A method to monitor corticomotor excitability during passive rhythmic movement of the upper limb

A procedure is outlined in which the excitability of the corticomotor pathway is examined during rhythmic, passive upper limb movement. Using a custom built apparatus and software, wrist flexion-extension movements of a programmable frequency, amplitude and duration are induced while transcranial magnetic stimuli are delivered to the contralateral cortex over the area representing the flexor carpi radialis muscle. Stimuli are timed to occur during different phases of the movement cycle in order to examine the influence of ascending sensory input on the excitability of the corticospinal pathway. The protocol enables modulations in evoked responses to be analysed during movement of different frequencies and amplitudes, and permits alterations in cortical excitability to be examined by using paired pulse paradigms. The technique may also be utilised to examine hemispheric and segmental transfer if a stationary target limb is probed while the contralateral limb is passively moved. The protocol has potential use in examining corticomotor excitability in subjects with deficits in sensory and/or motor function, such as patients with Parkinson's disease or individuals recovering from stroke.