Transcranial Magnetic Stimulation-based Assessment of Mental Training Effects on Motor Learning in Healthy Participants
Phase: NA
Conditions: Motor Learning
Sponsor: Institut National de la Santé Et de la Recherche Médicale, France

 
 
TRANSCRANIAL MAGNETIC STIMULATION-BASED ASSESSMENT OF 
MENTAL TRAINING EFFECTS ON MOTOR LEARNING IN HEALTHY 
PARTICIPANTS 
 
Acronym: IMAP-TMS 
Protocol ID: C19-19 
Registry Identifier: 2020-A00305-34 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
25/11/2020 

Sequence 1 
Protocol 
Four groups will be included. Three experimental groups will perform a mental training session 
followed by different actual movements in immediate post-test, depending on their groups: i) 
manual motor sequence, identical to the pre-test, ii) manual motor sequence, different from the 
pre-test, and iii) isometric muscle contractions (strength). The control group will not perform 
mental training but will perform all the test sessions. On Day 1, we will first conduct the KVIQ 
to measure the imagery abilities of the participants, as well as the Edinburgh laterality 
questionnaire to measure manual lateralization. Then we will carry out the first TMS 
recordings, followed by a pre-test phase. This pre-test phase will consist, for all the participants, 
in the physical execution of a manual sequence at a frequency of 0.5 Hz. The number of errors 
and omissions, as well as the respect of the tempo will be considered as measures of 
performance. Participants will then proceed to the mental training phase. For all mental training 
groups, this will consist in imagining the sequence performed in pre-test. The participants will 
imagine 100 sequences during the mental training phase. Following the training ("immediate" 
post-test phase), the participants will be divided into several experimental groups and will 
perform 10 actual movements, according to their group. On Days 2 to 4 of Weeks 1 & 2, the 
participants will follow the mental training as well as the actual movement session in immediate 
post-test. On Day 5 of Weeks 1 & 2, the protocol will be identical to that of Day 1. Finally, on 
Day 1 of the Week 3, we will carry out the final post-test and manage the final TMS recordings. 
 
Statistical design 
 
For the behavioral data, movement time and accuracy will be measured (pre- and post-tests), 
for each session. The normality of dependent variables will be evaluated by the Shapiro-Wilk 
test. If the data are normally distributed, parametric tests will be used: ANOVA or Mixed Linear 
Models with the Test (pre and post tests) as within-subject factor and Group as between-subject 
factor. Post hoc tests will allow pairwise comparisons. If the data are not normally distributed, 
non-parametric tests will be used: Generalized linear mixed models. Post hoc tests will allow 
pairwise comparisons. 
 
For the neurophysiological data (recruitment curves), the mean amplitude of the motor evoked 
potentials will be calculated in order to obtain recruitment curves (pre-training, immediate and 
delayed post-training). The normality of the dependent variables will be evaluated by the 
Shapiro-Wilk test. If the data are normally distributed, parametric tests will be used: ANOVA 
or mixed linear models with the test (pre-training, post-training) as within-subject factor and 
the group as between-subject factor. Post hoc tests will allow pairwise comparisons. If the data 
are not normally distributed, non-parametric tests will be used: Generalized linear mixed 
models. Post hoc tests will allow for pairwise comparisons.  
 
 
 
 
 
 
 
 

Sequence 2 
Protocol 
On Day 1, we will first conduct the KVIQ to measure the imagery abilities of the participants, 
as well as the Edinburgh laterality questionnaire to measure manual lateralization. Then we will 
carry out the first TMS recordings, followed by a pre-test phase. This pre-test phase will consist, 
for all the participants, in manipulating the robotic arm and reaching targets presented on the 
screen, as accurate and quickly as possible. This experiment will involve two groups (actual 
and imagined trainings), themselves divided into two groups (disturbance during the 
preparation phase or after it). The course of a session will be composed of: (i) an initial test for 
which no force field will be applied, (ii) a training phase during which the force field will be 
applied during or after the preparatory period according to the condition and (iii) final tests in 
which the force field will be absent to measure consequential adaptation effects (after-effects). 
TMS recordings will be then performed at post-test. The pre- and post-tests will consist of 120 
movements. The training phase will be composed of 240 actual or imagined movements 
(depending on the group) divided into 5 blocks. That protocol will take place over 10 days with 
5 training sessions per week. 
Statistical design 
For the behavioral data, the statistical analysis will focus on three measurements calculated 
from the actual trials to determine the adaptation to the force field : 1) the trajectory error, which 
corresponds to the area under the curve of the trajectory of the hand as a function of the straight 
line joining the starting target and the final target; 2) the maximum deviation, which is 
calculated from the maximum perpendicular distance between the position of the hand and the 
straight line joining the starting target and the final target; 3) the final error, which corresponds 
to the distance between the final position of the hand and the position of the final target to be 
reached. The analysis will be performed on the data related to duration, accuracy, error, and 
acceleration parameters. The normality of dependent variables will be evaluated by the Shapiro-
Wilk test. If the data are normally distributed, parametric tests will be used: ANOVA or Mixed 
Linear Models with the Test (pre and post tests) as within-subject factor and Group as between-
subject factor. Post hoc tests will allow for pairwise comparisons. If the data are not normally 
distributed, non-parametric tests will be used: Generalized linear mixed models. Post hoc tests 
will allow for pairwise comparisons. 
For the neurophysiological data (recruitment curves), the mean amplitude of the motor evoked 
potentials will be calculated in order to obtain recruitment curves (pre-training, immediate and 
delayed post-training). The normality of the dependent variables will be evaluated by the 
Shapiro-Wilk test. If the data are normally distributed, parametric tests will be used: ANOVA 
or mixed linear models with the Test (pre-training, post-training) as within-subject factor and 
the Group as between-subject factor. Post hoc tests will allow pairwise comparisons If the data 
are not normally distributed, non-parametric tests will be used: Generalized linear mixed 
models. Post hoc tests will allow for pairwise comparisons.  
 
