1
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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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2
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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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3
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Guimarães AN, Porto AB, Marcori AJ, Lage GM, Altimari LR, Alves Okazaki VH. Motor learning and tDCS: A systematic review on the dependency of the stimulation effect on motor task characteristics or tDCS assembly specifications. Neuropsychologia 2023; 179:108463. [PMID: 36567006 DOI: 10.1016/j.neuropsychologia.2022.108463] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
TDCS is one of the most commonly used methods among studies with transcranial electrical stimulation and motor skills learning. Differences between study results suggest that the effect of tDCS on motor learning is dependent on the motor task performed or on the tDCS assembly specification used in the learning process. This systematic review aimed to analyze the tDCS effect on motor learning and verify whether this effect is dependent on the task or tDCS assembly specifications. Searches were performed in PubMed, SciELO, LILACS, Web of Science, CINAHL, Scopus, SPORTDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and PsycINFO. Articles were included that analyzed the effect of tDCS on motor learning through pre-practice, post-practice, retention, and/or transfer tests (period ≥24 h). The tDCS was most frequently applied to the primary motor cortex (M1) or the cerebellar cortex (CC) and the majority of studies found significant stimulation effects. Studies that analyzed identical or similar motor tasks show divergent results for the tDCS effect, even when the assembly specifications are the same. The tDCS effect is not dependent on motor task characteristics or tDCS assembly specifications alone but is dependent on the interaction between these factors. This interaction occurs between uni and bimanual tasks with anodal uni and bihemispheric (bilateral) stimulations at M1 or with anodal unihemispheric stimulations (unilateral and centrally) at CC, and between tasks of greater or lesser difficulty with single or multiple tDCS sessions. Movement time seems to be more sensitive than errors to indicate the effects of tDCS on motor learning, and a sufficient amount of motor practice to reach the "learning plateau" also seems to determine the effect of tDCS on motor learning.
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Affiliation(s)
- Anderson Nascimento Guimarães
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Alessandra Beggiato Porto
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Alexandre Jehan Marcori
- University of São Paulo, Av. Professor Mello Moraes 65, CEP 05508-030, Vila Universitaria, São Paulo, SP, Brazil.
| | - Guilherme Menezes Lage
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Leandro Ricardo Altimari
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Victor Hugo Alves Okazaki
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
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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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Wilson MA, Greenwell D, Meek AW, Poston B, Riley ZA. Neuroenhancement of a dexterous motor task with Anodal tDCS. Brain Res 2022; 1790:147993. [PMID: 35760153 DOI: 10.1016/j.brainres.2022.147993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
Motor skill learning can cause structural and functional changes in the primary motor cortex (M1) leading to cortical plasticity that can be associated with the performance change during the motor skill that is practiced. Similarly, anodal transcranial direct current stimulation (a-tDCS) has been shown to facilitate and enhance plasticity in M1, causing even greater motor skill improvement. By using a fine motor task (O'Connor Tweezer Dexterity Task) in combination with a-tDCS we theorized that a-tDCS could increase the speed of skill acquisition. Forty subjects were recruited and randomized into either a-tDCS or SHAM groups. Subjects completed a single session performing the O'Connor Tweezer Dexterity Task with their non-dominant hand while receiving either a-tDCS stimulation or SHAM stimulation of the hand region of M1. The time it took to place 50- pins was assessed before and after 20 minutes of practice with a-tDCS or SHAM. We found that both groups had similar pre-test performance (P=0.94) and they both had a similar amount of practice pins placed (P=0.69). However, the a-tDCS group had a greater improvement than the SHAM group (p=0.028) for overall learning from pretest to posttest. These results suggest that a-tDCS improved the rate of motor learning and fine motor task performance. These results are in line with previous research and demonstrate that a-tDCS applied to M1 can increase manual precision and steadiness needed for delicate tasks and could have implications in the advancement of surgical training as well as in athletic, military, and other occupational settings.
