Objective: High-definition tDCS (HD-tDCS) using a 4x1 electrode montage has been previously shown to constrain the electric field within the spatial extent of the electrodes. The aim of this study was to determine if functional near-infrared spectroscopy (fNIRS) neuroimaging can be used to determine a hemodynamic correlate of this 4x1 HD-tDCS electric field on the brain. Materials and Methods:In a 3 session cross-over study design, 13 healthy males received sham (2mA, 30s) and real (HD-tDCS-1 and HD-tDCS-2, 2mA, 10min) anodal HD-tDCS targeting the left M1 via a 4x1 electrode montage (anode C3, 4 return electrodes 3.5cm from anode). fNIRS was used to measure changes in brain hemodynamics (oxygenated hemoglobin integral-O2Hbint) during each 10min session from 2 regions of interest (ROIs) in the stimulated left hemisphere that corresponded to "within" (Lin) and "outside" (Lout) the spatial extent of the 4x1 electrode montage, and 2 corresponding ROIs (Rin and Rout) in the right hemisphere. Results:The ANOVA showed that both real anodal HD-tDCS compared to sham induced a significantly greater O2Hbint in the Lin than Lout ROIs of the stimulated left hemisphere; while there were no significant differences between the real and sham sessions for the right hemisphere ROIs. Intra-class correlation coefficients for the 2 real HD-tDCS sessions showed "fair to good" reproducibility for Lin (0.54) and Lout (0.52) ROIs. Conclusion:The greater O2Hbint "within" than "outside" the spatial extent of the 4x1 electrode montage represents a hemodynamic correlate of the electrical field distribution, and thus provides a prospective reliable method to determine the dose of stimulation that is necessary to optimize HD-tDCS parameters in various applications.

Parkinson's disease (PD) is a neurodegenerative disorder affecting motor and cognitive abilities. There is no cure for PD, therefore identifying safe therapies to alleviate symptoms remains a priority. This meta-analysis quantified the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (TES) to improve motor and cognitive dysfunction in PD. PubMed, EMBASE, Web of Science, Google Scholar, Scopus, Library of Congress and Cochrane library were searched. 24 rTMS and 9 TES studies (n = 33) with a sham control group were included for analyses. The Physiotherapy Evidence Database and Cochrane Risk of Bias showed high quality (7.5/10) and low bias with included studies respectively. Our results showed an overall positive effect in favour of rTMS (SMD = 0.394, CI [0.106–0.683], p = 0.007) and TES (SMD = 0.611, CI [0.188–1.035], p = 0.005) compared with sham stimulation on motor function, with no significant differences detected between rTMS and TES (Q [1] = 0.69, p = 0.406). Neither rTMS nor TES improved cognition. No effects for stimulation parameters on motor or cognitive function were observed. To enhance the clinical utility of non-invasive brain stimulation (NBS), individual prescription of stimulation parameters based upon symptomology and resting excitability state should be a priority of future research.

BackgroundAfter a stroke, during seated reaching with their paretic upper limb, many patients spontaneously replace the use of their arm by trunk compensation movements, even though they are able to use their arm when forced to do so. We previously quantified this proximal arm non-use (PANU) with a motion capture system (Zebris, CMS20s). The aim of this study was to validate a low-cost Microsoft Kinect-based system against the CMS20s reference system to diagnose PANU.MethodsIn 19 hemiparetic stroke individuals, the PANU score, reach length, trunk length, and proximal arm use (PAU) were measured during seated reaching simultaneously by the Kinect (v2) and the CMS20s over two testing sessions separated by two hours.ResultsIntraclass correlation coefficients (ICC) and linear regression analysis showed that the PANU score (ICC = 0.96, r2 = 0.92), reach length (ICC = 0.81, r2 = 0.68), trunk length (ICC = 0.97, r2 = 0.94) and PAU (ICC = 0.97, r2 = 0.94) measured using the Kinect were strongly related to those measured using the CMS20s. The PANU scores showed good test-retest reliability for both the Kinect (ICC = 0.76) and CMS20s (ICC = 0.72). Bland and Altman plots showed slightly reduced PANU scores in the re-test session for both systems (Kinect: − 4.25 ± 6.76; CMS20s: − 4.71 ± 7.88), which suggests a practice effect.ConclusionWe showed that the Kinect could accurately and reliably assess PANU, reach length, trunk length and PAU during seated reaching in post stroke individuals. We conclude that the Kinect can offer a low-cost and widely available solution to clinically assess PANU for individualised rehabilitation and to monitor the progress of paretic arm recovery.Trial registrationThe study was approved by The Ethics Committee of Montpellier, France (N°ID-RCB: 2014-A00395–42) and registered in Clinical Trial (N° NCT02326688, Registered on 15 December 2014, https://clinicaltrials.gov/ct2/show/results/NCT02326688).

