Cerebellar Transcranial Direct Current Stimulation Research Articles

Electrode montage-dependent intracranial variability in electric fields induced by cerebellar transcranial direct current stimulation

Transcranial direct current stimulation (tDCS) is an increasingly popular tool to investigate the involvement of the cerebellum in a variety of brain functions and pathologies. However, heterogeneity and small effect sizes remain a common issue. One potential cause may be interindividual variability of the electric fields induced by tDCS. Here, we compared electric field distributions and directions between two conventionally used electrode montages (i.e., one placing the return electrode over the ipsilateral buccinator muscle and one placing the return electrode [25 and 35 cm2 surface area, respectively] over the contralateral supraorbital area; Experiment 1) and six alternative montages (electrode size: 9 cm2; Experiment 2) targeting the right posterior cerebellar hemisphere at 2 mA. Interindividual and montage differences in the achieved maximum field strength, focality, and direction of current flow were evaluated in 20 head models and the effects of individual differences in scalp–cortex distance were examined. Results showed that while maximum field strength was comparable for all montages, focality was substantially improved for the alternative montages over inferior occipital positions. Our findings suggest that compared to several conventional montages extracerebellar electric fields are significantly reduced by placing smaller electrodes in closer vicinity of the targeted area.

Portable neuroimaging and biped multi-task battery to study the effects of non-invasive cerebellar stimulation: a case series on hemiplegic patients with and without basal ganglia lesion

Abstract Introduction: The cerebello-thalamo-cortical(CTC) pathway plays a crucial role in postural control and balance. CTC pathway can be facilitated with cerebellar transcranial Direct Current Stimulation(ctDCS) while cortical responses can be measured with portable neuroimaging[1] that was investigated on stroke survivors with and without basal ganglia infarction. Methods: Twelve stroke survivors participated in a single-blind randomized-order crossover study on bipolar ctDCS targeting bilateral dentate nuclei and motor region of cerebellum(details in [1]). Current study investigated two subjects with basal ganglia(BG) lesions based on ctDCS effects on their performance during multi-task battery of overground/treadmill walking, standing weight-shifting(virtual reality-based balance training(VBaT)[2]) as-well-as brain activation at prefrontal cortex(PFC) and sensorimotor cortex(SMC) based on functional near-infrared spectroscopy(fNIRS) and electroencephalogram(EEG). Results: VBaT system identified directional weight-shifting dysfunction(measured by irregularity/sway in center of pressure trajectory) and dynamic variability(measured by coefficient of variation of step time and stride time characterizing walking). The ctDCS intervention did not affect performance in BG-lesion cases(when compared to others[1]). BG-lesioned cases did not fit general linear model well that putatively associated lobular electric field strength with changes in fNIRS-EEG measures at ipsilesional and contra-lesional PFC and SMC[1]. Furthermore, post-ctDCS cerebrovascular reactivity to ctDCS[3] was not significant in BG-lesioned cases while they were significantly(p<0.05) different between the hemispheres in other subjects. Conclusion: Deterioration in biped multi-task performance is postulated to be related to reduced error-correction ability because of BG infarction. Here, cerebrovascular reactivity to ctDCS[3] is postulated to identify responders where BG infarction may affected cerebello-cortical pathway[4] that needs investigation in a larger cohort.

Effects of Anodal Cerebellar Transcranial Direct Current Stimulation on Movements in Patients with Cerebellar Ataxias: A Systematic Review.

Cerebellar transcranial direct current stimulation (cerebellar tDCS) is a promising therapy for cerebellar ataxias and has attracted increasing attention from researchers and clinicians. A timely systematic review focusing on randomized sham-controlled trials and repeated measures studies is warranted. This study was to systematically review existing evidence regarding effects of anodal cerebellar tDCS on movements in patients with cerebellar ataxias. The searched databases included Web of Science, MEDLINE, PsycINFO, CINAHL, EMBASE, Cochrane Library, and EBSCOhost. Methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale. Five studies with 86 patients were identified. Among these, four studies showed positive effects of anodal cerebellar tDCS. Specifically, anodal cerebellar tDCS decreased disease severity and improved finger dexterity and quality of life in patients, but showed incongruent effects on gait control and balance, which may be due to heterogeneity of research participants and choices of measures. The protocols of anodal cerebellar tDCS that improved movements in patients commonly placed the anode over the whole cerebellum and provided ten 2-mA 20-min stimulation sessions. The results may show preliminary evidence that anodal cerebellar tDCS is beneficial to reducing disease severity and improving finger dexterity and quality of life in patients, which lays the groundwork for future studies further examining responses in the cerebello-thalamo-cortical pathway. An increase in sample size, the use of homogeneous patient groups, exploration of the optimal stimulation protocol, and investigation of detailed neural mechanisms are clearly needed in future studies.

