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Abbey C. Thomas, Brian G. Pietrosimone and Carter J. Bayer

Context: Transcranial magnetic stimulation (TMS) may provide important information regarding the corticospinal mechanisms that may contribute to the neuromuscular activation impairments. Paired-pulse TMS testing is a reliable method for measuring intracortical facilitation and inhibition; however, little evidence exists regarding agreement of these measures in the quadriceps. Objective: To determine the between-sessions and interrater agreement of intracortical excitability (short- and long-interval intracortical inhibition [SICI, LICI] and intracortical facilitation [ICF]) in the dominant-limb quadriceps. Design: Reliability study. Setting: Research laboratory. Participants: 13 healthy volunteers (n = 6 women; age 24.7 ± 2.1 y; height 1.7 ± 0.1 m; mass 77.1 ± 17.4 kg). Intervention: Participants completed 2 TMS sessions separated by 1 wk. Main Outcome Measures: Two investigators measured quadriceps SICI, LICI, and ICF at rest and actively (5% of maximal voluntary isometric contraction). All participants were seated in a dynamometer with the knee flexed to 90°. Intracortical-excitability paradigm and investigator order were randomized. Bland-Altman analyses were used to establish agreement. Results: Agreement was stronger between sessions within a single investigator than between investigators and for active than resting measures. Agreement was strongest for resting SICI and active ICF and LICI between sessions for each investigator. Conclusions: Quadriceps intracortical excitability may be measured longitudinally by a single investigator, though active muscle contraction should be elicited during testing.

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Masato Hirano, Shinji Kubota, Takuya Morishita, Kazumasa Uehara, Shusaku Fujimoto and Kozo Funase

The aim of this study was to investigate the plasticity of M1 innervating the tibialis anterior muscle (TA) induced by the long-term practice of football juggling using a transcranial magnetic stimulation (TMS) technique. Ten football juggling experts and ten novices participated in this study. Motor evoked potentials (MEP) and the H-reflex were recorded from the right TA during isometric dorsiflexion at 10% of maximum voluntary contraction. The MEP input-output curve of the experts was steeper than that of the novices, and reduced short-interval intracortical inhibition and long-interval intracortical inhibition were observed in the experts. In contrast, the ratio of Hmax to Mmax did not differ between the groups. Our results show that football juggling experts displayed enhanced excitability in the M1 innervating the TA, which was induced by the long-term practice of the ankle movements required to perform football juggling well.

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Sheng Li

This study investigated the possible role of the corticospinal system during force generation and force relaxation. Nine young and healthy subjects were instructed to produce a total force with four fingers within a hand following a preset force generation and relaxation ramp template closely. Excitability of corticospinal (CS) projections was assessed by single- and paired-pulse TMS. Errors introduced by a finger force were partially compensated by other finger forces during force generation, but were amplified during force relaxation. The CS excitability was greater during force generation than maintenance or relaxation. No difference in intracortical inhibition or facilitation was found. Nonnormalized finger extensor EMG responses remained unchanged. The findings suggest that force relaxation is not just a withdrawal from activation, and multifinger interactions are likely controlled beyond the primary motor cortex.

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Sofia I. Lampropoulou and Alexander V. Nowicky

The way psychometric and neurophysiological measurements of fatigue are connected is not well understood. Thus, the time course of perceived effort changes due to fatigue, as well as the peripheral and central neurophysiological changes accompanying fatigue, were evaluated. Twelve healthy participants (35 ± 9 years old) undertook 10 min intermittent isometric fatiguing exercise of elbow flexors at 50% of maximum voluntary contraction (MVC). Perceived effort ratings, using the 0–10 numeric rating scale (NRS), were recorded at midrange of MVC. Single pulse TMS of the left motor cortex and electrical stimulation over the biceps muscle was used for the assessment of voluntary activation and peripheral fatigue. The fatiguing exercise caused a 44% reduction in the MVC (p < .001) accompanied by an 18% nonsignificant reduction of the biceps MEP amplitude. The resting twitch force decreased (p < .001) while the superimposed twitches increased (p < .001) causing a decrease (19%) of the voluntary activation (p < .001). The perceived effort ratings increased by 1 point at 30%, by 2 points at 50% MVC respectively on the NRS (p < .001) and were accompanied by an increase in mean biceps EMG. A substantial role of the perceived effort in the voluntary motor control system was revealed.

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Sofia I. Lampropoulou and Alexander V. Nowicky

The purported ergogenic actions of transcranial direct current stimulation (tDCS) applied to motor cortex (M1) on force production and perception of effort were investigated using a 10-item numerical rating scale (0–10 NRS) in nonfatiguing bouts of a force-matching task utilizing isometric elbow flexion. Using a crossover design, 12 healthy volunteers received sham, anodal, and cathodal tDCS randomly for 10 min (1.5 mA, 62 μA/cm2) to the left M1 in a double-blind manner. Corticospinal excitability changes were also monitored using transcranial magnetic stimulation (TMS) with surface electromyography (sEMG) to monitor both motor evoked potentials (MEPs) and force-EMG from right m. biceps brachii and m. brachioradialis brachii. No significant differences between the verum and sham stimulation were obtained for elbow flexion maximum voluntary force, perception of effort, or sEMG. There were also no significant differences in MEP changes for the types of tDCS, which is consistent with reports that tDCS excitability effects are diminished during ongoing cognitive and motor activities.

