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Zhang F, Han Y, Wang H, Li Y, Tang D. Effects of transcranial direct current stimulation on motor learning in healthy elderly individuals: a systematic review and meta-analysis. Somatosens Mot Res 2024:1-11. [PMID: 38319133 DOI: 10.1080/08990220.2024.2310851] [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: 07/19/2022] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is widely used in motor recovery. Nevertheless, whether tDCS improves motor learning in healthy older adults is still controversial. This review aims to investigate the effectiveness of tDCS on motor learning in healthy elderly individuals. METHODS The PubMed, Cochrane Library, Web of Science and Embase databases were initially searched from inception to December 5, 2022. The standard mean difference (SMD) with the corresponding 95% confidence intervals (CIs) were analysed via random-effect models. RESULTS Compared with the sham group, no significant effects were found regarding improvement in motor learning based on the speed or accuracy of the task and reaction time for the tDCS intervention group. After subgroup analysis, a significant effect was found for improved motor learning based on reaction time in the primary motor cortex (M1)-cerebellar group. CONCLUSIONS This review revealed that tDCS had no significant effect on improving the speed or accuracy of motor learning in healthy elderly adults. However, it has a significant effect on improving the motor learning ability based on the reaction time of the task (mainly referring to the tDCS stimulation position of M1 and cerebellar), although the results have obvious heterogeneity and uncertainty.
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Affiliation(s)
- Fusheng Zhang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
- School of Physical Education, Zhaotong University, Zhaotong, China
| | - Yanbai Han
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Hongli Wang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Yong Li
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Dingyu Tang
- School of Physical Education, Zhaotong University, Zhaotong, China
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Corrêa FI, Kunitake AI, Segheto W, Duarte de Oliveira M, Fregni F, Ferrari Corrêa JC. The effect of transcranial direct current stimulation associated with video game training on the postural balance of older women in the community: A blind, randomized, clinical trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2046. [PMID: 37608641 DOI: 10.1002/pri.2046] [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: 05/03/2023] [Revised: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied. PURPOSE To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women. METHOD A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test. RESULTS Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001). CONCLUSION There was an improvement in the postural balance of the three training groups that were independent of tDCS. DISCUSSION Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.
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Affiliation(s)
- Fernanda Ishida Corrêa
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Andre Issao Kunitake
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Wellington Segheto
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Max Duarte de Oliveira
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Song JH, Yim JE. The Synergetic Effect of Plyometric Compound Exercises and Transcranial Direct Current Stimulation on Balance and Physical Function. Healthcare (Basel) 2023; 11:2774. [PMID: 37893849 PMCID: PMC10606722 DOI: 10.3390/healthcare11202774] [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: 09/05/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to investigate the effects of plyometric compound exercises and Transcranial Direct Current Stimulation (tDCS) on balance and body function in healthy adults. Forty-five students enrolled at Noryangjin Y Academy in Seoul who met the research criteria were equally and randomly divided into the following groups: the Experimental Group I, Experimental Group II, and Control Group. Experimental Groups I and II received tDCS and sham tDCS for 20 min, respectively; both groups performed plyometric compound exercises for 30 min twice weekly for four weeks. The Control Group received sham tDCS for 20 min twice weekly for four weeks. Tests such as the static balance test (Functional Reach Test, FRT), dynamic balance test (Y-Balance Test, Y-BT), power test (vertical jump test and long jump test), and agility test (t-test and side-step test) were conducted on the day of the experiment, before and after the intervention. Experimental Groups I and II significantly improved in static balance, dynamic balance, power, and agility (p < 0.001), whereas the Control Group did not. Experimental Group I showed greater effects on static balance, dynamic balance, power, and agility than Experimental Group II and the Control Group (p < 0.001). In conclusion, plyometric compound exercises + tDCS intervention can be effective for an ordinary person who trains balance and body functions (power and agility); in particular, to improve exercise performance.
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Affiliation(s)
| | - Jong-Eun Yim
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul 01795, Republic of Korea;
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4
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Saimpont A, Métais A, Collet C. Learning by motor imagery in older adults. Aging (Albany NY) 2023; 15:9894-9895. [PMID: 37837469 PMCID: PMC10599735 DOI: 10.18632/aging.205185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/04/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Arnaud Saimpont
- Université Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, France
| | - Angèle Métais
- Université Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, France
| | - Christian Collet
- Université Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, France
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5
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Metais A, Muller CO, Boublay N, Breuil C, Guillot A, Daligault S, Di Rienzo F, Collet C, Krolak-Salmon P, Saimpont A. Anodal tDCS does not enhance the learning of the sequential finger-tapping task by motor imagery practice in healthy older adults. Front Aging Neurosci 2022; 14:1060791. [PMID: 36570544 PMCID: PMC9780548 DOI: 10.3389/fnagi.2022.1060791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background Motor imagery practice (MIP) and anodal transcranial direct current stimulation (a-tDCS) are innovative methods with independent positive influence on motor sequence learning (MSL) in older adults. Objective The present study investigated the effect of MIP combined with a-tDCS over the primary motor cortex (M1) on the learning of a finger tapping sequence of the non-dominant hand in healthy older adults. Methods Thirty participants participated in this double-blind sham-controlled study. They performed three MIP sessions, one session per day over three consecutive days and a retention test 1 week after the last training session. During training / MIP, participants had to mentally rehearse an 8-element finger tapping sequence with their left hand, concomitantly to either real (a-tDCS group) or sham stimulation (sham-tDCS group). Before and after MIP, as well as during the retention test, participants had to physically perform the same sequence as fast and accurately as possible. Results Our main results showed that both groups (i) improved their performance during the first two training sessions, reflecting acquisition/on-line performance gains, (ii) stabilized their performance from one training day to another, reflecting off-line consolidation; as well as after 7 days without practice, reflecting retention, (iii) for all stages of MSL, there was no significant difference between the sham-tDCS and a-tDCS groups. Conclusion This study highlights the usefulness of MIP in motor sequence learning for older adults. However, 1.5 mA a-tDCS did not enhance the beneficial effects of MIP, which adds to the inconsistency of results found in tDCS studies. Future work is needed to further explore the best conditions of use of tDCS to improve motor sequence learning with MIP.
