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Concurrent effects of EMG-triggered NMES and anodal tDCS on cortical and behavioural outcome measures: The role of ipsilateral versus contralateral anodal stimulation.

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Τίτλος: Concurrent effects of EMG-triggered NMES and anodal tDCS on cortical and behavioural outcome measures: The role of ipsilateral versus contralateral anodal stimulation.
Συγγραφείς: Alanazi H; Department of Physiotherapy, Monash University, Melbourne, Australia; Department of Physiotherapy, University of Hail, Hail, Saudi Arabia. Electronic address: Hamed.Alanazi@monash.edu., Morgan P; Department of Physiotherapy, Monash University, Melbourne, Australia., Jaberzadeh S; Department of Physiotherapy, Monash University, Melbourne, Australia.
Πηγή: Brain research [Brain Res] 2026 Oct 15; Vol. 1889, pp. 150464. Date of Electronic Publication: 2026 Jul 10.
Τύπος έκδοσης: Journal Article; Randomized Controlled Trial
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier/North-Holland Biomedical Press Country of Publication: Netherlands NLM ID: 0045503 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-6240 (Electronic) Linking ISSN: 00068993 NLM ISO Abbreviation: Brain Res Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam Elsevier/North-Holland Biomedical Press.
Ιατρικοί όροι (MeSH): Transcranial Direct Current Stimulation*/methods , Motor Cortex*/physiology, Electromyography/methods ; Evoked Potentials, Motor/physiology ; Reaction Time/physiology ; Muscle, Skeletal/physiology ; Neuronal Plasticity/physiology ; Neural Inhibition/physiology ; Electric Stimulation/methods ; Transcranial Magnetic Stimulation/methods ; Functional Laterality/physiology ; Humans ; Female ; Male ; Adult ; Young Adult ; Cross-Over Studies
Περίληψη: Purpose: Neuromodulatory interventions are increasingly used to enhance neuroplasticity and motor performance. Electromyography-triggered neuromuscular electrical stimulation (EMG-triggered NMES) and anodal transcranial direct current stimulation (a-tDCS) target peripheral and cortical components of the motor system; however, the effects of their concurrent application remain unclear. This study examined whether concurrent EMG-triggered NMES and a-tDCS applied over the ipsilateral or contralateral primary motor cortex differentially modulate corticospinal excitability (CSE) and motor performance.
Methods: Twenty healthy adults participated in a randomized, counterbalanced, crossover study with three sessions: (1) EMG-triggered NMES + contralateral a-tDCS, (2) EMG-triggered NMES + ipsilateral a-tDCS, and (3) EMG-triggered NMES + sham a-tDCS. Primary outcomes were CSE, and secondary outcomes included short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI), intracortical facilitation (ICF), maximal voluntary contraction (MVCEMG), and performance on a choice reaction time task (CRTT).
Results: CSE increased significantly following EMG-triggered NMES + contralateral a-tDCS (p < 0.001and sham a-tDCS (p < 0.001), but not after ipsilateral a-tDCS (P = 0.806). EMG-triggered NMES + contralateral a-tDCS increased ICF (P = 0.038) and reduced SICI (P = 0.029) and LICI (P = 0.05). Conversely, MVC (P = 0.021) and CRTT (P = 0.035) increased following EMG-triggered NMES + ipsilateral a-tDCS, with MVC differing significantly from the other conditions (P = 0.001).
Conclusion: EMG-triggered NMES combined with contralateral stimulation enhances CSE, whereas ipsilateral stimulation improves behavioural outcomes without altering contralateral CSE. These findings indicate a dissociation between changes in CSE and behavioural performance, suggesting that behavioural improvements may reflect neural processes not captured by the measures used in this study.
(Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: Anodal transcranial direct current stimulation; Cortical excitability; EMG-triggered NMES; Intracortical inhibition and facilitation; Motor performance
Entry Date(s): Date Created: 20260710 Date Completed: 20260808 Latest Revision: 20260811
Update Code: 20260812
DOI: 10.1016/j.brainres.2026.150464
PMID: 42431572
Βάση Δεδομένων: MEDLINE
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  Data: Concurrent effects of EMG-triggered NMES and anodal tDCS on cortical and behavioural outcome measures: The role of ipsilateral versus contralateral anodal stimulation.
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  Label: Authors
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Alanazi+H%22&quot;&gt;Alanazi H&lt;/searchLink&gt;; Department of Physiotherapy, Monash University, Melbourne, Australia; Department of Physiotherapy, University of Hail, Hail, Saudi Arabia. Electronic address: Hamed.Alanazi@monash.edu.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Morgan+P%22&quot;&gt;Morgan P&lt;/searchLink&gt;; Department of Physiotherapy, Monash University, Melbourne, Australia.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Jaberzadeh+S%22&quot;&gt;Jaberzadeh S&lt;/searchLink&gt;; Department of Physiotherapy, Monash University, Melbourne, Australia.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%220045503%22&quot;&gt;Brain research&lt;/searchLink&gt; [Brain Res] 2026 Oct 15; Vol. 1889, pp. 150464. &lt;i&gt;Date of Electronic Publication: &lt;/i&gt;2026 Jul 10.