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Emma C. Neupert, Stewart T. Cotterill and Simon A. Jobson

An effective training-monitoring system (TMS) can positively influence performance through monitoring program effectiveness and reducing the risk of illness or injury. 1 However, successfully implementing a TMS can be problematic in elite sport, with issues relating to end-user buy-in and a

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Urs Granacher, Andre Lacroix, Katrin Roettger, Albert Gollhofer and Thomas Muehlbauer

This study investigated associations between variables of trunk muscle strength (TMS), spinal mobility, and balance in seniors. Thirty-four seniors (sex: 18 female, 16 male; age: 70 ± 4 years; activity level: 13 ± 7 hr/week) were tested for maximal isometric strength (MIS) of the trunk extensors, flexors, lateral flexors, rotators, spinal mobility, and steady-state, reactive, and proactive balance. Significant correlations were detected between all measures of TMS and static steady-state balance (r = .43−.57, p < .05). Significant correlations were observed between specific measures of TMS and dynamic steady-state balance (r = .42−.55, p < .05). No significant correlations were found between all variables of TMS and reactive/proactive balance and between all variables of spinal mobility and balance. Regression analyses revealed that TMS explains between 1–33% of total variance of the respective balance parameters. Findings indicate that TMS is related to measures of steady-state balance which may imply that TMS promoting exercises should be integrated in strength training for seniors.

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Y.L. Lo, H.H. Zhang, C.C. Wang, Z.Y. Chin, S. Fook-Chong, C. Gabriel and C.T. Guan

In overt reading and singing tasks, actual vocalization of words in a rhythmic fashion is performed. During execution of these tasks, the role of underlying vascular processes in relation to cortical excitability changes in a spatial manner is uncertain. Our objective was to investigate cortical excitability changes during reading and singing with transcranial magnetic stimulation (TMS), as well as vascular changes with nearinfrared spectroscopy (NIRS). Findings with TMS and NIRS were correlated. TMS and NIRS recordings were performed in 5 normal subjects while they performed reading and singing tasks separately. TMS was applied over the left motor cortex at 9 positions 2.5 cm apart. NIRS recordings were made over these identical positions. Although both TMS and NIRS showed significant mean cortical excitability and hemodynamic changes from baseline during vocalization tasks, there was no significant spatial correlation of these changes evaluated with the 2 techniques over the left motor cortex. Our findings suggest that increased left-sided cortical excitability from overt vocalization tasks in the corresponding “hand area” were the result of “functional connectivity,” rather than an underlying “vascular overflow mechanism” from the adjacent speech processing or face/mouth areas. Our findings also imply that functional neurophysiological and vascular methods may evaluate separate underlying processes, although subjects performed identical vocalization tasks. Future research combining similar methodologies should embrace this aspect and harness their separate capabilities.

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Robert Chen and Kaviraja Udupa

Several techniques that involve transcranial magnetic stimulation (TMS) can be used to measure brain plasticity noninvasively in humans. These include paired-associative stimulation (PAS), repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS). Some of these techniques are based the principle of use dependent plasticity or are designed to mimic protocols used to induce long-term potentiation or depression in animal studies. These studies have been applied to certain neurological and psychiatric disorders to investigate their pathophysiology. For example, PAS induced plasticity is enhanced in dystonia and stroke but is reduced in Huntington’s disease and schizophrenia. Furthermore, TMS may be used to modulate brain plasticity and has therapeutic potential in neurological and psychiatric disorders such as stroke, Parkinson’s disease, dystonia and depression.

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Brittney A. Luc, Adam S. Lepley, Michael A. Tevald, Phillip A. Gribble, Donald B. White and Brian G. Pietrosimone


Alterations in corticomotor excitability are observed in a variety of patient populations, including the musculature surrounding the knee and ankle after joint injury. Active motor threshold (AMT) and motor-evoked-potential (MEP) amplitudes elicited through transcranial magnetic stimulation (TMS) are outcome measures used to assess corticomotor excitability and have been deemed reliable in upper-extremity musculature. However, there are few studies assessing the reliability of TMS measures in lower-extremity musculature.


To determine the intersession reliability of AMT and MEP amplitudes over 14 and 28 d in the quadriceps and fibularis longus (FL).


Descriptive laboratory study.


University laboratory


20 able-bodied volunteers (10 men, 10 women; 22.35 ± 2.3 y, 1.71 ± 0.11 m, 73.61 ± 16.77 kg).

Main Outcome Measures:

AMT and MEP amplitudes were evaluated at 95%, 100%, 105%, 110%, 120%, 130%, and 140% of AMT in the dominant and nondominant quadriceps and FL. Interclass correlation coefficients (ICCs) were used to assess reliability for absolute agreement and internal consistency between baseline and 2 follow-up sessions at 14 and 28 d postbaseline. Each ICC was fit with the best-fit straight line or parabola to smooth out noise in the observations and best determine if a pattern existed in determining the most reliable MEP value.


All muscles yielded strong ICCs between baseline and both time points for AMT. MEPs in both the quadriceps and FL produced varying degrees of reliability, with the greatest reliability demonstrated on day 28 at 130% and 140% of AMT in the quadriceps and FL, respectively. The dominant FL muscle showed a significant pattern; as TMS intensity increased, MEP reliability increased.


TMS can be used to reliably identify corticomotor alterations after therapeutic interventions, as well as monitor disease progression.