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Affiliation(s)
- Angèle Metais
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, LIBM, Villeurbanne, France
| | - Camille O. Muller
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, LIBM, Villeurbanne, France,EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Nawale Boublay
- Centre de Recherche Clinique Vieillissement Cerveau - Fragilité, Hospices Civils de Lyon, Lyon, France
| | - Caroline Breuil
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, LIBM, Villeurbanne, France
| | - Aymeric Guillot
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, LIBM, Villeurbanne, France
| | - Sébastien Daligault
- Centre de Recherche Multimodal et Pluridisciplinaire en Imagerie du Vivant (CERMEP), Département de MagnétoEncéphalographie, Bron, France
| | - Franck Di Rienzo
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, LIBM, Villeurbanne, France
| | - Christian Collet
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, LIBM, Villeurbanne, France
| | - Pierre Krolak-Salmon
- Centre de Recherche Clinique Vieillissement Cerveau - Fragilité, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Saimpont
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, LIBM, Villeurbanne, France,*Correspondence: Arnaud Saimpont,
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Siew-Pin Leuk J, Yow KE, Zi-Xin Tan C, Hendy AM, Kar-Wing Tan M, Hock-Beng Ng T, Teo WP. A meta-analytical review of transcranial direct current stimulation parameters on upper limb motor learning in healthy older adults and people with Parkinson's disease. Rev Neurosci 2022; 34:325-348. [PMID: 36138560 DOI: 10.1515/revneuro-2022-0073] [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: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022]
Abstract
Current literature lacks consolidated evidence for the impact of stimulation parameters on the effects of transcranial direct current stimulation (tDCS) in enhancing upper limb motor learning. Hence, we aim to synthesise available methodologies and results to guide future research on the usage of tDCS on upper limb motor learning, specifically in older adults and Parkinson's disease (PD). Thirty-two studies (Healthy older adults, N = 526, M = 67.25, SD = 4.30 years; PD, N = 216, M = 66.62, SD = 6.25 years) were included in the meta-analysis. All included studies consisted of active and sham protocols. Random effect meta-analyses were conducted for (i) subjects (healthy older adults and PD); (ii) intensity (1.0, 1.5, 2 mA); (iii) electrode montage (unilateral anodal, bilateral anodal, unilateral cathodal); (iv) stimulation site (cerebellum, frontal, motor, premotor, SMA, somatosensory); (v) protocol (online, offline). Significant tDCS effect on motor learning was reported for both populations, intensity 1.0 and 2.0 mA, unilateral anodal and cathodal stimulation, stimulation site of the motor and premotor cortex, and both online and offline protocols. Regression showed no significant relationship between tDCS effects and density. The efficacy of tDCS is also not affected by the number of sessions. However, studies that reported only single session tDCS found significant negative association between duration with motor learning outcomes. Our findings suggest that different stimulation parameters enhanced upper limb motor learning in older adults and PD. Future research should combine tDCS with neuroimaging techniques to help with optimisation of the stimulation parameters, considering the type of task and population.
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Affiliation(s)
- Jessie Siew-Pin Leuk
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Kai-En Yow
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Clenyce Zi-Xin Tan
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Ashlee M Hendy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Mika Kar-Wing Tan
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Tommy Hock-Beng Ng
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
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Greeley B, Barnhoorn JS, Verwey WB, Seidler RD. Anodal Transcranial Direct Current Stimulation Over Prefrontal Cortex Slows Sequence Learning in Older Adults. Front Hum Neurosci 2022; 16:814204. [PMID: 35280208 PMCID: PMC8907426 DOI: 10.3389/fnhum.2022.814204] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Aging is associated with declines in sensorimotor function. Several studies have demonstrated that transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, can be combined with training to mitigate age-related cognitive and motor declines. However, in some cases, the application of tDCS disrupts performance and learning. Here, we applied anodal tDCS either over the left prefrontal cortex (PFC), right PFC, supplementary motor complex (SMC), the left M1, or in a sham condition while older adults (n = 63) practiced a Discrete Sequence Production (DSP), an explicit motor sequence, task across 3 days. We hypothesized that stimulation to either the right or left PFC would enhance motor learning for older adults, based on the extensive literature showing increased prefrontal cortical activity during motor task performance in older adults. Contrary to our predictions, stimulation to the right and left PFC resulted in slowed motor learning, as evidenced by a slower reduction rate of reduction of reaction time and the number of sequence chunks across trials relative to sham in session one and session two, respectively. These findings suggest an integral role of the right PFC early in sequence learning and a role of the left PFC in chunking in older adults, and contribute to mounting evidence of the difficultly of using tDCS in an aging population.
