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Pisano F, Mellace D, Fugatti A, Aiello EN, Diotti S, Curti B, Giust A, Marfoli A, Perin C, De Sandi A, Alimonti D, Priori A, Ferrucci R. Cerebellar tDCS combined with augmented reality treadmill for freezing of gait in Parkinson's disease: a randomized controlled trial. J Neuroeng Rehabil 2024; 21:173. [PMID: 39342307 PMCID: PMC11438075 DOI: 10.1186/s12984-024-01457-z] [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: 07/22/2024] [Accepted: 09/03/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is often accompanied by gait disorders and freezing of gait (FoG), disabling symptoms that are resistant to conventional dopamine treatments. Given the cerebellum's connectivity with the motor cortex and basal ganglia, and its implication in PD, combining transcranial direct current stimulation targeting the cerebellum (ctDCS) with physical exercise might improve gait and balance. OBJECTIVE This study aimed to evaluate the effectiveness of a novel rehabilitation approach that combines noninvasive cerebellar stimulation with motor-cognitive training via an augmented reality treadmill (C-Mill VR+) in individuals with PD and FoG. METHODS Seventeen individuals with PD exhibiting FoG were enrolled in a randomized controlled trial. The participants were randomly assigned to a group receiving motor-cognitive training on the C-Mill VR+ with either ctDCS or sham ctDCS. Assessments were conducted pre-intervention (T0), post-intervention (T1) after 10 sessions, and at 4-week follow-up (T2), using various clinical scales. Additionally, C-Mill assessments of postural stability and gait were conducted at T0 and T1. RESULTS Although no significant time*group interactions were observed for any of the clinical variables measured, some were found in the C-Mill measures. Specifically, right lower limb sway in static conditions, both with eyes open (OAD) and eyes closed (OCD), significantly improved at T1 in the ctDCS group compared with the sham group. CONCLUSIONS C-Mill outcomes indicate that the combined treatment may enhance motor control. Participants who received ctDCS along with augmented reality motor-cognitive training showed better postural stability.
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Affiliation(s)
- Fabrizio Pisano
- Neurological Rehabilitiation, Policlinico San Marco, Gruppo San Donato, Zingonia, Bergamo, Italy
| | - Denise Mellace
- Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, Milan, 20122, Italy
| | - Ambra Fugatti
- Neurological Rehabilitiation, Policlinico San Marco, Gruppo San Donato, Zingonia, Bergamo, Italy
| | - Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Diotti
- Neurological Rehabilitiation, Policlinico San Marco, Gruppo San Donato, Zingonia, Bergamo, Italy
| | - Beatrice Curti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessandra Giust
- Neurological Rehabilitiation, Policlinico San Marco, Gruppo San Donato, Zingonia, Bergamo, Italy
| | - Angelica Marfoli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, Milan, 20122, Italy
| | - Cecilia Perin
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Angelica De Sandi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Alimonti
- Neurology Unit, Department of Neuroscience, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Priori
- Neurological Clinic, ASST-Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Ferrucci
- Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, Milan, 20122, Italy.
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Pezzetta R, Gambarota F, Tarantino V, Devita M, Cattaneo Z, Arcara G, Mapelli D, Masina F. A meta-analysis of non-invasive brain stimulation (NIBS) effects on cerebellar-associated cognitive processes. Neurosci Biobehav Rev 2024; 157:105509. [PMID: 38101590 DOI: 10.1016/j.neubiorev.2023.105509] [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: 09/05/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
Non-invasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES), have provided valuable insights into the role of the cerebellum in cognitive processes. However, replicating findings from studies involving cerebellar stimulation poses challenges. This meta-analysis investigates the impact of NIBS on cognitive processes associated with the cerebellum. We conducted a systematic search and analyzed 66 studies and 91 experiments involving healthy adults who underwent either TMS or transcranial direct current stimulation (tDCS) targeting the cerebellum. The results indicate that anodal tDCS applied to the medial cerebellum enhances cognitive performance. In contrast, high-frequency TMS disrupts cognitive performance when targeting the lateral cerebellar hemispheres or when employed in online protocols. Similarly, low-frequency TMS and continuous theta burst stimulation (cTBS) diminish performance in offline protocols. Moreover, high-frequency TMS impairs accuracy. By identifying consistent effects and moderators of modulation, this meta-analysis contributes to improving the replicability of studies using NIBS on the cerebellum and provides guidance for future research aimed at developing effective NIBS interventions targeting the cerebellum.
