***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: Transcranial direct current stimulation ( tDCS ) uses a weak electric current to modulate neuronal activity . A neurophysiologic outcome measure to demonstrate reliable tDCS modulation at the group level is transcranial magnetic stimulation engendered motor evoked potentials ( MEPs ) . Here , we conduct a study testing the reliability of individual MEP response patterns following a common tDCS protocol . Fourteen participants ( 7m/7f ) each underwent nine r and omized sessions of 1 mA , 10 min tDCS ( 3 anode ; 3 cathode ; 3 sham ) delivered using an M1/orbito-frontal electrode montage ( sessions separated by an average of ~5.5 days ) . Fifteen MEPs were obtained prior to , immediately following and in 5 min intervals for 30 min following tDCS . TMS was delivered at 130 % resting motor threshold using neuronavigation to ensure consistent coil localization . A number of non-experimental variables were collected during each session . At the individual level , considerable variability was seen among different testing sessions . No participant demonstrated an excitatory response ≥20 % to all three anodal sessions , and no participant demonstrated an inhibitory response ≥20 % to all three cathodal sessions . Intra-class correlation revealed poor anodal and cathodal test – retest reliability [ anode : ICC(2,1 ) = 0.062 ; cathode : ICC(2,1 ) = 0.055 ] and moderate sham test – retest reliability [ ICC(2,1 ) = 0.433 ] . Results also revealed no significant effect of tDCS at the group level . Using this common protocol , we found the effects of tDCS on MEP amplitudes to be highly variable at the individual level . In addition , no significant effects of tDCS on MEP amplitude were found at the group level . Future studies should consider utilizing a more strict experimental protocol to potentially account for intra-individual response variations BACKGROUND Recovering h and function has important implication s for improving independence of patients with tetraplegia after traumatic spinal cord injury ( SCI ) .  Transcranial direct current stimulation ( tDCS ) is a noninvasive neuromodulation technique that has potential to improve motor function . OBJECTIVE To investigate the effects of one session of 1 mA , 2 mA , and sham anodal tDCS ( a-tDCS ) in the upper extremity ( h and ) motor performance ( grasp and lease ) in patients with chronic cervical SCI . METHODS Eleven participants with incomplete SCI were r and omized to receive 20 minutes of 1 mA , 2 mA , or sham stimulation over the targeted motor cortex over three separated sessions . H and motor performance was measured by a h and robotic evaluation ( kinematics ) and the Box and Blocks ( BB ) test before and after the stimulation period . RESULTS A significant improvement on the grasp mean to peak speed ratio ( GMP ) was observed in the 2 mA group ( pre : 0.38±0.02 ; post : 0.43±0.03 ; mean±SEM ; p = 0.031 ) . There was no statistically significant difference in BB test results , however the 2 mA intervention showed a positive trend for improvement . CONCLUSIONS A single session of 2 mA of a-tDCS showed gains in h and motor function in patients with chronic SCI that were not observed in functional clinical scales . The use of robotic kinematics showed promising results in assessing small changes in motor performance . Further studies are necessary to determine whether tDCS can be an effective long-term rehabilitation strategy for individuals with SCI OBJECTIVE /HYPOTHESIS Transcranial direct current stimulation ( tDCS ) is a potential tool to improve motor recovery in patients with neurological disorders . Safety and efficacy of this procedure for lower extremity motor strengthe and gait function in motor incomplete spinal cord injury ( SCI ) have not yet been addressed . The aim of this study is to optimize the functional outcome in early phases of gait rehabilitation assisted by Lokomat ( ® ) in motor incomplete SCI patients using tDCS as an additional treatment to physical therapy . METHODS We performed in a SCI unit a single-centre r and omized , double-blind , sham-controlled study to investigate safety and efficacy of anodal tDCS of over leg motor cortex in motor incomplete SCI patients . Twenty-four SCI patients received either daily sessions of anodal tDCS ( n=12 ) at 2mA for 20min to the vertex ( leg motor cortex ) during twenty days or sham tDCS ( n=12 ) . Motor deficit was assessed by the lower extremity motor score ( LEMS ) and for gait function : ten meter walking test ( 10MWT ) and Walking Index for SCI ( WISCI II ) at baseline , after last tDCS session ( after 4 weeks of stimulation ) , and after 8 weeks ( from baseline ) for follow-up . RESULTS No side effects were detected during either tDCS or sham . In both groups , there was a significant improvement in LEMS ( p<0.03 ) , which did not significantly differ when comparing anodal and sham tDCS groups . During follow-up , in both group 5 of 12 patients could perform gait , without significant differences in gait velocity , cadence , step length and WISCI-II between both groups . CONCLUSION Combination twenty sessions of daily tDCS to the leg motor cortex and Lokomat ( ® ) gait training appear to be safe in motor incomplete SCI patients . There was an expected improvement in both LEMS and gait scales however , did not differ between patients treated with anodal or sham tDCS 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 r and omized 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-h and ed 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 h and . 