Repetitive Transcranial Magnetic Stimulation Primed Self-controlled Practice on Motor Learning

NCT ID: NCT07197346

Last Updated: 2025-09-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

72 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-01

Study Completion Date

2028-12-31

Brief Summary

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This study aims to investigate the additive effects of combining self-controlled practice with repetitive transcranial magnetic stimulation (rTMS) pretreatment on motivation enhancement and motor learning performance in healthy young adults. According to the "Optimizing Performance Through Intrinsic Motivation and Attention for Learning" (OPTIMAL) theory, numerous studies have demonstrated that providing learners with autonomy during practice can facilitate intrinsic motivation and motor learning. However, self-controlled practice alone may have limited effects, and further interventions may be required to amplify learning outcomes.

In recent years, non-invasive brain stimulation techniques-particularly high-frequency (facilitatory) rTMS applied to the dorsolateral prefrontal cortex (DLPFC)-have been shown to enhance motivational drive and explicit learning performance by strengthening the connectivity of the DLPFC-midbrain dopamine pathway. For example, 10 Hz high-frequency stimulation can significantly improve learners' accuracy and motivation. Interestingly, several sequence learning studies have found that low-frequency (inhibitory) rTMS, when used as a priming intervention, can instead enhance implicit procedural learning. This effect may occur because inhibiting the lateral prefrontal cortex reduces its top-down suppression of implicit learning systems, thereby releasing procedural learning potential.

Based on the theory of metaplasticity, applying facilitatory or inhibitory stimulation beforehand can alter the threshold of synaptic plasticity, thus influencing subsequent learning outcomes. Therefore, this study designed two DLPFC pretreatments-facilitatory and inhibitory-and combined them with self-controlled practice to systematically examine the interaction between different stimulation protocols on motivation and motor learning.

This cross-sectional experiment plans to recruit 72 healthy participants aged 20 or older, randomly assigned to one of six groups: (1) facilitatory rTMS + self-controlled practice, (2) facilitatory rTMS + yoked control, (3) inhibitory rTMS + self-controlled practice, (4) inhibitory rTMS + yoked control, (5) sham rTMS + self-controlled practice, and (6) sham rTMS + yoked control.

The experiment will last for seven days. On Day 1, participants will complete baseline testing, followed by facilitatory rTMS, inhibitory rTMS, or sham stimulation over the DLPFC. Immediately afterward, they will engage in a trajectory-tracking learning task (manipulating a joystick to reproduce a sine-wave pattern). After practice, participants will complete a motivation assessment. During the trajectory-tracking task, the self-controlled group can choose when to receive feedback to adjust their learning, whereas the yoked control group will receive feedback at time points matched to their paired counterpart.

On Day 2, participants will again receive the assigned rTMS (facilitatory, inhibitory, or sham), complete the trajectory-tracking task, and undergo a motivation assessment. After a five-minute rest, they will perform retention and transfer tests, followed by TMS measurement of cortical excitability. On Day 7, participants will return to the laboratory to complete another retention and transfer test, along with cortical excitability measurement via TMS.

The primary behavioral outcomes are the root mean square error (RMSE) and error estimation (EE) in the trajectory-tracking task. Motivation will be assessed using the Intrinsic Motivation Inventory (IMI). As there have been no prior studies combining DLPFC rTMS pretreatment with practice autonomy, the results of this experimental design are expected to provide new insights and references for enhancing motor learning ability in healthy adults.

Detailed Description

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Conditions

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rTMS Stimulation Autonomy Healthy Young Adults

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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iTBS + autonomy

Participants receive intermittent theta-burst stimulation (iTBS) as priming, followed by self-controlled practice of a joystick task. The participants will be able to self-select the trials for receiving feedback.

