TMS-based Assessment of Mental Training Effects on Motor Learning in Healthy Participants

Study Overview
=================
Brief Summary
-----------------
The general purpose of this research project is to analyze the specific role of motor imagery on motor learning, assessed through corticospinal excitability measurements and behavioral data collection. This project is based on four sequences. For Sequence 1, the main objective is to examine the effect of mental training on movement speed and accuracy in a manual motor sequence task, as well as the influence of sensory feedback in immediate post-test (i.e., execution of a similar, but not identical, manual motor sequence, other manual tasks) on performance in delayed post-test. The secondary objective will be to examine corticospinal changes (i.e., amplitude of motor evoked potentials) induced by mental training, by measuring the amplitude of motor evoked potentials before and after mental training. For Sequence 2, the main objective is to examine the impact of a motor disturbance induced by a robotic arm at different intervals during the motor imagery process. The secondary objective will be to examine the corticospinal changes (i.e. amplitude of evoked motor potentials) induced by mental training as a function of the applied perturbations, before and after perturbation. For Sequence 3, the main objective will be to examine the influence of neuroplasticity on the quality of mental training. More specifically, the investigators will study the links between brain plasticity and motor learning through mental training. The secondary objective will be to examine the corticospinal changes (i.e. amplitude of evoked motor potentials) induced by mental training at different levels of the neuromuscular system (cortical, cervicomedullar, peripheral) after a training period. For Sequence 4, the main objective will be to examine the effect of short-term arm-immobilization of on the retention of motor learning induced by mental training. The secondary objective will be to examine the corticospinal changes (i.e., amplitude of motor evoked potentials) induced by of short-term arm-immobilization, or by transcranial direct current stimulation (tDCS), on motor learning. The results of this fundamental research project will allow a better understanding of neurophysiological and behavioral mechanisms that underlie motor learning through motor imagery. The results will allow to efficiently consider inter-individual specificities and will thus open up to clinical research perspectives, towards the establishment of adapted motor rehabilitation protocols.

Official Title
-----------------
Transcranial Magnetic Stimulation-based Assessment of Mental Training Effects on Motor Learning in Healthy Participants

Conditions
-----------------
Motor Learning

Intervention / Treatment
-----------------
* Device: Transcranial magnetic stimulation
* Device: Peripheral Nerve Stimulation
* Device: Transcranial direct current stimulation
* Device: Paired Associative Stimulation
* Device: Wrist
* Device: Robotic arm
* Device: Cervicomedullar stimulation
* Other: Physical training
* Other: Mental training


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Male or female between 18 and 60 years old Having given written informed consent Affiliated to a social security scheme Exclusion Criteria: History of psychiatric illness (declarative) Person under guardianship, curatorship, safeguard of justice Neurological problem that could bias the results of the study (declarative) Personal or family history of epilepsy Person deprived of liberty by judicial or administrative decision Person hospitalized without consent and not subject to legal protection, and person admitted to a health or social institution for purposes other than that of the research Person subject to an exclusion period for another research Pregnant women or women of childbearing age not using known contraception Breastfeeding women Person on medication that could influence neurophysiological measures (neuroleptics, anxiolytics, antidepressants) Person carrying : pacemaker or other device that could interfere with the magnetic field Implants (mechanical or electronic: cochlear implants, neural or cardiac pacemakers, infusion pumps, magnetic aneurysm clips, etc.) Metallic foreign bodies in the eye or nervous system Metallic objects (tattoos, piercings, etc.)

