Intersession reliability of quadriceps corticospinal excitability: A functional transcranial magnetic stimulation study

Young, Kiana M.; Rush, Justin L.; Lepley, Adam S.; Girmann, Adam M.; Norte, Grant E.

doi:10.1016/j.brainres.2023.148348

Cited by 2 publications

(4 citation statements)

References 31 publications

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“…Previous reliability studies in healthy participants have reported quadriceps AMT reliability to range between moderate to excellent, despite the different criterion used during AMT determination. 14,20,30 In accordance with prior studies, the relative approach in our investigation exhibited good-to-excellent reliability, and the absolute approach demonstrated moderate-to-excellent reliability. While mean AMT estimations across visits shifted in a similar direction for each criterion, our results indicated an overestimation of AMT across visits for the absolute approach.…”

Section: Discussionsupporting

confidence: 90%

“…To our knowledge, only one investigation reported good reliability (ICC = .850) in AMTs acquired from a quadriceps muscle (rectus femoris) using this same relative criterion. 14 Outside of that investigation, reliability of active TMS variables acquired via relative thresholding criteria in the quadriceps were not explored until the works of Temesi et al and Shih et al, in which moderate-toexcellent reliability was reported for VL MEPs and specific input/output curve variables during singlepulse stimulation 30,31 Considerations regarding AMT reporting and parameters for certain voltage criteria may be evaluated on a case-by-case basis. The SEM and MD scores observed in our study suggest that relative criterion approaches may be more sensitive in detecting AMT changes that can be considered meaningful.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only one investigation reported good reliability (ICC = .850) in AMTs acquired from a quadriceps muscle (rectus femoris) using this same relative criterion. 14 Outside of that investigation, reliability of active TMS variables acquired via relative thresholding criteria in the quadriceps were not explored until the works of Temesi et al and Shih et al, in which moderate-to-excellent reliability was reported for VL MEPs and specific input/output curve variables during single-pulse stimulation 30,31 . Of note, both the Temesi et al and Shih et al investigations used a relative thresholding criterion of “discernable” MEP responses larger than background EMG activation during 20% MVIC, which differed from the relative criterion of 2× background EMG at 10% MVIC employed in our investigation.…”

Section: Discussionmentioning

confidence: 99%

“…As our investigation assessed AMT estimations during open-chain activation, re-examining these criteria in more functional conditions (i.e., closed-chain) may yield different outcomes. For reference, Young et al used the TMS Motor Threshold Assessment Tool 12 to determine AMTs for the vastus medialis and demonstrated poor-togood reliability during a single let squat condition 30 . It is still unclear whether the voltage approaches used in the present investigation would yield better test-retest reliability during closed-chain activation.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of Techniques to Determine Active Motor Threshold for Transcranial Magnetic Stimulation Research

Beausejour,

Rusch,

Knowles

et al. 2024

Preprint

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The determination of active motor threshold (AMT) is a critical step in transcranial magnetic stimulation (TMS) research protocols involving voluntary muscle contractions. As AMT is frequently determined using an absolute electromyographic (EMG) threshold (e.g., 200 microvolts peak-to-peak amplitude), wide variation in EMG recordings across participants has given reason to consider a relative threshold (e.g., = 2x background EMG) for AMT determination. However, these approaches have never been systemically compared. PURPOSE: We sought to compare the AMT values derived from absolute and relative criteria commonly used to determine AMT in the quadriceps muscles, and assess the test-retest reliability of each approach (absolute = 200 microvolts vs. relative = 2x background EMG). METHODS: Eighteen young adults (9 males and 9 females; mean +/- SD age = 23 +/- 2 years) visited the research laboratory on two occasions. All testing was conducted on the dominant limb. During each laboratory visit, maximal voluntary isometric contraction (MVIC) quadriceps torque was measured, with all subsequent TMS procedures conducted as participants maintained 10% of MVIC torque. AMT values were derived from each criterion using motor evoked potentials recorded from the vastus lateralis (VL) and defined as the lowest stimulator output (SO%) needed to meet the specified criteria within at least 5/10 pulses. The order of criteria (i.e., absolute vs. relative) was randomized during the first laboratory visit, and counterbalanced during the second visit. A paired samples t-test, 95% confidence intervals and the effect size were used to compare mean differences in AMT values obtained from each criterion during the second laboratory visit. Paired samples t-tests, intraclass correlation coefficients (ICC2,1), standard errors of measurement (SEMs), and the minimal difference (MD) scores were calculated to assess test-retest reliability of each AMT criterion. RESULTS: Differences between the AMT criteria were small and not statistically significant (absolute criterion mean = 48.9%, relative criterion mean = 47.4%; p = .309, Cohens d = 0.247). The absolute criterion demonstrated moderate to excellent reliability (ICC2,1= .866 [0.648 , 0.950], SEM = 7.9%, MD = 10.4%), but higher AMTs were observed in the second visit compared to the first (p = 0.043). The relative criteria demonstrated good-to-excellent test-retest reliability (ICC2,1= .894 [0.746 , 0.959], SEM = 6.9%, MD = 8.9%) and AMTs were not different between visits (p = 0.420). CONCLUSION: Quantifying AMT with an absolute voltage threshold of 200 microvolts peak-to-peak amplitude and a relative voltage threshold 2x background EMG resulted in similar values within a single testing session. However, the relative voltage criterion demonstrated superior test-rest reliability. TMS researchers aiming to track cortical or corticospinal characteristics across visits should consider implementing relative criterion approaches during their AMT determination protocol.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only one investigation reported good reliability (ICC = .850) in AMTs acquired from a quadriceps muscle (rectus femoris) using this same relative criterion. 14 Outside of that investigation, reliability of active TMS variables acquired via relative thresholding criteria in the quadriceps were not explored until the works of Temesi et al and Shih et al, in which moderate-to-excellent reliability was reported for VL MEPs and specific input/output curve variables during single-pulse stimulation 30,31 . Of note, both the Temesi et al and Shih et al investigations used a relative thresholding criterion of “discernable” MEP responses larger than background EMG activation during 20% MVIC, which differed from the relative criterion of 2× background EMG at 10% MVIC employed in our investigation.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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