Head and shoulders-The impact of an extended head model on the simulation and optimization of transcranial electric stimulation.

Electric field calculations are increasingly used for dose characterization of transcranial electrical stimulation (tES), but existing open-source head models are inaccurate for extracephalic montages that include electrodes placed on the neck or shoulder. We introduce the "Ernie Extended" model, an MRI- and CT-derived open-source head model extending to the upper shoulder region. Simulations of extracephalic tES targeting the cerebellum and supplementary motor area show significant differences in electric fields when using Ernie Extended compared to the non-extended Ernie model. Additionally, we propose an electrode layout that complements the electroencephalography 10-20 system with extracephalic electrode positions. We demonstrate the use of this layout for optimizing multi-electrode tES montages for cerebellar stimulation, enhancing focality, and reducing off-target stimulation, particularly of the spinal cord. Our results highlight the practical value of the Ernie Extended model for accurately characterizing doses produced by extracephalic tES montages and when targeting more caudal brain regions.