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Affiliation(s)
| | - Filippo Gambarota
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Vincenza Tarantino
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy
| | - Maria Devita
- Department of General Psychology, University of Padova, Padova, Italy; Geriatrics Unit, Department of Medicine, University of Padova, Padova, Italy.
| | - Zaira Cattaneo
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Daniela Mapelli
- Department of General Psychology, University of Padova, Padova, Italy
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Ocklenburg S, Peterburs J. Monitoring Brain Activity in VR: EEG and Neuroimaging. Curr Top Behav Neurosci 2023; 65:47-71. [PMID: 37306852 DOI: 10.1007/7854_2023_423] [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] [Indexed: 06/13/2023]
Abstract
Virtual reality (VR) is increasingly used in neuroscientific research to increase ecological validity without sacrificing experimental control, to provide a richer visual and multisensory experience, and to foster immersion and presence in study participants, which leads to increased motivation and affective experience. But the use of VR, particularly when coupled with neuroimaging or neurostimulation techniques such as electroencephalography (EEG), functional magnetic resonance imaging (fMRI), or transcranial magnetic stimulation (TMS), also yields some challenges. These include intricacies of the technical setup, increased noise in the data due to movement, and a lack of standard protocols for data collection and analysis. This chapter examines current approaches to recording, pre-processing, and analyzing electrophysiological (stationary and mobile EEG), as well as neuroimaging data recorded during VR engagement. It also discusses approaches to synchronizing these data with other data streams. In general, previous research has used a range of different approaches to technical setup and data processing, and detailed reporting of procedures is urgently needed in future studies to ensure comparability and replicability. More support for open-source VR software as well as the development of consensus and best practice papers on issues such as the handling of movement artifacts in mobile EEG-VR will be essential steps in ensuring the continued success of this exciting and powerful technique in neuroscientific research.
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Affiliation(s)
- Sebastian Ocklenburg
- Department of Psychology, Faculty for Life Sciences, MSH Medical School Hamburg, Hamburg, Germany.
- ICAN Institute for Cognitive and Affective Neuroscience, MSH Medical School Hamburg, Hamburg, Germany.
- Faculty of Psychology, Institute of Cognitive Neuroscience, Biopsychology, Ruhr University Bochum, Bochum, Germany.
| | - Jutta Peterburs
- Institute of Systems Medicine & Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Modulating mental state recognition by anodal tDCS over the cerebellum. Sci Rep 2022; 12:22616. [PMID: 36585436 PMCID: PMC9803656 DOI: 10.1038/s41598-022-26914-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
Increasing evidence from neuroimaging and clinical studies has demonstrated cerebellar involvement in social cognition components, including the mentalizing process. The aim of this study was to apply transcranial direct current stimulation (tDCS) to modulate cerebellar excitability to investigate the role the cerebellum plays in mental state recognition. Forty-eight healthy subjects were randomly assigned to different groups in which anodal, cathodal, or sham tDCS (2 mA for 20 min) was delivered centering the electrode on the vermis to stimulate the posterior portion of the cerebellum. The ability to attribute mental states to others was tested before and after tDCS using a digital version of the 'Reading the Mind in the Eyes test', which includes visual perceptive and motor stimuli as control conditions. Correct response and reaction times (RTs) were recorded. The results revealed a significant reduction in RTs between the baseline and post-stimulation sessions after cerebellar anodal tDCS only for mental state stimuli (Wilcoxon test p = 0.00055), whereas no significant effect was found in the cathodal or sham conditions or for visual perceptive and motor stimuli. Overall, our study suggests that cerebellar anodal tDCS might selectively improve mental state recognition and constitute an effective strategy to positively modulate the mentalizing process.
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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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A Computational Approach for the Assessment of Executive Functions in Patients with Obsessive-Compulsive Disorder. J Clin Med 2019; 8:jcm8111975. [PMID: 31739514 PMCID: PMC6912564 DOI: 10.3390/jcm8111975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022] Open
Abstract
Previous studies on obsessive–compulsive disorder (OCD) showed impairments in executive domains, particularly in cognitive inhibition. In this perspective, the use of virtual reality showed huge potential in the assessment of executive functions; however, unfortunately, to date, no study on the assessment of these patients took advantage of the use of virtual environments. One of the main problems faced within assessment protocols is the use of a limited number of variables and tools when tailoring a personalized program. The main aim of this study was to provide a heuristic decision tree for the future development of tailored assessment protocols. To this purpose, we conducted a study that involved 58 participants (29 OCD patients and 29 controls) to collect both classic neuropsychological data and precise data based on a validated protocol in virtual reality for the assessment of executive functions, namely, the VMET (virtual multiple errands test). In order to provide clear indications for working on executive functions with these patients, we carried out a cross-validation based on three learning algorithms and computationally defined two decision trees. We found that, by using three neuropsychological tests and two VMET scores, it was possible to discriminate OCD patients from controls, opening a novel scenario for future assessment protocols based on virtual reality and computational techniques.
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