Transcranial direct current stimulation over multiple days enhances motor performance of a grip task

Evaluation of Transcranial Direct Current Stimulation in Motor Function and Neural Rehabilitation

ABSTRACT

Transcranial direct current stimulation (tDCS) is used in neuromodulation to regulate the excitability of the cerebral cortex and induce neural plasticity. It was initially used to rehabilitate patients with neurological diseases. However, with the increasing number of studies involving healthy individuals, this technology is currently used in the field of sports as well. The administration of tDCS to the cerebral cortex, especially over the primary motor cortex (M1), has been found to improve muscle strength, enhance endurance, and promote motor skills in humans. This study mainly summarizes the effects of tDCS on motor function, mainly involving motor promotion of tDCS in healthy athletes and nonathletes, and in patients diagnosed with neurological diseases. The tDCS is a promising and effective tool used to promote motor function by regulating cortical excitability. However, no consensus is available regarding individually appropriate models of tDCS.

Dual-hemisphere anodal transcranial direct current stimulation improves bilateral motor synergies

Transcranial direct current stimulation (tDCS) is one of the non-invasive brain stimulation techniques that can improve motor functions. As bimanual motor actions require high motor cortical activations between hemispheres, applying bilateral anodal stimulation on left and right sides of primary motor cortex (M1) can improve for improvements in bimanual motor tasks. This study investigated which bilateral tDCS protocol effectively improves bimanual hand-grip force control capabilities in healthy young adults. We used three different bilateral tDCS protocols: (a) dual-anodal stimulation on the M1 of bilateral hemispheres (Bi-AA), (b) anodal-cathodal stimulation on the M1 of dominant and nondominant hemispheres (Bi-AC), and (c) sham stimulation (Sham). The results indicated that applying the Bi-AA significantly improved bilateral motor synergies estimated by uncontrolled manifold analysis relative to Sham. However, these differences were not observed in the comparison between Bi-AA and Bi-AC as well as between Bi-AC and Sham. These findings suggest that facilitating motor cortical activations between both hemispheres may be an additional option for advancing interlimb motor coordination patterns.

A blended neurostimulation protocol to delineate cortico-muscular and spino-muscular dynamics following neuroplastic adaptation

In this paper we propose a novel neurostimulation protocol that provides an intervention-based assessment to distinguish the contributions of different motor control networks in the cortico-spinal system. Specifically, we use a combination of non-invasive brain stimulation and neuromuscular stimulation to probe neuromuscular system behavior with targeted impulse-response system identification. In this protocol, we use an in-house developed human-machine interface (HMI) for an isotonic wrist movement task, where the user controls a cursor on-screen. During the task, we generate unique motor evoked potentials based on triggered cortical or spinal level perturbations. Externally applied brain-level perturbations are triggered through TMS to cause wrist flexion/extension during the volitional task. The resultant contraction output and related reflex responses are measured by the HMI. These movements also include neuromodulation in the excitability of the brain-muscle pathway via transcranial direct current stimulation. Colloquially, spinal-level perturbations are triggered through skin-surface neuromuscular stimulation of the wrist muscles. The resultant brain-muscle and spinal-muscle pathways perturbed by the TMS and NMES, respectively, demonstrate temporal and spatial differences as manifested through the human-machine interface. This then provides a template to measure the specific neural outcomes of the movement tasks, and in decoding differences in the contribution of cortical- (long-latency) and spinal-level (short-latency) motor control. This protocol is part of the development of a diagnostic tool that can be used to better understand how interaction between cortical and spinal motor centers changes with learning, or injury such as that experienced following stroke.

Applied strategies of neuroplasticity

Various levels of somatotopic organization are present throughout the human nervous system. However, this organization can change when needed based on environmental demands, a phenomenon known as neuroplasticity. Neuroplasticity can occur when learning a new motor skill, adjusting to life after blindness, or following a stroke. Following an injury, these neuroplastic changes can be adaptive or maladaptive, and often occur regardless of whether rehabilitation occurs or not. But not all movements produce neuroplasticity, nor do all rehabilitation interventions. Here, we focus on research regarding how to maximize adaptive neuroplasticity while also minimizing maladaptive plasticity, known as applied neuroplasticity. Emphasis is placed on research exploring how best to apply neuroplastic principles to training environments and rehabilitation protocols. By studying and applying these principles in research and clinical practice, it is hoped that learning of skills and regaining of function and independence can be optimized.