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Affiliation(s)
- Brian Greeley
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan S. Barnhoorn
- Department of Learning, Data-Analytics and Technology, University of Twente, Enschede, Netherlands
| | - Willem B. Verwey
- Department of Learning, Data-Analytics and Technology, University of Twente, Enschede, Netherlands
| | - Rachael D. Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
- *Correspondence: Rachael D. Seidler,
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A Single Session of Mindfulness Meditation Expedites Immediate Motor Memory Consolidation to Improve Wakeful Offline Learning. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2022. [DOI: 10.1123/jmld.2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Posttraining meditation has been shown to promote wakeful memory stabilization of explicit motor sequence information in learners who are experienced meditators. We investigated the effect of single-session mindfulness meditation on wakeful and sleep-dependent forms of implicit motor memory consolidation in meditation naïve adults. Immediately after training with a target implicit motor sequence, participants (N = 20, eight females, 23.9 ± 3.3 years) completed either a 10-min mindfulness meditation (N = 10) or a control listening task before exposure to task interference induced by training with a novel implicit sequence. Target sequence performance was tested following 5-hr wakeful and 15-hr postsleep periods. Bayesian inference was applied to group comparisons of mean reaction time (RT) changes across training, interference, wakeful, and postsleep timepoints. Relative to control conditions, posttraining meditation reduced RT slowing between target sequence training and interference sequence introduction (BF10 [Bayes factors] = 6.61) and supported RT performance gains over the wakeful period (BF10 = 8.34). No group differences in postsleep RT performance were evident (BF10 = 0.38). These findings illustrate that posttraining mindfulness meditation expedites wakeful, but not sleep-dependent, offline learning with implicit motor sequences. Previous meditation experience is not required to obtain wakeful consolidation gains from posttraining mindfulness meditation.
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Sharma M, Farahani F, Bikson M, Parra LC. Weak DCS causes a relatively strong cumulative boost of synaptic plasticity with spaced learning. Brain Stimul 2021; 15:57-62. [PMID: 34749007 PMCID: PMC8816825 DOI: 10.1016/j.brs.2021.10.552] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Electric fields generated during direct current stimulation (DCS) are known to modulate activity-dependent synaptic plasticity in-vitro. This provides a mechanistic explanation for the lasting behavioral effects observed with transcranial direct current stimulation (tDCS) in human learning experiments. However, previous in-vitro synaptic plasticity experiments show relatively small effects despite using strong fields compared to what is expected with conventional tDCS in humans (20 V/m vs. 1 V/m). There is therefore a need to improve the effectiveness of tDCS at realistic field intensities. Here we leverage the observation that effects of learning are known to accumulate over multiple bouts of learning, known as spaced learning. Hypothesis: We propose that effects of DCS on synaptic long-term potentiation (LTP) accumulate over time in a spaced learning paradigm, thus revealing effects at more realistic field intensities. Methods: We leverage a standard model for spaced learning by inducing LTP with repeated bouts of theta burst stimulation (TBS) in hippocampal slice preparations. We studied the cumulative effects of DCS paired with TBS at various intensities applied during the induction of LTP in the CA1 region of rat hippocampal slices. Results: As predicted, DCS applied during repeated bouts of theta burst stimulation (TBS) resulted in an increase of LTP. This spaced learning effect is saturated quickly with strong TBS protocols and stronger fields. In contrast, weaker TBS and the weakest electric fields of 2.5 V/m resulted in the strongest relative efficacies (12% boost in LTP per 1 V/m applied). Conclusions: Weak DCS causes a relatively strong cumulative effect of spaced learning on synaptic plasticity. Staturarion may have masked stronger effects sizes in previous in-vitro studies. Relative effect sizes of DCS are now closer in line with human tDCS experiments.
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Affiliation(s)
- Mahima Sharma
- Department of Biomedical Engineering, The City College of New York, CUNY, 160 Convent Avenue, New York, NY, USA.
| | - Forouzan Farahani
- Department of Biomedical Engineering, The City College of New York, CUNY, 160 Convent Avenue, New York, NY, USA.
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, CUNY, 160 Convent Avenue, New York, NY, USA.
| | - Lucas C Parra
- Department of Biomedical Engineering, The City College of New York, CUNY, 160 Convent Avenue, New York, NY, USA.