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sequence 1 - Training with same task - Long follow-up<br>Motor task (Pretest and Posttests on the same task) Transcranial magnetic stimulation Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 1 - Training with same task - Short follow-up<br>Motor task (Pretest and Posttests on the same task) Transcranial magnetic stimulation Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 1 - Training with different tasks - Long follow-up<br>Motor task (different task in immediate post test) Transcranial magnetic stimulation Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 1 - Training with different tasks - Short follow-up<br>Motor task (different task in immediate post test) Transcranial magnetic stimulation Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 1 - Training with muscle contractions - Long follow-up<br>Motor task (isometric muscle contractions in immediate post test) Transcranial magnetic stimulation Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 1 - Training with muscle contractions - Short follow-up<br>Motor task (isometric muscle contractions in immediate post test) Transcranial magnetic stimulation Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Active Comparator: Sequence 1 - Control<br>Motor task (Pretest and Posttests on the same task) Transcranial magnetic stimulation No mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;|
| Active Comparator: Sequence 2 - Physical training with perturbation during preparation - Long follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Physical training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Physical training<br>* Training to perform the task by actually doing the task<br>|
| Active Comparator: Sequence 2 - Physical training with perturbation during preparation - Short follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Physical training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Physical training<br>* Training to perform the task by actually doing the task<br>|
| Active Comparator: Sequence 2 - Physical training with perturbation after preparation - Long follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Physical training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Physical training<br>* Training to perform the task by actually doing the task<br>|
| Active Comparator: Sequence 2 - Physical training with perturbation after preparation - Short follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Physical training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Physical training<br>* Training to perform the task by actually doing the task<br>|
| Experimental: Sequence 2 - Mental training with perturbation during preparation - Long follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 2 - Mental training with perturbation during preparation - Short follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 2 - Mental training with perturbation after preparation - Long follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 2 - Mental training with perturbation after preparation - Short follow-up<br>Motor task (Pretest and Posttests) Transcranial magnetic stimulation External pertubation (robotic arm) Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Robotic arm<br>* External perturbation of force field induced by robotic arm<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 3 - Training (same task) - Long follow-up<br>Paired Associative Stimulation Mental training (same as the motor task) Motor task Transcranial magnetic stimulation Peripheral nerve stimulation Cervicomedullar stimulation | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Peripheral Nerve Stimulation<br>* Electric stimulation of the nerves<br>Device: Paired Associative Stimulation<br>* Combined magnetic and electric stimulation of cortex and nerve, respectively<br>* Other names: PAS;Device: Cervicomedullar stimulation<br>* Electric stimulation of the muscle<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 3 - Training (same task) - Short follow-up<br>Paired Associative Stimulation Mental training (same as the motor task) Motor task Transcranial magnetic stimulation Peripheral nerve stimulation Cervicomedullar stimulation | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Peripheral Nerve Stimulation<br>* Electric stimulation of the nerves<br>Device: Paired Associative Stimulation<br>* Combined magnetic and electric stimulation of cortex and nerve, respectively<br>* Other names: PAS;Device: Cervicomedullar stimulation<br>* Electric stimulation of the muscle<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 3 - Training (different task) - Long follow-up<br>Paired Associative Stimulation Mental training (different of the motor task) Motor task Transcranial magnetic stimulation Peripheral nerve stimulation Cervicomedullar stimulation | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Peripheral Nerve Stimulation<br>* Electric stimulation of the nerves<br>Device: Paired Associative Stimulation<br>* Combined magnetic and electric stimulation of cortex and nerve, respectively<br>* Other names: PAS;Device: Cervicomedullar stimulation<br>* Electric stimulation of the muscle<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 3 - Training (different task) - Short follow-up<br>Paired Associative Stimulation Mental training (different of the motor task) Motor task Transcranial magnetic stimulation Peripheral nerve stimulation Cervicomedullar stimulation | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Peripheral Nerve Stimulation<br>* Electric stimulation of the nerves<br>Device: Paired Associative Stimulation<br>* Combined magnetic and electric stimulation of cortex and nerve, respectively<br>* Other names: PAS;Device: Cervicomedullar stimulation<br>* Electric stimulation of the