Simultaneous fMRI and tDCS for Enhancing Training of Flight Tasks.

There is a gap in our understanding of how best to apply transcranial direct-current stimulation (tDCS) to enhance learning in complex, realistic, and multifocus tasks such as aviation. Our goal is to assess the effects of tDCS and feedback training on task performance, brain activity, and connectivity using functional magnetic resonance imaging (fMRI). Experienced glider pilots were recruited to perform a one-day, three-run flight-simulator task involving varying difficulty conditions and a secondary auditory task, mimicking real flight requirements. The stimulation group (versus sham) received 1.5 mA high-definition HD-tDCS to the right dorsolateral prefrontal cortex (DLPFC) for 30 min during the training. Whole-brain fMRI was collected before, during, and after stimulation. Active stimulation improved piloting performance both during and post-training, particularly in novice pilots. The fMRI revealed a number of tDCS-induced effects on brain activation, including an increase in the left cerebellum and bilateral basal ganglia for the most difficult conditions, an increase in DLPFC activation and connectivity to the cerebellum during stimulation, and an inhibition in the secondary task-related auditory cortex and Broca's area. Here, we show that stimulation increases activity and connectivity in flight-related brain areas, particularly in novices, and increases the brain's ability to focus on flying and ignore distractors. These findings can guide applied neurostimulation in real pilot training to enhance skill acquisition and can be applied widely in other complex perceptual-motor real-world tasks.