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  Data: &lt;i&gt;Original Publication&lt;/i&gt;: Amsterdam Elsevier/North-Holland Biomedical Press.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Transcranial+Direct+Current+Stimulation%22&quot;&gt;Transcranial Direct Current Stimulation*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Transcranial+Direct+Current+Stimulation+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Motor+Cortex%22&quot;&gt;Motor Cortex*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Motor+Cortex+physiology%22&quot;&gt;physiology&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Electromyography%22&quot;&gt;Electromyography&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Electromyography+methods%22&quot;&gt;methods&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Evoked+Potentials%2C+Motor%22&quot;&gt;Evoked Potentials, Motor&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Evoked+Potentials%2C+Motor+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Reaction+Time%22&quot;&gt;Reaction Time&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Reaction+Time+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Muscle%2C+Skeletal%22&quot;&gt;Muscle, Skeletal&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Muscle%2C+Skeletal+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Neuronal+Plasticity%22&quot;&gt;Neuronal Plasticity&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Neuronal+Plasticity+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Neural+Inhibition%22&quot;&gt;Neural Inhibition&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Neural+Inhibition+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Electric+Stimulation%22&quot;&gt;Electric Stimulation&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Electric+Stimulation+methods%22&quot;&gt;methods&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Transcranial+Magnetic+Stimulation%22&quot;&gt;Transcranial Magnetic Stimulation&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Transcranial+Magnetic+Stimulation+methods%22&quot;&gt;methods&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Functional+Laterality%22&quot;&gt;Functional Laterality&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Functional+Laterality+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Female%22&quot;&gt;Female&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adult%22&quot;&gt;Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Young+Adult%22&quot;&gt;Young Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Cross-Over+Studies%22&quot;&gt;Cross-Over Studies&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: Neuromodulatory interventions are increasingly used to enhance neuroplasticity and motor performance. Electromyography-triggered neuromuscular electrical stimulation (EMG-triggered NMES) and anodal transcranial direct current stimulation (a-tDCS) target peripheral and cortical components of the motor system; however, the effects of their concurrent application remain unclear. This study examined whether concurrent EMG-triggered NMES and a-tDCS applied over the ipsilateral or contralateral primary motor cortex differentially modulate corticospinal excitability (CSE) and motor performance.&lt;br /&gt;Methods: Twenty healthy adults participated in a randomized, counterbalanced, crossover study with three sessions: (1) EMG-triggered NMES&#160;+&#160;contralateral a-tDCS, (2) EMG-triggered NMES&#160;+&#160;ipsilateral a-tDCS, and (3) EMG-triggered NMES&#160;+&#160;sham a-tDCS. Primary outcomes were CSE, and secondary outcomes included short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI), intracortical facilitation (ICF), maximal voluntary contraction (MVC&lt;subscript&gt;EMG&lt;/subscript&gt;), and performance on a choice reaction time task (CRTT).&lt;br /&gt;Results: CSE increased significantly following EMG-triggered NMES&#160;+&#160;contralateral a-tDCS (p&#160;&amp;lt;&#160;0.001and sham a-tDCS (p&#160;&amp;lt;&#160;0.001), but not after ipsilateral a-tDCS (P&#160;=&#160;0.806). EMG-triggered NMES&#160;+&#160;contralateral a-tDCS increased ICF (P&#160;=&#160;0.038) and reduced SICI (P&#160;=&#160;0.029) and LICI (P&#160;=&#160;0.05). Conversely, MVC (P&#160;=&#160;0.021) and CRTT (P&#160;=&#160;0.035) increased following EMG-triggered NMES&#160;+&#160;ipsilateral a-tDCS, with MVC differing significantly from the other conditions (P&#160;=&#160;0.001).&lt;br /&gt;Conclusion: EMG-triggered NMES combined with contralateral stimulation enhances CSE, whereas ipsilateral stimulation improves behavioural outcomes without altering contralateral CSE. These findings indicate a dissociation between changes in CSE and behavioural performance, suggesting that behavioural improvements may reflect neural processes not captured by the measures used in this study.&lt;br /&gt; (Copyright &#169; 2026 The Author(s). Published by Elsevier B.V. All rights reserved.)
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  Label: Competing Interests
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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  Label: Contributed Indexing
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;Anodal transcranial direct current stimulation; Cortical excitability; EMG-triggered NMES; Intracortical inhibition and facilitation; Motor performance
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  Data: &lt;i&gt;Date Created: &lt;/i&gt;20260710 &lt;i&gt;Date Completed: &lt;/i&gt;20260808 &lt;i&gt;Latest Revision: &lt;/i&gt;20260811
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  Data: 10.1016/j.brainres.2026.150464
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  Data: 42431572
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42431572
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        Value: 10.1016/j.brainres.2026.150464
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        Text: English
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        StartPage: 150464
    Subjects:
      – SubjectFull: Electromyography methods
        Type: general
      – SubjectFull: Evoked Potentials, Motor physiology
        Type: general
      – SubjectFull: Reaction Time physiology
        Type: general
      – SubjectFull: Muscle, Skeletal physiology
        Type: general
      – SubjectFull: Neuronal Plasticity physiology
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      – SubjectFull: Neural Inhibition physiology
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      – SubjectFull: Electric Stimulation methods
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      – SubjectFull: Transcranial Magnetic Stimulation methods
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      – SubjectFull: Functional Laterality physiology
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      – SubjectFull: Transcranial Direct Current Stimulation methods
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      – SubjectFull: Motor Cortex physiology
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      – TitleFull: Concurrent effects of EMG-triggered NMES and anodal tDCS on cortical and behavioural outcome measures: The role of ipsilateral versus contralateral anodal stimulation.
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              Text: 2026 Oct 15
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