Survey of occupational hygiene professional practice in Spanish-speaking countries.

Professional credentialing schemes based on experience and examination are used to clarify the scope and required competencies associated with the practice of a profession. National occupational hygiene (OH) credentials developed in 17 nations have been recognized by the International Occupational Hygiene Association (IOHA) to meet or exceed the requirements of a model certification program. To date, there is no credentialing or certification scheme for occupational hygienists in Spanish-speaking regions. To fill this void, a new credentialing body has been created named the Iberoamerican Board of Occupational Hygiene (JIHO). As a first step to the development of a certification exam for a profession, it is necessary to determine the interest in an occupational hygiene certification exam in Spanish and to clarify the most common work practices for those practicing the profession. To determine the proper exam weightings for occupational hygiene competencies needed to practice in Spanish-speaking regions JIHO conducted a comprehensive survey of professional practice of occupational hygiene in nations where Spanish is spoken as the primary language. Surveys were sent to 456 practicing occupational hygienists in nine different countries on a variety of topics. Results indicated that 79% of respondents felt the need for an OH certification exam in Spanish was very or extremely important. The most frequent and important technical competencies utilized in practice were (1) awareness about the health effects of hazardous agents to make decisions about workplace activities and exposures, (2) application of the hierarchy of controls, control banding, hazard communication, training of employees and other methods to reduce worker exposure and workplace risks, and (3) application of principles to recognize and control biohazards in the workplace. The study results have been used to guide the weighting and importance of various technical topics and rubrics on the JIHO exam. Data from this study can be used in the development of certification examinations, to improve international coherence in the profession, and the development of educational programs in OH.

Reflections on the Saudi FDA Regulatory Experience with Smart GxP Inspections.

Smart GxP inspections have gained increasing attention due to the COVID-19 pandemic, which, understandably, made it challenging for regulatory authorities to conduct on-site inspections. Smart GxP inspections are an oversight approach developed by the SFDA to enable remote compliance assessments of establishments. In this type of inspection, appropriate technical methods and tools (such as livestreaming video) are used without requiring the presence of inspectors onsite, ensuring efficient utilization of resources and the efficiency of inspection process. The objective of this research is to examine and document the shared encounters involving remote inspections and evaluations carried out by SFDA from 2020 to 2022. This will be achieved through the evaluation of the accuracy of document evaluation and the extent to which the objectives of smart GxP inspections were met. Data were collected from local and international smart inspections reports conducted by SFDA between 2020 and 2022, covering medical device manufacturers, pharmaceutical manufacturing sites, warehouses, accreditation offices, scientific offices, and food manufacturing facilities. The results indicate that smart GxP inspections were effective in achieving visit objectives, showing a high degree of document evaluation accuracy. The findings of this study support the use of smart GxP inspections as a valuable alternative to on-site inspections, offering a practical solution to regulatory compliance during the pandemic and beyond. Although the SFDA recognizes the usefulness of smart inspections in upholding regulatory oversight in the face of various challenges, it does not endorse the complete replacement of conventional on-site inspection methods. The SFDA acknowledges significant limitations associated with the current technological resources used in remote regulatory assessments, and these limitations will be explored in the relevant sections.

Intramuscular vs. Subcutaneous: Rethinking Influenza Vaccination Strategy in Japan.

In Japan, inactivated vaccines, including the influenza vaccine, are administered subcutaneously, which is contrary to global recommendations for intramuscular injections. This practice is attributed to historical medical incidents and unchallenged conventions. However, this outdated method, which differs from that of international standards and is linked with less immunogenicity and more adverse reactions, may contribute to vaccination hesitancy. Therefore, with the adoption of intramuscular vaccination administration, which was widely adopted in the coronavirus disease 2019 vaccination, a shift in the Japanese health policy to conform to international standards potentially improves vaccine acceptance and effectiveness.

QHFSS DNA laboratory - ISO/IEC 17025 conformance and accreditation.

This paper reviews evidence placed before a Commission of Inquiry (CoI) established by the State of Queensland, Australia, to consider the quality and reliability of DNA evidence. It also assesses whether the criticism levied in that report, of ISO/IEC 17025 being insufficient to assure the quality and reliability of DNA evidence, is warranted. The main conclusion drawn is that properly applied and embraced as a means of continuous improvement, conformance with ISO/IEC 17025:2017 alone is sufficient to assure the quality and reliability of the scientific outputs from a forensic science laboratory. Furthermore, it is clear from the observations and findings of the CoI and those recorded in this paper that the forensic science laboratory in question did not conform to ISO/IEC 17025:2017. Had it done so then the risk of the quality failures that led to the CoI would at least have been reduced and perhaps even avoided.