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Affiliation(s)
- Michaela A Wilson
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Davin Greenwell
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Anthony W Meek
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zachary A Riley
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
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6
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Tool-Tissue Forces in Hemangioblastoma Surgery. World Neurosurg 2022; 160:e242-e249. [PMID: 34999009 DOI: 10.1016/j.wneu.2021.12.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Surgical resection of intracranial hemangioblastoma poses technical challenges that may be difficult to impart to trainees. Here, we introduce knowledge of tool-tissue forces in Newton (N), observed during hemangioblastoma surgery. METHODS Seven surgeons (2 groups: trainees and mentor), with mentor (n = 1) and trainees (n = 6, PGY 1-6 including clinical fellowship), participated in 6 intracranial hemangioblastoma surgeries. Using sensorized bipolar forceps, we evaluated tool-tissue force profiles of 5 predetermined surgical tasks: 1) dissection, 2) coagulation, 3) retracting, 4) pulling, and 5) manipulating. Force profile for each trial included force duration, average, maximum, minimum, range, standard deviation (SD), and correlation coefficient. Force errors including unsuccessful trial bleeding or incomplete were compared between surgeons and with successful trials. RESULTS Force data from 718 trials were collected. The mean (standard deviation) of force used in all surgical tasks and across all surgical levels was 0.20 ± 0.17 N. The forces exerted by trainee surgeons were significantly lower than those of the mentor (0.15 vs. 0.24; P < 0.0001). A total of 18 (4.5%) trials were unsuccessful, 4 of them being unsuccessful trial-bleeding and the rest, unsuccessful trial-incomplete. The force in unsuccessful trial-bleeding was higher than successful trials (0.3 [0.09] vs. 0.17 [0.11]; P = 0.0401). Toward the end of surgery, higher force was observed (0.17 vs. 0.20; P < 0.0001). CONCLUSIONS The quantification of tool-tissue forces during hemangioblastoma surgery with feedback to the surgeon, could well enhance surgical training and allow avoidance of bleeding associated with high force error.
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7
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Gordon AM, Ferre CL, Robert MT, Chin K, Brandao M, Friel KM. HABIT+tDCS: a study protocol of a randomised controlled trial (RCT) investigating the synergistic efficacy of hand-arm bimanual intensive therapy (HABIT) plus targeted non-invasive brain stimulation to improve upper extremity function in school-age children with unilateral cerebral palsy. BMJ Open 2022; 12:e052409. [PMID: 35190424 PMCID: PMC8860006 DOI: 10.1136/bmjopen-2021-052409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Unilateral spastic cerebral palsy (USCP) is characterised by movement deficits primarily on one body side. The best available upper extremity (UE) therapies are costly and intensive. Thus, there is an urgent need for better, more efficient and thus more accessible therapies. Transcranial direct current stimulation (tDCS) is non-invasive and may enhance physical rehabilitation approaches. The aim of this study is to determine whether tDCS targeted to the hemisphere with corticospinal tract (CST) connectivity enhances the efficacy of UE training in children with USCP. Our central hypothesis is that hand-arm bimanual intensive therapy (HABIT) combined with a tDCS montage targeting the hemisphere with CST connectivity to the impaired UE muscles will improve UE function more than HABIT plus sham stimulation. We will test this by conducting a randomised clinical trial with clinical and motor cortex physiology outcomes. METHODS AND ANALYSES 81 children, aged 6-17 years, will be randomised to receive 2 mA anodal tDCS targeted to the affected UE motor map, 2 mA cathodal tDCS to the contralesional motor cortex or sham tDCS during the first 20 min of each HABIT session (10 hours: 2 hours/day for 5 days). Primary outcomes will be Box and Blocks Test, Assisting Hand Assessment and motor cortex excitability, determined with single-pulse transcranial magnetic stimulation. Secondary outcomes include ABILHAND-Kids, Canadian Occupational Performance Measure, Cooper Stereognosis, Dimension of Mastery Questionnaire and Participation and Environment Measure-Children and Youth. All measures will be collected before, immediately and 6 months after treatment. A group × test session Analysis of Variance will test differences among groups on all measures. ETHICS AND DISSEMINATION The study has been approved by the BRANY Institutional Review Board (#18-10-285-512). We will leverage our subject and family relationships to maximise dissemination and share results with the academic and patient/family advocacy groups. TRIAL REGISTRATION NUMBER NCT03402854.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
| | - Claudio L Ferre
- Burke Neurological Institute, White Plains, New York, USA
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Maxime T Robert
- Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada
| | - Karen Chin
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
- Burke Neurological Institute, White Plains, New York, USA
| | - Marina Brandao
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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8