Transcranial direct current stimulation influences repetitive bimanual force control and interlimb force coordination

This study aimed to investigate the potential effect of bilateral transcranial direct current stimulation (tDCS) on repetitive bimanual force control and force coordination in healthy young adults. In this sham-controlled crossover study, 18 right-handed young adults were enrolled. Repetitive bimanual handgrip force control trials were performed by the participants at 40% of maximum voluntary contraction until task failure. We randomly provided bilateral active and sham tDCS to the primary motor cortex (M1) of each participant before conducting the repetitive bimanual force control task. We quantified the number of successful trials to assess the ability to maintain bimanual force control across multiple trials. Moreover, we estimated bimanual force control and force coordination by quantifying force accuracy, variability, regularity, and correlation coefficient in maximal and adjusted successful trials. Force asymmetry was calculated to examine potential changes in motor dependency on each hand during the task. Bilateral tDCS significantly increased the number of successful trials compared with sham tDCS. The adjusted successful trial revealed that participants who received bilateral tDCS maintained better bimanual force control and coordination, as indicated by decreased force variability and regularity as well as more negative correlation coefficient values in comparison with sham condition. Moreover, participants who received bilateral tDCS produced more force from the dominant hand than from the nondominant hand in both maximal and adjusted successful trials. These findings suggest that bilateral tDCS on M1 successfully maintains bimanual force control with better force coordination by modulating motor dependency.

Transcranial direct current stimulation leads to faster acquisition of motor skills, but effects are not maintained at retention

Practice is required to improve one’s shooting technique in basketball or to play a musical instrument well. Learning these motor skills may be further enhanced by transcranial direct current stimulation (tDCS). We aimed to investigate whether tDCS leads to faster attainment of a motor skill, and to confirm prior work showing it improves skill acquisition and retention performance. Fifty-two participants were tested; half received tDCS with the anode on primary motor cortex and cathode on the contralateral forehead while concurrently practicing a sequential visuomotor isometric pinch force task on Day 1, while the other half received sham tDCS during practice. On Day 2, retention of the skill was tested. Results from a Kaplan-Meier survival analysis showed that participants in the anodal group attained a pre-defined target level of skill faster than participants in the sham group (χ2 = 9.117, p = 0.003). Results from a nonparametric rank-based regression analysis showed that the rate of improvement was greater in the anodal versus sham group during skill acquisition (F(1,249) = 5.90, p = 0.016), but there was no main effect of group or time. There was no main effect of group or time, or group by time interaction when comparing performance at the end of acquisition to retention. These findings suggest anodal tDCS improves performance more quickly during skill acquisition but does not have additional benefits on motor learning after a period of rest.

Neuroergonomic assessment of developmental coordination disorder

Until recently, neural assessments of gross motor coordination could not reliably handle active tasks, particularly in realistic environments, and offered a narrow understanding of motor-cognition. By applying a comprehensive neuroergonomic approach using optical mobile neuroimaging, we probed the neural correlates of motor functioning in young people with Developmental Coordination Disorder (DCD), a motor-learning deficit affecting 5-6% of children with lifelong complications. Neural recordings using fNIRS were collected during active ambulatory behavioral task execution from 37 Typically Developed and 48 DCD Children who performed cognitive and physical tasks in both single and dual conditions. This is the first of its kind study targeting regions of prefrontal cortical dysfunction for identification of neuropathophysiology for DCD during realistic motor tasks and is one of the largest neuroimaging study (across all modalities) involving DCD. We demonstrated that DCD is a motor-cognitive disability, as gross motor /complex tasks revealed neuro-hemodynamic deficits and dysfunction within the right middle and superior frontal gyri of the prefrontal cortex through functional near infrared spectroscopy. Furthermore, by incorporating behavioral performance, decreased neural efficiency in these regions were revealed in children with DCD, specifically during motor tasks. Lastly, we provide a framework, evaluating disorder impact in ecologically valid contexts to identify when and for whom interventional approaches are most needed and open the door for precision therapies.

