Effects of High-Definition and Conventional Transcranial Direct-Current Stimulation on Motor Learning in Children

Lauran Cole, Adrianna Giuffre, Patrick Ciechanski, Helen L Carlson, Ephrem Zewdie, Hsing-Ching Kuo, Adam Kirton, Lauran Cole, Adrianna Giuffre, Patrick Ciechanski, Helen L Carlson, Ephrem Zewdie, Hsing-Ching Kuo, Adam Kirton

Abstract

Background: Transcranial direct current stimulation (tDCS) can improve motor learning in children. High-definition approaches (HD-tDCS) have not been examined in children. Objectives/Hypothesis: We hypothesized that primary motor cortex HD-tDCS would enhance motor learning but be inferior to tDCS in children. Methods: Twenty-four children were recruited for a randomized, sham-controlled, double-blinded interventional trial (NCT03193580, clinicaltrials.gov/ct2/show/NCT03193580) to receive (1) right hemisphere (contralateral) primary motor cortex (M1) 1 mA anodal conventional 1 × 1 tDCS (tDCS), (2) right M1 1 mA anodal 4 × 1 HD-tDCS (HD-tDCS), or (3) sham. Over five consecutive days, participants trained their left hand using the Purdue Pegboard Test (PPTL). The Jebsen-Taylor Test, Serial Reaction Time Task, and right hand and bimanual PPT were also tested at baseline, post-training, and 6-week retention time (RT). Results: Both the tDCS and HD-tDCS groups demonstrated enhanced motor learning compared to sham with effects maintained at 6 weeks. Effect sizes were moderate-to-large for tDCS and HD-tDCS groups at the end of day 4 (Cohen's d tDCS = 0.960, HD-tDCS = 0.766) and day 5 (tDCS = 0.655, HD-tDCS = 0.851). Enhanced motor learning effects were also seen in the untrained hand. HD-tDCS was well tolerated and safe with no adverse effects. Conclusion: HD-tDCS and tDCS can enhance motor learning in children. Further exploration is indicated to advance rehabilitation therapies for children with motor disabilities such as cerebral palsy. Clinical Trial Registration: clinicaltrials.gov, identifier NCT03193580.

Keywords: HD-tDCS; child; developmental neuroplasticity; motor learning; non-invasive brain stimulation; tDCS.

Figures

FIGURE 1
FIGURE 1
Accelerated motor learning in pediatrics (AMPED) protocol. (A) Participants received an MRI, complete tasks in a virtual reality KINARM robotic system, received TMS motor mapping (TMSMM), completed a series of motor assessments and then received training paired with non-invasive brain stimulation interventions. On days 2–4, subjects perform the PPT during intervention. Participants repeat the Day 1 tasks on Day 5 (with training) and at a 6-weeks retention testing follow up (RT). (B) PPT training is paired with stimulation by treatment groups with electrode montages (C) shown for tDCS (left) and HD-tDCS (right) where dark gray electrodes are anodes and light gray electrodes are cathodes. Black arrows represent the direction of current flow from anode to cathode(s).
FIGURE 2
FIGURE 2
Motor learning by treatment group. (A) The mean daily change from baseline (B) in left Purdue Pegboard (PPTL) learning curves for sham (white triangles) were lower than both tDCS (gray circles) and HD-tDCS (black circles). Effects decayed by 6 weeks retention time (RT) for sham but not tDCS groups. (B) Daily mean scores per repetition of the PPTL are shown for the same three groups. ∗p < 0.05 for tDCS vs. sham, #p < 0.05 for HD-tDCS vs. sham.
FIGURE 3
FIGURE 3
Online and offline learning effects on left hand Purdue Pegboard (PPTL) for the three intervention groups. The online effects represent the difference in PPTL score from the first and last training point of the day. The offline learning represents the difference between the last training time point of the day to the first training point of the following day. ∗p < 0.05, ∗∗p < 0.01.
FIGURE 4
FIGURE 4
Effect of performance status on motor learning enhancement. (A) Low performers (baseline PPTL below the median score) demonstrated marked separation of PPTL learning curves with tDCS (gray circles) and HD-tDCS (black circles) outperforming sham (white triangles). (B) Treatment group effects were not observed for high performers. B refers to baseline. ∗p < 0.05 for sham vs. tDCS, #p < 0.05 for sham vs. HD-tDCS.
FIGURE 5
FIGURE 5
Secondary motor outcomes. (A) Change in Purdue Pegboard Test (PPT) scores at post-training and retention time (RT) demonstrated treatment group effects for PPTA. PPT subtests are left (PPTL), right (PPTR), bimanual (PPTLR), sum of scores (PPTS), and assembly (PPTA). ∗p < 0.05. (B) Jebsen–Taylor Test of Hand Function left and right (JTTL, JTTR) demonstrated treatment group effects bilaterally at post-training and RT. (C) Serial Reaction Time Task (SRTT) curves with and without <200 ms responses are shown. Blocks 1 and 6 are random while all others follow a 12-character sequence. (D) SRTT by intervention group with <200 ms responses excluded.
FIGURE 6
FIGURE 6
Combined PPTL training data for sham and tDCS groups over 3 days. (A) Sham (white triangles, n = 14) learning curves were inferior to both tDCS (gray circles, n = 14) and HD-tDCS (black circles, n = 8) groups. (B) Mean daily learning for the same three groups form the combined studies. Both the tDCS and HD-tDCS groups placed more pegs each day as compared to sham.

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