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Lee JH, Lee TL, Kang N. Transcranial direct current stimulation decreased cognition-related reaction time in older adults: A systematic review and meta-analysis. Ageing Res Rev 2021; 70:101377. [PMID: 34089900 DOI: 10.1016/j.arr.2021.101377] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/18/2021] [Accepted: 05/31/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND This systematic review and meta-analysis investigated the effects of transcranial direct current stimulation (tDCS) on the cognitive functions of healthy older adults by focusing on the changes in reaction time during cognitive tasks. METHOD A total of 31 studies qualified for this meta-analysis, and we acquired 36 comparisons from the included studies for data synthesis. The individual effect sizes were calculated by comparing the altered reaction time during the performance of a specific cognitive task between the active tDCS and sham groups. In two moderator variable analyses, we examined the potentially different effects of the tDCS protocols on the cognition-related reaction time based on the tDCS protocol used (i.e., online vs. offline tDCS) and the five cognitive domains: (a) perceptual-motor function, (b) learning and memory, (c) executive function / complex attention, (d) language, and (e) social cognition. Meta-regression analyses were conducted to estimate the relationship between demographic and tDCS parameter characteristics and the changes in reaction time. RESULTS The random-effects model meta-analysis revealed significant small effects of tDCS on cognition-related reaction time. Specifically, providing online tDCS significantly reduced the reaction time, and these patterns were observed during learning and memory and executive function / complex attention tasks. However, applying offline tDCS failed to find any significant reduction of reaction time across various cognitive tasks. The meta-regression analysis revealed that the effects of tDCS on the reaction time during the performance of cognitive tasks increased for the older people. CONCLUSIONS These findings suggest that providing online tDCS may effectively improve the ageing-induced reaction time related to specific cognitive functions of elderly people.
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Yi D, Sung Y, Yim J. Effect of Transcranial Direct Current Stimulation on Walking Speed, Functional Strength, and Balance in Older Adults: A Randomized, Double-Blind Controlled Trial. Med Sci Monit 2021; 27:e932623. [PMID: 34326299 PMCID: PMC8330444 DOI: 10.12659/msm.932623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The purpose of this study was to investigate the immediate effect of transcranial direct current stimulation (tDCS) on walking speed, functional strength of lower limbs, and balance in healthy older adults. Through this study, we intend to introduce a new method to improve the physical function of older adults. Material/Methods This was a randomized, controlled, double-blind study in which participants and evaluators were blinded. Among 57 healthy adults (aged 65 years or older), 31 underwent tDCS, while 26 received sham stimulation. For the pre-test, participants performed a 10-meter walk test, functional strength test of lower limbs, and static and dynamic balance tests. Next, the primary motor cortex area was subjected to tDCS for 20 min. Tests were repeated as post-tests. Results There were significant differences in group-by-time interaction for 10-meter walk speed, functional strength of lower limbs, and static balance on the left side (P<0.05). There was not a significant group-by-time interaction for dynamic and static balance on the right side (P>0.05). There were significant differences in the main effect of time for 10-meter walk speed, functional strength of lower limbs, static balance on the right side, and dynamic balance (P<0.05). Conclusions Results showed tDCS was effective in improving gait and functional strength of the lower limbs in older adults. We recommend tDCS as a safe and effective way to improve motor performance and increase physical function, including walking and functional strength of lower limbs, in older adults.
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Affiliation(s)
- Donghyun Yi
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
| | - YuJung Sung
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
| | - JongEun Yim
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
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12
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Age-related changes in motor cortex plasticity assessed with non-invasive brain stimulation: an update and new perspectives. Exp Brain Res 2021; 239:2661-2678. [PMID: 34269850 DOI: 10.1007/s00221-021-06163-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
It is commonly accepted that the brains capacity to change, known as plasticity, declines into old age. Recent studies have used a variety of non-invasive brain stimulation (NIBS) techniques to examine this age-related decline in plasticity in the primary motor cortex (M1), but the effects seem inconsistent and difficult to unravel. The purpose of this review is to provide an update on studies that have used different NIBS techniques to assess M1 plasticity with advancing age and offer some new perspective on NIBS strategies to boost plasticity in the ageing brain. We find that early studies show clear differences in M1 plasticity between young and older adults, but many recent studies with motor training show no decline in use-dependent M1 plasticity with age. For NIBS-induced plasticity in M1, some protocols show more convincing differences with advancing age than others. Therefore, our view from the NIBS literature is that it should not be automatically assumed that M1 plasticity declines with age. Instead, the effects of age are likely to depend on how M1 plasticity is measured, and the characteristics of the elderly population tested. We also suggest that NIBS performed concurrently with motor training is likely to be most effective at producing improvements in M1 plasticity and motor skill learning in older adults. Proposed NIBS techniques for future studies include combining multiple NIBS protocols in a co-stimulation approach, or NIBS strategies to modulate intracortical inhibitory mechanisms, in an effort to more effectively boost M1 plasticity and improve motor skill learning in older adults.