Maternal health and human rights impacts of Russian drug policy.

This article describes how Russian drug policy defies international ethical standards in patient care and violates the human rights of pregnant people who use drugs. While the CEDAW Committee previously found Russia to be in violation of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) by failing to ensure that pregnant people have access to gender-sensitive drug dependence treatment, to date the Committee has refused to address the role of drug criminalization in enabling this human rights violation. This article outlines the gendered impacts of Russia's punitive approach to drug use, including its detrimental effects on maternal health, and concludes by urging the CEDAW Committee to follow the approach of the UN Committee on Economic, Social and Cultural Rights, the UN Chief Executives, the World Health Organization, and UNAIDS, as well as senior UN lawyers and international legal experts to assess drug criminalization critically through the prism of the CEDAW convention.

First international proficiency study on human papillomavirus testing in cervical cancer screening.

BACKGROUND: Although cervical screening using Human Papillomavirus (HPV) testing is globally recommended public health policy, there has been no international proficiency studies specifically targeting HPV testing for cervical screening. OBJECTIVE: To obtain the first global overview of the current proficiency of HPV testing services for cervical cancer screening. STUDY DESIGN: A coded proficiency panel of 12 samples containing HPV types 16, 18, 31, 33, 45, 52, 58 or 35/39/51/56/59/68 in human DNA in varying amounts as well as control. Datasets detecting at least a) 10 International Units (IU) of HPV16 and 18, b) 1000 IU of HPV types 31, 33, 45, 52, 58 and c) having no false positives were considered proficient. RESULTS: In total, 84 laboratories worldwide submitted 158 datasets (some laboratories used >1 HPV testing platform). Of those, 122 (77%) were 100% proficient. Only 14/158 datasets (9%) contained false positive results. Comparison of results with assays approved by the Food and Drug Administration (FDA) suggest that future proficiency requirements should also accommodate assays detecting only 100 IU of HPV16/18. A pool of low oncogenicity HPV types that contributed very little to sensitivity, but adversely affected specificity, was detectable by most datasets. CONCLUSION: Internationally recognized proficiency studies of HPV screening, traceable to international standards, provided an overview of current testing performance. There was a high level of proficiency in terms of sensitivity and few false positives, but specificity was not optimal and further research on optimal specificity of HPV screening tests may be warranted.

Public health implementation of pathogen genomics: the role for accreditation and application of ISO standards.

Pathogen genomics has transitioned rapidly from the research setting into a powerful tool now routinely used in public health microbiology, for surveillance, outbreak investigations and disease control. As these investigations can have significant public health, treatment and legal impacts, we must ensure the accuracy of these results through validation of testing processes. For laboratories working in this space, it is important to approach this work with a quality and accreditation framework in mind, working towards implementation of quality systems and test validation that meet international regulatory standards. Here we outline the key international standards and processes that lead toward accreditation for pathogen genomics.

A Digital Twin Framework for Precision Neuromusculoskeletal Health Care: Extension Upon Industrial Standards.

There is a powerful global trend toward deeper integration of digital twins into modern life driven by Industry 4.0 and 5.0. Defense, agriculture, engineering, manufacturing, and urban planning sectors have thoroughly incorporated digital twins to great benefit across their respective product lifecycles. Despite clear benefits, a digital twin framework for health and medical sectors is yet to emerge. This paper proposes a digital twin framework for precision neuromusculoskeletal health care. We build upon the International Standards Organization framework for digital twins for manufacturing by presenting best available computational models within a digital twin framework for clinical application. We map a use case for modeling Achilles tendon mechanobiology, highlighting how current modeling practices align with our proposed digital twin framework. Similarly, we map a use case for advanced neurorehabilitation technology, highlighting the role of a digital twin in control of systems where human and machine are interfaced. Future work must now focus on creating an informatic representation to govern how digital data are passed to, from, and within the digital twin, as well as specific standards to declare which measurement systems and modeling methods are acceptable to move toward widespread use of the digital twin framework for precision neuromusculoskeletal health care.