The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial

Background

The results of transcranial direct current stimulation (tDCS) studies that seek to improve motor performance for people with neurological disorders, by targeting the primary motor cortex, have been inconsistent. One possible reason, among others, for this inconsistency, is that very little is known about the optimal protocols for enhancing motor performance in healthy individuals. The best way to optimize stimulation protocols for enhancing tDCS effects on motor performance by means of current intensity modulation has not yet been determined. We aimed to determine the effect of current intensity on motor performance using–for the first time–a montage optimized for maximal focal stimulation via anodal high-definition tDCS (HD-tDCS) on the right primary motor cortex in healthy subjects.

Methods

Sixty participants randomly received 20-min HD-tDCS at 1.5, 2 mA, or sham stimulation. Participants’ reaching performance with the left hand on a tablet was tested before, during, and immediately following stimulation, and retested after 24 h.

Results

In the current montage of HD-tDCS, movement time did not differ between groups in each timepoint. However, only after HD-tDCS at 1.5 mA did movement time improve at posttest as compared to pretest. This reduction in movement time from pretest to posttest was significantly greater compared to HD-tDCS 2 mA. Following HD-tDCS at 1.5 mA and sham HD-tDCS, but not 2 mA, movement time improved at retest compared to pretest, and at posttest and retest compared to the movement time during stimulation. In HD-tDCS at 2 mA, the negligible reduction in movement time from the course of stimulation to posttest was significantly lower compared to sham HD-tDCS. Across all groups, reaction time improved in retest compared to pretest and to the reaction time during stimulation, and did not differ between groups in each timepoint.

Conclusions

It appears that 2 mA in this particular experimental setup inhibited the learning effects. These results suggest that excitatory effects induced by anodal stimulation do not hold for every stimulation intensity, information that should be taken into consideration when translating tDCS use from the realm of research into more optimal neurorehabilitation.

Trial registration: Clinical Trials Gov, NCT04577768. Registered 6 October 2019 -Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A9B3&selectaction=Edit&uid=U0005AKF&ts=8&cx=buucf0.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-021-00899-z.

Dual Task Effects on Speed and Accuracy During Cognitive and Upper Limb Motor Tasks in Adults With Stroke Hemiparesis

Background

Adults with stroke need to perform cognitive-motor dual tasks during their day-to-day activities. However, they face several challenges owing to their impaired motor and cognitive functions.

Objective

This case-controlled pilot study investigates the speed and accuracy tradeoffs in adults with stroke while performing cognitive-upper limb motor dual tasks.

Methods

Ten adults with stroke and seven similar-aged controls participated in this study. The participants used a robotic arm for the single motor task and participated in either the serial sevens (S7) or the controlled oral word association test (COWAT) for single-cognitive task. For the dual task, the participants performed the motor and cognitive components simultaneously. Their speed and accuracy were measured for the motor and cognitive tasks, respectively.

Results

Two-sample t-statistics indicated that the participants with stroke exhibited a lower motor accuracy in the cross task than in the circle task. The cognitive speed and motor accuracy registered by the subjects with stroke in the dual task significantly decreased. There was a negative linear correlation between motor speed and accuracy in the subjects with stroke when the COWAT task was performed in conjunction with the cross task (ρ = -0.6922, p = 0.0388).

Conclusions

This study proves the existence of cognitive-upper limb motor interference in adults with stroke while performing dual tasks, based on the observation that their performance during one or both dual tasks deteriorated compared to that during the single task. Both speed and accuracy were complementary parameters that may indicate clinical effectiveness in motor and cognitive outcomes in individuals with stroke.