Group Type EXPERIMENTAL

Self-controlled (autonomy)

Intervention Type BEHAVIORAL

Self-controlled practice is a motor learning intervention in which participants are granted autonomy to make choices about key aspects of their practice sessions (e.g., when to receive feedback, the sequence/timing of trials, or selection of specific practice parameters). This design allows participants to actively control elements of the training experience according to their preference, thereby fostering intrinsic motivation and engagement. The intervention is grounded in the OPTIMAL theory of motor learning, which highlights the role of autonomy support in enhancing learning outcomes and motivation. In this study, participants in the self-controlled practice group make their own decisions regarding practice conditions, in contrast to yoked controls who follow externally assigned parameters.

rTMS- iTBS (Intermittent Theta-Burst Stimulation)

Intervention Type DEVICE

Intermittent theta-burst stimulation (iTBS) is a patterned form of repetitive transcranial magnetic stimulation (rTMS) consisting of bursts of three pulses at 50Hz, repeated every 200ms (5Hz). In this study, iTBS is delivered over the target cortical area using standard protocols (e.g., 2s trains of TBS repeated every 10s for a total of 600 pulses) at an intensity set as a percentage of the resting motor threshold. The procedure aims to facilitate cortical excitability as a priming intervention prior to motor practice.

iTBS + Yoked

Participants receive iTBS priming, then perform motor practice with yoked (non-self-controlled) parameters matched to a self-controlled participant.

Group Type ACTIVE_COMPARATOR

Yoked Practice

Intervention Type BEHAVIORAL

Yoked practice refers to a motor learning protocol in which participants perform tasks under externally controlled practice conditions, matched to the parameters (e.g., feedback) of a paired participant from a self-controlled practice group. This design removes participant autonomy over practice choices, allowing comparison between self-controlled and externally controlled practice to evaluate the effects of autonomy on motor learning and motivation.

rTMS- iTBS (Intermittent Theta-Burst Stimulation)

Intervention Type DEVICE

Intermittent theta-burst stimulation (iTBS) is a patterned form of repetitive transcranial magnetic stimulation (rTMS) consisting of bursts of three pulses at 50Hz, repeated every 200ms (5Hz). In this study, iTBS is delivered over the target cortical area using standard protocols (e.g., 2s trains of TBS repeated every 10s for a total of 600 pulses) at an intensity set as a percentage of the resting motor threshold. The procedure aims to facilitate cortical excitability as a priming intervention prior to motor practice.

cTBS + autonomy

Participants receive continuous theta-burst stimulation (cTBS) as priming, followed by self-controlled practice of a joystick task. The participants will be able to self-select the trials for receiving feedback.

Group Type EXPERIMENTAL

rTMS - cTBS (Continuous Theta-Burst Stimulation)

Intervention Type DEVICE

Continuous theta-burst stimulation (cTBS) is a patterned form of rTMS consisting of bursts of three pulses at 50Hz, repeated every 200ms (5Hz), administered continuously without breaks. In this study, cTBS is delivered over the target cortical area according to established safety guidelines (e.g., a continuous 40s train for a total of 600 pulses) at an intensity set as a percentage of the resting motor threshold. The procedure is used to induce a transient reduction in cortical excitability as a priming intervention prior to motor practice.

Self-controlled (autonomy)

Intervention Type BEHAVIORAL

Self-controlled practice is a motor learning intervention in which participants are granted autonomy to make choices about key aspects of their practice sessions (e.g., when to receive feedback, the sequence/timing of trials, or selection of specific practice parameters). This design allows participants to actively control elements of the training experience according to their preference, thereby fostering intrinsic motivation and engagement. The intervention is grounded in the OPTIMAL theory of motor learning, which highlights the role of autonomy support in enhancing learning outcomes and motivation. In this study, participants in the self-controlled practice group make their own decisions regarding practice conditions, in contrast to yoked controls who follow externally assigned parameters.

cTBS + Yoked

Participants receive cTBS priming, then perform motor practice with yoked practice parameters.

Group Type ACTIVE_COMPARATOR

rTMS - cTBS (Continuous Theta-Burst Stimulation)

Intervention Type DEVICE

Continuous theta-burst stimulation (cTBS) is a patterned form of rTMS consisting of bursts of three pulses at 50Hz, repeated every 200ms (5Hz), administered continuously without breaks. In this study, cTBS is delivered over the target cortical area according to established safety guidelines (e.g., a continuous 40s train for a total of 600 pulses) at an intensity set as a percentage of the resting motor threshold. The procedure is used to induce a transient reduction in cortical excitability as a priming intervention prior to motor practice.

