK
| | - Harsimrat Singh
- Department of Surgery and Cancer, Imperial College London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, UK
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Patel R, Singh H, Ashcroft J, Woods AJ, Darzi A, Leff DR. Dataset of prefrontal transcranial direct-current stimulation to improve early surgical knot-tying skills. Data Brief 2021; 35:106905. [PMID: 33732823 PMCID: PMC7941089 DOI: 10.1016/j.dib.2021.106905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
Transcranial direct-current stimulation (tDCS) has previously demonstrated promising effects in improving surgical performance with motor region stimulation [1], [2], [3], [4]. However, extensive prior research has revealed an important role of the prefrontal cortex in surgical skill development [5,6]. This article presents the data of a double-blind randomized sham-controlled trial investigating the effect of prefrontal tDCS on knot-tying performance [7]. Data was collected from an active (n = 20) and sham (n = 20) group across three blocks: pre-, online- (during) and post-tDCS. Group and block differences of knot-tying performance were analyzed using a Generalized linear mixed model and supported with a Friedman's test. Further sub-analyses were conducted to compare high vs. low skilled individuals and initial vs. last knots. Subjective workload was assessed after each block using a SURG-TLX questionnaire and side-effects of the tDCS block were recorded using an additional survey.
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Affiliation(s)
- Ronak Patel
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, QEQM Building, Praed Street, London W2 1NY, United Kingdom
| | - Harsimrat Singh
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, QEQM Building, Praed Street, London W2 1NY, United Kingdom
| | - James Ashcroft
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, QEQM Building, Praed Street, London W2 1NY, United Kingdom
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, QEQM Building, Praed Street, London W2 1NY, United Kingdom
| | - Daniel R Leff
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, QEQM Building, Praed Street, London W2 1NY, United Kingdom
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Tallent J, Woodhead A, Frazer AK, Hill J, Kidgell DJ, Howatson G. Corticospinal and spinal adaptations to motor skill and resistance training: Potential mechanisms and implications for motor rehabilitation and athletic development. Eur J Appl Physiol 2021; 121:707-719. [PMID: 33389142 DOI: 10.1007/s00421-020-04584-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/12/2020] [Indexed: 12/12/2022]
Abstract
Optimal strategies for enhancing strength and improving motor skills are vital in athletic performance and clinical rehabilitation. Initial increases in strength and the acquisition of new motor skills have long been attributed to neurological adaptations. However, early increases in strength may be predominantly due to improvements in inter-muscular coordination rather than the force-generating capacity of the muscle. Despite the plethora of research investigating neurological adaptations from motor skill or resistance training in isolation, little effort has been made in consolidating this research to compare motor skill and resistance training adaptations. The findings of this review demonstrated that motor skill and resistance training adaptations show similar short-term mechanisms of adaptations, particularly at a cortical level. Increases in corticospinal excitability and a release in short-interval cortical inhibition occur as a result of the commencement of both resistance and motor skill training. Spinal changes show evidence of task-specific adaptations from the acquired motor skill, with an increase or decrease in spinal reflex excitability, dependant on the motor task. An increase in synaptic efficacy of the reticulospinal projections is likely to be a prominent mechanism for driving strength adaptations at the subcortical level, though more research is needed. Transcranial electric stimulation has been shown to increase corticospinal excitability and augment motor skill adaptations, but limited evidence exists for further enhancing strength adaptations from resistance training. Despite the logistical challenges, future work should compare the longitudinal adaptations between motor skill and resistance training to further optimise exercise programming.
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Affiliation(s)
- Jamie Tallent
- Faculty of Sport, Health and Applied Sciences, St Mary's University, Waldgrave Road, Twickenham, TW1 4SX, UK.
| | - Alex Woodhead
- Faculty of Sport, Health and Applied Sciences, St Mary's University, Waldgrave Road, Twickenham, TW1 4SX, UK
| | - Ashlyn K Frazer
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Jessica Hill
- Faculty of Sport, Health and Applied Sciences, St Mary's University, Waldgrave Road, Twickenham, TW1 4SX, UK
| | - Dawson J Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK.,Water Research Group, Faculty of Natural and Agricultural Sciences, North West University, Potchefstroom, South Africa
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Prefrontal transcranial direct-current stimulation improves early technical skills in surgery. Brain Stimul 2020; 13:1834-1841. [DOI: 10.1016/j.brs.2020.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
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Patel R, Dawidziuk A, Darzi A, Singh H, Leff DR. Systematic review of combined functional near-infrared spectroscopy and transcranial direct-current stimulation studies. NEUROPHOTONICS 2020; 7:020901. [PMID: 32607389 PMCID: PMC7315225 DOI: 10.1117/1.nph.7.2.020901] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/15/2020] [Indexed: 05/05/2023]
Abstract
Significance: Combining transcranial direct-current stimulation (tDCS) with functional near-infrared spectroscopy (fNIRS) is a recent approach to exploring brain activation evoked by neurostimulation. Aim: To critically evaluate studies combining tDCS and fNIRS and provide a consolidated overview of cortical hemodynamic responses to neurostimulation. Approach: Key terms were searched in three databases (MEDLINE, EMBASE, and PsycINFO) with cross-referencing and works from Google Scholar also evaluated. All studies reporting on fNIRS-derived hemoglobin changes evoked by tDCS were included. Results: Literature searches revealed 474 articles, of which 28 were included for final review (22 in healthy individuals: 9 involving rest and 13 with tasks; 6 in the clinical setting). At rest, an overall increase in cortical activation was observed in fNIRS responses at the site of stimulation, with evidence suggesting nonstimulated brain regions are also similarly affected. Conversely, during tasks, reduced cortical activation was observed during online stimulation. Offline and poststimulation effects were less consistent, as is the impact on clinical populations and their symptom correlation. Conclusion: This review explores the methodological frameworks for fNIRS-tDCS evaluations and summarizes hemodynamic responses associated with tDCS in all populations. Our findings provide further evidence of the impact of tDCS on neuronal activation within functionally connected networks.
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Affiliation(s)
- Ronak Patel
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
- Address all correspondence to Ronak Patel, E-mail:
| | - Aleksander Dawidziuk
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Ara Darzi
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Harsimrat Singh
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Daniel Richard Leff
- St. Mary’s Hospital Campus, Imperial College London, Department of Surgery and Cancer, London, United Kingdom
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