***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials A novel Hebbian stimulation paradigm was employed to examine physiological correlates of motor memory formation in humans .  Repetitive pairing of median nerve stimulation with transcranial magnetic stimulation over the contralateral motor cortex ( paired associative stimulation , PAS ) may decrease human motor cortical excitability at interstimulus intervals of 10 ms ( PAS10 ) or increase excitability at 25 ms ( PAS25 ) . The properties of this plasticity have previously been shown to resemble associative timing-dependent long-term depression ( LTD ) and long-term potentiation ( LTP ) as established in vitro . Immediately after training a novel dynamic motor task , the capacity of the motor cortex to undergo plasticity in response to PAS25 was abolished . PAS10-induced  plasticity remained unchanged . When retested after 6 h ,  PAS25-induced plasticity recovered to baseline levels . After training , normal PAS25-induced  plasticity was observed in the contralateral training-naive motor cortex . Motor training did not reduce the efficacy of PAS25 to enhance cortical excitability when PAS10 was interspersed between the training and application of the PAS25 protocol . This indicated that the mechanism supporting PAS25-induced  plasticity had remained intact immediately after training . Behavioral evidence was obtained for continued optimization of force generation at a time when PAS25-induced plasticity was blocked in the training motor cortex . Application of the PAS protocol s after motor training did not prevent the consolidation of motor skills evident as performance gains at later retesting . The results are consistent with a concept of temporary suppression of associative cortical plasticity by neuronal mechanisms involved in motor training . Although it remains an open question exactly which element of motor training was responsible for this effect , our findings may link dynamic properties of LTP formation , as established in animal experiments , with human motor memory formation and possibly dynamic motor learning Transcranial direct current stimulation ( tDCS ) is a relatively new non-invasive brain stimulation technique that modulates neural processes . When applied to the human primary motor cortex ( M1 ) , tDCS has beneficial effects on motor skill learning and consolidation in healthy controls and in patients . However , it remains unclear whether tDCS improves motor learning in a general manner or whether these effects depend on which motor task is acquired . Here we compare whether the effect of tDCS differs when the same individual acquires ( 1 ) a Sequential Finger Tapping Task ( SEQTAP ) and ( 2 ) a Visual Isometric Pinch Force Task ( FORCE ) . Both tasks have been shown to be sensitive to tDCS applied over M1 , however , the underlying processes mediating learning and memory formation might benefit differently from anodal transcranial direct current stimulation ( anodal-tDCS ) .  Thirty healthy subjects were r and omly assigned to an anodal-tDCS group or sham-group . Using a double-blind , sham-controlled cross-over design , tDCS was applied over M1 while subjects acquired each of the motor tasks over three consecutive days , with the order being r and omized across subjects . We found that anodal-tDCS affected each task differently : the SEQTAP task benefited from anodal-tDCS during learning , whereas the FORCE task showed improvements only at retention . These findings suggest that anodal-tDCS applied over M1 appears to have a task-dependent effect on learning and memory formation Behavioural studies indicate that a newly acquired motor skill is rapidly consoli date d from an initially unstable state to a more stable state , whereas neuroimaging studies demonstrate that the brain engages new regions for performance of the task as a result of this consolidation . However , it is not known where a new skill is retained and processed before it is firmly consoli date d. Some early aspects of motor skill acquisition involve the primary motor cortex ( M1 ) , but the nature of that involvement is unclear . We tested the possibility that the human M1 is essential to early motor consolidation . We monitored changes in elementary motor behaviour while subjects practised fast finger movements  that rapidly improved in movement acceleration and muscle force generation . Here we show that low-frequency , repetitive transcranial magnetic stimulation of M1 but not other brain areas specifically disrupted the retention of the behavioural improvement , but did not affect basal motor behaviour , task performance , motor learning by subsequent practice , or recall of the newly acquired motor skill . These findings indicate that the human M1 is specifically engaged during the early stage of motor consolidation Decline in cognitive functions , including impaired acquisition of novel skills , is a feature of older age that impacts activities of daily living , independence , and integration in modern societies Weak transcranial direct current stimulation ( tDCS ) induces persisting excitability changes in the human motor cortex . These plastic excitability changes are selectively controlled by the polarity , duration and current strength of stimulation . To reveal the underlying mechanisms of direct current (DC)-induced neuroplasticity , we combined tDCS of the motor cortex with the application of Na(+)-channel-blocking carbamazepine ( CBZ ) and the N-methyl-D-aspartate (NMDA)-receptor antagonist dextromethorphan ( DMO ) . Monitored by transcranial magnetic stimulation ( TMS ) , motor cortical excitability changes of up to 40 % were achieved in the drug-free condition . Increase of cortical excitability could be selected by anodal stimulation , and decrease by cathodal stimulation . Both types of excitability change lasted several minutes after cessation of current stimulation . DMO suppressed the post-stimulation effects of both anodal and cathodal DC stimulation , strongly suggesting the involvement of NMDA receptors in both types of DC-induced neuroplasticity . In contrast , CBZ selectively eliminated anodal effects . Since CBZ stabilizes the membrane potential voltage-dependently , the results reveal that after-effects of anodal tDCS require a depolarization of membrane potentials . Similar to the induction of established types of short- or long-term neuroplasticity , a combination of glutamatergic and membrane mechanisms is necessary to induce the after-effects of tDCS . On the basis of these results , we suggest that polarity-driven alterations of resting membrane potentials represent the crucial mechanisms of the DC-induced after-effects , leading to both an alteration of spontaneous discharge rates and to a change in NMDA-receptor activation The primary motor cortex ( M1 ) area recruitment enlarges while learning a finger tapping sequence . Also M1 excitability increases during procedural consolidation . Our aim was to investigate whether increasing M1 excitability by anodal transcranial DC stimulation ( AtDCS ) when procedural consolidation occurs was able to induce an early consolidation improvement .  