muscle<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Active Comparator: Sequence 3 - Control 1<br>Mental Training Motor task (same as the motor task) Transcranial magnetic stimulation Peripheral nerve stimulation Cervicomedullar stimulation | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Peripheral Nerve Stimulation<br>* Electric stimulation of the nerves<br>Device: Cervicomedullar stimulation<br>* Electric stimulation of the muscle<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Active Comparator: Sequence 3 - Control 2<br>Paired Associative Stimulation Motor task Transcranial magnetic stimulation Peripheral nerve stimulation Cervicomedullar stimulation | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Peripheral Nerve Stimulation<br>* Electric stimulation of the nerves<br>Device: Paired Associative Stimulation<br>* Combined magnetic and electric stimulation of cortex and nerve, respectively<br>* Other names: PAS;Device: Cervicomedullar stimulation<br>* Electric stimulation of the muscle<br>|
| Experimental: Sequence 4 - Immobilization - Short follow-up<br>Transcranial magnetic stimulation Arm immobilization Motor task Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Wrist<br>* Short-term immobilization of the arm<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 4 - Immobilization - Long follow-up<br>Transcranial magnetic stimulation Arm immobilization Motor task Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Wrist<br>* Short-term immobilization of the arm<br>Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 4 - Cathodal - Short follow-up<br>Transcranial magnetic stimulation Cathodal transcranial direct current stimulation Motor task Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Transcranial direct current stimulation<br>* Electric stimulation of the cortex<br>* Other names: tDCS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 4 - Cathodal - Long follow-up<br>Transcranial magnetic stimulation Cathodal transcranial direct current stimulation Motor task Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Transcranial direct current stimulation<br>* Electric stimulation of the cortex<br>* Other names: tDCS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 4 - Anodal - Short follow-up<br>Transcranial magnetic stimulation Anodal transcranial direct current stimulation Motor task Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Transcranial direct current stimulation<br>* Electric stimulation of the cortex<br>* Other names: tDCS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Experimental: Sequence 4 - Anodal - Long follow-up<br>Transcranial magnetic stimulation Anodal transcranial direct current stimulation Motor task Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Device: Transcranial direct current stimulation<br>* Electric stimulation of the cortex<br>* Other names: tDCS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|
| Sham Comparator: Sequence 4 - Control<br>Transcranial magnetic stimulation Motor task Mental training | Device: Transcranial magnetic stimulation<br>* Magnetic stimulation of the cortex<br>* Other names: TMS;Other: Mental training<br>* Training to perform the task by imaging doing the task<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evolution of movement speed - Sequence 1 | The duration of performed movement sequences | Each day in Sequence 1 (Sequence 1 is 11 days) | 
| Evolution of movement accuracy - Sequence 1 | The accuracy of performed movement sequences (i.e., the correspondence between the performed finger motor sequences and the requested finger motor sequence). | Each day in Sequence 1 (Sequence 1 is 11 days) | 
| Evolution of trajectory error - Sequence 2 | The area under the curve of hand's trajectory according to the straight line joining the starting target and the final target. | Each day in Sequence 2 (Sequence 1 is 10 days) | 
| Evolution of maximal deviation - Sequence 2 | The maximal perpendicular distance between the position of the hand and the straight line joining the starting target and the final target | Each day in Sequence 2 (Sequence 1 is 10 days) | 
| Evolution of final error - Sequence 2 | The distance between the final position of the hand and the position of the final target. | Each day in Sequence 2 (Sequence 1 is 10 days) | 
| Evolution of movement speed - Sequence 3 | The duration of performed movement sequences | Each day from day 2 to day 11 of Sequence 3 (Sequence 3 is 11 days) | 
| Evolution of movement accuracy - Sequence 3 | The accuracy of performed movement sequences (i.e., the correspondence between the performed finger motor sequences and the requested finger motor sequence). | Each day from day 2 to day 11 of Sequence 3 (Sequence 3 is 11 days) | 
| Evolution of movement speed - Sequence 4 | The duration of performed movement sequences | Each day in Sequence 4 (Sequence 4 is 6 days) | 
| Evolution of movement accuracy - Sequence 4 | The accuracy of performed movement sequences (i.e., the correspondence between the performed finger motor sequences and the requested finger motor sequence). | Each day in Sequence 4 (Sequence 4 is 6 days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evolution of motor evoked potentials amplitude - Sequence 1 | Peak-to-peak amplitude of motor evoked potentials | Day 1, 5, 6, 10 and 11 in Sequence 1 (Sequence 1 is 11 days). | 
| Evolution of motor evoked potentials amplitude - Sequence 2 | Peak-to-peak amplitude of motor evoked potentials | Each day in Sequence 2 (Sequence 2 is 10 days) | 
| Evolution of motor evoked potentials amplitude - Sequence 3 | Peak-to-peak amplitude of motor evoked potentials | Day 1, 5, 6, 10 and 11 in Sequence 3 (Sequence 1 is 11 days) | 
| Evolution of motor evoked potentials amplitude - Sequence 4 | Peak-to-peak amplitude of motor evoked potentials | Days 1, 5, and 6 in Sequence 4 (Sequence 4 is 6 days) |