Enhanced motor skill acquisition in the non-dominant upper extremity using intermittent theta burst stimulation and transcranial direct current stimulation.

Raymond J Butts,Melissa B Kolar,Roger D Newman-Norlund

doi:10.3389/fnhum.2014.00451

Abstract

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.

Highlights

Of the 795,000 people that will suffer from a stroke in the U.S this year, two thirds will survive and require rehabilitative services (Lloyd-Jones et al, 2009)
All subjects tolerated the combined intermittent theta burst stimulation (iTBS)/bihemispheric stimulation protocol well, and no adverse reactions related to either treatment were reported
A 2 × 4 repeated measures Analysis of Variance (ANOVA) was performed on total Jebsen-Taylor Hand Function (JTHF) time to determine the main effect of time, condition, and the interaction of time and condition

Summary

Introduction

Of the 795,000 people that will suffer from a stroke in the U.S this year, two thirds will survive and require rehabilitative services (Lloyd-Jones et al, 2009). While new therapeutic techniques have improved functional outcomes by applying the principles of forced use and massed practice, significant stroke-related disabilities often persist following treatment. More than 85% of patients that have suffered a stroke have lasting functional impairments (Wolf et al, 2006) and approximately 50–60% of stroke survivors continue to require functional assistance to complete activities of daily living after completion of intensive physical therapy (PT; Bolognini et al, 2009)

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