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      The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period

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          Abstract

          Background. Upper-limb impairment in patients with chronic stroke appears to be partly attributable to an upregulated reticulospinal tract (RST). Here, we assessed whether the impact of corticospinal (CST) and RST connectivity on motor impairment and skill-acquisition differs in sub-acute stroke, using transcranial magnetic stimulation (TMS)–based proxy measures. Methods. Thirty-eight stroke survivors were randomized to either reach training 3-6 weeks post-stroke (plus usual care) or usual care only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and contralesional cortical connectivity (surrogates for CST and RST connectivity, respectively) to weak pre-activated triceps and deltoid muscles with single pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity Index) and synergies (Fugl-Meyer upper-limb score). Results. Strength and presence of synergies were associated with ipsilesional (CST) connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar reaching skill beyond that expected from spontaneous recovery and occurred for both weak and strong ipsilesional tract integrity. Reaching ability, presence of synergies, skill-acquisition and strength were not affected by either the presence or absence of contralesional (RST) connectivity. Conclusion. The degree of ipsilesional CST connectivity is the main determinant of proximal dexterity, upper-limb strength and synergy expression in sub-acute stroke. In contrast, there is no evidence for enhanced contralesional RST connectivity contributing to any of these components of impairment. In the sub-acute post-stroke period, the balance of activity between CST and RST may matter more for the paretic phenotype than RST upregulation per se.

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          Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research.

          This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7-9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible.
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            Development of recommendations for SEMG sensors and sensor placement procedures

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              Development of recommendations for SEMG sensors and sensor placement procedures.

              The knowledge of surface electromyography (SEMG) and the number of applications have increased considerably during the past ten years. However, most methodological developments have taken place locally, resulting in different methodologies among the different groups of users.A specific objective of the European concerted action SENIAM (surface EMG for a non-invasive assessment of muscles) was, besides creating more collaboration among the various European groups, to develop recommendations on sensors, sensor placement, signal processing and modeling. This paper will present the process and the results of the development of the recommendations for the SEMG sensors and sensor placement procedures. Execution of the SENIAM sensor tasks, in the period 1996-1999, has been handled in a number of partly parallel and partly sequential activities. A literature scan was carried out on the use of sensors and sensor placement procedures in European laboratories. In total, 144 peer-reviewed papers were scanned on the applied SEMG sensor properties and sensor placement procedures. This showed a large variability of methodology as well as a rather insufficient description. A special workshop provided an overview on the scientific and clinical knowledge of the effects of sensor properties and sensor placement procedures on the SEMG characteristics. Based on the inventory, the results of the topical workshop and generally accepted state-of-the-art knowledge, a first proposal for sensors and sensor placement procedures was defined. Besides containing a general procedure and recommendations for sensor placement, this was worked out in detail for 27 different muscles. This proposal was evaluated in several European laboratories with respect to technical and practical aspects and also sent to all members of the SENIAM club (>100 members) together with a questionnaire to obtain their comments. Based on this evaluation the final recommendations of SENIAM were made and published (SENIAM 8: European recommendations for surface electromyography, 1999), both as a booklet and as a CD-ROM. In this way a common body of knowledge has been created on SEMG sensors and sensor placement properties as well as practical guidelines for the proper use of SEMG.
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                Author and article information

                Journal
                Neurorehabil Neural Repair
                Neurorehabil Neural Repair
                spnnr
                NNR
                Neurorehabilitation and Neural Repair
                SAGE Publications (Sage CA: Los Angeles, CA )
                1545-9683
                1552-6844
                4 July 2021
                September 2021
                : 35
                : 9
                : 812-822
                Affiliations
                [1 ]Geoffrey Jefferson Brain Research Centre, Ringgold 158986, universityManchester Academic Health Science Centre; , Faculty of Biology, Medicine and Healthy, Ringgold 5292, universityUniversity of Manchester; , Manchester, UK
                [2 ]Department of Health Professions, Faculty of Health, Psychology and Social Care, Ringgold 5289, universityManchester Metropolitan University; , Manchester, UK
                [3 ]Department of Medical Physics, universityNorthern Care Alliance NHS Trust; , Salford, UK
                [4 ]Department of Health Sciences, Ringgold 105168, universityUniversity of Salford; , Salford, UK
                [5 ]Departments of Neurology, Neuroscience and Physical Medicine & Rehabilitation, Ringgold 1500, universityThe John Hopkins University School of Medicine; , Baltimore, MD, USA
                [6 ]universityThe Santa Fe Institute; , Santa Fe, NM, USA
                [7 ]Institute of Neurology, universityUniversity College London; , London, UK
                Author notes
                [*]Ulrike Hammerbeck, PhD, The Manchester Academic Health Science Centre, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Hulme, Manchester M15 6GX, UK. Email: u.hammerbeck@ 123456mmu.ac.uk
                Author information
                https://orcid.org/0000-0003-2657-4347
                https://orcid.org/0000-0001-6301-8791
                Article
                10.1177_15459683211028243
                10.1177/15459683211028243
                8414832
                34219510
                5f95529b-d2ae-4113-802e-d54240c49d21
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Funding
                Funded by: The Stroke Association, Post-doctoral Fellowship;
                Award ID: TSA PDF 2015/02
                Categories
                Original Research Articles
                Custom metadata
                ts10

                stroke,upper limb,motor impairment,skill learning,corticospinal tract,reticulospinal tract

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