Models of Video Feedback for Youth Athletes Performing an American Football Tackle.

CONTEXT: Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance. OBJECTIVE: To determine the effect of video feedback in the instruction of tackling form. DESIGN: Controlled laboratory study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 32 youth football athletes (28 boys, 4 girls; age = 11.8 ± 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and a 48-hour retention and transfer test. INTERVENTION(S): Video feedback using self as model, expert as model, combined self and expert model, and oral feedback to promote safe tackling performance in a laboratory environment. MAIN OUTCOME MEASURE(S): Shoulder extension, cervical extension, trunk angle, pelvis height, and step length by training block and over time. RESULTS: For the 1-day training group, main effects for time were observed for shoulder extension (P < .01), cervical extension (P = .01), pelvis height (P < .01), and step length (P < .01), with better performance for pelvis height and step length after combined feedback. For the 3-day training group, main effects of time were identified in pelvis height (P < .01) and step length (P < .01), with combined feedback showing better performance than other methods in shoulder extension and pelvis height. Combined feedback resulted in better performance compared with its component parts and oral feedback alone. In the combined model, participants viewed both their performance and the expert model, enabling them to see the difference between current and required performance. CONCLUSIONS: Combined feedback may be superior to other forms of feedback in improving movement performance. This effect can be generalized across disciplines that provide instruction and feedback in movement.

3D Motion Capture May Detect Spatiotemporal Changes in Pre-Reaching Upper Extremity Movements with and without a Real-Time Constraint Condition in Infants with Perinatal Stroke and Cerebral Palsy: A Longitudinal Case Series.

Perinatal stroke (PS), occurring between 20 weeks of gestation and 28 days of life, is a leading cause of hemiplegic cerebral palsy (HCP). Hallmarks of HCP are motor and sensory impairments on one side of the body-especially the arm and hand contralateral to the stroke (involved side). HCP is diagnosed months or years after the original brain injury. One effective early intervention for this population is constraint-induced movement therapy (CIMT), where the uninvolved arm is constrained by a mitt or cast, and therapeutic activities are performed with the involved arm. In this preliminary investigation, we used 3D motion capture to measure the spatiotemporal characteristics of pre-reaching upper extremity movements and any changes that occurred when constraint was applied in a real-time laboratory simulation. Participants were N = 14 full-term infants: N = six infants with typical development; and N = eight infants with PS (N = three infants with PS were later diagnosed with cerebral palsy (CP)) followed longitudinally from 2 to 6 months of age. We aimed to evaluate the feasibility of using 3D motion capture to identify the differences in the spatiotemporal characteristics of the pre-reaching upper extremity movements between the diagnosis group, involved versus uninvolved side, and with versus and without constraint applied in real time. This would be an excellent application of wearable sensors, allowing some of these measurements to be taken in a clinical or home setting.

Upper Limb Movement Classification Via Electromyographic Signals and an Enhanced Probabilistic Network.

Few studies in the literature have researched the use of surface electromyography (sEMG) for motor assessment post-stroke due to the complexity of this type of signal. However, recent advances in signal processing and machine learning have provided fresh opportunities for analyzing complex, non-linear, non-stationary signals, such as sEMG. This paper presents a method for identification of the upper limb movements from sEMG signals using a combination of digital signal processing, that is discrete wavelet transform, and the enhanced probabilistic neural network (EPNN). To explore the potential of sEMG signals for monitoring motor rehabilitation progress, this study used sEMG signals from a subset of movements of the Arm Motor Ability Test (AMAT) as inputs into a movement classification algorithm. The importance of a particular frequency domain feature, that is the ratio of the mean absolute values between sub-bands, was discovered in this work. An average classification accuracy of 75.5% was achieved using the proposed approach with a maximum accuracy of 100%. The performance of the proposed method was compared with results obtained using three other classification algorithms: support vector machine (SVM), k-Nearest Neighbors (k-NN), and probabilistic neural network (PNN) in terms of sEMG movement classification. The study demonstrated the capability of using upper limb sEMG signals to identify and distinguish between functional movements used in standard upper limb motor assessments for stroke patients. The classification algorithm used in the proposed method, EPNN, outperformed SVM, k-NN, and PNN.

THE EFFECT OF TACKLING TRAINING ON HEAD ACCELERATIONS IN YOUTH AMERICAN FOOTBALL.