Forty-seven right-h and ed healthy participants were trained in a nine-element serial finger tapping task ( SFTT ) executed with the left h and . R and om series blocks were interspersed with training series blocks . Anodal or sham tDCS was administered over the right M1 after the end of the training session . After stimulation , the motor skills of both trained and a new untrained sequential series blocks were tested again . For each block , performance was estimated as the median execution time of correct series . Early consolidation of the trained series , assessed by the performance difference between the first block after and the last block before stimulation normalized by the r and om , was enhanced by anodal and not by sham tDCS . Stimulation did not affect r and om series execution . No stimulation effect was found on the on-line learning of the trained and new untrained series . Our results suggest that AtDCS applied on M1 soon after training improves early consolidation of procedural learning . Our data highlight the importance of neuromodulation procedures for underst and ing learning processes and support their use in the motor rehabilitation setting , focusing on the timing of the application Individuals suffering from motor impairments often require physical therapy ( PT ) to help improve their level of function . Previous investigations suggest that both intermittent theta burst stimulation ( iTBS ) and bihemispheric transcranial direct current stimulation ( tDCS ) may increase the speed and extent of motor learning/relearning . The purpose of the current study was to explore the feasibility and effectiveness of a novel , non-invasive brain stimulation approach that combined an iTBS primer , and bihemispheric stimulation coupled with motor training . We hypothesized that individuals exposed to this novel treatment would make greater functional improvements than individuals undergoing sham stimulation when tested immediately following , 24-h , and 7-days post-training . A total of 26 right-h and ed , healthy young adults were r and omly assigned to either a treatment ( n = 15 ) or control group ( n = 12 ) . iTBS ( 20 trains of 10 pulse triplets each delivered at 80 % active motor threshold ( AMT ) / 50 Hz over 191.84 s ) and bihemispheric tDCS ( 1.0 ma for 20 min ) were used as a primer to , and in conjunction with , 20 min of motor training , respectively . Our primary outcome measure was performance on the Jebsen-Taylor H and Function ( JTHF ) test . Participants tolerated the combined iTBS/bihemispheric stimulation treatment without complaint . While performance gains in the sham and stimulation group were not significant immediately after training , they were nearly significant 24-h post training ( p = 0.055 ) , and were significant at 7-days post training ( p < 0.05 ) . These results suggest that the combined iTBS/bihemispheric stimulation protocol is both feasible and effective . Future research should examine the mechanistic explanation of this approach as well as the potential of using this approach in clinical population Background This study was undertaken to test the hypothesis that a combination of excitatory anodal transcranial direct current stimulation ( tDCS ) to the contralateral motor cortex and inhibitory cathodal tDCS to the ipsilateral motor cortex of the motor performing h and ( Bi-tDCS ) would elicit more implicit motor sequence learning than anodal tDCS applied to the contralateral motor cortex alone ( Uni-tDCS ) . Methods Eleven healthy right-h and ed adults underwent a r and omized crossover experiment of Uni-tDCS , Bi-tDCS , or sham stimulation . Subjects performed a 12-digit finger sequence serial reaction time task with the right h and at baseline ( Pre ) , at immediately ( Post 1 ) , and 24 hours after stimulation ( Post 2 ) . The ratios of reaction times of predetermined repeating sequence versus r and om sequence were subjected to statistical analysis . Results The paired t test showed that reaction time ratios were significant decreased by all stimulation types at Post 1 versus Pre ( P < 0.01 ) . However , mean reaction time ratios showed a significant decrease after Uni-tDCS ( P < 0.01 ) and Bi-tDCS ( P < 0.01 ) , but only a marginal decreased after Sham ( P = 0.05 ) at Post 2 , which suggests that motor sequence learning is consoli date d by Uni-tDCS and Bi-tDCS , but only partially consoli date d by sham stimulation . No significant differences were observed between Uni-tDCS and Bi-tDCS in terms of in reaction time ratios at Post 1 or 2 . Conclusions No significant difference was found between Uni-tDCS and Bi-tDCS in terms of induced implicit motor sequence learning , but tDCS led to greater consolidation of the learned motor sequence than sham stimulation . These findings need to be tested in the context of stroke h and motor rehabilitation To test the clinical counterpart of the learned nonuse theory , 25 chronic hemiplegic stroke and head-injured patients with minimal to moderate upper extremity extensor muscle function were required to keep their uninvolved upper extremities within a h and -enclosed sling during waking hours over a 2-week interval . During this forced use period and for 1 year thereafter , changes in force or time-based measures among 21 functional tasks were compared to values at the sixth baseline session , a preintervention time when relearning had plateaued . Significant ( P less than 0.05 , Friedman 's repeated measures followed by Tukey multiple comparison tests ) changes were seen in 19 of the 21 tasks with most persisting at the 1-year follow-up . There were no apparent differences between right- and left-sided involvement or between stroke versus head injury clients ( Mann-Whitney procedure ) . Ratings for quality of movement scored from videotapes presented in r and om order showed no change over time . These data suggest that learned nonuse does occur in select neurological patients and that this behavior can be reversed through application of a forced use paradigm OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epide 
    Output:
    
The results indicate that application of multiple sessions of a-tDCS , compared to single session a-tDCS induced a significant improvement in skill in both SEQTAP/SRTT and SVIPT .
Retention after a single day and multiple days of a-tDCS was statistically significant for the SEQTAP/SRTT task but not for SVIPT .
Therefore , our findings suggest that application of M1 a-tDCS across the three or five consecutive days can be helpful to improve motor sequence learning