Background Noninvasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS) have the potential to mitigate a variety of symptoms associated with neurological and psychiatric conditions, including stroke, cerebral palsy, autism, depression, and Tourette syndrome. While the safety of these modalities has been established in adults, there is a paucity of research assessing the safety of NIBS among children. Objective To examine the existing literature regarding the safety of NIBS techniques in children and adolescents with neurologic and neuropsychiatric disorders. Methods An electronic search was performed on online databases for studies using NIBS in individuals less than 18 years of age. Non-English publications, diagnostic studies, electroconvulsive therapy, single/dual pulse TMS studies, and reviews were excluded. Adverse events reported in the studies were carefully examined and synthesized to understand the safety and tolerability of NIBS among children and adolescents. Results The data from 48 studies involving more than 513 children/adolescents (2.5–17.8 years of age) indicate that the side-effects of NIBS were, in general, mild and transient [TMS: headache (11.5%), scalp discomfort (2.5%), twitching (1.2%), mood changes (1.2%), fatigue (0.9%), tinnitus (0.6%); tCS: tingling (11.5%), itching (5.8%), redness (4.7%), scalp discomfort (3.1%)] with relatively few serious adverse events. Conclusion Our findings indicate that both repetitive TMS and tCS are safe modalities in children and adolescents with various neurological conditions, especially when safety guidelines are followed. The incidence of adverse events appears to be similar to that observed in adults; however, further studies with longer treatment and follow-up periods are needed to better understand the benefits and tolerance of long-term use of NIBS in children.
Automatic real-time monitoring of deltaPP is possible using a standard bedside monitor and was found to be a reliable method to predict fluid responsiveness after cardiac surgery. Additional studies are needed to determine if this technique can be used to avoid the complications of fluid administration in high-risk patients.
This study assessed the contribution of the "anchor system's" haptic information to balance control during walking at two levels of difficulty. Seventeen young adults and seventeen older adults performed 20 randomized trials of tandem walking in a straight line, on level ground and on a slightly-raised balance beam, both with and without the use of the anchors. The anchor consists of two flexible cables, whose ends participants hold in each hand, to which weights (125 g) are attached at the opposing ends, and which rest on the ground. As the participants walk, they pull on the cables, dragging the anchors. Spatiotemporal gait variables (step speed and single- and double-support duration) were processed using retro-reflective markers on anatomical sites. An accelerometer positioned in the cervical region registered trunk acceleration. Walking on the balance beam increased single- and double-support duration and reduced step speed in older adults, which suggests that this condition was more difficult than walking on the level ground. The anchors reduced trunk acceleration in the frontal plane, but the level of difficulty of the walking task showed no effect. Thus, varying the difficulty of the task had no influence on the way in which participants used the anchor system while tandem walking. The older adults exhibited more difficulty in walking on the balance beam as compared to the younger adults; however, the effect of the anchor system was similar in both groups.
Noninvasive brain stimulation has recently been used to augment motor training-induced plasticity. However, the exact time during which noninvasive brain stimulation can be combined with motor therapy to maximize neuroplasticity and behavioral changes is unknown. We conducted a randomized sham-controlled crossover trial to examine when (before, during, or after training) transcranial direct current stimulation (tDCS) should be applied to best reinforce motor training-induced plasticity in 12 healthy right-handed participants (mean age: 21.8±1.6) who underwent active or sham tDCS combined with motor training. Transcranial magnetic stimulation-elicited motor-evoked potentials from the right first dorsal interosseous muscle were recorded before (baseline) and immediately after each session. The training task comprised four practice trials - 3 min each (30 s pause between trials) - of repetitive finger movements (thumb abduction/adduction) with the right hand. Anodal tDCS (1 mA, 13 min, on the motor primary cortex) was applied before, during, and after the training. Compared with baseline motor-evoked potentials and the sham condition, tDCS that was applied before, but not during or after, the motor task enhanced corticospinal excitability. These data suggest that tDCS performed before - not during or after - promotes optimization of motor training-induced plasticity.
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