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Asbee J, Parsons TD. Effects of Transcranial Direct Current Stimulation on Cognitive and Affective Outcomes Using Virtual Stimuli: A Systematic Review. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2021; 24:699-714. [PMID: 33625878 DOI: 10.1089/cyber.2020.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive form of brain stimulation used to influence neural activity. While early tDCS studies primarily used static stimuli, there is growing interest in dynamic stimulus presentations using virtual environments (VEs). This review attempts to convey the state of the field. This is not a quantitative meta-analysis as there are not yet enough studies following consistent protocols and/or reporting adequate data. In addition to reviewing the state of the literature, this review includes an exploratory analysis of the available data. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, studies were culled from several databases. Results from this review reveal differences between online and offline stimulation. While offline stimulation did not influence affective and cognitive outcomes, online stimulation led to small changes in affect and cognition. Future studies should include randomized controlled trials with larger samples. Furthermore, greater care needs to be applied to full data reporting (e.g., means, standard deviations, and data for their nonsignificant findings) to improve our understanding of the combined effects of virtual stimuli with tDCS.
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Affiliation(s)
- Justin Asbee
- Department of Psychology, University of North Texas, Denton, Texas, USA
- Computational Neuropsychology & Simulation (CNS) Laboratory, University of North Texas, Denton, Texas, USA
| | - Thomas D Parsons
- Computational Neuropsychology & Simulation (CNS) Laboratory, University of North Texas, Denton, Texas, USA
- College of Information, University of North Texas, Denton, Texas, USA
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9
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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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10
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Application of Eye Tracking Technology in Aviation, Maritime, and Construction Industries: A Systematic Review. SENSORS 2021; 21:s21134289. [PMID: 34201734 PMCID: PMC8271947 DOI: 10.3390/s21134289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
Most accidents in the aviation, maritime, and construction industries are caused by human error, which can be traced back to impaired mental performance and attention failure. In 1596, Du Laurens, a French anatomist and medical scientist, said that the eyes are the windows of the mind. Eye tracking research dates back almost 150 years and it has been widely used in different fields for several purposes. Overall, eye tracking technologies provide the means to capture in real time a variety of eye movements that reflect different human cognitive, emotional, and physiological states, which can be used to gain a wider understanding of the human mind in different scenarios. This systematic literature review explored the different applications of eye tracking research in three high-risk industries, namely aviation, maritime, and construction. The results of this research uncovered the demographic distribution and applications of eye tracking research, as well as the different technologies that have been integrated to study the visual, cognitive, and attentional aspects of human mental performance. Moreover, different research gaps and potential future research directions were highlighted in relation to the usage of additional technologies to support, validate, and enhance eye tracking research to better understand human mental performance.
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11
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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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12
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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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13
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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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14
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Romanella SM, Sprugnoli G, Ruffini G, Seyedmadani K, Rossi S, Santarnecchi E. Noninvasive Brain Stimulation & Space Exploration: Opportunities and Challenges. Neurosci Biobehav Rev 2020; 119:294-319. [PMID: 32937115 PMCID: PMC8361862 DOI: 10.1016/j.neubiorev.2020.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/22/2020] [Accepted: 09/03/2020] [Indexed: 01/11/2023]
Abstract
As NASA prepares for longer space missions aiming for the Moon and Mars, astronauts' health and performance are becoming a central concern due to the threats associated with galactic cosmic radiation, unnatural gravity fields, and life in extreme environments. In space, the human brain undergoes functional and structural changes related to fluid shift and changes in intracranial pressure. Behavioral abnormalities, such as cognitive deficits, sleep disruption, and visuomotor difficulties, as well as psychological effects, are also an issue. We discuss opportunities and challenges of noninvasive brain stimulation (NiBS) methods - including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) - to support space exploration in several ways. NiBS includes safe and portable techniques already applied in a wide range of cognitive and motor domains, as well as therapeutically. NiBS could be used to enhance in-flight performance, supporting astronauts during pre-flight Earth-based training, as well as to identify biomarkers of post-flight brain changes for optimization of rehabilitation/compensatory strategies. We review these NiBS techniques and their effects on brain physiology, psychology, and cognition.