BACKGROUND: Many organizations have introduced frameworks to reduce the incidence of football related concussions through proper equipment fitting, coach education, and alteration of tackling technique. PURPOSE: The purpose of this study was to examine the effects of training in a vertical, head up tackling style on the number of head accelerations experienced while tackling in a controlled laboratory situation. The authors hypothesized that training in a head up tackling technique would reduce the severity of head acceleration experienced by participants. DESIGN: Controlled Laboratory Study. METHODS: Twenty-four participants (11.5 ± 0.6 years old, 60.5 ± 2.2 in, 110 ± 18.4 lbs.) with previous playing experience completed a one-day training session on tackling technique utilizing a tackling dummy. A subgroup of these participants completed an additional two days of training with a 48 hour retention test. Head accelerations were analyzed at baseline and end of training. Feedback consisted of verbal feedback utilizing the Qualitative Youth Tackling Scale (QYTS) and video tackling playback. RESULTS: A significant reduction in the number of peak linear head accelerations over 10 g and peak rotational head accelerations over 1885 deg/s2 were found in dummy tackling after training in both the one day and three day training regimens. A significant change in QYTS tackling form score was found between pretest and post-test (p = 0.004). Participants with larger steps had a 2.28, 4.42 and 4.14 increased odds ratio of sustaining head accelerations over 10, 15 and 20 g respectively. CONCLUSIONS: Training in a vertical, head up tackling style decreased the number of head accelerations over threshold values sustained while tackling; decreased step length may be the driving factor in the effectiveness of this tackling form. LEVEL OF EVIDENCE: Level 3b.

INTER-RATER AGREEMENT AND VALIDITY OF A TACKLING PERFORMANCE ASSESSMENT SCALE IN YOUTH AMERICAN FOOTBALL.

BACKGROUND: Long term neurologic injury and concussion have been identified as risks from participation in American football. Altering tackling form has been recommended to reduce the risk of neurologic injury caused by head accelerations when tackling. The purpose of this research is to determine the inter-rater agreement and validity of the Qualitative Youth Tackling System (QYTS), a six-item feedback scale to correct tackling form, when utilized by novice and expert raters. HYPOTHESIS: Experienced raters will have higher levels of agreement with each other and with motion capture when compared to novice raters. METHODS: Both novice and experienced raters viewed video of youth athletes (ages 9-13) tackling a dummy in a laboratory setting along. The raters identified successful performance according to a binary rating scale for each component. Analysis of both the raters' agreement with each other and with an objective motion capture measure were completed. RESULTS: Fliess' Kappa measures between all raters were found to be moderate for head placement (k=.48), fair for cervical extension (k=.38), trunk inclination (k=.37), shoulder extension (k=.27) and step length (k=.29), and there was no agreement for pelvic height (k=.-16). When compared to the dichotomized validation measures of each of the five components provided by the motion capture system the average Cohen's Kappa agreement was substantial for pelvic height (k=.63), fair for step length (k=.34), cervical extension (k=.40), trunk inclination (k=.35), and slight for shoulder extension (k=.16). The experienced raters outperformed the novice raters in all categories. CONCLUSION: The results of this study indicate that skilled raters are better able to identify the movement patterns included in the QYTS when compared to a validation measure as well have higher rates of inter-rater agreement than novice raters. LEVEL OF EVIDENCE: 3b.

Computer-aided prediction of extent of motor recovery following constraint-induced movement therapy in chronic stroke.

Constraint-induced movement therapy (CI therapy) is a well-researched intervention for treatment of upper limb function. Overall, CI therapy yields clinically meaningful improvements in speed of task completion and greatly increases use of the more affected upper extremity for daily activities. However, individual improvements vary widely. It has been suggested that intrinsic feedback from somatosensation may influence motor recovery from CI therapy. To test this hypothesis, an enhanced probabilistic neural network (EPNN) prognostic computational model was developed to identify which baseline characteristics predict extent of motor recovery, as measured by the Wolf Motor Function Test (WMFT). Individual characteristics examined were: proprioceptive function via the brief kinesthesia test, tactile sensation via the Semmes-Weinstein touch monofilaments, motor performance captured via the 15 timed items of the Wolf Motor Function Test, stroke affected side. A highly accurate predictive classification was achieved (100% accuracy of EPNN based on available data), but facets of motor functioning alone were sufficient to predict outcome. Somatosensation, as quantified here, did not play a large role in determining the effectiveness of CI therapy.

