Transcranial direct current stimulation to optimise participation in stroke rehabilitation – A Sham-Controlled Cross-Over feasibility study

Background: Fatigue and attentional decline limit the duration of many therapy sessions in older adults poststroke. Transcranial direct current stimulation (tDCS) may facilitate participation in rehabilitation, potentially via reduced fatigue and improved sustained attention poststroke. Objective: To evaluate whether tDCS results in an increase in the number of completed rehabilitation therapy sessions in stroke survivors. Methods: Nineteen participants were randomly allocated to receive 10 sessions of 2-mA anodal (excitatory) tDCS, or sham tDCS, applied to the left dorsolateral prefrontal cortex (DLPFC) for 20 minutes within 1 hour prior to the first rehabilitation therapy session of the day. After a 2-day washout period, participants then crossed-over. Researchers applying the tDCS, and those recording measures were blinded to group allocation. The number of first rehabilitation therapy sessions completed as planned, as well as the total duration of rehabilitation therapy, were used to determine the influence of tDCS on participation in stroke rehabilitation. Results: The total number of first therapy sessions completed as planned did not vary according to group allocation (111 of 139 sessions for tDCS, 110 of 147 sessions for sham treatment; chi-square 1.0; P = .31). Conclusions: Our results suggest that, while tDCS to the DLPFC was well tolerated, it did not significantly influence the number of completed rehabilitation therapy sessions in stroke survivors

Childhood motor performance is increased by participation in organized sport: the CHAMPS Study-DK

Evidence suggests that motor performance in children is declining globally. We tested whether participation in organized sport is associated with motor performance, and estimate the effect of 30 months participation in organized sport on motor performance. Study participants were 1067 primary school students, enrolled in the Danish Childhood Health, Activity, and Motor Performance School study. Participation in organized sport was reported via text messaging. Coordination-related motor performance composite, fitness-related motor performance composite, and total motor performance composite were calculated. Data were analyzed using Generalized Estimating Equations. Participation in organized sport was positively associated with motor performance (all composites) in models that did and did not control for baseline motor performance. For models that did not control for baseline motor performance, this equated to 2–6% increases in motor performance per weekly sport session; for models that did control for baseline motor performance, this equated to 1–5% increases in motor performance per weekly sport session. Positive associations between participation in organized sport and motor performance identify participation in organized sport as a way to improve motor performance in children. These results might provide the basis to determine whether participation in organized sport could be beneficial for children with developmental movement disorders

Day differences in the cortisol awakening response predict day differences in synaptic plasticity in the brain

The cortisol awakening response (CAR) is the most prominent, dynamic and variable part of the circadian pattern of cortisol secretion. Despite this its precise purpose is unknown. Aberrant patterns of the CAR are associated with impaired physical and mental health and reduced cognitive function, suggesting that it may have a pervasive role or roles. It has been suggested that the CAR primes the brain for the expected demands of the day but the mechanisms underlying this process are unknown. We examined temporal covariation of the CAR and rapid transcranial magnetic stimulation (rTMS)-induced long term depression (LTD)-like responses in the motor cortex. Plasticity was evaluated across 180 measures from 5 time points on 4 sessions across 9 researcher participants, mean age 25 ± 2.5 years. Plasticity estimates were obtained in the afternoon after measurement of the CAR on 4 days, at least 3 days apart. As both CAR magnitude and rTMS-induced responses are variable across days we hypothesised that days with larger than individual average CARs would be associated with a greater than individual average plasticity response. This was confirmed by mixed regression modelling where variation in the CAR predicted variation in rTMS-induced responses (Df: 1, 148.24; F: 10.41; p=0.002). As the magnitude of the CAR is regulated by the ‘master’ circadian CLOCK, and synaptic plasticity is known to be modulated by peripheral ‘slave’ CLOCK genes, we suggest that the CAR may be a mediator between the master and peripheral circadian systems to entrain daily levels of synaptic plasticity

Repetitive transcranial magnetic stimulation (rTMS) in autism spectrum disorder: protocol for a multicentre randomised controlled clinical trial

Introduction There are no well-established biomedical treatments for the core symptoms of autism spectrum disorder (ASD). A small number of studies suggest that repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, may improve clinical and cognitive outcomes in ASD. We describe here the protocol for a funded multicentre randomised controlled clinical trial to investigate whether a course of rTMS to the right temporoparietal junction (rTPJ), which has demonstrated abnormal brain activation in ASD, can improve social communication in adolescents and young adults with ASD. Methods and analysis This study will evaluate the safety and efficacy of a 4-week course of intermittent theta burst stimulation (iTBS, a variant of rTMS) in ASD. Participants meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ASD (n=150, aged 14–40 years) will receive 20 sessions of either active iTBS (600 pulses) or sham iTBS (in which a sham coil mimics the sensation of iTBS, but no active stimulation is delivered) to the rTPJ. Participants will undergo a range of clinical, cognitive, epi/genetic, and neurophysiological assessments before and at multiple time points up to 6 months after iTBS. Safety will be assessed via a structured questionnaire and adverse event reporting. The study will be conducted from November 2020 to October 2024. Ethics and dissemination The study was approved by the Human Research Ethics Committee of Monash Health (Melbourne, Australia) under Australia’s National Mutual Acceptance scheme. The trial will be conducted according to Good Clinical Practice, and findings will be written up for scholarly publication. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12620000890932)

Investigation of Perceptual-Motor Behavior Across the Expert Athlete to Disabled Patient Skill Continuum can Advance Theory and Practical Application

A framework is presented of how theoretical predictions can be tested across the expert athlete to disabled patient skill continuum. Common-coding theory is used as the exemplar to discuss sensory and motor system contributions to perceptual-motor behavior. Behavioral and neural studies investigating expert athletes and patients recovering from cerebral stroke are reviewed. They provide evidence of bi-directional contributions of visual and motor systems to perceptual-motor behavior. Majority of this research is focused on perceptual-motor performance or learning, with less on transfer. The field is ripe for research designed to test theoretical predictions across the expert athlete to disabled patient skill continuum. Our view has implications for theory and practice in sports science, physical education, and rehabilitation

Chronic tension-type headache is associated with impaired motor learning

Background: Supraspinal activity-dependent neuroplasticity may be important in the transition from acute to chronic pain. We examined neuroplasticity in a cortical region not considered to be a primary component of the central pain matrix in chronic tension-type headache (CTTH) patients. We hypothesised that neuroplasticity would be exaggerated in CTTH patients compared to healthy controls, which might explain (in part) the development of chronic pain in these individuals. Methods: Neuroplasticity was examined following a ballistic motor training task in CTTH patients and control subjects (CS). Changes in peak acceleration (motor learning) and motor-evoked potential (MEP) amplitude evoked by single-pulse transcranial magnetic stimulation were compared. Results: CTTH patients showed significantly less motor learning on the training task than CS (mean acceleration increase 87% CTTH, 204% CS, p.05). Conclusions: These findings suggest a deficit in use-dependent neuroplasticity within networks responsible for task performance in CTTH patients which might reflect reciprocal influences between primary motor cortex and interconnected pain processing networks. These findings may help explain the positive effects of facilitatory non-invasive brain stimulation targeting motor areas on chronic pain and help elucidate the mechanisms mediating chronic pain. © 2013 International Headache Society