The World Organisation for Animal Health Observatory: a data-driven approach to address the needs of its Members.

This article reviews the Observatory of the World Organisation for Animal Health (WOAH, founded as OIE), including its objectives, direction and progress achieved so far. It explains the benefits offered by this data-driven programme in improving access to data and information analysis while ensuring confidentiality. In addition, the authors examine the challenges that the Observatory faces and its inextricable link to the Organisation's data management. The development of the Observatory is of the utmost importance, not only for its relevance to the development of WOAH International Standards and their implementation worldwide, but also because of its role as one of the drivers of WOAH's digital transformation plan. This transformation is essential, given the major role of information technologies in supporting regulation for animal health, animal welfare and veterinary public health.

Cet article consacré à l'Observatoire de l'Organisation mondiale de la santé animale (OMSA, fondée en tant qu'OIE) fait le point sur ses objectifs, ses orientations et les accomplissements réalisés à ce jour. Les auteurs expliquent les bénéfices et améliorations apportés par ce programme axé sur les données, en termes à la fois d'accès aux données, d'analyse de l'information et de confidentialité. Ils abordent aussi les défis auxquels l'Observatoire doit faire face et son lien indissociable avec la gestion des données de l'Organisation. Le développement de l'Observatoire revêt une importance fondamentale, non seulement en regard de sa pertinence pour l'élaboration et la mise en oeuvre des normes internationales de l'OMSA partout dans le monde, mais aussi parce qu'il est le moteur de la planification de la transformation numérique de l'OMSA. Cette transformation est cruciale, compte tenu du rôle majeur que jouent les technologies de l'information en appui de la réglementation de la santé animale, du bien-être animal et de la santé publique vétérinaire.

Los autores presentan el Observatorio de la Organización Mundial de Sanidad Animal (OMSA, fundada como OIE), deteniéndose en particular en sus objetivos, su orientación y el camino recorrido hasta ahora. También exponen las ventajas que ofrece este programa centrado en los datos para mejorar tanto el acceso a los datos como los análisis de información, asegurando al mismo tiempo la confidencialidad. Además, examinan las dificultades a que hace frente el Observatorio y el indisociable vínculo que este guarda con la gestión de datos de la Organización. El desarrollo del Observatorio reviste una importancia capital, no solo por su utilidad para la elaboración de las normas internacionales de la OMSA y su aplicación en todo el mundo, sino también porque constituye uno de los motores del plan de transformación digital de la OMSA. Se trata de un proceso de transformación esencial, dada la importante función que cumplen las tecnologías de la información a la hora de regular la sanidad y el bienestar animales y la salud pública veterinaria.

North American Clinical Trials Network for Spinal Cord Injury Registry: Methodology and Analysis.

The North American Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of neurosurgery departments at university affiliated hospitals with medical, nursing, and rehabilitation personnel who are skilled in the assessment, evaluation, and management of SCI. NACTN was established with the goal of consistently advancing the quality of life of people with SCI through clinical trials of new therapies that provide robust evidence of safety and effectiveness. A prospective multi-center Registry was created to collect the natural course of the acute traumatic SCI patient from time of injury to 12 months follow-up. NACTN's network of hospitals enrolls a significant number of patients, defines and adheres to standard protocols, and provides the infrastructure and highly skilled personnel to conduct trials of therapy for SCI. Registry data have been used by academic institutions and by the biotechnology and pharmaceutical sectors to create comparison datasets for Phase I clinical trials of new therapies.

PROCEDURAL STATUS OF PERSONS SUFFERING FROM MENTAL DISORDERS: INTERNATIONAL STANDARDS.

OBJECTIVE: The aim: To identify, group and analyze international standards in terms of regulating the criminal procedural status of persons su!ering from mental disorders. PATIENTS AND METHODS: Materials and methods: In preparing the article, the following issues were worked out: the provisions of international legal acts; legal positions of the European Court of Human Rights regarding the observance of the right to a fair trial of persons su!ering from mental disorders; scienti"c research to ensure the rights of persons su!ering from mental disorders in criminal proceedings. The methodological basis of the research is dialectical, comparative-legal, systemic-structural, analytical, synthetic, complex research methods. CONCLUSION: Conclusions: Universal international standards of human rights retain their validity for persons su!ering from mental disorders; today, a clear synchronization of universal (global) and European standards for determining the procedural status of persons su!ering from mental disorders is being followed; the most justi"ed is a di!erentiated approach to solving the issue of personal participation of a person su!ering from a mental disorder in a court hearing.