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Differences in the neural mechanisms underpinning eccentric (ECC) and concentric (CON) contractions exist; however, the acute effects of fatiguing muscle contractions on intracortical and corticospinal excitability are not well understood. Therefore, we compared maximal ECC and CON contractions of the right biceps brachii (BB) muscle for changes in corticospinal excitability, short‐ (SICI) and long‐interval intracortical inhibition (LICI) and intracortical facilitation (ICF) up to 1 hour post‐exercise. Fourteen right‐handed adults (11 M/3F; 26.8 ± 2.9 year) undertook a single session of 3 sets of 10 maximal ECC or CON contractions (180‐second rest between sets) on an isokinetic dynamometer (40°/s) separated by 1 week, in a randomized crossover study. Maximum voluntary isometric contraction torque (MVIC), maximal muscle compound waves (MMAX), and motor‐evoked potentials elicited through transcranial magnetic stimulation (TMS) were recorded via surface electromyography from the right BB. MVIC decreased (P < 0.001) immediately after ECC and CON contractions similarly, but the decrease was sustained at 1 hour post‐ECC contractions only. MMAX was reduced immediately (P = 0.014) and 1 hour post‐exercise (P = 0.019) only for ECC contractions. SICI and ICF increased immediately after ECC and CON contractions (P < 0.001), but LICI increased only after ECC contractions (P < 0.001), and these increases remained at 1 hour post‐ECC contractions only. These findings suggest that ECC contractions induced a longer‐lasting neuromodulatory effect on intracortical inhibition and facilitation, which could indicate a central compensatory response to peripheral fatigue.

Cortical oxygenation and transcranial stimulation Highlights  Functional near infrared spectroscopy probed the sensorimotor cortex activity when using online, offline and sham high definition anodal tDCS.  Online and offline high definition anodal tDCS induced greater cortical activation 30 min after stimulation.  Concurrent application of high definition anodal tDCS during a motor task induced more pronounced changes in sensorimotor cortex activation

Transcranial direct current stimulation (tDCS) has been shown to evoke hemodynamics response; however, the mechanisms have not been investigated systematically using systems biology approaches. We postulate that such a mechanistic understanding of the hemodynamics response, called cerebrovascular reactivity (CVR) to tDCS, can facilitate adequate delivery of the tDCS current density to the neurovascular tissue in cerebrovascular diseases. Our study presents a systems biology approach to evaluate CVR during high-definition (HD) tDCS using a physiologically constrained grey-box linear model. Our grey-box linear model was developed for the multi-compartmental neurovascular unit consisting of the vascular smooth muscle, perivascular space, synaptic space, and astrocyte glial cell. The physiologically detailed model generated vessel oscillations in the frequency range of 0.05 – 0.2 Hz driven mainly by non-linear calcium dynamics. Then, model linearization was performed to develop a grey-box linear model for evaluating the acute effects during the first 150 seconds of anodal HD-tDCS in eleven healthy humans using functional near-infrared spectroscopy (fNIRS) based measure of blood volume. The grey-box linear model was fitted to the total hemoglobin concentration (tHb) changes with optodes in the vicinity of 4x1 HD-tDCS electrodes. We found that the grey-box model pathway from perivascular potassium to the vessel circumference (Pathway 3) presented the best fit to fNIRS tHb time series with the least mean square error (MSE, median < 2.5%). Then, minimal realization transfer function with reduced-order approximations of the grey-box model pathways was fitted to the average tHb time series. Pathway 3, with nine poles and two zeros (all free parameters), provided the best Chi-Square Goodness of Fit of 0.0078. Therefore, our study provided a sound systems biology approach to investigate the hemodynamic response to tDCS that needs further investigation in health, aging, and disease. Future studies can leverage transcranial alternating current stimulation for frequency-dependent physiological entrainment of relevant pathways, e.g., oscillations driven by nonlinear calcium dynamics, that can provide additional insights based on our grey-box modeling approach.

The crossed-facilitation (CF) effect refers to when motor-evoked potentials (MEPs) evoked in the relaxed muscles of one arm are facilitated by contraction of the opposite arm. The aim of this study was to determine whether high-definition transcranial direct-current stimulation (HD-tDCS) applied to the right primary motor cortex (M1) controlling the left contracting arm [50% maximum voluntary isometric contraction (MVIC)] would further facilitate CF toward the relaxed right arm. Seventeen healthy right-handed subjects participated in an anodal and cathodal or sham HD-tDCS session of the right M1 (2 mA for 20 min) separated by at least 48 h. Single-pulse transcranial magnetic stimulation (TMS) was used to elicit MEPs and cortical silent periods (CSPs) from the left M1 at baseline and 10 min into and after right M1 HD-tDCS. At baseline, compared with resting, CF (i.e., right arm resting, left arm 50% MVIC) increased left M1 MEP amplitudes (+97%) and decreased CSPs (-11%). The main novel finding was that right M1 HD-tDCS further increased left M1 excitability (+28.3%) and inhibition (+21%) from baseline levels during CF of the left M1, with no difference between anodal and cathodal HD-tDCS sessions. No modulation of CSP or MEP was observed during sham HD-tDCS sessions. Our findings suggest that CF of the left M1 combined with right M1 anodal or cathodal HD-tDCS further facilitated interhemispheric interactions during CF from the right M1 (contracting left arm) toward the left M1 (relaxed right arm), with effects on both excitatory and inhibitory processing. NEW & NOTEWORTHY This study shows modulation of the nonstimulated left M1 by right M1 HD-tDCS combined with crossed facilitation, which was probably achieved through modulation of interhemispheric interactions.