MUSIC-Expected maximization gaussian mixture methodology for clustering and detection of task-related neuronal firing rates.

Researchers often rely on simple methods to identify involvement of neurons in a particular motor task. The historical approach has been to inspect large groups of neurons and subjectively separate neurons into groups based on the expertise of the investigator. In cases where neuron populations are small it is reasonable to inspect these neuronal recordings and their firing rates carefully to avoid data omissions. In this paper, a new methodology is presented for automatic objective classification of neurons recorded in association with behavioral tasks into groups. By identifying characteristics of neurons in a particular group, the investigator can then identify functional classes of neurons based on their relationship to the task. The methodology is based on integration of a multiple signal classification (MUSIC) algorithm to extract relevant features from the firing rate and an expectation-maximization Gaussian mixture algorithm (EM-GMM) to cluster the extracted features. The methodology is capable of identifying and clustering similar firing rate profiles automatically based on specific signal features. An empirical wavelet transform (EWT) was used to validate the features found in the MUSIC pseudospectrum and the resulting signal features captured by the methodology. Additionally, this methodology was used to inspect behavioral elements of neurons to physiologically validate the model. This methodology was tested using a set of data collected from awake behaving non-human primates.

Sparing of Descending Axons Rescues Interneuron Plasticity in the Lumbar Cord to Allow Adaptive Learning After Thoracic Spinal Cord Injury.

This study evaluated the role of spared axons on structural and behavioral neuroplasticity in the lumbar enlargement after a thoracic spinal cord injury (SCI). Previous work has demonstrated that recovery in the presence of spared axons after an incomplete lesion increases behavioral output after a subsequent complete spinal cord transection (TX). This suggests that spared axons direct adaptive changes in below-level neuronal networks of the lumbar cord. In response to spared fibers, we postulate that lumbar neuron networks support behavioral gains by preventing aberrant plasticity. As such, the present study measured histological and functional changes in the isolated lumbar cord after complete TX or incomplete contusion (SCI). To measure functional plasticity in the lumbar cord, we used an established instrumental learning paradigm (ILP). In this paradigm, neural circuits within isolated lumbar segments demonstrate learning by an increase in flexion duration that reduces exposure to a noxious leg shock. We employed this model using a proof-of-principle design to evaluate the role of sparing on lumbar learning and plasticity early (7 days) or late (42 days) after midthoracic SCI in a rodent model. Early after SCI or TX at 7 days, spinal learning was unattainable regardless of whether the animal recovered with or without axonal substrate. Failed learning occurred alongside measures of cell soma atrophy and aberrant dendritic spine expression within interneuron populations responsible for sensorimotor integration and learning. Alternatively, exposure of the lumbar cord to a small amount of spared axons for 6 weeks produced near-normal learning late after SCI. This coincided with greater cell soma volume and fewer aberrant dendritic spines on interneurons. Thus, an opportunity to influence activity-based learning in locomotor networks depends on spared axons limiting maladaptive plasticity. Together, this work identifies a time dependent interaction between spared axonal systems and adaptive plasticity in locomotor networks and highlights a critical window for activity-based rehabilitation.

Computer-Aided Diagnosis of Parkinson's Disease Using Enhanced Probabilistic Neural Network.

Early and accurate diagnosis of Parkinson's disease (PD) remains challenging. Neuropathological studies using brain bank specimens have estimated that a large percentages of clinical diagnoses of PD may be incorrect especially in the early stages. In this paper, a comprehensive computer model is presented for the diagnosis of PD based on motor, non-motor, and neuroimaging features using the recently-developed enhanced probabilistic neural network (EPNN). The model is tested for differentiating PD patients from those with scans without evidence of dopaminergic deficit (SWEDDs) using the Parkinson's Progression Markers Initiative (PPMI) database, an observational, multi-center study designed to identify PD biomarkers for diagnosis and disease progression. The results are compared to four other commonly-used machine learning algorithms: the probabilistic neural network (PNN), support vector machine (SVM), k-nearest neighbors (k-NN) algorithm, and classification tree (CT). The EPNN had the highest classification accuracy at 92.5% followed by the PNN (91.6%), k-NN (90.8%) and CT (90.2%). The EPNN exhibited an accuracy of 98.6% when classifying healthy control (HC) versus PD, higher than any previous studies.