Yoked Practice

Intervention Type BEHAVIORAL

Yoked practice refers to a motor learning protocol in which participants perform tasks under externally controlled practice conditions, matched to the parameters (e.g., feedback) of a paired participant from a self-controlled practice group. This design removes participant autonomy over practice choices, allowing comparison between self-controlled and externally controlled practice to evaluate the effects of autonomy on motor learning and motivation.

Sham + autonomy

Participants receive sham TBS stimulation as priming, followed by self-controlled practice of a joystick task. The participants will be able to self-select the trials for receiving feedback.

Group Type SHAM_COMPARATOR

Self-controlled (autonomy)

Intervention Type BEHAVIORAL

Self-controlled practice is a motor learning intervention in which participants are granted autonomy to make choices about key aspects of their practice sessions (e.g., when to receive feedback, the sequence/timing of trials, or selection of specific practice parameters). This design allows participants to actively control elements of the training experience according to their preference, thereby fostering intrinsic motivation and engagement. The intervention is grounded in the OPTIMAL theory of motor learning, which highlights the role of autonomy support in enhancing learning outcomes and motivation. In this study, participants in the self-controlled practice group make their own decisions regarding practice conditions, in contrast to yoked controls who follow externally assigned parameters.

Sham

Intervention Type DEVICE

Sham TBS involves the application of a sham theta-burst stimulation protocol designed to mimic the sensory experience of active TBS without delivering effective magnetic pulses to the brain. This is typically achieved by angling the coil to prevent cortical stimulation. The procedure controls for placebo effects and participant expectations while ensuring blinding. The sham stimulation session matches the timing and setup of active TBS interventions but does not induce cortical excitability changes.

Sham + Yoked

Participants receive sham TBS priming, then perform motor practice with yoked parameters.

Group Type SHAM_COMPARATOR

Sham

Intervention Type DEVICE

Sham TBS involves the application of a sham theta-burst stimulation protocol designed to mimic the sensory experience of active TBS without delivering effective magnetic pulses to the brain. This is typically achieved by angling the coil to prevent cortical stimulation. The procedure controls for placebo effects and participant expectations while ensuring blinding. The sham stimulation session matches the timing and setup of active TBS interventions but does not induce cortical excitability changes.

Yoked Practice

Intervention Type BEHAVIORAL

Yoked practice refers to a motor learning protocol in which participants perform tasks under externally controlled practice conditions, matched to the parameters (e.g., feedback) of a paired participant from a self-controlled practice group. This design removes participant autonomy over practice choices, allowing comparison between self-controlled and externally controlled practice to evaluate the effects of autonomy on motor learning and motivation.

Interventions

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rTMS - cTBS (Continuous Theta-Burst Stimulation)

Continuous theta-burst stimulation (cTBS) is a patterned form of rTMS consisting of bursts of three pulses at 50Hz, repeated every 200ms (5Hz), administered continuously without breaks. In this study, cTBS is delivered over the target cortical area according to established safety guidelines (e.g., a continuous 40s train for a total of 600 pulses) at an intensity set as a percentage of the resting motor threshold. The procedure is used to induce a transient reduction in cortical excitability as a priming intervention prior to motor practice.

Intervention Type DEVICE

Self-controlled (autonomy)

Self-controlled practice is a motor learning intervention in which participants are granted autonomy to make choices about key aspects of their practice sessions (e.g., when to receive feedback, the sequence/timing of trials, or selection of specific practice parameters). This design allows participants to actively control elements of the training experience according to their preference, thereby fostering intrinsic motivation and engagement. The intervention is grounded in the OPTIMAL theory of motor learning, which highlights the role of autonomy support in enhancing learning outcomes and motivation. In this study, participants in the self-controlled practice group make their own decisions regarding practice conditions, in contrast to yoked controls who follow externally assigned parameters.