Polarity-dependent cerebellar transcranial direct current stimulation modulates online functions of the alerting attention network.

Objectives:To investigate the modulatory effect of anodal, cathodal and sham cerebellar transcranial direct current stimulation (ctDCS) on the efficiency of the 3 attention networks namely alerting network, orienting network, and the network of executive control.Methods:A sham-controlled, single-blind study. Experiments were performed at the neuroscience lab of Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia, between the months of January-July of 2018. Sixty-three healthy subjects were assessed for eligibility and a total of 60 subjects (30 males and 30 females) met the inclusion criteria. Subjects were randomly divided into 3 groups that received a single 20-minute session of 2 mA of anodal, cathodal or sham ctDCS while performing tasks. The tasks corresponded to the 3 attention networks-vigilance task assessed the alerting network, Posner’s attention task assessed the orienting network and Flanker task assessed the network of executive control. The Edinburgh handedness inventory-short form determined the subjects’ handedness.Results:Analysis of variance (ANOVA) showed a highly significant polarity-independent group*task effect (p=0.003) for the vigilance task. Moreover, there was a significant polarity-independent group*task effect for valid cues (p=0.006). A polarity-dependent group*task effect was observed for invalid cues (p=0.011).Conclusion:Conclusion: Findings demonstrate that ctDCS modulates alerting attention and highlights a more profound effect of cerebellar modulation in attention tasks with higher cognitive load.

Role of peroxisomal proliferator-activated Y-receptors in analgesia induced with cerebellar stimulations in kindled rats

Background. Antiepileptic effects induced with cerebellar transcranial direct current stimulation (TDCS), and the role of peroxisomal proliferator-activated γ-receptors (PPARγ) in its development have been shown (Godlevsky, Pervak, 2017; 2019). Aims. To investigate the pronouncement of pain behaviors in rats with anodal TDCS of cerebellum and modulation of PPARγ activity.

Cerebellar Transcranial Direct Current Stimulation Reconfigures Brain Networks Involved in Motor Execution and Mental Imagery.

Transcranial direct current stimulation (tDCS) is growingly applied to the cerebellum to modulate the activity of cerebellar circuitry, affecting both motor and cognitive performances in a polarity-specific manner. The remote effects of tDCS are mediated in particular via the dentato-thalamo-cortical pathway. We showed recently that tDCS of the cerebellum exerts dynamic effects on resting state networks. We tested the neural hypothesis that tDCS reconfigurates brain networks involved in motor execution (ME) and motor mental imagery (MMI). We combined tDCS applied over the right cerebellum and fMRI to investigate tDCS-induced reconfiguration of ME- and MMI-related networks using a randomized, sham-controlled design in 21 right-handed healthy volunteers. Subjects were instructed to draw circles at comfortable speed and to imagine drawing circles with their right hand. fMRI data were recorded after real anodal stimulation (1.5mA, 20min) or sham tDCS. Real tDCS compared with SHAM specifically reconfigurated the functional links between the main intrinsic connected networks, especially the central executive network, in relation with lobule VII, and the salience network. The right cerebellum mainly influenced prefrontal and anterior cingulate areas in both tasks, and improved the overt motor performance. During MMI, the cerebellum also modulated the default-mode network and associative visual areas. These results demonstrate that tDCS of the cerebellum represents a novel tool to modulate cognitive brain networks controlling motor execution and mental imagery, tuning the activity of remote cortical regions. This approach opens novel doors for the non-invasive neuromodulation of disorders involving cerebello-thalamo-cortical paths.

Cerebellar Transcranial Direct Current Stimulation in Children with Developmental Coordination Disorder: A Randomized, Double-Blind, Sham-Controlled Pilot Study

Evidence-based therapeutic options for children with developmental coordination disorder (DCD) are scarce. This work explored the effects of cerebellar anodal transcranial direct current stimulation (atDCS) on three 48 h-apart motor sequence learning and upper limb coordination sessions in children with DCD. The results revealed that, as compared to a Sham intervention (n = 10), cerebellar atDCS (n = 10) did not meaningfully improve execution speed but tended to reduce the number of execution errors during motor sequence learning. However, cerebellar atDCS did neither meaningfully influence offline learning nor upper limb coordination, suggesting that atDCS’ effects are circumscribed to its application duration. These results suggest that cerebellar atDCS could have beneficial effects as a complementary therapeutic tool for children with DCD.

