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PERSPECTIVE article

Front. Hum. Neurosci.
Sec. Motor Neuroscience
Volume 18 - 2024 | doi: 10.3389/fnhum.2024.1408818
This article is part of the Research Topic The Role of Neuromodulation Techniques in Facilitating Motor Recovery and Brain Plasticity: An Integrative Approach View all articles

TMS assessment of Corticospinal Tract integrity after stroke: Broadening the concept to inform Neurorehabilitation Prescription

Provisionally accepted
Sapna Kumar Sapna Kumar 1*Mary Ferraro Mary Ferraro 1Lienhoung Nguyen Lienhoung Nguyen 2Ning Cao Ning Cao 3Nathaniel Ung Nathaniel Ung 1,4Joshua S. Jose Joshua S. Jose 2Cheryl Weidenauer Cheryl Weidenauer 2Dylan J. Edwards Dylan J. Edwards 1Nathaniel H. Mayer Nathaniel H. Mayer 2
  • 1 Moss Rehabilitation Research Institute (MRRI), Philadelphia, United States
  • 2 Moss Rehabilitation Hospital, Philadelphia, Pennsylvania, United States
  • 3 School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  • 4 Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States

The final, formatted version of the article will be published soon.

    Upper limb actions require intersegmental coordination of scapula, shoulder, elbow, forearm, wrist and hand muscles. Stroke hemiparesis, presenting as impairment of intersegmentally coordinated voluntary movement, is associated with altered integrity of corticospinal tract (CST) transmission from motor cortex (M1) to muscles. Motor Evoked Potentials (MEPs) elicited by M1 TMS of “at rest” muscles, or as a back-up, during muscle contraction, has been used to identify CST integrity and predict outcome after hemiparesis, under the implicit assumption that MEP presence in only one or two muscles are manifest surrogates of CST integrity for other muscles of the upper limb. This paper describes a method of applying TMS during motor tasks that span proximal and distal muscles, evaluating multi-muscle electromyography (EMG) and MEPs across all task-relevant limb segments. Protocols are presented for assessing voluntary motor behavior in hemiparetic stroke using isometric, unimanual, bimanual and ‘REST’ conditions that broaden the concept of the degree of CST integrity in order to inform clinical prescription for neurorehabilitation, and is to be differentiated from a potential prognostic role. Data describing multi-muscle TMS-MEP recordings will be presented in a case of subacute hemiparetic stroke to elucidate our perspective.

    Keywords: Transcranial magnetic stimulation (TMS), Stroke, multi-muscle, EMG - Electromyogram, Neuromodulation, motor recovery, Therapy prescription, hemiparesis

    Received: 28 Mar 2024; Accepted: 31 Jul 2024.

    Copyright: © 2024 Kumar, Ferraro, Nguyen, Cao, Ung, Jose, Weidenauer, Edwards and Mayer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Sapna Kumar, Moss Rehabilitation Research Institute (MRRI), Philadelphia, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.