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Paired corticospinal-motoneuronal stimulation (PCMS), which delivers repeated pairs of transcranial magnetic stimuli (TMS) and maximal motor nerve stimuli, can alter corticospinal transmission to low-threshold motoneurons in the human spinal cord. To determine whether similar changes occur for high-threshold motoneurons, we tested whether maximal voluntary activation and force can be affected by PCMS in healthy individuals. On 2 separate days, healthy participants ( n = 14) performed brief thumb adduction maximal voluntary contractions (MVCs) before and after a control protocol (TMS only) or PCMS designed to facilitate corticospinal transmission to adductor pollicis. Peripheral nerve stimulation alone was not performed. During each MVC, a superimposed twitch was elicited by a supramaximal stimulus delivered to the ulnar nerve. With muscles relaxed following the maximal contraction, a similar stimulus elicited a resting twitch. Voluntary activation was calculated as (1 - superimposed twitch/resting twitch) × 100%. Although voluntary activation decreased over time in both conditions, the decrease was less after PCMS (-0.4 ± 4.1%) than after the control protocol (-4.9 ± 4.9%; P = 0.007). This was supported by a greater increase in electromyographic response after PCMS than control (7 ± 13% vs. -3 ± 10%; P = 0.043). However, maximal force was not affected. The findings indicate a modest effect of PCMS on maximal neural drive to adductor pollicis, suggesting that PCMS can affect corticospinal transmission to high-threshold motoneurons. NEW &amp; NOTEWORTHY Paired corticospinal-motoneuronal stimulation (PCMS) induces changes in the human spinal cord. To date, the reported effects of PCMS have been limited to low-threshold motoneurons and low-force tasks in healthy and spinal cord injured individuals. For the first time, we show that these plastic changes are not limited to lower threshold motoneurons, but occur across the entire motoneuron pool as demonstrated by the increases in voluntary activation and muscle activity during maximal voluntary contractions of adductor pollicis.

Paired corticospinal-motoneuronal stimulation increases maximal voluntary activation of human adductor pollicis