Long-Term Application of Cerebellar Transcranial Direct Current Stimulation Does Not Improve Motor Learning in Parkinson's Disease.

Cerebellar transcranial direct current stimulation (c-tDCS) enhances motor skill acquisition and motor learning in young and old adults. Since the cerebellum is involved in the pathophysiology of Parkinson’s disease (PD), c-tDCS may represent an intervention with potential to improve motor learning in PD. The primary purpose was to determine the influence of long-term application of c-tDCS on motor learning in PD. The secondary purpose was to examine the influence of long-term application of c-tDCS on transfer of motor learning in PD. The study was a randomized, double-blind, SHAM-controlled, between-subjects design. Twenty-one participants with PD were allocated to either a tDCS group or a SHAM stimulation group. Participants completed 9 practice sessions over a 2-week period that involved extensive practice of an isometric pinch grip task (PGT) and a rapid arm movement task (AMT). These practice tasks were performed over a 25-min period concurrent with either anodal c-tDCS or SHAM stimulation. A set of transfer tasks that included clinical rating scales, manual dexterity tests, and lower extremity assessments were quantified in Test sessions at Baseline, 1, 14, and 28 days after the end of practice (EOP). There were no significant differences between the c-tDCS and SHAM groups as indicated by performance changes in the practice and transfer tasks from Baseline to the 3 EOP Tests. The findings indicate that long-term application of c-tDCS does not improve motor learning or transfer of motor learning to a greater extent than practice alone in PD.

The Effect of Transcranial Direct Current Stimulation and Core Stability Training on the Balance and Disability of Patients With Multiple Sclerosis

Purpose: Physicians report balance disorders and fatigue as the symptoms of Multiple Sclerosis (MS) disease. The present study compares the effect of transcranial Direct Current Stimulation (tDCS) and core stability training on the balance and disability of patients with MS. Methods: This is a pre-test, post-test experiment study. The statistical population included all patients with MS who reffered to Rofaydeh Rehabilitation Hospital in Tehran City, Iran, in the winter of 2019. A total of 30 male and female patients aged 27-70 years were selected through available and purposive sampling methods and then randomly divided into experimental and control groups (each group 15 persons). The initial measurements of the participants’ kinetic variables of postural control were carried out by the posturography device, and afterward, Kurtzke Expanded Disability Status Scale (EDSS) was employed to measure disability. The participants’ training included core stability training for 8 weeks (30-40 min, 3 sessions per week) with 20 min online cerebellar transcranial direct current stimulation, 2 sessions per week (The first and third sessions). Then, the research variables were measured again. Results: The results demonstrated the significant influence of cerebellar tDCS on the variables of postural control equilibrium in the second sensory condition (P&lt;0.001), third sensory condition (P&lt;0.001), fourth sensory condition (P&lt;0.001), fifth sensory condition (P=0.034), and combine equilibrium (P&lt;0.001). Besides, the cerebellar current stimulation enhanced the sensory performance of the experimental group in using the vestibular system input data (P&lt;0.001) and vision (P&lt;0.001), but it had no significant effect on the ability to use somatosensory input (P=0.203) and vision preference (P=0.343). This research also revealed that the cerebellar current stimulation decreased EDSS in MS patients (P=0.026). Conclusion: The cerebellar tDCS has a beneficial effect on balance, EDSS, and modified fatigue impact scale in MS patients. The study findings also indicate that the cerebellum, vestibular system, and visual system are related, and they have an impact on balance, and cerebellar stimulation can facilitate learning motor skills.

