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Enhanced Motor Skill Acquisition in the Non-Dominant Upper Extremity Using Intermittent Theta Burst Stimulation and Transcranial Direct Current Stimulation


Enhanced Motor Skill Acquisition in the Non-Dominant Upper Extremity Using Intermittent Theta Burst Stimulation and Transcranial Direct Current Stimulation

Raymond J Butts et al. Front Hum Neurosci.


Individuals suffering from motor impairments often require physical therapy (PT) to help improve their level of function. Previous investigations suggest that both intermittent theta burst stimulation (iTBS) and bihemispheric transcranial direct current stimulation (tDCS) may increase the speed and extent of motor learning/relearning. The purpose of the current study was to explore the feasibility and effectiveness of a novel, non-invasive brain stimulation approach that combined an iTBS primer, and bihemispheric stimulation coupled with motor training. We hypothesized that individuals exposed to this novel treatment would make greater functional improvements than individuals undergoing sham stimulation when tested immediately following, 24-h, and 7-days post-training. A total of 26 right-handed, healthy young adults were randomly assigned to either a treatment (n = 15) or control group (n = 12). iTBS (20 trains of 10 pulse triplets each delivered at 80% active motor threshold (AMT) / 50 Hz over 191.84 s) and bihemispheric tDCS (1.0 ma for 20 min) were used as a primer to, and in conjunction with, 20 min of motor training, respectively. Our primary outcome measure was performance on the Jebsen-Taylor Hand Function (JTHF) test. Participants tolerated the combined iTBS/bihemispheric stimulation treatment without complaint. While performance gains in the sham and stimulation group were not significant immediately after training, they were nearly significant 24-h post training (p = 0.055), and were significant at 7-days post training (p < 0.05). These results suggest that the combined iTBS/bihemispheric stimulation protocol is both feasible and effective. Future research should examine the mechanistic explanation of this approach as well as the potential of using this approach in clinical populations.

Keywords: Jebsens; TMS; brain; learning; motor cortex; tDCS.


Figure 1
Figure 1
Graphical depiction of the experimental design comparing functional outcomes of college-age students following motor training augmented with real and sham iTBS/bihemispheric stimulation. T1-T4 represent time points at which motor skill performance was measured: T1 = pre-test, T2 = immediate post-test, T3 = 24-h post-test, and T4 = 7-days post-test, respectively.
Figure 2
Figure 2
(A) Graphical representation of overall functional improvement on the JTHF test. (B) Direct comparison of improvement (post-test – pre-test) on the JTHF test in sham and treatment groups. (C) Direct comparison of total performance time on the JTHF test in sham and stimulation groups. (D) Results of the JTHF test at each time point (immediate post-test, 24-hrs post-test, and 7-days, post-test). The dark gray and light gray line represents the iTBS/bihemispheric stimulation experimental group and placebo-control group, respectively. * = significant effect at p < 0.05.

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