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Lu H, Liu Q, Guo Z, Zhou G, Zhang Y, Zhu X, Wu S. Modulation of Repeated Anodal HD-tDCS on Attention in Healthy Young Adults. Front Psychol 2020; 11:564447. [PMID: 33329194 PMCID: PMC7714753 DOI: 10.3389/fpsyg.2020.564447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/24/2020] [Indexed: 11/13/2022] Open
Abstract
High-definition transcranial direct current stimulation (HD-tDCS) is a valid brain stimulation technology to optimize cognitive function. Recent evidence indicates that single anodal tDCS session enhances attention; however, the variation in attention produced by repeated anodal HD-tDCS over a longer period of time has not been explored. We examined the modulation of attention function in healthy young participants (39 young adults) who received repeated HD-tDCS sustained for 4 weeks. The results showed a robust benefit of anodal HD-tDCS on executive control and psychomotor efficiency, but not on orienting, alerting, or selective attention (inhibition); the benefit increased successively over 4 weeks; and the enhancement on executive control of each week was significant compared to baseline in the anodal group. In addition, the subjects' performances on the test of executive control and psychomotor efficiency gradually restored to the initial level in the sham group, which appeared obviously from week 3 (after 9 interventions), but the improvement of attention in the anodal group was persistent. We conclude that repeated anodal HD-tDCS provides a positive benefit on executive control and psychomotor efficiency and has obvious accumulative effect after 9 or more times intervention compared to sham HD-tDCS. Additionally, our findings might provide pivotal guidance for the formulation of a strategy for the use of repeated anodal HD-tDCS to modulate on attention function.
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Affiliation(s)
- Hongliang Lu
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an, China
| | - Quanhui Liu
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an, China
| | - Zhihua Guo
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an, China
| | - Guangxin Zhou
- School of Basic Medical Sciences, Air Force Military Medical University, Xi'an, China
| | - Yajuan Zhang
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an, China
| | - Xia Zhu
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an, China
| | - Shengjun Wu
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an, China
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14
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Oki K, Clark LA, Amano S, Clark BC. Effect of Anodal Transcranial Direct Current Stimulation of the Motor Cortex on Elbow Flexor Muscle Strength in the Very Old. J Geriatr Phys Ther 2020; 42:243-248. [PMID: 28906348 DOI: 10.1519/jpt.0000000000000145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Muscle weakness predisposes older adults to a fourfold increase in functional limitations and has previously been associated with reduced motor cortex excitability in aging adults. The purpose of this study was to determine whether a single session of anodal transcranial direct current stimulation (tDCS) of the motor cortex would increase elbow flexion muscle strength and electromyographic (EMG) amplitude in very old individuals. METHODS Eleven very old individuals-85.8 (4.3) years-performed 3 maximal isometric elbow flexion contractions before and after 20 minutes of sham or anodal tDCS on different days. Order of stimulation was randomized, and the study participants and investigators were blinded to condition. In addition, voluntary activation capacity of the elbow flexors was determined by comparing voluntary and electrically evoked forces. RESULTS Anodal tDCS did not alter muscle strength or EMG activity in comparison to sham stimulation. Elbow flexion voluntary activation capacity was very high among the study participants: 99.3% (1.8%). CONCLUSION Contrary to our hypothesis, we observed no effect of anodal tDCS and no impairment in elbow flexor voluntary activation capacity in the very old. Whether anodal tDCS would exert a positive effect and support our initial hypothesis in another muscle group that does exhibit impairments in voluntary activation in older adults is a question that is still to be addressed.
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Affiliation(s)
- Kentaro Oki
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens
| | - Leatha A Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens
| | - Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens.,Clinical and Translational Research Unit, Ohio University, Athens
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens.,Department of Biomedical Sciences, Ohio University, Athens.,Department of Geriatric Medicine, Ohio University, Athens
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15
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Investigating the influence of paired-associative stimulation on multi-session skill acquisition and retention in older adults. Clin Neurophysiol 2020; 131:1497-1507. [DOI: 10.1016/j.clinph.2020.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/19/2020] [Accepted: 04/13/2020] [Indexed: 12/26/2022]
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16
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Workman CD, Kamholz J, Rudroff T. Transcranial Direct Current Stimulation (tDCS) to Improve Gait in Multiple Sclerosis: A Timing Window Comparison. Front Hum Neurosci 2019; 13:420. [PMID: 31849628 PMCID: PMC6893177 DOI: 10.3389/fnhum.2019.00420] [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: 09/30/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022] Open
Abstract
Unilateral weakness of the lower limb is a hallmark of multiple sclerosis (MS) and a significant contributor to the progressive worsening of walking ability. There are currently no effective rehabilitation strategies targeting strength asymmetries and/or gait impairments in people with MS (PwMS). Transcranial direct current stimulation (tDCS) has improved motor outcomes in various populations, but the effect of tDCS on gait in PwMS and the ideal timing window of tDCS application are still unknown. This study investigated the effects of tDCS, either before or during a 6 min walk test (6MWT), on the distance walked and gait characteristics in PwMS. Twelve participants were recruited and randomly assigned into BEFORE or DURING groups (both n = 6). The BEFORE group received stimulation before performing a 6MWT (sham/2 mA, 13 min). The DURING group received stimulation only during a 6MWT (sham/2 mA, 6 min). Stimulation was over the more MS-affected primary motor cortex (M1). Distance walked and gait characteristics of the walk were the primary and secondary outcomes. The results indicated a significant decrease in distance walked in the DURING group (p = 0.026) and a significant increase in gait velocity in the BEFORE group (p = 0.04). These changes were accompanied by trends (p < 0.1) in distance walked, gait velocity, and stride length. Overall, the results of this study suggest that tDCS performed before a 6MWT might be more effective than tDCS during a 6MWT and that a single session of tDCS may not be sufficient to influence gait. Clinical Trial Registration: www.ClinicalTrials.gov, identifier #NCT03757819.