Evidence for a role of the reticulospinal system in recovery of skilled reaching after cortical stroke: initial results from a model of ischemic cortical injury.

The purposes of this pilot study were to create a model of focal cortical ischemia in Macaca fascicularis and to explore contributions of the reticulospinal system in recovery of reaching. Endothelin-1 was used to create a focal lesion in the shoulder/elbow representation of left primary motor cortex (M1) of two adult female macaques. Repetitive microstimulation was used to map upper limb motor outputs from right and left cortical motor areas and from the pontomedullary reticular formation (PMRF). In subject 1 with a small lesion and spontaneous recovery, reaching was mildly impaired. Changes were evident in the shoulder/elbow representations of both the lesioned and contralesional M1, and there appeared to be fewer than expected upper limb responses from the left (ipsilesional) PMRF. In subject 2 with a substantial lesion, reaching was severely impaired immediately after the lesion. After 12 weeks of intensive rehabilitative training, reach performance recovered to near-baseline levels, but movement times remained about 50% slower. Surprisingly, the shoulder/elbow representation in the lesioned M1 remained completely absent after recovery, and there was a little change in the contralesional M1. There was a definite difference in motor output patterns for left versus right PMRF for this subject, with an increase in right arm responses from right PMRF and a paucity of left arm responses from left PMRF. The results are consistent with increased reliance on PMRF motor outputs for recovery of voluntary upper limb motor control after significant cortical ischemic injury.

Wavelet methodology to improve single unit isolation in primary motor cortex cells.

The proper isolation of action potentials recorded extracellularly from neural tissue is an active area of research in the fields of neuroscience and biomedical signal processing. This paper presents an isolation methodology for neural recordings using the wavelet transform (WT), a statistical thresholding scheme, and the principal component analysis (PCA) algorithm. The effectiveness of five different mother wavelets was investigated: biorthogonal, Daubachies, discrete Meyer, symmetric, and Coifman; along with three different wavelet coefficient thresholding schemes: fixed form threshold, Stein's unbiased estimate of risk, and minimax; and two different thresholding rules: soft and hard thresholding. The signal quality was evaluated using three different statistical measures: mean-squared error, root-mean squared, and signal to noise ratio. The clustering quality was evaluated using two different statistical measures: isolation distance, and L-ratio. This research shows that the selection of the mother wavelet has a strong influence on the clustering and isolation of single unit neural activity, with the Daubachies 4 wavelet and minimax thresholding scheme performing the best.

Bilateral force transients in the upper limbs evoked by single-pulse microstimulation in the pontomedullary reticular formation.

Neurons in the pontomedullary reticular formation (PMRF) give rise to the reticulospinal tract. The motor output of the PMRF was investigated using stimulus-triggered averaging of electromyography (EMG) and force recordings in two monkeys (M. fascicularis). EMG was recorded from 12 pairs of upper limb muscles, and forces were detected using two isometric force-sensitive handles. Of 150 stimulation sites, 105 (70.0%) produced significant force responses, and 139 (92.5%) produced significant EMG responses. Based on the average flexor EMG onset latency of 8.3 ms and average force onset latency of 15.9 ms poststimulation, an electromechanical delay of ∼7.6 ms was calculated. The magnitude of force responses (∼10 mN) was correlated with the average change in EMG activity (P < 0.001). A multivariate linear regression analysis was used to estimate the contribution of each muscle to force generation, with flexors and extensors exhibiting antagonistic effects. A predominant force output pattern of ipsilateral flexion and contralateral extension was observed in response to PMRF stimulation, with 65.3% of significant ipsilateral force responses directed medially and posteriorly (P < 0.001) and 78.6% of contralateral responses directed laterally and anteriorly (P < 0.001). This novel approach permits direct measurement of force outputs evoked by central nervous system microstimulation. Despite the small magnitude of poststimulus EMG effects, low-intensity single-pulse microstimulation of the PMRF evoked detectable forces. The forces, showing the combined effect of all muscle activity in the arms, are consistent with reciprocal pattern of force outputs from the PMRF detectable with stimulus-triggered averaging of EMG.

Brain-computer interface after nervous system injury.