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 Transcranial direct current stimulation ( tDCS ) of the primary motor h and area ( M1 ) can produce lasting polarity-specific effects on corticospinal excitability and motor learning in humans . In 16 healthy volunteers , O positron emission tomography ( PET ) of regional cerebral blood flow ( rCBF ) at rest and during finger movements was used to map lasting changes in regional synaptic activity following 10 min of tDCS ( + /-1 mA ) . Bipolar tDCS was given through electrodes placed over the left M1 and right frontopolar cortex . Eight subjects received anodal or cathodal tDCS  of the left M1 , respectively . When compared to sham tDCS , anodal and cathodal tDCS induced widespread increases and decreases in rCBF in cortical and subcortical areas . These changes in rCBF were of the same magnitude as task-related rCBF changes during finger movements and remained stable throughout the 50-min period of PET scanning . Relative increases in rCBF after real tDCS compared to sham tDCS were found in the left M1 , right frontal pole , right primary sensorimotor cortex and posterior brain regions irrespective of polarity . With the exception of some posterior and ventral areas , anodal tDCS increased rCBF in many cortical and subcortical regions compared to cathodal tDCS . Only the left dorsal premotor cortex demonstrated an increase in movement related activity after cathodal tDCS , however , modest compared with the relatively strong movement-independent effects of tDCS . Otherwise , movement related activity was unaffected by tDCS . Our results indicate that tDCS is an effective means of provoking sustained and widespread changes in regional neuronal activity . The extensive spatial and temporal effects of tDCS need to be taken into account when tDCS is used to modify brain function BACKGROUND After cervical spinal cord injury , current options for treatment of upper extremity motor functions have been limited to traditional approaches . However , there is a substantial need to explore more rigorous alternative treatments to facilitate motor recovery . OBJECTIVE To demonstrate whether anodal- primary motor cortex ( M1 ) excitability enhancement ( with cathodal-supra orbital area ) ( atDCS ) combined with robot-assisted arm training ( R-AAT ) will provide greater improvement in contralateral arm and h and motor functions compared to sham stimulation ( stDCS ) and R-AAT in patients with chronic , incomplete cervical spinal cord injury ( iCSCI ) . METHODS In this parallel-group , double-blinded , r and omized and sham-controlled trial , nine participants with chronic iCSCI ( AIS C and D level ) were r and omized to receive 10 sessions of atDCS or stDSC combined with R-AAT .  Feasibility and tolerability was assessed with attrition rate and occurrence of adverse events , Changes in arm and h and function were assessed with Jebson Taylor H and Function Test ( JTHFT ) . Amount of Use Scale of Motor Activity Log ( AOU-MAL ) , American Spinal Injury Association Upper Extremity Motor Score and Modified Ashworth Scale ( MAS ) at baseline , after treatment , and at two-month follow-up . RESULTS None of the participants missed a treatment session or dropped-out due to adverse events related to the treatment protocol . Participants tended to perform better in JTHFT and AOU-MAL after treatment . Active group at post-treatment and two-month follow-up demonstrated better arm and h and performance compared to sham group . CONCLUSION These preliminary findings support that modulating excitatory input of the corticospinal tracts on spinal circuits may be a promising strategy in improving arm and h and functions in persons with incomplete tetraplegia . Further study is needed to explore the underlying mechanisms of recovery Background . The Spinal Cord Injury Locomotor Trial ( SCILT ) compared 12 weeks of step training with body weight support on a treadmill ( BWSTT ) that included overground practice to a defined but more conventional overground mobility intervention ( CONT ) in patients with incomplete traumatic SCI within 8 weeks of onset . No previous studies have reported walking-related outcomes during rehabilitation . Methods . This single-blinded , r and omized trial entered 107 American Spinal Injury Association ( ASIA ) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation .  The Functional Independence Measure ( FIM-L ) for walking , 15-m walking speed , and lower extremity motor score ( LEMS ) were collected every 2 weeks . Results . No significant differences were found at entry and during the treatment phase ( 12-week mean FIM-L = 5 , velocity = 0.8 m/s , LEMS = 35 , distance walked in 6 min = 250 m ) . Combining the 2 arms , a FIM-L ≥ 4 was achieved in < 10 % of ASIA B patients , 92 % of ASIA C patients , and all of ASIA D patients . Walking speed of ≥ 0.6 m/s correlated with a LEMS near 40 or higher . Conclusions . Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT , consistent with the primary outcome data at 6 months . Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes . By about 6 weeks after entry , most patients who will recover have improved their FIM-L to > 3 and are improving in walking speed . Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still grade d ASIA B and at > 12 weeks if still ASIA 
    Output:
    
No significant adverse events were reported .
Overall , there was a significant effect of tDCS in improving motor functionality following iSCI .