{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T23:33:44Z","timestamp":1789083224059,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,15]],"date-time":"2024-12-15T00:00:00Z","timestamp":1734220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"publisher","award":["2017\/12943-8"],"award-info":[{"award-number":["2017\/12943-8"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Objective: This study aimed to explore longitudinal relationships between neurophysiological biomarkers and upper limb motor function recovery in stroke patients, focusing on electroencephalography (EEG) and transcranial magnetic stimulation (TMS) metrics. Methods: This longitudinal cohort study analyzed neurophysiological, clinical, and demographic data from 102 stroke patients enrolled in the DEFINE cohort. We investigated the associations between baseline and post-intervention changes in the EEG theta\/alpha ratio (TAR) and TMS metrics with upper limb motor functionality, assessed using the outcomes of five tests: the Fugl-Meyer Assessment (FMA), Handgrip Strength Test (HST), Pinch Strength Test (PST), Finger Tapping Test (FTT), and Nine-Hole Peg Test (9HPT). Results: Our multivariate models identified that a higher baseline TAR in the lesioned hemisphere was consistently associated with poorer motor outcomes across all five assessments. Conversely, a higher improvement in the TAR was positively associated with improvements in FMA and 9HPT. Additionally, an increased TMS motor-evoked potential (MEP) amplitude in the non-lesioned hemisphere correlated with greater FMA-diff, while a lower TMS Short Intracortical Inhibition (SICI) in the non-lesioned hemisphere was linked to better PST improvements. These findings suggest the potential of the TAR and TMS metrics as biomarkers for predicting motor recovery in stroke patients. Conclusion: Our findings highlight the significance of the TAR in the lesioned hemisphere as a predictor of motor function recovery post-stroke and also a potential signature for compensatory oscillations. The observed relationships between the TAR and motor improvements, as well as the associations with TMS metrics, underscore the potential of these neurophysiological measures in guiding personalized rehabilitation strategies for stroke patients.<\/jats:p>","DOI":"10.3390\/brainsci14121257","type":"journal-article","created":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T04:14:52Z","timestamp":1734322492000},"page":"1257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Adaptive Compensatory Neurophysiological Biomarkers of Motor Recovery Post-Stroke: Electroencephalography and Transcranial Magnetic Stimulation Insights from the DEFINE Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1449-6539","authenticated-orcid":false,"given":"Guilherme J. M.","family":"Lacerda","sequence":"first","affiliation":[{"name":"Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02138, USA"},{"name":"Instituto de Medicina F\u00edsica e Reabilita\u00e7\u00e3o, Hospital das Cl\u00ednicas, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 04101-300, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda M. Q.","family":"Silva","sequence":"additional","affiliation":[{"name":"Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02138, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Pacheco-Barrios","sequence":"additional","affiliation":[{"name":"Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02138, USA"},{"name":"Vicerrectorado de Investigaci\u00f3n, Unidad de Investigaci\u00f3n para la Generaci\u00f3n y S\u00edntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15023, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5275-0733","authenticated-orcid":false,"given":"Linamara Rizzo","family":"Battistella","sequence":"additional","affiliation":[{"name":"Instituto de Medicina F\u00edsica e Reabilita\u00e7\u00e3o, Hospital das Cl\u00ednicas, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 04101-300, SP, Brazil"},{"name":"Departamento de Medicina Legal, Bio\u00e9tica, Medicina do Trabalho e Medicina F\u00edsica e Reabilita\u00e7\u00e3o, Faculdade de Medicina, Universidade de S\u00e3o Paulo (FMUSP), S\u00e3o Paulo 01246-903, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1703-7526","authenticated-orcid":false,"given":"Felipe","family":"Fregni","sequence":"additional","affiliation":[{"name":"Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02138, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S1474-4422(19)30030-4","article-title":"The Global Burden of Stroke: Persistent and Disabling","volume":"18","author":"Gorelick","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.neurol.2015.07.013","article-title":"Epidemiology of Stroke and Transient Ischemic Attacks: Current Knowledge and Perspectives","volume":"172","author":"Daubail","year":"2016","journal-title":"Rev. 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