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Affiliation(s)
- S M Romanella
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - G Sprugnoli
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Radiology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Ruffini
- Neuroelectrics Corporation, Cambridge, MA, USA
| | - K Seyedmadani
- University Space Research Association NASA Johnson Space Center, Houston, TX, USA; Ann and H.J. Smead Aerospace Engineering Sciences, University of Colorado, Boulder, CO, USA
| | - S Rossi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - E Santarnecchi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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15
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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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16
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Gao Y, Cavuoto L, Schwaitzberg S, Norfleet JE, Intes X, De S. The Effects of Transcranial Electrical Stimulation on Human Motor Functions: A Comprehensive Review of Functional Neuroimaging Studies. Front Neurosci 2020; 14:744. [PMID: 32792898 PMCID: PMC7393222 DOI: 10.3389/fnins.2020.00744] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/24/2020] [Indexed: 01/05/2023] Open
Abstract
Transcranial electrical stimulation (tES) is a promising tool to enhance human motor skills. However, the underlying physiological mechanisms are not fully understood. On the other hand, neuroimaging modalities provide powerful tools to map some of the neurophysiological biomarkers associated with tES. Here, a comprehensive review was undertaken to summarize the neuroimaging evidence of how tES affects human motor skills. A literature search has been done on the PubMed database, and 46 relative articles were selected. After reviewing these articles, we conclude that neuroimaging techniques are feasible to be coupled with tES and offer valuable information of cortical excitability, connectivity, and oscillations regarding the effects of tES on human motor behavior. The biomarkers derived from neuroimaging could also indicate the motor performance under tES conditions. This approach could advance the understanding of tES effects on motor skill and shed light on a new generation of adaptive stimulation models.
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Affiliation(s)
- Yuanyuan Gao
- 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
| | | | - Jack E. Norfleet
- U.S. Army Combat Capabilities Development Command, Soldier Center (CCDC SC), Orlando, FL, United States
- SFC Paul Ray Smith Simulation & Training Technology Center (STTC), Orlando, FL, United States
- Medical Simulation Research Branch (MSRB), Orlando, FL, 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
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States
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17
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Patel R, Ashcroft J, Darzi A, Singh H, Leff DR. Neuroenhancement in surgeons: benefits, risks and ethical dilemmas. Br J Surg 2020; 107:946-950. [DOI: 10.1002/bjs.11601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Surgeons traditionally aim to reduce mistakes in healthcare through repeated training and advancement of surgical technology. Recently, performance-enhancing interventions such as neurostimulation are emerging which may offset errors in surgical practice.
Methods
Use of transcranial direct-current stimulation (tDCS), a novel neuroenhancement technique that has been applied to surgeons to improve surgical technical performance, was reviewed. Evidence supporting tDCS improvements in motor and cognitive performance outside of the field of surgery was assessed and correlated with emerging research investigating tDCS in the surgical setting and potential applications to wider aspects of healthcare. Ethical considerations and future implications of using tDCS in surgical training and perioperatively are also discussed.
Results
Outside of surgery, tDCS studies demonstrate improved motor performance with regards to reaction time, task completion, strength and fatigue, while also suggesting enhanced cognitive function through multitasking, vigilance and attention assessments. In surgery, current research has demonstrated improved performance in open knot-tying, laparoscopic and robotic skills while also offsetting subjective temporal demands. However, a number of ethical issues arise from the potential application of tDCS in surgery in the form of safety, coercion, distributive justice and fairness, all of which must be considered prior to implementation.
Conclusion
Neuroenhancement may improve motor and cognitive skills in healthcare professions with impact on patient safety. Implementation will require accurate protocols and regulations to balance benefits with the associated ethical dilemmas, and to direct safe use for clinicians and patients.