Brain-computer interface (BCI) has proven to be a useful tool for providing alternative communication and mobility to patients suffering from nervous system injury. BCI has been and will continue to be implemented into rehabilitation practices for more interactive and speedy neurological recovery. The most exciting BCI technology is evolving to provide therapeutic benefits by inducing cortical reorganization via neuronal plasticity. This article presents a state-of-the-art review of BCI technology used after nervous system injuries, specifically: amyotrophic lateral sclerosis, Parkinson's disease, spinal cord injury, stroke, and disorders of consciousness. Also presented is transcending, innovative research involving new treatment of neurological disorders.

Combined corticospinal and reticulospinal effects on upper limb muscles.

Both the reticulospinal and corticospinal systems are known to control recruitment of upper limb muscles, yet no known studies have attempted to assess their combined effects in the same experiment in the awake, behaving primate. The purpose of this study is to present an approach for the analysis of the cooperative control from these two motor systems. Muscle responses to electrical stimulation in the reticulospinal system and corticospinal system alone or in combination were studied. The responses were categorized based on simple neural circuits that could explain the interactions of these systems. Five such circuits were identified that could explain 86% of the observed patterns of combined recruitment during stimulation. Improved understanding of the cooperation between these motor systems could provide insight for development of better rehabilitation approaches for stroke patients and others with movement disorders.

Establishing an Imaging Protocol for Detection of Vascularity within the Median Nerve Using Contrast-Enhanced Ultrasound.

This preclinical study was conducted to develop discrete sonographic instrumentation settings and also safe contrast dosing that would consistently demonstrate perineural vascularity along the median nerve. This set of imaging studies was conducted with a convenience cohort of young adult female monkeys (Macaca fascicularis). Sonographic equipment settings and dosing were refined throughout the imaging series to ensure consistent contrast-enhanced ultrasound imaging. A mechanical index of 0.13 was consistently used for imaging. Perineural vessels were imaged with a suspension solution of 0.04 mL Definity/0.96 mL saline introduced over 5 minutes for a total dose of 0.8 mL of contrast solution. Blinded studies of high and low dose contrast, along with saline injections, were correctly identified by two experienced sonographers. This preclinical study established adequate equipment settings and dosing that allowed for a valid demonstration of vascularity surrounding the median nerve.

Recruitment of ipsilateral and contralateral upper limb muscles following stimulation of the cortical motor areas in the monkey.

It is well established that cortical motor stimulation results in contralateral upper limb (UL) activity. Motor responses are also elicited in the ipsilateral UL, though controversy surrounds the significance of these effects. Evidence suggests that ipsilateral muscle activity is more common following the stimulation of the supplementary motor area (SMA) and dorsal premotor area (PMd), compared to the primary motor cortex (M1), but none of these studies compared effects from all three areas in the same subjects. This has limited our understanding of how these three cortical motor areas influence ipsilateral UL muscle activity. The purpose of this study was to determine the contribution of each of three cortical areas to the production of ipsilateral and contralateral UL. To maximize sensitivity and allow comparison of the effects across cortical areas, we applied the same stimulation parameters (36 pulse stimulus train at 330 Hz) to M1, SMA, and PMd in three adult M. fascicularis and recorded electromyographic (EMG) activity from muscles in the trunk and both ULs. Of all muscle responses identified, 24 % were ipsilateral to the stimulation, mostly in proximal muscles. The highest percentage of ipsilateral responses occurred following SMA stimulation. We also observed that PMd stimulation elicited more suppression responses compared with stimulation of M1 and SMA. The results indicate that ipsilateral motor areas provide a significant contribution to cortical activation of the trunk and proximal UL muscles. These understudied pathways may represent a functional substrate for future strategies to shape UL recovery following injury or stroke.

Trunk muscle reflex amplitudes increased in patients with subacute, recurrent LBP treated with a 10-week stabilization exercise program.

Altered trunk muscle reflexes have been observed in patients with low back pain (LBP). Altered reflexes may contribute to impaired postural control, and possibly recurrence of LBP. Specific stabilization exercise (SSE) programs have been shown to decrease the risk of LBP recurrence in a select group of patients with acute, first episode LBP. It is not known if trunk muscle reflex responses improve with resolution of subacute, recurrent LBP when treated with a SSE program. A perturbation test was used to compare trunk muscle reflexes in patients with subacute, recurrent LBP, before and after 10 weeks of a SSE program and a group of matched control subjects (CNTL). The LBP group pre therapy had delayed trunk muscle reflexes compared with the CNTL group. Post therapy reflex latencies remained delayed, but amplitudes increased. Increased reflex amplitudes could limit excessive movement of the spine when perturbed; potentially helping prevent recurrence.

