BA4 labelling and registration to the functional space.

<p>An example of the quality of the cortical segmentation and labelling of BA4 is depicted, which was performed with Freesurfer in one of the participants. Panels <b>A</b> and <b>B</b> show the BA4 label over the pial and inflated brain surface respectively. Panel <b>C</b> shows the left BA4 label registered in the original T1 image. The red line shows the portion of the cortical segmentation performed by Freesurfer that corresponds to the left BA4 label (in this image left is right). Notice the tDCS electrode over the scalp of the subject is positioned over the central sulcus. Panel <b>D</b> shows the registration of the cortical segmentation and BA4 label in the native functional space of the same subject (first row: first 14 images of the native functional space. Second row: cortical segmentation registered from Freesurfer to the native functional space was overlapped. Third row: BA4 label (red) registered from Freesurfer space to the native functional space). For visualization purposes, we show the approximate location of the tDCS electrode over left BA4 in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030971#pone.0030971.s001" target="_blank">figure S1</a>.</p

Highly efficient nodes within M1.

<p>The average <i>L</i> maps for all subjects and all before-tDCS fMRI scans were averaged. Nodes that showed the highest <i>L_rand/Li</i> values (i.e. nodes that communicate more efficiently within M1) were mapped over the flattened BA4. As an exploratory threshold we used the 15% of the voxels that showed the highest <i>L_rand/Li</i> values.</p

Dependency of the tDCS-induced effects on baseline functional architecture.

<p>Panel A shows that the effect of nodal clustering coefficient (<i>C</i>) increase found in the cluster of <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030971#pone-0030971-g003" target="_blank">Figure 3F</a> strongly correlated with baseline <i>C</i> (P = 0.0051; R² = 0.46). Panel B shows that the positive decrease found in the characteristic path length (<i>L</i>) maps that was found after anodal tDCS (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030971#pone-0030971-g003" target="_blank">Figure 3H</a>) also has a positive correlation with the baseline <i>L</i> (P = 0.002; R² = 0.51).</p

Graph parameter statistics at the BA4 cortical surface.

<p>(A) Shown is the flattening of the left BA4 (green labelled region) obtained from the left hemisphere surface average subject, which was used to project the statistical maps. Panels B to D show the ANOVA for the interaction effects (time*stimulation) Montecarlo cluster corrected at p<0.05 for the nodal connectivity degree maps (B), clustering coefficient maps (C) and the characteristic path length maps (D). Panels E to H show post hoc paired t-tests for the following contrasts: (E) After_Cathodal – After_Sham in the clustering coefficient maps; (F) After_Anodal – Before_Anodal in the clustering coefficient maps; (G) After_Anodal – After Sham in the characteristic path length maps; (H) After_Anodal – Before_Anodal in the characteristic path length maps. Notice that the <i>L</i> maps were <i>L_rand/Li</i> normalized, which means that the values of <i>L</i> in the significant cluster are lower after stimulation (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030971#s2" target="_blank">methods</a> section).</p

Global network metrics.

<p>Shown are the results of the global network parameters that were calculated in the present study (mean connectivity degree (<i>K</i>) and the small-world parameters gamma, lambda and sigma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030971#pone.0030971-Sporns2" target="_blank">[32]</a>) calculated at each threshold T (0.25–0.35 in increasing steps of 0.002) before and after each Sham (A), Cathodal (B) and Anodal (C) tDCS. The second row - second column of each panel show that the approximate number of nodes (M1 voxels) of each undirected graph was ∼470. As expected, the mean connectivity degree monotonically decreases as <i>T</i> increases. M1 has salient small-world properties i.e. <i>lambda≈1</i>, <i>gamma≫1</i>, thus <i>sigma≫1 </i><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030971#pone.0030971-Sporns2" target="_blank">[32]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030971#pone.0030971-Achard1" target="_blank">[41]</a>. No significant differences were observed for any of the network metrics before and after each of the tDCS sessions (P>0.05 paired two-tailed t-tests). Error bars represent the s.e.m.</p

For all contrasts the values for the effect size, power and the required sample size to reach a power of 0.80 are reported.

<p>Results for the evolution of the slopes and at post-intervention are shown. Note that the effect size is defined as the absolute value of the mean difference between two groups.</p

Mean (StDev) sleep (duration and quality) and level (0 = low, 10 = high) of attention, fatigue, and discomfort perceived during each session (SHAM tDCS, 1 mA atDCS and 1.5 mA atDCS).

<p>No significant differences were reported between sessions (all, p>0.05).</p

Subjects were instructed to perform a 8-element finger sequence with the dominant hand by pressing different keys, each corresponding to one of the four fingers (2nd–5th).

<p>Subjects were instructed to perform a 8-element finger sequence with the dominant hand by pressing different keys, each corresponding to one of the four fingers (2nd–5th).</p

Evolution of motor performance during motor learning and at post-intervention (% normalized relative to baseline) for the 1.5 mA atDCS, 1 mA atDCS and sham tDCS condition.

<p>Evolution of motor performance during motor learning and at post-intervention (% normalized relative to baseline) for the 1.5 mA atDCS, 1 mA atDCS and sham tDCS condition.</p

Transcranial direct current stimulation associated with gait training in Parkinson’s disease: A pilot randomized clinical trial

<p><i>Objective</i>: The aim of this study is to investigate the effects of transcranial direct current stimulation (tDCS) combined with cueing gait training (CGT) on functional mobility in patients with Parkinson´s disease (PD). <i>Methods</i>: A pilot double-blind controlled, randomized clinical trial was conducted with 22 patients with PD assigned to the experimental (anodal tDCS plus CGT) and control group (sham tDCS plus CGT). The primary outcome (functional mobility) was assessed by 10-m walk test, cadence, stride length, and Timed Up and Go test. Motor impairment, bradykinesia, balance, and quality of life were analyzed as secondary outcomes. Minimal clinically important differences (MCIDs) were observed when assessing outcome data. <i>Results</i>: Both groups demonstrated similar gains in all outcome measures, except for the stride length. The number of participants who showed MCID was similar between groups. <i>Conclusion</i>: The CGT provided many benefits to functional mobility, motor impairment, bradykinesia, balance, and quality of life. However, these effect magnitudes were not influenced by stimulation, but tDCS seems to prolong the effects of cueing therapy on functional mobility.</p