Effects of Bilateral Transcranial Direct Current Stimulation on Simultaneous Bimanual Handgrip Strength

Although the effects of transcranial direct current stimulation (tDCS) on contralateral unimanual movement have been well reported, its effects on coordinated multi-limb movements remain unclear. Because multi-limb coordination is often performed in daily activities and sports, clarifying the effects of tDCS on multi-limb coordination may have valuable implications. However, considering the neural crosstalk involved in bimanual movements, including the transcallosal pathway and ipsilateral motor pathway, the extent of tDCS-induced improvement may differ between unimanual and bimanual movement. We examined how tDCS affects simultaneous bimanual maximal voluntary contraction (MVC) by testing the effects of tDCS of the bilateral primary motor cortex (M1) on unimanual and bimanual handgrip strength. Twenty-one right-handed healthy adults underwent three bilateral tDCS protocols ("RaLc," with an anode on right M1 and a cathode on left M1, "RcLa," with an anode on left M1 and a cathode on right M1, and "Sham") in a randomized order. A 1.5 mA current was applied for 15 min during tDCS. Participants then performed maximal unimanual and bimanual handgrip tests. Bimanual handgrip force was higher in both hands in the RcLa condition than in the Sham condition. Similarly, unimanual handgrip force was higher in the RcLa condition than in the Sham condition. Stimulus responses were asymmetrical and were not observed in the RaLc condition. Our findings demonstrate that RcLa tDCS leads to neuromodulation that can produce greater unimanual and bimanual handgrip strength. This result provides basic evidence that tDCS may be useful in sports, particularly those involving bilateral coordination of upper limb movement.

Small Enhancement of Bimanual Typing Performance after 20 Sessions of tDCS in Healthy Young Adults

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that may improve motor learning. However, the long-term effects of tDCS have not been explored, and the ecological validity of the evaluated tasks was limited. To determine whether 20 sessions of tDCS over the primary motor cortex (M1) would enhance the performance of a complex life motor skill, i.e., typing, in healthy young adults. Healthy young adults (n = 60) were semi-randomly assigned to three groups: the tDCS group (n = 20) received anodal tDCS over M1; the SHAM group (n = 20) received sham tDCS, both while performing a typing task; and the Control group (CON, n = 20) only performed the typing task. Typing speed and errors at maximum (mTT) and submaximal (iTT) speeds were measured before training, and after 10 and 20 sessions of tDCS. Every subject increased maximum typing speed after 10 and 20 tDCS sessions, with no significant differences (p > 0.05) between the groups. The number of errors at submaximal rates decreased significantly (p < 0.05) by 4% after 10 tDCS sessions compared with the 3% increase in the SHAM and the 2% increase in the CON groups. Between the 10th and 20th tDCS sessions, the number of typing errors increased significantly in all groups. While anodal tDCS reduced typing errors marginally, such performance-enhancing effects plateaued after 10 sessions without any further improvements in typing speed. These findings suggest that long-term tDCS may not have functionally relevant effects on healthy young adults' typing performance.

No Impact of Cerebellar Anodal Transcranial Direct Current Stimulation at Three Different Timings on Motor Learning in a Sequential Finger-Tapping Task

Background: Recently, attention has grown toward cerebellar neuromodulation in motor learning using transcranial direct current stimulation (tDCS). An important point of discussion regarding this modulation is the optimal timing of tDCS, as this parameter could significantly influence the outcome. Hence, this study aimed to investigate the effects of the timing of cerebellar anodal tDCS (ca-tDCS) on motor learning using a sequential finger-tapping task (FTT).

Methods: One hundred and twenty two healthy young, right-handed subjects (96 females) were randomized into four groups (During_sham, Before, During_real, After). They performed 2 days of FTT with their non-dominant hand on a custom keyboard. The task consisted of 40 s of typing followed by 20 s rest. Each participant received ca-tDCS (2 mA, sponge electrodes of 25 cm², 20 min) at the appropriate timing and performed 20 trials on the first day (T1, 20 min). On the following day, only 10 trials of FTT were performed without tDCS (T2, 10 min). Motor skill performance and retention were assessed.

Results: All participants showed a time-dependent increase in learning. Motor performance was not different between groups at the end of T1 (p = 0.59). ca-tDCS did not facilitate the retention of the motor skill in the FTT at T2 (p = 0.27). Thus, our findings indicate an absence of the effect of ca-tDCS on motor performance or retention of the FTT independently from the timing of stimulation.