Anodal Transcranial Direct Current Stimulation over the Cerebellum Enhances Sadness Recognition in Parkinson\u2019s Disease Patients: a Pilot Study

Emotional processing impairments, resulting in a difficulty to decode emotions from faces especially for negative emotions, are characteristic non-motor features of Parkinson’s disease (PD). There is limited evidence about the specific contribution of the cerebellum to the recognition of emotional contents in facial expressions even though patients with cerebellar dysfunction often lose this ability. In this study, we aimed to evaluate whether the recognition of facial expressions can be modulated by cerebellar transcranial direct current stimulation (tDCS) in PD patients. Nine PD patients were enrolled and received anodal and sham tDCS (2 mA, 20 min), for 5 consecutive days, in two separate cycles at intervals of at least 1 month. The facial emotion recognition task was administered at baseline (T0) and after cerebellar tDCS on day 5 (T1). Our preliminary study showed that anodal cerebellar tDCS significantly enhanced emotional recognition in response to sad facial expressions by about 16%, but left recognition of anger, happiness, and neutral facial expressions unchanged. Despite the small sample size, our preliminary results show that anodal tDCS applied for five consecutive days over the cerebellum modulates the way PD patients recognize specific facial expressions, thus suggesting that the cerebellum plays a crucial role in recognition of negative emotions and corroborating previous knowledge on the link between social cognition and the cerebellum.

Non-invasive brain stimulation shows possible cerebellar contribution in transfer of prism adaptation after-effects from pointing to throwing movements

Whether sensorimotor adaptation can be generalized from one context to others represents a crucial interest in the field of neurological rehabilitation. Nonetheless, the mechanisms underlying transfer to another task remain unclear. Prism Adaptation (PA) is a useful method employed both to study short-term plasticity and for rehabilitation. Neuro-imaging and neuro-stimulation studies show that the cerebellum plays a substantial role in online control, strategic control (rapid error reduction), and realignment (after-effects) in PA. However, the contribution of the cerebellum to transfer is still unknown. The aim of this study was to test whether interfering with the activity of the cerebellum affected transfer of prism after-effects from a pointing to a throwing task. For this purpose, we delivered cathodal cerebellar transcranial Direct Current Stimulation (tDCS) to healthy participants during PA while a control group received cerebellar Sham Stimulation. We assessed longitudinal evolutions of pointing and throwing errors and pointing trajectories orientations during pre-tests, exposure and post-tests. Results revealed that participants who received active cerebellar stimulation showed (1) altered error reduction and pointing trajectories during the first trials of exposure; (2) increased magnitude but reduced robustness of pointing after-effects; and, crucially, (3) slightly altered transfer of after-effects to the throwing task. Therefore, the present study confirmed that cathodal cerebellar tDCS interferes with processes at work during PA and provides evidence for a possible contribution of the cerebellum in after-effects transfer.

Feasibility of combining functional near-infrared spectroscopy with electroencephalography to identify chronic stroke responders to cerebellar transcranial direct current stimulation-a computational modeling and portable neuroimaging methodological study.

Feasibility of portable neuroimaging of cerebellar transcranial direct current stimulation (ctDCS) effects on the cerebral cortex has not been investigated vis-à-vis cerebellar lobular electric field strength. We studied functional near-infrared spectroscopy (fNIRS) in conjunction with electroencephalography (EEG) to measure changes in the brain activation at the prefrontal cortex (PFC) and the sensorimotor cortex (SMC) following ctDCS as well as virtual reality-based balance training (VBaT) before and after ctDCS treatment in 12 hemiparetic chronic stroke survivors. We performed general linear modeling (GLM) that putatively associated the lobular electric field strength with the changes in the fNIRS-EEG measures at the ipsilesional and contra-lesional PFC and SMC. Here, fNIRS-EEG measures were found in the latent space from canonical correlation analysis (CCA) between the changes in total hemoglobin (tHb) concentrations (0.01-0.07Hz and 0.07-0.13Hz bands) and log10-transformed EEG bandpower within 1-45 Hz where significant (Wilks' lambda>0.95) canonical correlations were found only for the 0.07-0.13-Hz band. Also, the first principal component (97.5% variance accounted for) of the mean lobular electric field strength was a good predictor of the latent variables of oxy-hemoglobin (O2Hb) concentrations and log10-transformed EEG bandpower. GLM also provided insights into non-responders to ctDCS who also performed poorly in the VBaT due to ideomotor apraxia. Future studies should investigate fNIRS-EEG joint-imaging in a larger cohort to identify non-responders based on GLM fitting to the fNIRS-EEG data.

