Subjects
Ten participants took part in this study after providing written informed consent (eight females, two males; mean age ± standard deviation (SD), 23 ± 3.94 years old). Dartmouth Institutional Review Board approval was granted for all procedures. All subjects were right handed, as determined using the Edinburgh Handedness Inventory (Oldfield 1971).
Materials
A total of six different stimuli were used in the experiment, comprising four-number sequences consisting of the numbers 1 through 4. Stimuli did not contain runs of three or more consecutive numbers (e.g. 4123). Sequences 1234 and 4321 were used as practice stimuli. Of the six different stimuli selected, three were assigned to the TMS block, three were assigned to the no TMS block; the sequences assigned to each block were counterbalanced across subjects. Custom written MATLAB scripts were used to present stimuli to participants. Each stimulus was presented to subjects on a computer monitor for a total of 200 ms, after which time the screen went blank for 2 s, allowing time for the subjects to make their response. After the 2 s response window subjects received feedback as to their accuracy in reproducing the stimuli (correct/incorrect). Feedback information was available on the screen for 1 s, after which time the next trial commenced. The presentation of stimuli is depicted in Fig. 1.
Procedure
The experiment consisted of two sessions: (1) training session; (2) retest session. Each session was separated by 24 h and was carried out in the morning, between 8 am and noon. The timing of the task was important as previous studies have demonstrated that different aspects of a skill undergo consolidation over day and over night (Cohen et al. 2005; Cohen and Robertson 2007) and we wanted to ensure that all subjects were consolidating the skill in the same fashion. Subjects were seated 57 cm in front of a computer monitor and asked to place their left hand on the keyboard, with their fingers positioned over the keys A, S, D, F (such that their little finger was over A, ring finger over S, middle finger over D and index finger over F). Asking subjects to respond with their non-dominant left hand while we stimulated left M1 allowed us to specifically probe the involvement of M1 in response planning, without impairing response execution due to TMS-induced contraction of the intrinsic hand muscles of the contra-lateral hand. Subjects were instructed that a sequence of four numbers (comprising the numbers 1, 2, 3, 4) would appear briefly on the screen, and that their task was to reproduce the sequence of numbers using the keys A, S, D, F (which corresponded to the numbers 1, 2, 3, 4). The cue to respond appeared as soon as the numbers disappeared off the screen. Participants were instructed to make their response as quickly and accurately as possible. Before beginning each session, subjects were given a block of practice trials, where they practiced the sequences 1, 2, 3, 4 and 4, 3, 2, 1.
Training session
During the training session, subjects completed two blocks of trials: (1) TMS block; (2) no-TMS block. The presentation of blocks was counterbalanced across subjects. For the TMS block, TMS was delivered to the primary motor cortex on every trial (see below for details) simultaneous with presentation of the sequence. For the no TMS block, no TMS was delivered. Each block comprised 54 trials, made up of 18 repetitions of three different sequences. Within each block the trials were presented in a random order. Subjects were allowed a short break after each set of 18 trials.
Retest session
In the retest session subjects viewed: (1) TMS sequences; (2) No-TMS sequences. These sets of sequences were presented to subjects in separate blocks, the order of which was counterbalanced across subjects. It is important to note that no TMS was delivered in the retest session (the TMS sequences refer to the sequences where they had received TMS during the training session). For the no-TMS block these sequences were the same three sequences from the training session where subjects had received no TMS. For the TMS block the sequences were the three sequences where subjects had received TMS during the training session. Each block comprised a total of 18 trials, made up of six repetitions of three sequences. Within each block of 18 trials, half the trials were presented in a random fashion, and half were presented in a massed fashion, the order of which was counterbalanced across subjects.
Localization of brain site and TMS
One cortical site was chosen for stimulation: primary motor cortex of the left hemisphere. This site was localised functionally for all subjects, with the coil being placed tangentially over the skull with the handle pointing backwards. The coil was moved over the surface of the skull until a visible contraction of the intrinsic hand muscles in the right hand was observed. The intensity of the stimulation was gradually reduced to each subject’s motor threshold. Motor threshold was determined as the intensity required to produce a visible contraction of the intrinsic hand muscles on five out of ten consecutive trials.
A Neotonus PNS stimulator (model no. N-0233-A-110V) with an air cooled iron-core butterfly shaped coil was used to administer TMS. Pulse duration for this stimulator and head coil is 180 μs (at 100% of operating power). TMS was applied at 110% of motor threshold, which corresponded to an average stimulator output of 54.9% (range = 48–59%). Ear plugs were provided to dampen the noise associated with the discharge from the TMS coil. For the TMS block, subjects received two pulses of TMS to primary motor cortex on every trial, the first pulse was applied simultaneous with the presentation of the stimulus on the screen, and the second pulse occurred 100 ms after the first. Such a method of applying TMS has been described elsewhere (Rice et al. 2006, 2007; Cohen et al. 2009), and was utilized in to disrupt processing within M1 during the entire stimulus viewing period (for discussion, see Rice et al. 2006). It should be noted that two pulses of TMS on every trial, with a 100 ms inter-stimulation interval and a 3 s interval between pairs of trials, would not be expected to cause sustained alteration in cortical activity that is usually associated with rTMS. A review of all our studies using these stimulation parameters has shown that the effects of our double-pulsed TMS last approximately 350 ms after administration of the pulses (Cohen et al. 2009).
Statistical analysis
Trials were coded as incorrect if the wrong sequence was reproduced, if subjects commenced their reproduction while the stimulus was on the screen, or if subjects took more than 2 s to respond. Only correct trials were included in the analysis. For the training session this involved 91.12% of trials, and for the retest session this involved 91.67% of trials. Our dependent variables included response planning time and response execution time. Response planning time refers to the time subjects make the first key press, minus the disappearance of the stimuli from the screen. This pre-response interval may involve multiple steps, including selection, planning and preparation (Hoshi and Tanji 2007). Response execution time refers to the time subjects make their final key press, minus the time they make their first key press. For analysis of the training data, which provides a measure of skill acquisition, trials were binned into three groups of 18 trials (to make analysis of the training and retest data comparable). A repeated measures ANOVA was performed with the within-subjects factors of sequence (TMS versus no TMS sequences) and bin (three groups of 18 consecutive trials). To compute skill consolidation, we compared test to retest data. Here we computed the mean of the last 18 trials in the training data for each condition, and then subtracted this from each of the corresponding trials in the retest session. All data is provided in Table 1.
Table 1 Summarizes means and standard deviations for each condition