Conclusion: The present results suggest that the outcome of ca-tDCS is highly dependent on the task and stimulation parameters. Future studies need to establish a clear basis for the successful and reproducible clinical application of ca-tDCS.

Effectiveness of Unihemispheric Concurrent Dual-Site Stimulation over M1 and Dorsolateral Prefrontal Cortex Stimulation on Pain Processing: A Triple Blind Cross-Over Control Trial

Background: Transcranial direct current stimulation (tDCS) of the motor cortex (M1) produces short-term inhibition of pain. Unihemispheric concurrent dual-site tDCS (UHCDS-tDCS) over the M1 and dorsolateral prefrontal cortex (DLPFC) has greater effects on cortical excitability than when applied alone, although its effect on pain is unknown. The aim of this study was to test if anodal UHCDS-tDCS over the M1 and DLPFC in healthy participants could potentiate conditioned pain modulation (CPM) and diminish pain temporal summation (TS). Methods: Thirty participants were randomized to receive a sequence of UHCDS-tDCS, M1-tDCS and sham-tDCS. A 20 min 0.1 mA/cm² anodal or sham-tDCS intervention was applied to each participant during three test sessions, according to a triple-blind cross-over trial design. For the assessment of pain processing before and after tDCS intervention, the following tests were performed: tourniquet conditioned pain modulation (CPM), pressure pain temporal summation (TS), pressure pain thresholds (PPTs), pressure pain tolerance, mechanosensitivity and cold hyperalgesia. Motor function before and after tDCS intervention was assessed with a dynamometer to measure maximal isometric grip strength. Results: No statistically significant differences were found between groups for CPM, pressure pain TS, PPT, pressure pain tolerance, neural mechanosensitivity, cold hyperalgesia or grip strength (p > 0.05). Conclusions: Neither UHCDS-tDCS nor M1-tDCS facilitated CPM or inhibited TS in healthy subjects following one intervention session.

Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review

Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.

Investigating prismatic adaptation effects in handgrip strength and in plantar pressure in healthy subjects

BACKGROUND

Prismatic Adaptation (PA) is a visuomotor procedure inducing a shift of the visual field that has been shown to modulate activation of a number of brain areas, in posterior (i.e. parietal cortex) and anterior regions (i.e. frontal cortex). This neuromodulation could be useful to study neural mechanisms associated with either postural measures such as the distribution of plantar pressure or to the generation of muscle strength. Indeed, plantar pressure distribution is associated to activation of high-level cognitive mechanisms taking place within the posterior regions of the brain dorsal stream, especially of the right hemisphere. Conversely, hand force mostly rely on sensorimotor mechanisms, fulfilled by anterior regions of the brain and involving both hemispheres.

RESEARCH QUESTION

Since PA effects have been reported to affect both sensorimotor and higher level cognitive processes, is it possible to hypothesize a modulation of both hands strenght and plantar pressure after PA?

METHODS

Forty-six healthy subjects (male = 23; mean age = 25 ± 3 years) were randomly divided into two groups: a leftward prismatic adaptation group (l-PA) and a rightward prismatic adaptation group (r-PA). Hand strength and plantar pressure were assessed, immediately before and after PA, using the handgrip task and baropodometric measurement, respectively.

RESULTS

Both l-PA and r-PA induced a significant decrease of strength in the hand contralateral to the lenses deviation side. Only r-PA was associated with an increase of the forefoot plantar pressure in both feet. Modulation of interhemispheric inhibitory processes at sensorimotor and higher cognitive level may account for the present results.

SIGNIFICANCE

PA exerts effects on body posture and hand strength relying on different mechanisms. The PA effects on hand strength are probably related to the modulation of interhemispheric inhibition of sensorimotor processes, involving both hemispheres. The PA effects on body posture are probably related to modulation of body representation, involving mainly the right hemisphere.

Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes

Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.

Acquisition and consolidation of implicit motor learning with physical and mental practice across multiple days of anodal tDCS

BACKGROUND

Acquisition and consolidation of a new motor skill occurs gradually over long time span. Motor imagery (MI) and brain stimulation have been showed as beneficial approaches that boost motor learning, but little is known about the extent of their combined effects.

