Effects of Transcranial Direct-Current Stimulation on Neurosurgical Skill Acquisition: A Randomized Controlled Trial

Ciechanski, Patrick; Cheng, Adam; Lopushinsky, Steven R.; Hecker, Kent G.; Gan, Liu Shi; Lang, Stefan; Zareinia, Kourosh; Kirton, Adam

doi:10.1016/j.wneu.2017.08.123

Cited by 32 publications

(57 citation statements)

References 41 publications

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“…Mirror movements are present in young, typically developing children and decline with age 14 as shown here. This timeline appears similar to a recent TMS study of the developmental profile of interhemispheric inhibition in children, 30 suggesting a possible connection. However, a complex bidirectional relationship of interhemispheric inhibition and facilitation was recently described in a TMS study of children with perinatal stroke that would refute such a simple explanation for mirror movements.…”

Section: Discussionsupporting

confidence: 87%

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Riddell

Kuo

Zewdie

et al. 2019

Develop Med Child Neuro

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Aim We aimed to determine if the mirror movements that often result in children with unilateral cerebral palsy (CP) after perinatal stroke represent a clinical biomarker of developmental plasticity. Method This was a prospective, controlled cohort study. Mirror movements in children with unilateral CP from a population‐based cohort were compared to those of typically developing controls. The population with stroke was assessed further via electromyography (EMG), motor function, and corticospinal organization investigations. Mirror movements were quantified (0–5) bidirectionally. EMG mirror movements were quantified during voluntary contraction. Motor function was quantified by validated measures including the Assisting Hand Assessment (AHA). Corticospinal organization was categorized as ipsilateral or contralateral using transcranial magnetic stimulation (TMS). The relationships between mirror movements, function, and corticospinal organization were assessed (t‐tests, Pearson rank correlation coefficients). Results Ninety‐two participants were scored (55 males, 37 females, mean [SD] 12y [5y 6mo], range 4–17y), 63 with complete motor outcomes and 39 with TMS data. EMG ratios correlated with clinical mirror movements (r=0.562, p=0.008). Mild mirror activity in controls declined with age (r=−0.459, p<0.001). Mirroring was stronger with tasks performed by the affected hand (p<0.001). Mirror movements correlated with AHA scores (r=−0.255, p=0.04) and poor motor outcome (p<0.001). Unaffected hand mirror activity was higher in children with ipsilateral corticospinal tract arrangements (p<0.001). Interpretation Clinical mirror movements correlate with disability and corticospinal organization in children with unilateral CP with perinatal stroke. This simple bedside biomarker could facilitate patient selection for personalized rehabilitation. What this paper adds Mirror movements are a clinical indicator of corticospinal organization in children with unilateral cerebral palsy with perinatal stroke. Mirroring is strongest in children with ipsilateral corticospinal tract reorganization. The concept of a ‘directionality factor’ to mirror movements highlights additional, clinically relevant functional correlations.

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Section: Discussionsupporting

confidence: 87%

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Riddell

Kuo

Zewdie

et al. 2019

Develop Med Child Neuro

Self Cite

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“…Anodal tDCS over the dominant primary motor cortex may enhance the acquisition of purely unimanual simulation‐based tumour resection skill25. The finding of enhanced pattern‐cutting skill acquisition supports these previous findings.…”

Section: Discussionsupporting

confidence: 83%

“…Sample size calculations were based on previous work25 examining the effects of tDCS on neurosurgical skill acquisition. The application of tDCS concurrent with training of simulation‐based tumour resection resulted in a skill acquisition enhancement of approximately 10 per cent.…”

Section: Methodsmentioning

confidence: 99%

“…Neuroimaging and neurophysiology studies are beginning to elucidate the possible mechanisms behind this enhancement of learning24. The application of tDCS concurrent with simulation‐based tumour resection training has been shown to enhance acquisition of the skill25. This novel finding suggests the potential value of tDCS in medical training.…”

Section: Introductionmentioning

confidence: 97%

“…Based on the ability of tDCS to enhance simple motor26 and complex tumour resection25 skill acquisition, it was hypothesized that anodal tDCS over the dominant primary motor cortex would enhance the acquisition of two FLS skills.…”

Section: Introductionmentioning

confidence: 99%

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Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

et al. 2018

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BackgroundChanges in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct‐current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation‐based laparoscopic surgical skill acquisition.MethodsIn this double‐blind, sham‐controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation‐based training. Primary outcomes of laparoscopic pattern‐cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent‐to‐treat analysis examined the effects of treatment group on skill acquisition and retention.ResultsOf 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern‐cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.ConclusionThe addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non‐simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).

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Neuroenhancement in surgeons: benefits, risks and ethical dilemmas

Patel

Ashcroft

Darzi

et al. 2020

British Journal of Surgery

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Background Surgeons traditionally aim to reduce mistakes in healthcare through repeated training and advancement of surgical technology. Recently, performance‐enhancing interventions such as neurostimulation are emerging which may offset errors in surgical practice. Methods Use of transcranial direct‐current stimulation (tDCS), a novel neuroenhancement technique that has been applied to surgeons to improve surgical technical performance, was reviewed. Evidence supporting tDCS improvements in motor and cognitive performance outside of the field of surgery was assessed and correlated with emerging research investigating tDCS in the surgical setting and potential applications to wider aspects of healthcare. Ethical considerations and future implications of using tDCS in surgical training and perioperatively are also discussed. Results Outside of surgery, tDCS studies demonstrate improved motor performance with regards to reaction time, task completion, strength and fatigue, while also suggesting enhanced cognitive function through multitasking, vigilance and attention assessments. In surgery, current research has demonstrated improved performance in open knot‐tying, laparoscopic and robotic skills while also offsetting subjective temporal demands. However, a number of ethical issues arise from the potential application of tDCS in surgery in the form of safety, coercion, distributive justice and fairness, all of which must be considered prior to implementation. Conclusion Neuroenhancement may improve motor and cognitive skills in healthcare professions with impact on patient safety. Implementation will require accurate protocols and regulations to balance benefits with the associated ethical dilemmas, and to direct safe use for clinicians and patients.

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Effects of Transcranial Direct-Current Stimulation on Neurosurgical Skill Acquisition: A Randomized Controlled Trial

Cited by 32 publications

References 41 publications

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

Neuroenhancement in surgeons: benefits, risks and ethical dilemmas

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