This training is for staff who will be using TMS to identify MEP status for patients enrolled in the VERIFY study.
TMS is used to test the descending motor pathways from the primary motor cortex of the stroke side of the brain to the muscles of the paretic upper limb. This is a critical component of the VERIFY study.
This training has nine modules and we recommend working through them in the following order:
- TMS Overview provides background information about TMS and how it works.
- TMS Safety Checklist describes the contraindications for TMS and provides a checklist for screening patients.
- EMG Technique describes how to set up surface electromyography and troubleshoot if needed.
- VERIFY TMS Protocol will teach you how to perform the VERIFY TMS protocol to determine MEP status
- Simple MEP Identification will help you learn how to decide whether a patient is MEP+ or MEP-.
- Challenging MEP Identification will provide some challenging examples of MEP determination.
- TMS Source Document will help you see how to use the Source Document for VERIFY TMS Data.
- Practical TMS Training with Healthy Volunteers will provide information about the practical TMS training that is required following the self-directed online training.
- TMS with VERIFY Stroke Patients will provide specific information about doing TMS with patients early after stroke.
You will need to complete the final quizzes and be certified for the first six modules in order to progress to the practical TMS training for VERIFY. Modules 7-9 do not have quizzes. Once you have completed modules 1-6 you will be emailed information about the practical training from the VERIFY team.
Following the practical TMS training all TMSOs will need to perform a technique check, and this will be with a TMS expert present in-person or virtually. Further details about the technique check can be found in module 8.
Practice will need to involve:
- Orientation to the TMS equipment and software
- Training sessions involving people who haven’t experienced a stroke
- Performing the VERIFY TMS protocol on healthy volunteers and uploading the data to REDCap
- A technique check where your skills will be evaluated by an expert in TMS. A template competency document is available on the Resources page so you can see how you will be evaluated
Please contact us on verify.study.tms@gmail.com or c.stinear@auckland.ac.nz if you and your team would like to discuss TMS training.
If you require urgent assistance or advice during a TMS session please call or text the TMS hotline at: (833)337-2227 (Available Mon-Fri 8am-9pm ET)
Glossary
ECR Extensor carpi radialis
EMG Electromyography
FDI First dorsal interosseous
MEP Motor evoked potential
MSO Maximum stimulator output
TMS Transcranial magnetic stimulation