Motor Activated Auricular Vagus Nerve Stimulation as a Potential Neuromodulation Approach for Post-Stroke Motor Rehabilitation: A Pilot Study.

IF 3.7 2区 医学 Q1 CLINICAL NEUROLOGY
Neurorehabilitation and Neural Repair Pub Date : 2023-06-01 Epub Date: 2023-05-20 DOI:10.1177/15459683231173357
Bashar W Badran, Xiaolong Peng, Brenna Baker-Vogel, Scott Hutchison, Patricia Finetto, Kelly Rishe, Andrew Fortune, Ellen Kitchens, Georgia H O'Leary, Abigail Short, Christian Finetto, Michelle L Woodbury, Steve Kautz
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引用次数: 0

Abstract

Background: Implanted vagus nerve stimulation (VNS), when synchronized with post-stroke motor rehabilitation improves conventional motor rehabilitation training. A non-invasive VNS method known as transcutaneous auricular vagus nerves stimulation (taVNS) has emerged, which may mimic the effects of implanted VNS.

Objective: To determine whether taVNS paired with motor rehabilitation improves post-stroke motor function, and whether synchronization with movement and amount of stimulation is critical to outcomes.

Methods: We developed a closed-loop taVNS system for motor rehabilitation called motor activated auricular vagus nerve stimulation (MAAVNS) and conducted a randomized, double-blind, pilot trial investigating the use of MAAVNS to improve upper limb function in 20 stroke survivors. Participants attended 12 rehabilitation sessions over 4-weeks, and were assigned to a group that received either MAAVNS or active unpaired taVNS concurrently with task-specific training. Motor assessments were conducted at baseline, and weekly during rehabilitation training. Stimulation pulses were counted for both groups.

Results: A total of 16 individuals completed the trial, and both MAAVNS (n = 9) and unpaired taVNS (n = 7) demonstrated improved Fugl-Meyer Assessment upper extremity scores (Mean ± SEM, MAAVNS: 5.00 ± 1.02, unpaired taVNS: 3.14 ± 0.63). MAAVNS demonstrated greater effect size (Cohen's d = 0.63) compared to unpaired taVNS (Cohen's d = 0.30). Furthermore, MAAVNS participants received significantly fewer stimulation pulses (Mean ± SEM, MAAVNS: 36 070 ± 3205) than the fixed 45 000 pulses unpaired taVNS participants received (P < .05).

Conclusion: This trial suggests stimulation timing likely matters, and that pairing taVNS with movements may be superior to an unpaired approach. Additionally, MAAVNS effect size is comparable to that of the implanted VNS approach.

将运动激活耳廓迷走神经刺激作为脑卒中后运动康复的一种潜在神经调节方法:试点研究。
背景:植入式迷走神经刺激(VNS)与中风后运动康复训练同步进行时,可改善传统的运动康复训练。一种被称为经皮耳廓迷走神经刺激(taVNS)的非侵入性迷走神经刺激方法已经出现,它可以模拟植入式迷走神经刺激的效果:目的:确定经皮耳迷走神经刺激(taVNS)与运动康复相结合是否能改善中风后的运动功能,以及与运动的同步性和刺激量是否对结果至关重要:我们开发了一种用于运动康复的闭环 taVNS 系统,称为运动激活耳廓迷走神经刺激(MAAVNS),并开展了一项随机、双盲、试验研究,调查使用 MAAVNS 改善 20 名中风幸存者的上肢功能。参与者参加了为期 4 周的 12 次康复治疗,并被分配到接受 MAAVNS 或主动无配对 taVNS 治疗的小组,同时接受特定任务训练。运动评估在基线和康复训练期间每周进行一次。两组均对刺激脉冲进行计数:共有 16 人完成了试验,MAAVNS(9 人)和非配对 taVNS(7 人)均改善了 Fugl-Meyer 评估的上肢得分(平均值 ± SEM,MAAVNS:5.00 ± 1.02,非配对 taVNS:3.14 ± 0.63)。与未配对的 taVNS(Cohen's d = 0.30)相比,MAAVNS 的效果更大(Cohen's d = 0.63)。此外,MAAVNS 参与者接受的刺激脉冲数(平均值 ± SEM,MAAVNS:36 070 ± 3205)明显少于无配对 taVNS 参与者接受的固定 45 000 脉冲数(P 结论:MAAVNS 参与者接受的刺激脉冲数明显少于无配对 taVNS 参与者接受的固定 45 000 脉冲数:该试验表明,刺激时机可能很重要,将 taVNS 与运动配对可能优于不配对的方法。此外,MAAVNS 的效应大小与植入式 VNS 方法相当。
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来源期刊
CiteScore
8.30
自引率
4.80%
发文量
52
审稿时长
6-12 weeks
期刊介绍: Neurorehabilitation & Neural Repair (NNR) offers innovative and reliable reports relevant to functional recovery from neural injury and long term neurologic care. The journal''s unique focus is evidence-based basic and clinical practice and research. NNR deals with the management and fundamental mechanisms of functional recovery from conditions such as stroke, multiple sclerosis, Alzheimer''s disease, brain and spinal cord injuries, and peripheral nerve injuries.
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