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Affiliation(s)
- Craig D Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - John Kamholz
- Department of Neurology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States.,Department of Neurology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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17
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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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18
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Debarnot U, Neveu R, Samaha Y, Saruco E, Macintyre T, Guillot A. Acquisition and consolidation of implicit motor learning with physical and mental practice across multiple days of anodal tDCS. Neurobiol Learn Mem 2019; 164:107062. [PMID: 31377178 DOI: 10.1016/j.nlm.2019.107062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/16/2019] [Accepted: 07/30/2019] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Ursula Debarnot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622 Villeurbanne, France.
| | - Rémi Neveu
- Division of Child and Adolescent Psychiatry, University of Geneva, 1200 Geneva, Switzerland
| | - Yvette Samaha
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622 Villeurbanne, France
| | - Elodie Saruco
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622 Villeurbanne, France; Neurologische Universitätsklinik, Bergmannsheil gGmbH, Forschungsgruppe Plastizität, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Tadhg Macintyre
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Aymeric Guillot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622 Villeurbanne, France
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19
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Dumel G, Bourassa ME, Charlebois-Plante C, Desjardins M, Doyon J, Saint-Amour D, De Beaumont L. Motor Learning Improvement Remains 3 Months After a Multisession Anodal tDCS Intervention in an Aging Population. Front Aging Neurosci 2018; 10:335. [PMID: 30405402 PMCID: PMC6207687 DOI: 10.3389/fnagi.2018.00335] [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: 07/10/2018] [Accepted: 10/04/2018] [Indexed: 01/04/2023] Open
Abstract
Healthy aging is associated with decline of motor function that can generate serious consequences on the quality of life and safety. Our studies aim to explore the 3-month effects of a 5-day multisession anodal transcranial direct current stimulation (a-tDCS) protocol applied over the primary motor cortex (M1) during motor sequence learning in elderly. The present sham-controlled aging study investigated whether tDCS-induced motor improvements previously observed 1 day after the intervention persist beyond 3 months. A total of 37 cognitively-intact aging participants performed five consecutive daily 20-min sessions of the serial-reaction time task (SRTT) concomitant with either anodal (n = 18) or sham (n = 19) tDCS over M1. All participants performed the Purdue Pegboard Test and transcranial magnetic stimulation (TMS) measures of cortical excitability were collected before, 1 day after and 3 months after the intervention. The last follow-up session also included the execution of the trained SRTT. The main findings are the demonstration of durable effects of a 5-day anodal tDCS intervention at the trained skill, while the active intervention did not differ from the sham intervention at both the untrained task and on measures of M1-disinhibition. Thus, the current article revealed for the first time the durability of functional effects of a-tDCS combined with motor training after only 5 days of intervention in an aging population. This finding provides evidence that the latter treatment alternative is effective in achieving our primary motor rehabilitation goal, that is to allow durable motor training effects in an aging population.
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Affiliation(s)
- Gaëlle Dumel
- Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Marie-Eve Bourassa
- Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | | | - Martine Desjardins
- Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Julien Doyon
- Unité de Neuroimagerie Fonctionnelle, Centre de Recherche de l'Institut de Gériatrie de Montréal, Montréal, QC, Canada
| | - Dave Saint-Amour
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Louis De Beaumont
- Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Département de Chirurgie, Université de Montréal, Montréal, QC, Canada
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20
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Dumel G, Bourassa MÈ, Charlebois-Plante C, Desjardins M, Doyon J, Saint-Amour D, De Beaumont L. Multisession anodal transcranial direct current stimulation induces motor cortex plasticity enhancement and motor learning generalization in an aging population. Clin Neurophysiol 2017; 129:494-502. [PMID: 29223355 DOI: 10.1016/j.clinph.2017.10.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/17/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The present aging study investigated the impact of a multisession anodal-tDCS protocol applied over the primary motor cortex (M1) during motor sequence learning on generalization of motor learning and plasticity-dependent measures of cortical excitability. METHODS A total of 32 cognitively-intact aging participants performed five consecutive daily 20-min sessions of the serial-reaction time task (SRTT) concomitant with either anodal (n = 16) or sham (n = 16) tDCS over M1. Before and after the intervention, all participants performed the Purdue Pegboard Test (PPT) and Transcranial Magnetic Stimulation (TMS) measures of cortical excitability were collected. RESULTS Relative to sham, participants assigned to the anodal-tDCS intervention revealed significantly greater performance gains on both the trained SRTT and the untrained PPT as well as a greater disinhibition of long-interval cortical inhibition (LICI). Generalization effects of anodal-tDCS significantly correlated with LICI disinhibition. CONCLUSION Anodal-tDCS facilitates motor learning generalisation in an aging population through intracortical disinhibition effects. SIGNIFICANCE The current findings demonstrate the potential clinical utility of a multisession anodal-tDCS over M1 protocol as an adjuvant to motor training in alleviating age-associated motor function decline. This study also reveals the pertinence of implementing brain stimulation techniques to modulate age-associated intracortical inhibition changes in order to facilitate motor function gains.