Cerebellar transcranial direct current stimulation reconfigurates static and dynamic functional connectivity of the resting-state networks

BackgroundTranscranial direct current stimulation (tDCS) of the cerebellum dynamically modulates cerebello-thalamo-cortical excitability in a polarity-specific manner during motor, visuo- motor and cognitive tasks. It remains to be established whether tDCS of the cerebellum impact also on resting-state intrinsically connected networks (ICNs). Such impact would open novel research and therapeutical doors for the neuromodulation of ICNs in human.MethodWe combined tDCS applied over the right cerebellum and fMRI to investigate tDCS- induced resting-state intrinsic functional reconfiguration, using a randomized, sham-controlled design. fMRI data were recorded both before and after real anodal stimulation (2 mA, 20 min) or sham tDCS in 12 right-handed healthy volunteers. We resorted to a region-of-interest static correlational analysis and to a sliding window analysis to assess temporal variations in resting state FC between the cerebellar lobule VII and nodes of the main ICNs.ResultsAfter real tDCS and compared with sham tDCS, functional changes were observed between the cerebellum and ICNs. Static FC showed enhanced or decreased correlation between cerebellum and brain areas belonging to visual, default-mode (DMN), sensorimotor and salience networks (SN) (p-corrected < 0.05). The temporal variability (TV) of BOLD signal was significantly modified after tDCS displaying in particular a lesser TV between the whole lobule VII and DMN and central executive network and a greater TV between crus 2 and SN. Static and dynamic FC was also modified between cerebellar lobuli.ConclusionThese results demonstrate short- and long-range static and majorly dynamic effects of tDCS stimulation of the cerebellum affecting distinct resting-state ICNs, as well as intracerebellar functional connectivity, so that tDCS of the cerebellum appears as a non-invasive tool reconfigurating the dynamics of ICNs.

Direct and indirect effects of cathodal cerebellar TDCS on visuomotor adaptation of hand and arm movements

Adaptation of movements involving the proximal and distal upper-limb can be differentially facilitated by anodal transcranial direct current stimulation (TDCS) over the cerebellum and primary motor cortex (M1). Here, we build on this evidence by demonstrating that cathodal TDCS impairs motor adaptation with a differentiation of the proximal and distal upper-limbs, relative to the site of stimulation. Healthy young adults received M1 or cerebellar cathodal TDCS while making fast ‘shooting’ movements towards targets under 60° rotated visual feedback conditions, using either whole-arm reaching or fine hand and finger movements. As predicted, we found that cathodal cerebellar TDCS resulted in impairment of adaptation of movements with the whole arm compared to M1 and sham groups, which proved significantly different during late adaptation. However, cathodal cerebellar TDCS also significantly enhanced adaptation of hand movements, which may reflect changes in the excitability of the pathway between the cerebellum and M1. We found no evidence for change of adaptation rates using arm or finger movements following cathodal TDCS directly over M1. These results are further evidence to support movement specific effects of TDCS, and highlight how the connectivity and functional organisation of the cerebellum and M1 must be considered when designing TDCS-based therapies.

Effects of Cerebellar Transcranial Direct Current Stimulation (tDCS) on Timed Up and Go Test with Foot Placement in Chronic Stroke Patients

Objectives: The purpose of this study was to assess the effect of a single session of cerebellar anodal cerebellar transcranial direct current stimulation (tDCS) on timed up and go test (TUG) with foot placement in patients with chronic stroke. Methods: Twenty patients with chronic stroke participated in this clinical trial. TUG test was carried out with four different foot positions, 1- spontaneous foot positions (SP), 2- symmetrical foot positions (SYP), 3- asymmetrical foot positions (PBNP), paretic foot behind the non-paretic foot, and 4- asymmetrical foot positions (NPBP), nonparetic foot behind the paretic foot, before and after using tDCS. Anodal tDCS (1.5 mA) was applied over the cerebellum for 20 minutes. Results: The time of the TUG test was significantly different after using tDCS at all foot positions: SP (P = 0.012), SYP (P = 0.010), PBNP (P = 0.047), and NPBP (P = 0.037). Conclusions: It seems that cerebellar tDCS can be a useful method in improving functional balance in chronic stroke patients.

