Wang Meng-Huan, Wang Yi-Xiu, Xie Min, Chen Li-Yan, He Meng-Fei, Lin Feng, Jiang Zhong-Li
School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Front Neurosci. 2024 Mar 8;18:1346634. doi: 10.3389/fnins.2024.1346634. eCollection 2024.
Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising brain stimulation modality in poststroke upper extremity rehabilitation. Although several studies have examined the safety and reliability of taVNS, the mechanisms underlying motor recovery in stroke patients remain unclear.
This study aimed to investigate the effects of taVNS paired with task-oriented training (TOT) on upper extremity function in patients with subacute stroke and explore the potential underlying mechanisms.
In this double-blinded, randomized, controlled pilot trial, 40 patients with subacute stroke were randomly assigned to two groups: the VNS group (VG), receiving taVNS during TOT, and the Sham group (SG), receiving sham taVNS during TOT. The intervention was delivered 5 days per week for 4 weeks. Upper extremity function was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT). Activities of daily living were measured by the modified Barthel Index (MBI). Motor-evoked potentials (MEPs) were measured to evaluate cortical excitability. Assessments were administered at baseline and post-intervention. Additionally, the immediate effect of taVNS was detected using functional near-infrared spectroscopy (fNIRS) and heart rate variability (HRV) before intervention.
The VG showed significant improvements in upper extremity function (FMA-UE, ARAT) and activities of daily living (MBI) compared to the SG at post-intervention. Furthermore, the VG demonstrated a higher rate of elicited ipsilesional MEPs and a shorter latency of MEPs in the contralesional M1. In the VG, improvements in FMA-UE were significantly associated with reduced latency of contralesional MEPs. Additionally, fNIRS revealed increased activation in the contralesional prefrontal cortex and ipsilesional sensorimotor cortex in the VG in contrast to the SG. However, no significant between-group differences were found in HRV.
The combination of taVNS with TOT effectively improves upper extremity function in patients with subacute stroke, potentially through modulating the bilateral cortex excitability to facilitate task-specific functional recovery.
经皮耳迷走神经刺激（taVNS）已成为中风后上肢康复中一种有前景的脑刺激方式。尽管有多项研究探讨了taVNS的安全性和可靠性，但中风患者运动恢复的潜在机制仍不清楚。
本研究旨在探讨taVNS联合任务导向训练（TOT）对亚急性中风患者上肢功能的影响，并探索其潜在机制。
在这项双盲、随机、对照的试点试验中，40例亚急性中风患者被随机分为两组：迷走神经刺激组（VG），在TOT期间接受taVNS；假刺激组（SG），在TOT期间接受假taVNS。干预每周进行5天，共4周。使用Fugl-Meyer上肢评估量表（FMA-UE）、动作研究臂测试（ARAT）评估上肢功能。采用改良Barthel指数（MBI）评估日常生活活动能力。测量运动诱发电位（MEP）以评估皮质兴奋性。在基线和干预后进行评估。此外，在干预前使用功能近红外光谱（fNIRS）和心率变异性（HRV）检测taVNS的即时效应。
干预后，与SG相比，VG在上肢功能（FMA-UE、ARAT）和日常生活活动能力（MBI）方面有显著改善。此外，VG患侧MEP引出率更高，对侧M1区MEP潜伏期更短。在VG中FMA-UE的改善与对侧MEP潜伏期缩短显著相关。此外，与SG相比，fNIRS显示VG对侧前额叶皮质和患侧感觉运动皮质激活增加。然而，HRV在组间未发现显著差异。
taVNS与TOT联合可有效改善亚急性中风患者的上肢功能，可能是通过调节双侧皮质兴奋性来促进特定任务的功能恢复。