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Affiliation(s)
- Gaëlle Dumel
- Centre de recherche de l'hôpital du Sacré-Cœur de Montréal, 5400, boulevard Gouin Ouest, Montréal, Québec H4J1C5, Canada; Département de Psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, Québec H2X3P2, Canada.
| | - Marie-Ève Bourassa
- Centre de recherche de l'hôpital du Sacré-Cœur de Montréal, 5400, boulevard Gouin Ouest, Montréal, Québec H4J1C5, Canada; Département de Psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, Québec H2X3P2, Canada
| | - Camille Charlebois-Plante
- Centre de recherche de l'hôpital du Sacré-Cœur de Montréal, 5400, boulevard Gouin Ouest, Montréal, Québec H4J1C5, Canada
| | - Martine Desjardins
- Centre de recherche de l'hôpital du Sacré-Cœur de Montréal, 5400, boulevard Gouin Ouest, Montréal, Québec H4J1C5, Canada; Département de Psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, Québec H2X3P2, Canada
| | - Julien Doyon
- Unité de neuroimagerie fonctionnelle, Centre de recherche de l'institut de gériatrie de Montréal, 4545, chemin Queen-Mary, Montréal, Québec H3W1W4, Canada
| | - Dave Saint-Amour
- Département de Psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, Québec H2X3P2, Canada
| | - Louis De Beaumont
- Centre de recherche de l'hôpital du Sacré-Cœur de Montréal, 5400, boulevard Gouin Ouest, Montréal, Québec H4J1C5, Canada; Département de Chirurgie, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, Québec H3T1J4, Canada
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21
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Antal A, Alekseichuk I, Bikson M, Brockmöller J, Brunoni AR, Chen R, Cohen LG, Dowthwaite G, Ellrich J, Flöel A, Fregni F, George MS, Hamilton R, Haueisen J, Herrmann CS, Hummel FC, Lefaucheur JP, Liebetanz D, Loo CK, McCaig CD, Miniussi C, Miranda PC, Moliadze V, Nitsche MA, Nowak R, Padberg F, Pascual-Leone A, Poppendieck W, Priori A, Rossi S, Rossini PM, Rothwell J, Rueger MA, Ruffini G, Schellhorn K, Siebner HR, Ugawa Y, Wexler A, Ziemann U, Hallett M, Paulus W. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol 2017; 128:1774-1809. [PMID: 28709880 PMCID: PMC5985830 DOI: 10.1016/j.clinph.2017.06.001] [Citation(s) in RCA: 655] [Impact Index Per Article: 93.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/29/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022]
Abstract
Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.
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Affiliation(s)
- A Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.
| | - I Alekseichuk
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - M Bikson
- Department of Biomedical Engineering, The City College of New York, New York, USA
| | - J Brockmöller
- Department of Clinical Pharmacology, University Medical Center Goettingen, Germany
| | - A R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27) and Interdisciplinary Center for Applied Neuromodulation University Hospital, University of São Paulo, São Paulo, Brazil
| | - R Chen
- Division of Neurology, Department of Medicine, University of Toronto and Krembil Research Institute, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke NIH, Bethesda, USA
| | | | - J Ellrich
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Institute of Physiology and Pathophysiology, University of Erlangen-Nürnberg, Erlangen, Germany; EBS Technologies GmbH, Europarc Dreilinden, Germany
| | - A Flöel
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurologie, Greifswald, Germany
| | - F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - M S George
- Brain Stimulation Division, Medical University of South Carolina, and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - R Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - J Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Germany
| | - C S Herrmann
- Experimental Psychology Lab, Department of Psychology, European Medical School, Carl von Ossietzky Universität, Oldenburg, Germany
| | - F C Hummel
- Defitech Chair of Clinical Neuroengineering, Centre of Neuroprosthetics (CNP) and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, and EA 4391, Nerve Excitability and Therapeutic Team (ENT), Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - D Liebetanz
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - C K Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - C D McCaig
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - C Miniussi
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - P C Miranda
- Institute of Biophysics and Biomedical Engineering, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - V Moliadze
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein (UKSH), Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - M A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
| | - R Nowak
- Neuroelectrics, Barcelona, Spain
| | - F Padberg
- Department of Psychiatry and Psychotherapy, Munich Center for Brain Stimulation, Ludwig-Maximilian University Munich, Germany
| | - A Pascual-Leone
- Division of Cognitive Neurology, Harvard Medical Center and Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, Boston, USA
| | - W Poppendieck
- Department of Information Technology, Mannheim University of Applied Sciences, Mannheim, Germany
| | - A Priori
- Center for Neurotechnology and Experimental Brain Therapeutich, Department of Health Sciences, University of Milan Italy; Deparment of Clinical Neurology, University Hospital Asst Santi Paolo E Carlo, Milan, Italy
| | - S Rossi
- Department of Medicine, Surgery and Neuroscience, Human Physiology Section and Neurology and Clinical Neurophysiology Section, Brain Investigation & Neuromodulation Lab, University of Siena, Italy
