The overarching goal of the National Center of Neuromodulation for Rehabilitation (NM4R) is to exert a sustained, powerful influence on the research field of NM4R through advancing understanding of the mechanisms and use of brain stimulation and operant conditioning of brain and spinal cord networks integrated with rehabilitation principles. To do so, the center offers free workshops.
Introductory (Level 1) Workshop
- The participant will gain basic skills carrying out NM4R studies, such as ability to make basic TMS neurophysiology measurements (e.g., determine motor threshold).
- Participants will become part of a community of NM4R researchers who are familiar with the physiological and technical background underlying the use of NM4R.
- The participant’s background in NM4R will extend beyond just brain stimulation or operant conditioning alone and that knowing the basics of both creates knowledge that is greater than the sum of the parts.
- The participant will infuse the principles of rehabilitation into their neuromodulation experimental designs and specific aims for grant proposals.
Thus, the purpose of this level one workshop is to introduce a range of concepts of NM4R (brain stimulation and operant conditioning) and give skills in basic TMS and operant conditioning neurophysiology.
Individuals desiring certification will be tested by Dr. Mark George on TMS use. Successful individuals will receive a certificate for learning and demonstrating the basic skills.
Advanced (Level 2) Workshops
Three follow-up Level 2 workshops will go into greater detail on TMS, TDCS, and operant conditioning. The Level 2 workshops are appropriate to those with existing expertise in neuromodulation. These workshops will include intensive hands on experience along with an emphasis on analyzing and interpreting data.
Operant Conditioning of EMG Evoked Potential Workshop
Operant conditioning is a powerful method to induce behavioral learning. Through operant conditioning, modification of a behavior is brought about by the consequence of that behavior. Since the first time Wolpaw and his colleagues demonstrated that the spinal stretch reflex can be changed through operant conditioning more than 30 years ago, variations of operant conditioning protocols have been applied to the stretch reflex or its electrical analog, the H-reflex, in monkeys, rats, mice, and humans, and repeatedly confirmed that a specific change (i.e., up- or down-regulation) can be induced in the activity of a targeted reflex pathway. Because a spinal reflex pathway serves many different movements and skills, the plasticity induced through operant conditioning can affect many motor skills in which the conditioned pathway participates. In fact, appropriate reflex conditioning can improve walking in rats and people with partial spinal cord injuries. Thus, it should be possible to facilitate/improve function recovery in other movement disorders and in other populations through operant conditioning.
Human evoked-potential operant conditioning protocols are completely non-invasive (although it is possible to include invasive procedures should there be a need for them) and can be applied to many different spinal reflexes and EMG evoked potentials (e.g., motor evoked potential to transcranial magnetic stimulation). Because these protocols can change the function of specific neural pathways, they can be designed to address the specific functional deficits of an individual with CNS disorder. Operant conditioning protocols may be combined with other rehabilitation methods, in order to enhance functional recovery. Successful applications require appropriate designing of a protocol and close adherence to designed procedures, as well as close attention to accommodating and engaging the individual subject in the conditioning process. The goal of this workshop is to provide participants with hands-on opportunities to learn and practice the fundamentals of human operant conditioning protocols. In hope to inspire different directions of conditioning applications, participants will be exposed to several different variations of conditioning protocols.
Repetitive Transcranial Magnetic Stimulation for Rehabilitation Workshop
Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved treatment for depression and is currently being investigated as a tool to aid motor rehabilitation in patients with stroke and spinal cord injury as well as improve motor symptoms in neurologic disorders such as Parkinson’s disease and Tourette Syndrome. Through rTMS it is possible to increase or decrease cortical (and subcortical) excitability by applying various frequencies of stimulation to different cortical sites. In the domain of stroke rehabilitation, common strategies of rTMS trial design include 1) increasing cortical excitability in the injured motor/premotor cortex, and 2) decreasing cortical excitability in the hemisphere not directly affected by the stroke. While this is typically done with fixed frequency protocols, there is an increasing interest in using patterned protocols such as theta burst stimulation. Furthermore, there is increasing data that suggesting there are clinical, genetic, and demographic variables that contribute to the efficacy of rTMS as a successful treatment for a given individual. Although there is neither a widely accepted nor FDA-approved protocol for motor rehabilitation, the opportunities for innovation and discovery in this field is plentiful. This is due in part to a growing emphasis on robust clinical trial design and novel brain stimulation protocols.
The goal of this workshop is to provide participants with hands-on opportunities to learn and practice the fundamentals of rTMS, neuronavigation, and robust experimental design. In this workshop students will learn to acquire rTMS data, design well-controlled studies, and use neuronavigation to select and maintain a cortical target. The course will be taught by NIH–funded researchers and clinicians. Students will end the course with an original data set which they collected & analyzed, and an abstract which summarizes their findings.
Transcranial Direct Current Stimulation for Rehabilitation Workshop
Transcranial direct current stimulation (tDCS) is a form of neurostimulation that uses constant, low current delivered to the brain area of interest via electrodes on the scalp. Transcranial direct current stimulation is a relatively simple technique requiring only a few parts, and works by sending constant, low direct current through the electrodes. When these electrodes are placed in the region of interest, the current induces intracerebral current flow. This current flow then either increases or decreases the neuronal excitability in the specific area being stimulated based on which type of stimulation is being used. This change of neuronal excitability leads to alteration of brain function, which can be used in various therapies as well as to provide more information about the functioning of the human brain.
This workshop will explore the fundamental physics of tDCS and the neurophysiology and neurochemistry potentially effected by tDCS. Participants will gain experience with common tDCS devices, electrode placement skills and montages, and best practices, all with an eye to crucial safety considerations. We will explore potential applications of the technique in stroke rehabilitation, pain management, and other in other clinical conditions. Goals include workshop participants gaining a basic understanding of the state of clinical knowledge in tDCS, developing a working knowledge of responsible experiment design, and acquiring essentials skills on the use of various tDCS devices.