![]() Motor behaviors paired with implanted VNS following stroke demonstrated selective increases in the size of their motor representations within the motor cortex, while motor representations for untrained tasks or tasks performed without VNS remained relatively unchanged ( Porter et al., 2011 Khodaparast et al., 2014). VNS has been shown to activate cholinergic basal forebrain, noradrenergic locus coeruleus networks important for plasticity and learning, and to enhance the release of GABA ( Capone et al., 2015 Hays, 2016 Colzato and Beste, 2020), thereby potentially facilitating improvement when it is combined with motor rehabilitation.Īnimal models of motor recovery following stroke have indicated specificity of recovery for only those tasks or stimuli paired with VNS. Recently, the combination of upper limb rehabilitation with vagus nerve stimulation (VNS) was demonstrated to improve motor outcomes in individuals with chronic post-stroke hemiparesis ( Dawson et al., 2016, 2021 Kimberley et al., 2018). Even with aggressive standard rehabilitation, more than 40% of patients experience chronic upper limb hemiparesis ( Cramer et al., 1997). ![]() Stroke is the leading cause of long-term disability in the United States ( American Heart Association, 2021). ![]() taVNS administered during premotor planning of movement may play a role in improving coordinated activation of the agonist-antagonist upper arm muscle groups by mitigating spasticity and increasing motor control following stroke.Ĭlinical Trial Registration: identifier (NCT03592745). Thus, robot training improved the motor capacity of both groups, and taVNS, decreased spasticity. The EMG results also demonstrated significantly increased variance for the bicep peak sEMG amplitude during extension for the active taVNS group compared to the sham group at discharge (active = 26.29% MVC ± 3.89, sham = 10.63% MVC ± 3.10, mean absolute change admission to discharge, p < 0.01), and at 3-month follow-up, the bicep peak sEMG amplitude was significantly reduced in the active taVNS group ( P < 0.05). Compared to the sham group, the active taVNS group showed a significant reduction in spasticity of the wrist and hand at discharge (Modified Tardieu Scale taVNS = –8.94% vs. Significant motor improvements were measured for both the active and sham taVNS groups, and these improvements were robust at 3 month follow-up. Clinical assessments and surface electromyography (sEMG) measures of the biceps and triceps brachii were collected during separate test sessions. taVNS was triggered by the onset of a visual cue prior to center-out arm extension movements. Thirty-six patients with chronic, moderate-severe upper limb hemiparesis (>6 months mean Upper Extremity Fugl-Meyer score = 25 ± 2, range 13–48), were randomized to receive 9 sessions (1 h in length, 3x/week for 3 weeks) of active ( N = 18) or sham ( N = 18) taVNS (500 ms bursts, frequency 30 Hz, pulse width 0.3 ms, max intensity 5 mA, ∼250 stimulated movements per session) delivered during robotic training. There is much discussion about the optimal approach for combining VNS and physical therapy, as such we sought to determine whether taVNS administered during robotic training, specifically delivered during the premotor planning stage for arm extension movements, would confer additional motor improvement in patients with chronic stroke. Transcutaneous auricular VNS (taVNS) offers a non-invasive alternative to implanted VNS and may provide similar therapeutic benefit. ![]() Implanted vagus nerve stimulation (VNS) delivered concurrently with upper limb rehabilitation has been shown to improve arm function after stroke. 3Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.2Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States.1Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.Coggins 1, Maira Saul 1, Alexandra Paget-Blanc 3, Malgorzata Straka 2, Jason Wright 2, Timir Datta-Chaudhuri 2, Stavros Zanos 2 and Bruce T.
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