The International Standards for Neurological Classification of Spinal Cord Injury: Classification Accuracy and Challenges.

Background: Successful utilization of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) requires a comprehensive understanding of its rules, terminology, and several complex concepts. There have been no studies investigating classification accuracy since the newest ISNCSCI revision (2019). Objectives: To evaluate classification accuracy of SCI professionals using the 2019 ISNCSCI edition, identify common mistakes and areas of confusion, and assess associations between experience in ISNCSCI classification and performance. Methods: Members of the International Spinal Cord Society (ISCoS) and attendees of the ISCoS Annual Scientific Meeting 2021 were invited to complete an online survey that included six ISNCSCI cases to classify. Results: A total of 107 persons completed the survey, with overall classification accuracy of 74.6%. Accuracy was highest for injury completeness (95.3%) and sensory level (91.1%) and lowest for motor zone of partial preservation (ZPP; 54.7%) and ASIA Impairment Scale (AIS) grade (57.3%). Newer concepts, including the appropriate documentation of non-SCI conditions and classification of ZPP in incomplete injuries, contributed to several common errors. There was a significant association between overall classification accuracy and self-rated experience in the ISNCSCI classification (p = .017). Experience with the ISNCSCI examination, experience in SCI medicine, and occupation were not found to be significantly associated with overall classification accuracy. Conclusion: Classification accuracy of an international cohort of SCI professionals was modest but greater than previous reports. Knowledge deficits about the 2019 ISNCSCI updates are prevalent and contribute to common classification errors. Further training in the utilization of the ISNCSCI is needed.

Adaptation of Global Standards of Comprehensive Sexuality Education in China: Characteristics, Discussions, and Expectations.

This is a project report to introduce the Comprehensive Sexuality Education Technical Guideline-Adaptation of Global Standards for Potential Use in China (First Edition) (hereafter referred to as the Guideline) as the first adaptation of the International Technical Guidance on Sexuality Education (ITGSE) in China. The project was supported by the United Nations Population Fund (UNFPA) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) from 2018 to 2022. The development process included rounds of participatory consultation, validation, and revisions led by the project team and a group of technical advisers from diverse backgrounds. The Guideline is developed to respond to the increasing demands of a technical tool integrating international standards and local context that can be used by all comprehensive sexuality education (CSE) stakeholders in China. While keeping the structure of the ITGSE, the Guideline made modifications and additions in light of the up-to-date Chinese policies, laws, and relevant national programs, as well as Chinese culture and social norms. It is expected that the Guideline could be widely acknowledged, distributed, and used to inform and support the future development of CSE in China.

Characterization and Comparison Analysis of WHO Monographs on Selected Medicinal Plants and ISO Standards of Chinese Materia Medica.

Medicinal plants or Chinese materia medica (CMM) are now attracting worldwide attention as they have increasingly prominent advantages over chemical drugs in disease treatment and healthcare. Since the 1990s, World Health Organization (WHO) and International Organization for Standardization established the Technical Committee of Traditional Chinese Medicine (ISO/TC 249) have carried out the development of quality standards on medicinal plants or CMMs respectively, and a considerable number of monographs and international standards have been published. Since the two international organizations adhere to different principles, the standards they develop naturally have different emphasis. Driven by market demand and international trade, ISO mainly takes quality, efficacy and safety into consideration when developing standards, while WHO pays more attention to clinical practice, quality control and medication guidance. Up to now, there is a lack of comparative analysis on the records, background, principles, basic content, and main requirements of quality standards on medicinal plants or CMMs respectively published by WHO and ISO. Therefore, based on international standards of CMM developed by ISO/TC 249 platform and WHO Monographs on Selected Medicinal Plants, this paper systematically compares the purposes, selected principles, standard-developing process, basic content, and main quality requirements to summarize their similarities and differences, and find their merits, aiming to serve as a reference to the development of international standards for CMMs that helps them go global.

Concordance between the international standards for neurological classification of spinal cord injury motor examination and needle electromyography findings in muscles with a motor power grade of zero or trace.