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Affiliation(s)
- R Patel
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - J Ashcroft
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - A Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - H Singh
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - D R Leff
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
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18
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Cox ML, Deng ZD, Palmer H, Watts A, Beynel L, Young JR, Lisanby SH, Migaly J, Appelbaum LG. Utilizing transcranial direct current stimulation to enhance laparoscopic technical skills training: A randomized controlled trial. Brain Stimul 2020; 13:863-872. [PMID: 32289719 PMCID: PMC8474665 DOI: 10.1016/j.brs.2020.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/25/2020] [Accepted: 03/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that delivers constant, low electrical current resulting in changes to cortical excitability. Prior work suggests it may enhance motor learning giving it the potential to augment surgical technical skill acquisition. OBJECTIVES The aim of this study was to test the efficacy of tDCS, coupled with motor skill training, to accelerate laparoscopic skill acquisition in a pre-registered (NCT03083483), double-blind and placebo-controlled study. We hypothesized that relative to sham tDCS, active tDCS would accelerate the development of laparoscopic technical skills, as measured by the Fundamentals of Laparoscopic Surgery (FLS) Peg Transfer task quantitative metrics. METHODS In this study, sixty subjects (mean age 22.7 years with 42 females) were randomized into sham or active tDCS in either bilateral primary motor cortex (bM1) or supplementary motor area (SMA) electrode configurations. All subjects practiced the FLS Peg Transfer Task during six 20-min training blocks, which were preceded and followed by a single trial pre-test and post-test. The primary outcome was changes in laparoscopic skill performance over time, quantified by group differences in completion time from pre-test to post-test and learning curves developed from a calculated score accounting for errors. RESULTS Learning curves calculated over the six 20-min training blocks showed significantly greater improvement in performance for the bM1 group than the sham group (t = 2.07, p = 0.039), with the bM1 group achieving approximately the same amount of improvement in 4 blocks compared to the 6 blocks required of the sham group. The SMA group also showed greater mean improvement than sham, but exhibited more variable learning performance and differences relative to sham were not significant (t = 0.85, p = 0.400). A significant main effect was present for pre-test versus post-test times (F = 133.2, p < 0.001), with lower completion times at post-test, however these did not significantly differ for the training groups. CONCLUSION Laparoscopic skill training with active bilateral tDCS exhibited significantly greater learning relative to sham. The potential for tDCS to enhance the training of surgical skills, therefore, merits further investigation to determine if these preliminary results may be replicated and extended.
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Affiliation(s)
- Morgan L Cox
- Department of Surgery, Duke University, Durham, NC, USA.
| | - Zhi-De Deng
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Hannah Palmer
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Amanda Watts
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Lysianne Beynel
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Jonathan R Young
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - John Migaly
- Department of Surgery, Duke University, Durham, NC, USA
| | - Lawrence G Appelbaum
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Patel R, Ashcroft J, Patel A, Ashrafian H, Woods AJ, Singh H, Darzi A, Leff DR. The Impact of Transcranial Direct Current Stimulation on Upper-Limb Motor Performance in Healthy Adults: A Systematic Review and Meta-Analysis. Front Neurosci 2019; 13:1213. [PMID: 31803003 PMCID: PMC6873898 DOI: 10.3389/fnins.2019.01213] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) has previously been reported to improve facets of upper limb motor performance such as accuracy and strength. However, the magnitude of motor performance improvement has not been reviewed by contemporaneous systematic review or meta-analysis of sham vs. active tDCS. Objective: To systematically review and meta-analyse the existing evidence regarding the benefits of tDCS on upper limb motor performance in healthy adults. Methods: A systematic search was conducted to obtain relevant articles from three databases (MEDLINE, EMBASE, and PsycINFO) yielding 3,200 abstracts. Following independent assessment by two reviewers, a total of 86 articles were included for review, of which 37 were deemed suitable for meta-analysis. Results: Meta-analyses were performed for four outcome measures, namely: reaction time (RT), execution time (ET), time to task failure (TTF), and force. Further qualitative review was performed for accuracy and error. Statistically significant improvements in RT (effect size −0.01; 95% CI −0.02 to 0.001, p = 0.03) and ET (effect size −0.03; 95% CI −0.05 to −0.01, p = 0.017) were demonstrated compared to sham. In exercise tasks, increased force (effect size 0.10; 95% CI 0.08 to 0.13, p < 0.001) and a trend towards improved TTF was also observed. Conclusions: This meta-analysis provides evidence attesting to the impact of tDCS on upper limb motor performance in healthy adults. Improved performance is demonstrable in reaction time, task completion time, elbow flexion tasks and accuracy. Considerable heterogeneity exists amongst the literature, further confirming the need for a standardised approach to reporting tDCS studies.