 
 
 
 
 
 

Sequence 3 
Protocol 
Four groups of subjects will be included: two experimental and two control groups. On Day 1, 
we will first conduct the KVIQ to measure the imagery abilities of the participants, as well as 
the Edinburgh laterality questionnaire to measure manual lateralization. After initial TMS 
recordings, the first experimental group will have, as a pre-test, to imagine a manual motor 
sequence (A) for 50 trials, undergo the protocol of PAS on Day 1 of Weeks 1 & 2 and come 
back to physically perform the sequence A on Days 2 to 4 of Weeks 1 & 2 (10 trials per days). 
The second group will have to imagine another motor sequence (B) for 50 trials, undergo the 
protocol of PAS to imagine the sequence (A) for 50 trials on Day 1 of Weeks 1 & 2 and come 
back to physically perform the sequence A on Days 2 to 4 of the Weeks 1 & 2. The motor 
sequences (A) and (B) consist of 5 keys, differently ordered in each sequence. The two control 
groups will monitor the effects of PAS and motor imagery; one group will perform the protocol 
without undergoing PAS on Day 1 of Weeks 1 & 2, the other will watch a documentary and 
undergo the PAS protocol on Day 1 of Weeks 1 & 2. Both groups will return from Days 2 to 4 
of Weeks 1 & 2 to physically perform the sequence (A). Finally, participants will have to 
perform 10 actuals trials on Day 1 of Week 3. TMS recordings will be performed on Day 5 of 
Week 1 & 2, as well as on Day 1 of Week 3.  
Statistical design 
For the behavioral data, statistical analysis will focus on time, accuracy and error. The normality 
of dependent variables will be evaluated by the Shapiro-Wilk test. If the data are normally 
distributed, parametric tests will be used: ANOVA or Mixed Linear Models with the Test (pre 
and post tests) as within-subject factor and Group as between-subject factor. Post hoc tests will 
allow for pairwise comparisons. If the data are not normally distributed, non-parametric tests 
will be used: Generalized linear mixed models. Post hoc tests will allow for pairwise 
comparisons. 
For the neurophysiological data (recruitment curves), the mean amplitude of the motor evoked 
potentials will be calculated in order to obtain recruitment curves (pre-training, immediate and 
delayed post-training). The normality of the dependent variables will be evaluated by the 
Shapiro-Wilk test. If the data are normally distributed, parametric tests will be used: ANOVA 
or mixed linear models with the test (pre-training, post-training) as within-subject factor and 
the group as between-subject factor. Post hoc tests will allow for pairwise comparisons If the 
data are not normally distributed, non-parametric tests will be used: Generalized linear mixed 
models. Post hoc tests will allow for pairwise comparisons.  
 
 
 
 
 
 
 

 
Sequence 4 
Protocol 
To carry out this study, four groups will be formed (3 experimental, 1 control). On Day 1, we 
will first conduct the KVIQ to measure the imagery abilities of the participants, as well as the 
Edinburgh laterality questionnaire to measure manual lateralization. Then, TMS recordings will 
be performed. Participants of the first experimental group will have their left arm immobilized 
for 8 hours. The second experimental group will undergo the tDCS protocol, aimed at inducing 
hypoexcitability. The third group will undergo a protocol using anodal tDCS (a-tDCS), to 
induce an increase in excitability. The control group will undergo a protocol Sham (no effect). 
TMS recordings will be perform once more to measure changes in excitability induced by 
immobilization and by tDCS. The task will then consist, for the four groups, of the execution 
of a maximum number of motor sequences, consisting of 5 keys to be pressed on a computer 
keyboard. Participants will perform 2 series of actual trials, then perform 15 series of mental 
training trials, followed by 2 series of actual movements. On Days 2 to 4, participants will 
complete 15 imagine trials, followed by 2 series of actual movements. On Day 5 of Week 1 as 
well as Day 1 of Week 2, the participants will perform 2 series of actual movements and TMS 
recordings will be manage.  
Statistical design 
For the behavioral data, statistical analysis will focus on duration, accuracy and error. The 
normality of dependent variables will be evaluated by the Shapiro-Wilk test. If the data are 
normally distributed, parametric tests will be used: ANOVA or Mixed Linear Models with the 
Test (pre and post tests) as within-subject factor and Group as between-subject factor. Post hoc 
tests will allow for pairwise comparisons. If the data are not normally distributed, non-
parametric tests will be used: generalized linear mixed models. Post hoc tests will allow for 
pairwise comparisons. 
For the neurophysiological data (recruitment curves), the mean amplitude of the motor evoked 
potentials will be calculated in order to obtain recruitment curves (pre-training, immediate and 
delayed post-training). The normality of the dependent variables will be evaluated by the 
Shapiro-Wilk test. If the data are normally distributed, parametric tests will be used: ANOVA 
or mixed linear models with the test (pre-training, post-training) as within-subject factor and 
the group as a between-subject factor. Post hoc tests will allow for pairwise comparisons If the 
data are not normally distributed, non-parametric tests will be used: generalized linear mixed 
models. Post hoc tests will allow for pairwise comparisons.