OBJECTIVE

Here, we aimed to investigate, for the first time, whether delivering multiple sessions of transcranial direct current stimulation (tDCS) over primary motor cortex during physical and MI practice might improve implicit motor sequence learning in a young population.

METHODS

Participants practiced a serial reaction time task (SRTT) either physically or through MI, and concomitantly received either an anodal (excitatory) or sham stimulation over the primary motor cortex during three successive days. The effect of anodal tDCS on the general motor skill and sequence specific learning were assessed on both acquisition (within-day) and consolidation (between-day) processes. We further compared the magnitude of motor learning reached after a single and three daily sessions of tDCS.

RESULTS

The main finding showed that anodal tDCS boosted MI practice, but not physical practice, during the first acquisition session. A second major result showed that compared to sham stimulation, multiple daily session of anodal tDCS, for both types of practice, resulted in greater implicit motor sequence learning rather than a single session of stimulation.

CONCLUSIONS

The present study is of particular importance in the context of rehabilitation, where we postulate that scheduling mental training when patients are not able to perform physical movement might beneficiate from concomitant and consecutive brain stimulation sessions over M₁ to promote functional recovery.

Finding the Intersection of Neuroplasticity, Stroke Recovery, and Learning: Scope and Contributions to Stroke Rehabilitation

Aim

Neural plastic changes are experience and learning dependent, yet exploiting this knowledge to enhance clinical outcomes after stroke is in its infancy. Our aim was to search the available evidence for the core concepts of neuroplasticity, stroke recovery, and learning; identify links between these concepts; and identify and review the themes that best characterise the intersection of these three concepts.

Methods

We developed a novel approach to identify the common research topics among the three areas: neuroplasticity, stroke recovery, and learning. A concept map was created a priori, and separate searches were conducted for each concept. The methodology involved three main phases: data collection and filtering, development of a clinical vocabulary, and the development of an automatic clinical text processing engine to aid the process and identify the unique and common topics. The common themes from the intersection of the three concepts were identified. These were then reviewed, with particular reference to the top 30 articles identified as intersecting these concepts.

Results

The search of the three concepts separately yielded 405,636 publications. Publications were filtered to include only human studies, generating 263,751 publications related to the concepts of neuroplasticity (n = 6,498), stroke recovery (n = 79,060), and learning (n = 178,193). A cluster concept map (network graph) was generated from the results; indicating the concept nodes, strength of link between nodes, and the intersection between all three concepts. We identified 23 common themes (topics) and the top 30 articles that best represent the intersecting themes. A time-linked pattern emerged.

Discussion and Conclusions

Our novel approach developed for this review allowed the identification of the common themes/topics that intersect the concepts of neuroplasticity, stroke recovery, and learning. These may be synthesised to advance a neuroscience-informed approach to stroke rehabilitation. We also identified gaps in available literature using this approach. These may help guide future targeted research.

Noninvasive brain stimulation over M1 and DLPFC cortex enhances the learning of bimanual isometric force control

Motor learning plays an important role in upper-limb function and the recovery of lost functionality. This study aimed to investigate the relative impact of transcranial direct current stimulation (tDCS) on learning in relation to the left primary motor cortex (M1) and left dorsolateral prefrontal cortex (DLPFC) during bimanual isometric force-control tasks performed with both hands under different task constraints. In a single-blind cross-over design, 20 right-handed participants were randomly assigned to either the M1 group (n = 10; mean age, 22.90 ± 1.66 years, mean ± standard deviation) or the DLPFC group (n = 10; mean age, 23.20 ± 1.54 years). Each participant received 30 min of tDCS (anodal or sham, applied randomly in two experiments) while performing the bimanual force control tasks. Anodal tDCS of the M1 improved the accuracy of maintenance and rhythmic alteration of force tasks, while anodal tDCS of the DLPFC improved only the maintenance of the force control tasks compared with sham tDCS. Hence, tDCS over the left M1 and DLPFC has a beneficial effect on the learning of bimanual force control.