Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA.
Departments of Physical Therapy and Rehabilitation Science, Rehabilitation Science PhD Program, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA.
Phys Ther. 2023 Dec 6;103(12). doi: 10.1093/ptj/pzad097.
The purpose of this case report is to describe pairing vagus nerve stimulation (VNS) with mobility training in an individual after stroke.
A 53-year-old man with left hemiparesis 14.2 months after an ischemic stroke participated in a pilot study investigating the safety and feasibility of VNS paired with upper limb rehabilitation. In addition to upper limb impairment, the participant had impaired gait and wanted to improve his mobility. A single-subject design investigation of VNS paired with self-directed mobility training was conducted. Following the conclusion of the pilot study, the participant was instructed to complete daily sessions of self-activated VNS paired with walking or stationary biking. The 10-Meter Walk Test and timed distance (6-Minute Walk Test) were assessed at 4 baseline points and at 3 to 41 months after mobility training.
The participant had stable baseline values and was classified as a household ambulator with a quad cane. After VNS-paired mobility training, statistically significant improvements were observed in all measures, with the greatest improvements at 9 months exceeding the minimal detectable change: self-selected gait speed from 0.34 (standard deviation [SD] = 0.01) to 0.60 meters/second, fast gait speed from 0.37 (SD = 0.03) to 0.79 meters/second, and 6-Minute Walk Test distance from 106.91 (SD = 6.38) to 179.83 meters. The participant reported increased confidence and balance when walking. No falls or adverse events were reported.
The participant demonstrated improved gait speed and timed distance after VNS-paired mobility training. Randomized, blinded trials are needed to determine treatment efficacy.
This is the first documented case of VNS-paired mobility training in an individual with chronic poststroke gait impairments. VNS paired with mobility training may improve poststroke gait impairments.
本病例报告旨在描述在卒中后患者中联合迷走神经刺激（VNS）与运动训练。
一名 53 岁男性，在缺血性卒中后 14.2 个月时出现左侧偏瘫，参与了一项关于 VNS 联合上肢康复的安全性和可行性的试点研究。除了上肢功能障碍外，该患者还存在步态障碍，希望提高其活动能力。采用单病例设计，研究 VNS 联合自我指导的运动训练。在试点研究结束后，指导患者进行每日自行激活 VNS 联合行走或固定自行车训练。在基线时进行 10 米步行测试（10MWT）和计时距离（6 分钟步行测试，6MWT）评估，然后在 3 至 41 个月时进行评估。
该患者基线值稳定，被归类为使用四足助行器的室内活动者。在 VNS 联合运动训练后，所有指标均有显著改善，9 个月时的最大改善超过最小可检测变化：自我选择的步行速度从 0.34（标准差[SD] = 0.01）增加到 0.60 米/秒，快速步行速度从 0.37（SD = 0.03）增加到 0.79 米/秒，6MWT 距离从 106.91（SD = 6.38）增加到 179.83 米。患者报告说，在行走时，信心和平衡感增强。未报告跌倒或不良事件。
该患者在 VNS 联合运动训练后表现出了步行速度和计时距离的改善。需要进行随机、盲法试验来确定治疗效果。
这是首例在慢性卒中后步态障碍患者中联合 VNS 与运动训练的病例报道。VNS 联合运动训练可能改善卒中后步态障碍。