Context/Objective: To evaluate the accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor examination in individuals with spinal cord injury (SCI) with motor grade 0 or 1 and analyze its degree of concordance with needle electromyography (EMG) findings for each key muscle.Design: Retrospective study.Setting: University hospital in Goyang, Korea.Participants: Individuals with SCI admitted to the Department of Rehabilitation from January 2013 to June 2019.Interventions: In the enrolled persons, needle EMG was performed on muscles with motor grade 0 or 1 on ISNCSCI examination, and muscle contraction was confirmed through the detection of motor unit action potential.Outcome measures: The agreement between motor examination and needle EMG findings was analyzed.Results: In 175 key muscles, needle EMG findings in 115 and 60 muscles evaluated as grades 0 and 1 on ISNCSCI examination showed 80% and 50% agreements, respectively. We found a fair agreement between motor examination and needle EMG findings (κ = 0.309, P < 0.0001). Moreover, statistically significant agreement was seen only in T1, L2, and S1 key muscles (κ = 1, P < 0.0001; κ = 0.359, P = 0.019; and κ = 0.521, P = 0.004, respectively).Conclusions: It is important to accurately distinguish between grade 0 and 1 motor power to maximize the positive outcomes from rehabilitation treatment and predict the possibility of recovery in individuals with SCI. Therefore, to improve the accuracy of motor examination and the American Spinal Injury Association Impairment Scale, needle EMG confirmation could be considered for muscles with motor grade 0 or 1 in individuals with SCI.

Characterization and Comparison Analysis of WHO Monographs on Selected Medicinal Plants and ISO Standards of Chinese Materia Medica / 中国结合医学杂志

Medicinal plants or Chinese materia medica (CMM) are now attracting worldwide attention as they have increasingly prominent advantages over chemical drugs in disease treatment and healthcare. Since the 1990s, World Health Organization (WHO) and International Organization for Standardization established the Technical Committee of Traditional Chinese Medicine (ISO/TC 249) have carried out the development of quality standards on medicinal plants or CMMs respectively, and a considerable number of monographs and international standards have been published. Since the two international organizations adhere to different principles, the standards they develop naturally have different emphasis. Driven by market demand and international trade, ISO mainly takes quality, efficacy and safety into consideration when developing standards, while WHO pays more attention to clinical practice, quality control and medication guidance. Up to now, there is a lack of comparative analysis on the records, background, principles, basic content, and main requirements of quality standards on medicinal plants or CMMs respectively published by WHO and ISO. Therefore, based on international standards of CMM developed by ISO/TC 249 platform and WHO Monographs on Selected Medicinal Plants, this paper systematically compares the purposes, selected principles, standard-developing process, basic content, and main quality requirements to summarize their similarities and differences, and find their merits, aiming to serve as a reference to the development of international standards for CMMs that helps them go global.

Display the Phenomenon by Tongue Image——Tracing the Development of Tongue Image and its Value in International Standards / 世界科学技术-中医药现代化

By combing the development of tongue image,this paper analyzes the image features,advantages and disadvantages of different stages,and makes it clear that tongue image is an important carrier of clinical information of tongue diagnosis.It has been regarded as an important way to understand tongue image since the first monograph on tongue diagnosis.The article also analyzes the formation and development of modern digital and standardized tongue image,and explains the role and value of tongue image in the development of TCM tongue diagnosis terminology,providing reference for the formulation of international standards of TCM diagnosis terminology and the consensus reached by international experts.

Application of International Standards for Neurological Classification of Spinal Cord Injury in China: a bibliometrics re-analysis / 中国康复理论与实践

ObjectiveTo analyze the application of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in China. MethodsResearches using ISNCSCI in the spinal cord injury were retrieved from CNKI, from January 1st, 2020 to December 31st, 2022. The authors and the keywords of the included literatures were analyzed using VOSviewer and CiteSpace to generate a collaboration network graph of authors and a theme distribution map of keywords. The objects, purposes, causes of spinal cord injury, distribution of researchers' departments, ISNCSCI version used, corresponding publication time and other information of the included studies were manual searched and analyzed. ResultsA total of 285 literatures were finally included, involving 1 279 authors, out of whom 111 published 97.19% of the total number of articles. The main keywords included spinal cord injury, spinal fractures, neurological function, thoracolumbar fractures and spinal tuberculosis, which classified in seven clusters, and the topics of spinal cord injury, efficacy, spinal fractures, quality of life and prognosis were the hotspots in the field. With manual searching, the main topic was spinal cord injury; the main object was traumatic spinal cord injury; the main purpose was to evaluate the surgical efficacy; the research institutions were mostly the comprehensive hospitals or specialized hospitals focusing on orthopedics (spinal surgery); the clinical departments that used ISNCSCI the most were orthopedics (including spinal surgery) and rehabilitation medicine, and nursing teams were paying more attention to ISNCSCI; the most commonly used versions of ISNCSCI were 2011 (7th edition) and 2000 (6th edition), however, for a large number of articles, the versions were not clear or earlier than 2000. ConclusionThe application of ISNCSCI in China should be improved in the standardization.