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Affiliation(s)
- Ronak Patel
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - James Ashcroft
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Ashish Patel
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery & Cancer, Imperial College London, London, 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
| | - Harsimrat Singh
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Daniel Richard Leff
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
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20
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Kumari N, Taylor D, Signal N. The Effect of Cerebellar Transcranial Direct Current Stimulation on Motor Learning: A Systematic Review of Randomized Controlled Trials. Front Hum Neurosci 2019; 13:328. [PMID: 31636552 PMCID: PMC6788395 DOI: 10.3389/fnhum.2019.00328] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Cerebellar transcranial direct current stimulation (ctDCS) appears to modulate motor performance in both adaptation and motor skill tasks; however, whether the gains are long-lasting is unclear. Objectives: This systematic review aims to evaluate the effect of ctDCS with respect to different time scales of motor learning. Methods: Ten electronic databases (CINAHL, MEDLINE, SPORT Discus, Scopus, Web of Science, Cochrane via OVID, Evidence-Based Reviews (EBM) via OVID, AMED: Allied and Complementary Medicine, PsycINFO, and PEDro) were systematically searched. Studies evaluating the effect of ctDCS compared to sham ctDCS on motor learning in healthy individuals were selected and reviewed. Two authors independently reviewed the quality of the included studies using the revised Cochrane's risk-of-bias tool. The results were extracted with respect to the time scale in which changes in motor performance were evaluated. Results: Seventeen randomized controlled trials met the eligibility criteria of which 65% of the studies had a “high” risk-of-bias, and 35% had “some concerns.” These studies included data from 629 healthy participants. Of the studies that evaluated the effect of anodal ctDCS during and immediately after the stimulation, four found enhanced, three found impaired, and ten found no effect on gains in motor performance. Of the studies that evaluated the effect of anodal ctDCS after a break of 24 h or more, seven found enhanced, two found impaired, and one found no effect on gains in motor performance. Of the studies that evaluated the effect of cathodal ctDCS across a range of time scales, five found impaired, one found enhanced, and five found no effect on gains in motor performance. Conclusions: In healthy individuals, anodal ctDCS appears to improve short to longer-term motor skill learning, whereas it appears to have no effect on gains in motor performance during and immediate after the stimulation. ctDCS may have potential to improve motor performance beyond the training period. The challenge of the motor task and its characteristics, and the stimulation parameters are likely to influence the effect of ctDCS on motor learning.
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Affiliation(s)
- Nitika Kumari
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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21
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Riddell M, Kuo HC, Zewdie E, Kirton A. Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization. Dev Med Child Neurol 2019; 61:943-949. [PMID: 30690708 DOI: 10.1111/dmcn.14155] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Abstract
AIM We aimed to determine if the mirror movements that often result in children with unilateral cerebral palsy (CP) after perinatal stroke represent a clinical biomarker of developmental plasticity. METHOD This was a prospective, controlled cohort study. Mirror movements in children with unilateral CP from a population-based cohort were compared to those of typically developing controls. The population with stroke was assessed further via electromyography (EMG), motor function, and corticospinal organization investigations. Mirror movements were quantified (0-5) bidirectionally. EMG mirror movements were quantified during voluntary contraction. Motor function was quantified by validated measures including the Assisting Hand Assessment (AHA). Corticospinal organization was categorized as ipsilateral or contralateral using transcranial magnetic stimulation (TMS). The relationships between mirror movements, function, and corticospinal organization were assessed (t-tests, Pearson rank correlation coefficients). RESULTS Ninety-two participants were scored (55 males, 37 females, mean [SD] 12y [5y 6mo], range 4-17y), 63 with complete motor outcomes and 39 with TMS data. EMG ratios correlated with clinical mirror movements (r=0.562, p=0.008). Mild mirror activity in controls declined with age (r=-0.459, p<0.001). Mirroring was stronger with tasks performed by the affected hand (p<0.001). Mirror movements correlated with AHA scores (r=-0.255, p=0.04) and poor motor outcome (p<0.001). Unaffected hand mirror activity was higher in children with ipsilateral corticospinal tract arrangements (p<0.001). INTERPRETATION Clinical mirror movements correlate with disability and corticospinal organization in children with unilateral CP with perinatal stroke. This simple bedside biomarker could facilitate patient selection for personalized rehabilitation. WHAT THIS PAPER ADDS Mirror movements are a clinical indicator of corticospinal organization in children with unilateral cerebral palsy with perinatal stroke. Mirroring is strongest in children with ipsilateral corticospinal tract reorganization. The concept of a 'directionality factor' to mirror movements highlights additional, clinically relevant functional correlations.
