{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:00:09Z","timestamp":1777888809921,"version":"3.51.4"},"reference-count":57,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Restorative Neurology and Neuroscience"],"published-print":{"date-parts":[[2022,8,19]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>\n                      Assessment of voluntary activation is useful in the study of neuromuscular impairments, particularly after spinal cord injury (SCI). Measurement of voluntary activation with transcranial magnetic stimulation (VA\n                      <jats:sub>TMS<\/jats:sub>\n                      ) is limited by technical challenges, including the difficulty in preferential stimulation of cortical neurons projecting to the target muscle and minimal stimulation of antagonists. Thus, the motor evoked potential (MEP) response to TMS in the target muscle compared to its antagonist may be an important parameter in the assessment of VA\n                      <jats:sub>TMS<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>\n                      The purpose of this study was to evaluate the effect of isometric elbow flexion angle on two metrics in individuals with tetraplegia following SCI: 1) the ratio of biceps\/triceps MEP amplitude across a range of voluntary efforts, and 2) VA\n                      <jats:sub>TMS<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      Ten individuals with tetraplegia and ten nonimpaired individuals were recruited to participate in three sessions wherein VA\n                      <jats:sub>TMS<\/jats:sub>\n                      was assessed at 45\u00b0, 90\u00b0, and 120\u00b0 of isometric elbow flexion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      In SCI participants, the biceps\/triceps MEP ratio was not modulated by elbow angle. In nonimpaired participants, the biceps\/triceps MEP ratio was greater in the more flexed elbow angle (120\u00b0 flexion) compared to 90\u00b0 during contractions of 50% and 75% MVC, but VA\n                      <jats:sub>TMS<\/jats:sub>\n                      was not different. VA\n                      <jats:sub>TMS<\/jats:sub>\n                      assessed in the more extended elbow angle (45\u00b0 flexion) was lower relative to 90\u00b0 elbow flexion; this effect was dependent on the biceps\/triceps MEP ratio. In both groups, VA\n                      <jats:sub>TMS<\/jats:sub>\n                      was sensitive to the linearity of the voluntary moment and superimposed twitch relationship, regardless of elbow angle. Linearity was lower in SCI relative to nonimpaired participants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      Increasing the MEP ratio via elbow angle did not enable estimation of VA\n                      <jats:sub>TMS<\/jats:sub>\n                      in SCI participants. VA\n                      <jats:sub>TMS<\/jats:sub>\n                      may not be a viable approach to assess neuromuscular function in individuals with tetraplegia.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3233\/rnn-221254","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T11:00:38Z","timestamp":1657882838000},"page":"169-184","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The assessment of biceps voluntary activation with transcranial magnetic stimulation in individuals with tetraplegia"],"prefix":"10.1177","volume":"40","author":[{"given":"Thibault","family":"Roumengous","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie 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