Preliminary Research on the Sustainable Determinants of Taiwanese Ecotourism with the International Standards.

To analyze Taiwanese ecotourism with international standards, this research employed the social learning theory (SLT) to identify the determinants of Taiwanese community ecotourism with the international standards. This basic theory of social psychology comprehensively assays the interplays and interconnections among the three analytical perspectives (ecotourism tours, destinations, and accommodations), the four essential issues (management, social, cultural, and environment) of the Global Sustainable Tourism Council, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations. It was then possible to comprehensively explore the sustainable determinants of Taiwanese ecotourism with the international standards through the FA of quantitative and qualitative analyses in combination with the highest research validity, reliability, representativeness, and accuracy. After analyzing the evaluated measurements, the empirical and valuable conclusions and findings are (1) these analytical perspectives, appraised attitudes, evaluated criteria, and sub-criteria positively advance Taiwanese ecotourism with the international standards (PITEEICIS); (2) the sustainable determinants of Taiwanese ecotourism with the international standards include the Support for Capacity Building of the Local Community (SCBLC), Cooperation with the Local Community (CLC), Supports for the Local Enterprises (SLE), Local Participation and Benefits Sharing Duties (LPBSD), Tourist Management (TM), and Responsible Tourist Behaviors Inducement (RTBI). Importantly, the majority of ecotourism industrialists and experts still focus on the economic benefits, such as supporting the local community and enterprises, rather than tourist behavior inducement to stimulate ecotourism participation in order to promote and advance the Taiwanese ecotourism to the international standards; (3) in order to promote Taiwanese ecotourism to the international conventions, the Taiwanese government and organizations in ecotourism should contribute toward the local welfare and create and design various training programs and courses to enhance local community's awareness and capability of ecotourism development in order to establish a complete system that stimulates the ongoing planning and decision making of local community participation and regularly monitors, records, and reflects their opinions, based on the area's history, culture, and natural attributes, to develop and sell sustainable local products by creating fair trade principles and valuable products.

Utility of transcranial magnetic stimulation in the assessment of spinal cord injury: Current status and future directions.

Comprehensive assessment following traumatic spinal cord injury (SCI) is needed to improve prognostication, advance the understanding of the neurophysiology and better targeting of clinical interventions. The International Standards for Neurological Classification of Spinal Cord Injury is the most common clinical examination recommended for use after a SCI. In addition, there are over 30 clinical assessment tools spanning across different domains of the International Classification of Functioning, Disability, and Health that have been validated and recommended for use in SCI. Most of these tools are subjective in nature, have limited value in predicting neurologic recovery, and do not provide insights into neurophysiological mechanisms. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiology technique that can supplement the clinical assessment in the domain of body structure and function during acute and chronic stages of SCI. TMS offers a better insight into neurophysiology and help in better detection of residual corticomotor connectivity following SCI compared to clinical assessment alone. TMS-based motor evoked potential and silent period duration allow study of excitatory and inhibitory mechanisms following SCI. Changes in muscle representations in form of displacement of TMS-based motor map center of gravity or changes in the map area can capture neuroplastic changes resulting from SCI or following rehabilitation. Paired-pulse TMS measures help understand the compensatory reorganization of the cortical circuits following SCI. In combination with peripheral stimulation, TMS can be used to study central motor conduction time and modulation of spinal reflexes, which can be used for advanced diagnostic and treatment purposes. To strengthen the utility of TMS in SCI assessment, future studies will need to standardize the assessment protocols, address population-specific concerns, and establish the psychometric properties of TMS-based measurements in the SCI population.