Investigating the feasibility of cerebellar transcranial direct current stimulation to facilitate post-stroke overground gait performance in chronic stroke: a partial least-squares regression approach

BackgroundInvestigation of lobule-specific electric field effects of cerebellar transcranial direct current stimulation (ctDCS) on overground gait performance has not been performed, so this study aimed to investigate the feasibility of two lobule-specific bilateral ctDCS montages to facilitate overground walking in chronic stroke.MethodsTen chronic post-stroke male subjects participated in this repeated-measure single-blind crossover study, where we evaluated the single-session effects of two bilateral ctDCS montages that applied 2 mA via 3.14 cm2 disc electrodes for 15 min targeting (a) dentate nuclei (also, anterior and posterior lobes), and (b) lower-limb representations (lobules VIIb-IX). A two-sided Wilcoxon rank-sum test was performed at a 5% significance level on the percent normalized change measures in the overground gait performance. Partial least squares regression (PLSR) analysis was performed on the quantitative gait parameters as response variables to the mean lobular electric field strength as the predictors. Clinical assessments were performed with the Ten-Meter walk test (TMWT), Timed Up & Go (TUG), and the Berg Balance Scale based on minimal clinically important differences (MCID).ResultsThe ctDCS montage specific effect was found significant using a two-sided Wilcoxon rank-sum test at a 5% significance level for 'Step Time Affected Leg' (p = 0.0257) and '%Stance Time Unaffected Leg' (p = 0.0376). The changes in the quantitative gait parameters were found to be correlated to the mean electric field strength in the lobules based on PLSR analysis (R2 statistic = 0.6574). Here, the mean electric field strength at the cerebellar lobules, Vermis VIIIb, Ipsi-lesional IX, Vermis IX, Ipsi-lesional X, had the most loading and were positively related to the 'Step Time Affected Leg' and '%Stance Time Unaffected Leg,' and negatively related to the '%Swing Time Unaffected Leg,' '%Single Support Time Affected Leg.' Clinical assessments found similar improvement in the TMWT (MCID: 0.10 m/s), TUG (MCID: 8 s), and BBS score (MCID: 12.5 points) for both the ctDCS montages.ConclusionOur feasibility study found an association between the lobular mean electric field strength and the changes in the quantitative gait parameters following a single ctDCS session in chronic stroke. Both the ctDCS montages improved the clinical outcome measures that should be investigated with a larger sample size for clinical validation.Trial registration: Being retrospectively registered.

How social is the cerebellum? Exploring the effects of cerebellar transcranial direct current stimulation on the prediction of social and physical events.

Congenital or acquired cerebellum alterations are associated with a complex pattern of motor, cognitive and social disorders. These disturbances may reflect the involvement of the cerebellum in generating and updating the internal models that sub-serve-the prediction of sensory events. Here, we tested whether the cerebellar involvement in using contextual expectations to interpret ambiguous sensory sceneries is specific for social actions or also extends to physical events. We applied anodic, cathodic and sham cerebellar transcranial Direct Current Stimulation (ctDCS) to modulate the performance of an adult sample in two tasks requiring the prediction of social actions or moving shapes. For both tasks, in an earlier implicit-learning phase (familiarization), we manipulated the probability of co-occurrence between a particular action/shape and contextual elements, which could provide either strongly or moderately informative expectations. The use of these expectations was then tested when participants had to predict the unfolding of temporally occluded videos, in situations of perceptual uncertainty (testing). Results showed that in the testing, but not in the familiarization phase, cathodic as compared to anodic and sham ctDCS hindered participants' sensitivity in predicting actions embedded in strongly, but not moderately, informative contexts. Conversely, anodic as compared to sham ctDCS boosted the prediction of actions embedded in moderately, but not strongly, informative contexts. We observed no ctDCS effects for the shape prediction task, thus pointing to a specific involvement of the cerebellum in forming expectations related to social events. Our results encourage the exploration of rehabilitative effects of ctDCS in patients with social perception deficits.

Investigating the effects of cerebellar transcranial direct current stimulation on saccadic adaptation and cortisol response

BackgroundTranscranial Direct Current Stimulation (tDCS) over the prefrontal cortex has been shown to modulate subjective, neuronal and neuroendocrine responses, particularly in the context of stress processing. However, it is currently unknown whether tDCS stimulation over other brain regions, such as the cerebellum, can similarly affect the stress response. Despite increasing evidence linking the cerebellum to stress-related processing, no studies have investigated the hormonal and behavioural effects of cerebellar tDCS.MethodsThis study tested the hypothesis of a cerebellar tDCS effect on mood, behaviour and cortisol. To do this we employed a single-blind, sham-controlled design to measure performance on a cerebellar-dependent saccadic adaptation task, together with changes in cortisol output and mood, during online anodal and cathodal stimulation. Forty-five participants were included in the analysis. Stimulation groups were matched on demographic variables, potential confounding factors known to affect cortisol levels, mood and a number of personality characteristics.ResultsResults showed that tDCS polarity did not affect cortisol levels or subjective mood, but did affect behaviour. Participants receiving anodal stimulation showed an 8.4% increase in saccadic adaptation, which was significantly larger compared to the cathodal group (1.6%).ConclusionThe stimulation effect on saccadic adaptation contributes to the current body of literature examining the mechanisms of cerebellar stimulation on associated function. We conclude that further studies are needed to understand whether and how cerebellar tDCS may module stress reactivity under challenge conditions.