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Affiliation(s)
- Madison Riddell
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Hsing-Ching Kuo
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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22
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Cole L, Giuffre A, Ciechanski P, Carlson HL, Zewdie E, Kuo HC, Kirton A. Effects of High-Definition and Conventional Transcranial Direct-Current Stimulation on Motor Learning in Children. Front Neurosci 2018; 12:787. [PMID: 30429768 PMCID: PMC6220373 DOI: 10.3389/fnins.2018.00787] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/11/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) can improve motor learning in children. High-definition approaches (HD-tDCS) have not been examined in children. Objectives/Hypothesis: We hypothesized that primary motor cortex HD-tDCS would enhance motor learning but be inferior to tDCS in children. Methods: Twenty-four children were recruited for a randomized, sham-controlled, double-blinded interventional trial (NCT03193580, clinicaltrials.gov/ct2/show/NCT03193580) to receive (1) right hemisphere (contralateral) primary motor cortex (M1) 1 mA anodal conventional 1 × 1 tDCS (tDCS), (2) right M1 1 mA anodal 4 × 1 HD-tDCS (HD-tDCS), or (3) sham. Over five consecutive days, participants trained their left hand using the Purdue Pegboard Test (PPTL). The Jebsen-Taylor Test, Serial Reaction Time Task, and right hand and bimanual PPT were also tested at baseline, post-training, and 6-week retention time (RT). Results: Both the tDCS and HD-tDCS groups demonstrated enhanced motor learning compared to sham with effects maintained at 6 weeks. Effect sizes were moderate-to-large for tDCS and HD-tDCS groups at the end of day 4 (Cohen's d tDCS = 0.960, HD-tDCS = 0.766) and day 5 (tDCS = 0.655, HD-tDCS = 0.851). Enhanced motor learning effects were also seen in the untrained hand. HD-tDCS was well tolerated and safe with no adverse effects. Conclusion: HD-tDCS and tDCS can enhance motor learning in children. Further exploration is indicated to advance rehabilitation therapies for children with motor disabilities such as cerebral palsy. Clinical Trial Registration: clinicaltrials.gov, identifier NCT03193580.
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Affiliation(s)
- Lauran Cole
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Adrianna Giuffre
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Helen L. Carlson
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Ephrem Zewdie
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Hsing-Ching Kuo
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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23
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Campbell MJ, Toth AJ, Moran AP, Kowal M, Exton C. eSports: A new window on neurocognitive expertise? PROGRESS IN BRAIN RESEARCH 2018; 240:161-174. [PMID: 30390829 DOI: 10.1016/bs.pbr.2018.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Understanding the neurological changes that take place as expertise develops is a central topic in both cognitive psychology and cognitive neuroscience. Here, we argue that video games, despite previous misconceptions, are an excellent model environment from which one can examine the development of neurocognitive expertise. Of particular relevance we argue is the area of esports, which encompass video/computer games played within the medium of cyberspace competitively and increasingly professionally. The massive scale of participation, controlled environments, structured skill ratings, pervasive social nature, and large repositories of data, together make esports potentially a very fruitful area for scientific research to increase our understanding of a new era of cognitive athletes. This chapter reviews the progress and prospects for esports research with a particular focus on the effects of gaming on neurocognition. We also outline some exciting new avenues and techniques from which we hope to further elucidate the benefits of esports on the brain.
