Premotor Cortex: A New Target for Stroke Motor Rehabilitation

Motor training is an important part of recovery after stroke. During motor training, stroke
patients practice performing a movement and become better at performing the trained movement
over time. Repetitive transcranial magnetic stimulation (rTMS), which uses magnetism to
excite neurons near the surface of the brain, may further improve performance. Healthy adults
made larger training-related improvements in their motor performance when they received rTMS
over the primary motor cortex during motor training. There is evidence that the premotor
cortex may be a more effective target than the primary motor cortex for rTMS for some stroke
survivors. In the current study, the investigator will determine the effect of rTMS over the
premotor cortex on training-related improvements in motor performance in healthy adults.

Inclusion Criteria:

Motor training only (pilot participants):

- Have the ability to give informed, written consent

- Be aged 18-80 years old

- Be right-handed using the Edinburgh handedness inventory

- Have intact cognitive abilities (score higher than 75th percentile on the Repeatable
Battery for the Assessment of Neuropsychological Status (RBANS))

- No current depression (score less than 7 on the Hamilton Depression Rating Scale
(HDRS))

- No neurological disease

- No contradictions to Transcranial Magnetic Stimulation (TMS)

- TMS over the extensor carpi ulnaris (ECU) hotspot must evoke a motor evoked potential
(MEP) in the ECU muscle

- MEP amplitude must increase by at least 20% as the TMS intensity increases

- The subjects must be comfortable when receiving TMS of all strengths.

Remaining study participants:

- Have the ability to give informed, written consent

- Be aged 55-80 years old

- Be right-handed using the Edinburgh handedness inventory

- Have intact cognitive abilities (score higher than 75th percentile on the Repeatable
Battery for the Assessment of Neuropsychological Status (RBANS))

- No current depression (score less than a 7 on the Hamilton Depression Rating Scale
(HDRS))

- No neurological disease

- No contradictions to Transcranial Magnetic Stimulation (TMS)

- TMS over the extensor carpi ulnaris (ECU) hotspot must be able to evoke a motor evoked
potential (MEP) in the ECU muscle

- MEP amplitude must increase by at least 20% as the TMS intensity increases

- The subjects must be comfortable when receiving TMS of all strengths.

Exclusion Criteria:

- Impaired cognitive abilities (score lesser than 75th percentile on the Repeatable
Battery for the Assessment of Neuropsychological Status (RBANS))

- Current depression (score more than 7 on the Hamilton Depression Rating Scale (HDRS))

- Neurological disease

- Has a contradiction to TMS

- MEP cannot be evoked with TMS in the ECU muscle

- Inability to tolerate one or more TMS strengths