Manual dexterity, the ability to manipulate objects with the hands, and the related position sense, or proprioception, are often impaired after stroke. Associative stimulation of motor points (MPAS) in hand muscles is known to modify motor cortex excitability and improve manual dexterity (McDonnell and Ridding, 2006).
However, it is not known whether the effect of this peripheral stimulation can be increased by central stimulation of sensorimotor cortex, in terms of function, proprioception, or cortical neurophysiology. Here we compare the functional and neurophysiological consequences of MPAS with and without transcranial direct current (tDCS) in healthy adults. MPAS was applied to two right hand muscles important for manual dexterity: APB and FDI. tDCS, a non-invasive brain stimulation technique, was simultaneously applied over left sensorimotor cortex. Both techniques stimulate motor as well as somatosensory pathways. Neurophysiological measures of motor cortex, including SICI (short intra-cortical inhibition), ICF (intracortical facilitation), and input/output (I/O) curve, were assessed with transcranial magnetic stimulation (TMS). Manual dexterity and proprioceptive acuity were also measured. 14 subjects completed 3 sessions of MPAS in combination with sham, anodal (excitatory) and cathodal (inhibitory) tDCS. 13 subjects completed 2 sessions of sham MPAS with sham or anodal tDCS. In combination with MPAS, anodal tDCS significantly increased the plateau of manual dexterity, increased cortical response to TMS, and tended to improve proprioceptive acuity compared to sham tDCS. The neural basis for the observed functional improvements may thus include somatosensory as well as motor cortex. Neither MPAS nor tDCS alone had any measurable effect. These results suggest that adding tDCS as a central intervention to complement peripheral MPAS may be a promising avenue of treatment for patients with impaired manual dexterity.
|Advisor:||Block, Hannah J.|
|Commitee:||Koceja, David M., Puce, Aina, Shea, John B.|
|Department:||School of Public Health|
|School Location:||United States -- Indiana|
|Source:||DAI-B 76/11(E), Dissertation Abstracts International|
|Keywords:||MPAS, Neurophysiology, TMS, tDCS|
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