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Affiliation(s)
- Mark J Campbell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Lero Irish Software Research Centre, University of Limerick, Limerick, Ireland.
| | - Adam J Toth
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Lero Irish Software Research Centre, University of Limerick, Limerick, Ireland
| | - Aidan P Moran
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Magdalena Kowal
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Lero Irish Software Research Centre, University of Limerick, Limerick, Ireland
| | - Chris Exton
- Lero Irish Software Research Centre, University of Limerick, Limerick, Ireland; Department of Computer Science, University of Limerick, Limerick, Ireland
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24
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Sánchez-Kuhn A, Pérez-Fernández C, Moreno M, Flores P, Sánchez-Santed F. Differential Effects of Transcranial Direct Current Stimulation (tDCS) Depending on Previous Musical Training. Front Psychol 2018; 9:1465. [PMID: 30250439 PMCID: PMC6139306 DOI: 10.3389/fpsyg.2018.01465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/25/2018] [Indexed: 12/23/2022] Open
Abstract
Previous studies have shown that transcranial direct current stimulation (tDCS) facilitates motor performance, but individual differences such as baseline performance seem to influence this effect. Accordingly, musicians offer an inter-individual differences model due to anatomical and functional variances displayed among the motor cortex regions. The aim of the present work was to study if the baseline motor skill predicts whether tDCS can enhance motor learning. For that objective, we administered anodal (n = 20) or sham (n = 20) tDCS on the right primary motor cortex region of 40 right-handed healthy participants, who were divided into four groups: musicians (tDCS/sham) and non-musicians (tDCS/sham). We measured the skill index (SI) presented in the sequential finger-tapping task (SEQTAP) at baseline, during three 20 min/2 mA stimulation sessions, and in follow-up tests after 20 min and 8 days. Depending on the normality of the data distribution, statistical differences were estimated by ANOVA and Bonferroni post hoc test or Kruskal-Wallis and U Mann-Whitney. Results showed that musicians scored higher in baseline performance than non-musicians. The non-musicians who received tDCS scored higher than the sham group in the first and second stimulation session. This effect was extended to the 20 min and 8 days follow-up test. In musicians, there was no effect of tDCS. The present method seems to be suitable for the achievement of positive and consolidated tDCS effects on motor learning in inexperienced participants, but not in musicians. These data may have an implication for the rehabilitation of motor impairments, contributing to more individualized stimulation protocols.
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Affiliation(s)
- Ana Sánchez-Kuhn
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
| | | | - Margarita Moreno
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
| | - Pilar Flores
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
- Instituto de Neurorehabilitación Infantil InPaula, Almería, Spain
| | - Fernando Sánchez-Santed
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
- Instituto de Neurorehabilitación Infantil InPaula, Almería, Spain
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Ciechanski P, Cheng A, Damji O, Lopushinsky S, Hecker K, Jadavji Z, Kirton A. Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition. BJS Open 2018; 2:70-78. [PMID: 29951631 PMCID: PMC5989997 DOI: 10.1002/bjs5.43] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/13/2017] [Indexed: 02/05/2023] Open
Abstract
Background Changes in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct-current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation-based laparoscopic surgical skill acquisition. Methods In this double-blind, sham-controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation-based training. Primary outcomes of laparoscopic pattern-cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent-to-treat analysis examined the effects of treatment group on skill acquisition and retention. Results Of 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern-cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures. Conclusion The addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non-simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).
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Affiliation(s)
- P Ciechanski
- Department of Neuroscience University of Calgary Calgary Alberta Canada
| | - A Cheng
- Department of Pediatrics University of Calgary Calgary Alberta Canada
| | - O Damji
- Department of Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - S Lopushinsky
- Department of Surgery University of Calgary Calgary Alberta Canada
| | - K Hecker
- Department of Veterinary Medicine University of Calgary Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Z Jadavji
- Department of Neuroscience University of Calgary Calgary Alberta Canada
| | - A Kirton
- Department of Pediatrics University of Calgary Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada
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