Intervention Type BEHAVIORAL

Sham

Sham TBS involves the application of a sham theta-burst stimulation protocol designed to mimic the sensory experience of active TBS without delivering effective magnetic pulses to the brain. This is typically achieved by angling the coil to prevent cortical stimulation. The procedure controls for placebo effects and participant expectations while ensuring blinding. The sham stimulation session matches the timing and setup of active TBS interventions but does not induce cortical excitability changes.

Intervention Type DEVICE

Yoked Practice

Yoked practice refers to a motor learning protocol in which participants perform tasks under externally controlled practice conditions, matched to the parameters (e.g., feedback) of a paired participant from a self-controlled practice group. This design removes participant autonomy over practice choices, allowing comparison between self-controlled and externally controlled practice to evaluate the effects of autonomy on motor learning and motivation.

Intervention Type BEHAVIORAL

rTMS- iTBS (Intermittent Theta-Burst Stimulation)

Intermittent theta-burst stimulation (iTBS) is a patterned form of repetitive transcranial magnetic stimulation (rTMS) consisting of bursts of three pulses at 50Hz, repeated every 200ms (5Hz). In this study, iTBS is delivered over the target cortical area using standard protocols (e.g., 2s trains of TBS repeated every 10s for a total of 600 pulses) at an intensity set as a percentage of the resting motor threshold. The procedure aims to facilitate cortical excitability as a priming intervention prior to motor practice.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Healthy adults aged 18-35 years
2. Right-handed (per Edinburgh Handedness Inventory)
3. Normal or corrected-to-normal vision and hearing
4. Eligible for non-invasive brain stimulation per safety screening (no contraindications to TMS)
5. Able to understand study procedures and provide written informed consent in Chinese
6. Willing to comply with all study visits and tasks, including TBS/rTMS and motor practice
7. For yoked pairing: able to be matched to a counterpart participant for practice parameters

Exclusion Criteria

1. History of epilepsy, seizures, or unexplained fainting; family history of epilepsy in first-degree relatives
2. Any intracranial metal or implanted medical devices (e.g., cochlear implant, deep brain stimulator, aneurysm clips); non-removable metallic objects in head/neck
3. Cardiac pacemaker or other implanted electronic devices
4. Current or past major neurological or psychiatric disorders (e.g., stroke, traumatic brain injury, multiple sclerosis, major depression, bipolar disorder, schizophrenia)
5. Current use of medications lowering seizure threshold or affecting cortical excitability (e.g., tricyclic antidepressants, bupropion, clozapine, lithium, stimulant or sedative-hypnotic abuse); or unstable psychotropic regimens
6. Active migraine with aura or chronic severe headaches
7. Pregnancy or planning pregnancy during participation; breastfeeding (if your site policy excludes)
8. Substance or alcohol use disorder within the past 12 months; positive alcohol/drug screen on visit days
9. Sleep deprivation (\<5 hours) on the day before stimulation, or excessive caffeine (\>400 mg) within 6 hours pre-stimulation
10. Dermatologic conditions or open wounds at stimulation or EMG/electrode sites
11. Prior extensive training on the specific motor task used in this study (risk of ceiling effects)
12. Concurrent participation in another interventional study or received brain stimulation (TMS/tDCS) within the past 3 months
13. Any condition that, in the investigator's judgment, makes participation unsafe or data unreliable
Minimum Eligible Age

18 Years

Maximum Eligible Age

35 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Science and Technology Council, R.O.C.

UNKNOWN

Sponsor Role collaborator

National Taiwan University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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National Taiwan University Hospital

Taipei, , Taiwan

Site Status RECRUITING

Countries

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Taiwan

Central Contacts

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Min Tse Lee, bachelor

Role: CONTACT

+886 986858379

Facility Contacts

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Ya Yun Lee, Associate Professor

Role: primary

02-33668155

Other Identifiers

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202506021RINB

Identifier Type: -

Identifier Source: org_study_id

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