Characterization of recovered walking patterns and motor control after contusive spinal cord injury in rats.

Currently, complete recovery is unattainable for most individuals with spinal cord injury (SCI). Instead, recovery is typically accompanied by persistent sensory and motor deficits. Restoration of preinjury function will likely depend on improving plasticity and integration of these impaired systems. Eccentric muscle actions require precise integration of sensorimotor signals and are predominant during the yield (E2) phase of locomotion. Motor neuron activation and control during eccentric contractions is impaired across a number of central nervous system (CNS) disorders, but remains unexamined after SCI. Therefore, we characterized locomotor recovery after contusive SCI using hindlimb (HL) kinematics and electromyographic (EMG) recordings with specific consideration of eccentric phases of treadmill (TM) walking. Deficits in E2 and a caudal shift of locomotor subphases persisted throughout the 3-week recovery period. EMG records showed notable deficits in the semitendinosus (ST) during yield. Unlike other HL muscles, recruitment of ST changed with recovery. At 7 days, the typical dual-burst pattern of ST was lost and the second burst (ST2) was indistinct. By 21 days, the dual-burst pattern returned, but latencies remained impaired. We show that ST2 burst duration is highly predictive of open field Basso, Beattie, Bresnahan (BBB) scores. Moreover, we found that simple changes in locomotor specificity which enhance eccentric actions result in new motor patterns after SCI. Our findings identify a caudal shift in stepping kinematics, irregularities in E2, and aberrant ST2 bursting as markers of incomplete recovery. These residual impairments may provide opportunities for targeted rehabilitation.

Measuring the motor output of the pontomedullary reticular formation in the monkey: do stimulus-triggered averaging and stimulus trains produce comparable results in the upper limbs?

The pontomedullary reticular formation (PMRF) of the monkey produces motor outputs to both upper limbs. EMG effects evoked from stimulus-triggered averaging (StimulusTA) were compared with effects from stimulus trains to determine whether both stimulation methods produced comparable results. Flexor and extensor muscles of scapulothoracic, shoulder, elbow, and wrist joints were studied bilaterally in two male M. fascicularis monkeys trained to perform a bilateral reaching task. The frequency of facilitation versus suppression responses evoked in the muscles was compared between methods. Stimulus trains were more efficient (94% of PMRF sites) in producing responses than StimulusTA (55%), and stimulus trains evoked responses from more muscles per site than from StimulusTA. Facilitation (72%) was more common from stimulus trains than StimulusTA (39%). In the overall results, a bilateral reciprocal activation pattern of ipsilateral flexor and contralateral extensor facilitation was evident for StimulusTA and stimulus trains. When the comparison was restricted to cases where both methods produced a response in a given muscle from the same site, agreement was very high, at 80%. For the remaining 20%, discrepancies were accounted for mainly by facilitation from stimulus trains when StimulusTA produced suppression, which was in agreement with the under-representation of suppression in the stimulus train data as a whole. To the extent that the stimulus train method may favor transmission through polysynaptic pathways, these results suggest that polysynaptic pathways from the PMRF more often produce facilitation in muscles that would typically demonstrate suppression with StimulusTA.

Bilateral spike-triggered average effects in arm and shoulder muscles from the monkey pontomedullary reticular formation.

Pontomedullary reticular formation (PMRF) neurons (309) were recorded simultaneously with electromyographic activity from arm and shoulder muscles in four monkeys performing arm-reaching tasks. Spike-triggered averages (SpikeTAs) were compiled for 292 neurons (3836 neuron-muscle pairs). Fourteen PMRF neurons located in a region ventral to the abducens nucleus produced 42 significant SpikeTA effects in arm and shoulder muscles. Of these 14 PMRF neurons, nine produced SpikeTA effects bilaterally. Overall, PMRF neurons facilitated ipsilateral flexors and contralateral extensors, while suppressing ipsilateral extensors and contralateral flexors. Spike- and stimulus-triggered averaging effects obtained from the same recording site were similar. These findings indicate that single PMRF neurons can directly influence movements of both upper limbs.