Record each response to update the MT estimate, next test intensity and live graphs. This tool works independently of the other CTDS pages.
How to use this toolRecord responses with RR CTDS or ML-PEST CTDS, or document an external result.+
Choose RR CTDS, ML-PEST CTDS or the external-result pathway. Select the hand or leg, muscle and response method; record the relevant device and coil details.
Confirm preparation, the motor hotspot and a clinician-set output ceiling. Resting EMG and visual responses are distinct methods; use the method permitted by the applicable device protocol.
For RR CTDS, set the starting intensity and mark each delivered pulse Yes or No. Review the block count and search suggestion; untested pulses remain untested. Follow the displayed bracketing and refinement process.
For ML-PEST CTDS, choose the start and review plan, then record each delivered intensity and response. The estimate, next suggestion and graphs update from the observations; checkpoints are review points rather than confidence-based stopping rules.
Review the result, response history, cautions and method reference before retaining it. Independent clinical validation of ML-PEST CTDS is pending; confirm its estimate independently before treatment. For an external result, record its original application, method and clinician review.
Clinical validation pending. Use as an evaluation aid and independently confirm MT before treatment. Estimates are not automatically accepted for treatment setup. Use trained supervision, hearing protection and device-specific limits; visual movement and EMG thresholds are distinct.
Simulation findings
Independent clinical validation pending
Results cover matching-model, broader-response and stress scenarios.
127,000Synthetic assessments 20- and 30-pulse plans
99.92%Within ±5 MSO points Matching model assumptions · 6,000 runs
Accuracy figures use 30 pulses and the default 7% model spread. ±5 MSO points is a descriptive simulation measure, not a clinical acceptance threshold; stress-test results and review-readiness limitations are reported on the results page.
ML-PEST CTDS matched MTAT outputs in 37 of 37 isolated numerical reference cases. Simulation accuracy was tested against known synthetic thresholds, not against MTAT. Similar overall performance to MTAT has not been demonstrated; independent clinical validation is pending.
Setup locks once trials are recorded. Reset before changing muscle, side, hotspot, coil or waveform.
2. Count responses
Advanced · model spread: 7% of MT
Default: 7%, following the Awiszus model. For MT = 40% MSO, this means a model response spread of 2.8% MSO. It is not a stopping tolerance or confidence interval. Other values are research settings. The 0.1–100% input limits are computational bounds, not a recommended clinical range. This setting locks when the run starts.
No previous MT is required. Review pauses at the selected pulse count; reaching that count alone does not establish accuracy.
Choose the first test intensity within the device and patient-specific limits. The default is 37% MSO; every subsequent suggestion updates from the recorded responses.
Before starting
Confirm the hotspot, resting muscle and preparation checks
Set the clinician output ceiling
3. Review the result
Assessment not complete
Review after 30 valid pulses, with both positive and negative responses and no blocking flags.
Review the response history and equipment setup before accepting the estimate.
Next test intensity: paused for review. Output ceiling: not set% MSO.
Setup and verification
Preparation checks: not confirmed.
Limitations and review
REVIEW REQUIRED: Set an integer output ceiling between 1 and 100% MSO.
Method: maximum-likelihood sequential estimation; response spread 7% of candidate MT. No confidence interval is provided.
Evaluation estimate; clinical validation is pending. Independently confirm MT before treatment. This estimate is not automatically accepted for treatment setup.
References: Awiszus (2003), doi:10.1016/S1567-424X(09)70205-3; Mishory et al. (2004), doi:10.1097/00124509-200409000-00007.
Choose Save as PDF in the print dialog; turn off browser headers and footers. Use Full record for details and references.
Entries stay in this browser tab across pages and refreshes. No patient identifiers.
Method and standard references
ML-PEST updates a maximum-likelihood MT estimate after every recorded response and suggests the next whole-percent test intensity. The default response model is a cumulative Gaussian with spread equal to 7% of candidate MT. Computational 0% negative / 100% positive anchors are model assumptions and are not counted as delivered pulses.
The 20- and 30-pulse options are review checkpoints, not confidence-based stopping criteria. The curve shows relative likelihood, not a confidence interval; clinical validation of this implementation is pending.
CTDS