| | - P M Rossini
- Area of Neuroscience, Institute of Neurology, University Clinic A. Gemelli, Catholic University, Rome, Italy
| | | | - M A Rueger
- Department of Neurology, University Hospital of Cologne, Germany
| | | | | | - H R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Y Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical University, Japan
| | - A Wexler
- Department of Science, Technology & Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - W Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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22
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Cosentino G, Valentino F, Todisco M, Alfonsi E, Davì R, Savettieri G, Fierro B, D'Amelio M, Brighina F. Effects of More-Affected vs. Less-Affected Motor Cortex tDCS in Parkinson's Disease. Front Hum Neurosci 2017; 11:309. [PMID: 28659778 PMCID: PMC5466958 DOI: 10.3389/fnhum.2017.00309] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/29/2017] [Indexed: 12/19/2022] Open
Abstract
Objective: To evaluate therapeutic potential of different montages of transcranial direct current stimulation (tDCS) in Parkinson’s Disease (PD) patients with asymmetric motor symptoms. Materials and Methods: Fourteen patients with asymmetric PD underwent, while on treatment, seven separate sessions including electrophysiological and clinical evaluation at baseline and after anodal, cathodal and sham tDCS of the primary motor cortex (M1) of the two hemispheres. Changes in motor cortical excitability were evaluated by transcranial magnetic stimulation (TMS). Effects on motor symptoms were assessed by testing finger tapping (FT) and upper limb bradykinesia, and by using the Italian validated Movement Disorder Society revision of the Unified PD Rating Scale (MDS-UPDRS). Results: Only anodal tDCS of the more-affected M1 (contralateral to the more-affected body side) and cathodal tDCS of the less-affected M1 (contralateral to the less-affected body side) were able to induce significant changes in cortical excitability, i.e., facilitation and inhibition of the motor evoked potentials respectively. The motor performances of both hands significantly improved after anodal tDCS of the more-affected M1, as well as after cathodal tDCS of the less-affected one. Conclusion: Our findings support the potential usefulness of tDCS as add-on treatment for asymmetric PD, also providing interesting clues on the possible pathophysiological role played by an asymmetric activation of homologous motor cortical areas in PD.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Francesca Valentino
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Massimiliano Todisco
- Department of Neurophysiopathology, C. Mondino National Institute of Neurology Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)Pavia, Italy
| | - Enrico Alfonsi
- Department of Neurophysiopathology, C. Mondino National Institute of Neurology Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)Pavia, Italy
| | - Rosaria Davì
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Giovanni Savettieri
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Brigida Fierro
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Marco D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
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23
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Reinhart RMG, Cosman JD, Fukuda K, Woodman GF. Using transcranial direct-current stimulation (tDCS) to understand cognitive processing. Atten Percept Psychophys 2017; 79:3-23. [PMID: 27804033 PMCID: PMC5539401 DOI: 10.3758/s13414-016-1224-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Noninvasive brain stimulation methods are becoming increasingly common tools in the kit of the cognitive scientist. In particular, transcranial direct-current stimulation (tDCS) is showing great promise as a tool to causally manipulate the brain and understand how information is processed. The popularity of this method of brain stimulation is based on the fact that it is safe, inexpensive, its effects are long lasting, and you can increase the likelihood that neurons will fire near one electrode and decrease the likelihood that neurons will fire near another. However, this method of manipulating the brain to draw causal inferences is not without complication. Because tDCS methods continue to be refined and are not yet standardized, there are reports in the literature that show some striking inconsistencies. Primary among the complications of the technique is that the tDCS method uses two or more electrodes to pass current and all of these electrodes will have effects on the tissue underneath them. In this tutorial, we will share what we have learned about using tDCS to manipulate how the brain perceives, attends, remembers, and responds to information from our environment. Our goal is to provide a starting point for new users of tDCS and spur discussion of the standardization of methods to enhance replicability.
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Affiliation(s)
- Robert M G Reinhart
- Department of Psychological and Brain Sciences, Center for Research in Sensory Communications and Neural Technology, Center for Systems Neuroscience, Boston University, Boston, MA, 02215, USA.
| | - Josh D Cosman
- Department of Translational Medicine, Pfizer Inc., Cambridge, MA, 02215, USA
| | - Keisuke Fukuda
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Geoffrey F Woodman
- Department of Psychology, Center for Integrative and Cognitive Neuroscience, Vanderbilt Vision Research Center, Vanderbilt University, Nashville, TN, 37240, USA.
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