Motor cortical measures of use-dependent plasticity are graded from distal to proximal in the human upper limb

In humans, it is well established that practicing simple, repetitive movements with the distal upper limb induces short-term plasticity in the neural pathways that control training. It is unknown how the neural response to similar training at more proximal joints differs. The purpose of this study was to quantify how ballistic training at proximal and distal upper limb joints influences measures of corticomotor plasticity. To accomplish this goal, we had subjects repetitively practice simple movements for 30 min using the index finger, wrist, or elbow. Before and after training, transcranial magnetic stimulation (TMS) was used to activate the corticomotor pathways innervating the trained joint. We assessed the effect of training by quantifying changes in TMS-elicited joint movements and motor-evoked potentials in the training agonists and antagonists. These measures of training-induced neural plasticity were graded from distal to proximal in the upper limb. Training had the greatest immediate effect on the pathways controlling the index finger and this effect decreased for more proximal joints. Our results suggest that the relative sizes and properties of the cortical areas controlling the proximal and distal upper limb influence the effect of training on the corticomotor pathways. These results have implications for how training influences the neural pathways controlling movement in the proximal and distal portions of the human upper limb and the degree to which these effects can be quantified using TMS.