Transcranial Direct Current Stimulation enhances long-term retention after 5 days of lower-limb motor skill learning

Transcranial direct current stimulation (tDCS) holds the potential to affect behavior by modulating ongoing neural activity, and tDCS paired with hand motor practice can enhance motor learning. While augmenting the behavioral benefits of motor practice is relevant for neurorehabilitation following central and peripheral lesions to the motor system, as well as in sports, the short- and long-term effects of tDCS targeting the mesial motor cortex (M1-Leg) during lower-limb motor skill practice remain unexplored. We tested whether five days of anodal tDCS over M1-Leg during training of a sequential visuomotor tracking task improves within- and between-session learning and one-week retention. Participants were randomized to skill practice with active tDCS, skill practice with sham stimulation, or volume-matched non-skilled ankle movements with sham stimulation. Changes in corticospinal excitability accompanying skill and nonskill motor practice with real and sham tDCS, were assessed as motor evoked potential amplitudes recorded from the tibialis anterior muscle at rest. Compared to non-skill practice, motor skill practice yielded robust sequence-specific performance gains, which were transferred to the untrained leg and persisted for at least one week after practice ended. Concurrent tDCS did not increase learning within or between training sessions, but it did lead to improved one-week retention compared to sham stimulation. Corticospinal excitability did not increase after practice and was unaffected by tDCS. These findings suggest that combining lower-limb motor skill practice with tDCS over M1-Leg can strengthen retention of skill learning without measurable changes in resting corticospinal excitability. This is relevant for motor practice scheduling in neurorehabilitation.