Feasibility of Cerebellar Transcranial Direct Current Stimulation to Facilitate Goal-Directed Weight Shifting in Chronic Post-Stroke Hemiplegics.

Neurological disorder such as stroke can adversely affect one's weight-bearing symmetry leading to dysfunctional postural control. Recovery after stroke is facilitated through functionally-relevant neuroplastic modulation. Functionally-relevant cerebellum coordinates voluntary movements. Specifically, the dentate nuclei and lower limb representations (lobules VII-IX) of the cerebellum are involved in error-correction, crucial for postural control. It is postulated that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and lobules VII-IX can modulate postural control in chronic stroke survivors. The objectives of this work were to (1) present a refined Virtual Reality (VR)-based balance training platform (VBaT) that can measure Center of Pressure (CoP) and (2) carry out a study to understand the implication of ctDCS stimulating the dentate nuclei (PhaseD) and lobules VII-IX (PhaseL) on the postural control of chronic stroke patients when they interacted with VBaT. Also, we investigated whether hemiplegic patients (with intact cerebellum) having Basal Ganglia (BG) infarction had any differential abilities to correct postural sway from those with no BG infarction (while shifting weight to the Affected side). Results of a single-session single-blind crossover study on randomized PhaseD and PhaseL stimulation (with an intermediate resting state bipolar bilateral ctDCS) on 12 chronic hemiplegic patients on separate days indicated differentiated findings (post stimulation) on CoP-related indices. We observed an incremental effect on one's postural control during PhaseD and inhibitory effect on the dentate nuclei during PhaseL. Clustering analysis showed that those with BG infarction demonstrated poor postural control and deficit in error correction ability irrespective of the ctDCS Phase.

Cerebellar Transcranial Direct Current Stimulation for Motor Learning in People with Chronic Stroke: A Pilot Randomized Controlled Trial.

Cerebellar transcranial direct current stimulation (ctDCS) is a non-invasive brain stimulation technique that alters neural plasticity through weak, continuous, direct currents delivered to the cerebellum. This study aimed to evaluate the feasibility of conducting a randomized controlled trial (RCT) delivering three consecutive days of ctDCS during split-belt treadmill training (SBTT) in people with chronic stroke. Using a double-blinded, parallel-group RCT design, eligible participants were randomly allocated to receive either active anodal ctDCS or sham ctDCS combined with SBTT on three consecutive days. Outcomes were assessed at one-week follow-up, using step length symmetry as a measure of motor learning and comfortable over-ground walking speed as a measure of walking capacity. The feasibility of the RCT protocol was evaluated based on recruitment, retention, protocol deviations and data completeness. The feasibility of the intervention was assessed based on safety, adherence and intervention fidelity. Of the 26 potential participants identified over four months, only four were enrolled in the study (active anodal ctDCS n = 1, sham ctDCS n = 3). Both the inclusion criteria and the fidelity of the SBTT relied upon the accurate estimation of step length asymmetry. The method used to determine the side of the step length asymmetry was unreliable and led to deviations in the protocol. The ctDCS intervention was well adhered to, safe, and delivered as per the planned protocol. Motor learning outcomes for individual participants revealed that treadmill step length symmetry remained unchanged for three participants but improved for one participant (sham ctDCS). Comfortable over-ground walking speed improved for two participants (sham ctDCS). The feasibility of the planned protocol and intervention was limited by intra-individual variability in the magnitude and side of the step length asymmetry. This limited the sample and compromised the fidelity of the SBTT intervention. To feasibly conduct a full RCT investigating the effect of ctDCS on locomotor adaptation, a reliable method of identifying and defining step length asymmetry in people with stroke is required. Future ctDCS research should either optimize the methods for SBTT delivery or utilize an alternative motor adaptation task.