Redgrave Jessica N, Moore Lucy, Oyekunle Tosin, Ebrahim Maryam, Falidas Konstantinos, Snowdon Nicola, Ali Ali, Majid Arshad
Sheffield Institute of Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, United Kingdom.
J Stroke Cerebrovasc Dis. 2018 Jul;27(7):1998-2005. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.056. Epub 2018 Mar 23.
Invasive vagus nerve stimulation (VNS) has the potential to enhance the effects of physiotherapy for upper limb motor recovery after stroke. Noninvasive, transcutaneous auricular branch VNS (taVNS) may have similar benefits, but this has not been evaluated in stroke recovery. We sought to determine the feasibility of taVNS delivered alongside upper limb repetitive task-specific practice after stroke and its effects on a range of outcome measures evaluating limb function.
Thirteen participants at more than 3 months postischemic stroke with residual upper limb dysfunction were recruited from the community of Sheffield, United Kingdom (October-December 2016). Participants underwent 18 × 1-hour sessions over 6 weeks in which they made 30-50 repetitions of 8-10 arm movements concurrently with taVNS (NEMOS; Cerbomed, Erlangen, Germany, 25 Hz, .1-millisecond pulse width) at maximum tolerated intensity (mA). An electrocardiogram and rehabilitation outcome scores were obtained at each visit. Qualitative interviews determined the acceptability of taVNS to participants.
Median time after stroke was 1.16 years, and baseline median/interquartile range upper limb Fugl-Meyer (UFM) score was 63 (54.5-99.5). Participants attended 92% of the planned treatment sessions. Three participants reported side effects, mainly fatigue, but all performed mean of more than 300 arm repetitions per session with no serious adverse events. There was a significant change in the UFM score with a mean increase per participant of 17.1 points (standard deviation 7.8).
taVNS is feasible and well-tolerated alongside upper limb repetitive movements in poststroke rehabilitation. The motor improvements observed justify a phase 2 trial in patients with residual arm weakness.
侵入性迷走神经刺激（VNS）有可能增强中风后上肢运动恢复的物理治疗效果。非侵入性经皮耳支VNS（taVNS）可能具有类似的益处，但尚未在中风恢复中进行评估。我们试图确定中风后taVNS与上肢重复性特定任务练习同时进行的可行性及其对一系列评估肢体功能的结局指标的影响。
从英国谢菲尔德社区招募了13名缺血性中风后3个月以上且存在上肢功能障碍的参与者（2016年10月至12月）。参与者在6周内接受了18次每次1小时的治疗，期间他们在最大耐受强度（mA）下，与taVNS（NEMOS；德国埃尔朗根的Cerbomed公司，25Hz，0.1毫秒脉冲宽度）同时进行30-50次8-10种手臂动作的重复练习。每次就诊时获取心电图和康复结局评分。定性访谈确定了参与者对taVNS的可接受性。
中风后的中位时间为1.16年，基线时上肢Fugl-Meyer（UFM）评分的中位数/四分位间距为63（54.5-99.5）。参与者参加了92%的计划治疗课程。三名参与者报告了副作用，主要是疲劳，但所有参与者每次课程平均进行超过300次手臂重复练习，无严重不良事件。UFM评分有显著变化，每位参与者平均增加17.1分（标准差7.8）。
在中风后康复中，taVNS与上肢重复性运动同时进行是可行的且耐受性良好。观察到的运动改善证明对残留手臂无力的患者进行2期试验是合理的。
