Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke

• DOI: 10.3389/fnins.2021.767302
• Publication Date: 2021-12-01T00:49:44Z
• Authors: Johanna L. Chang; Ashley N. Coggins; Maira Saul; Alexandra Paget-B...; Malgorzata Straka; Jason Wright; Timir Datta-Chaud...; Stavros Zanos; Bruce T. Volpe
• Keywords: Vagus Nerve Stimulation; Stroke; Hemiparesis

Implanted vagus nerve stimulation (VNS) delivered concurrently with upper limb rehabilitation has been shown to improve arm function after stroke. Transcutaneous auricular VNS (taVNS) offers a non-invasive alternative implanted and may provide similar therapeutic benefit. There is much discussion about the optimal approach for combining physical therapy, as such we sought determine whether taVNS administered during robotic training, specifically premotor planning stage extension movements, would confer additional motor improvement in patients chronic Thirty-six chronic, moderate-severe hemiparesis (>6 months; mean Upper Extremity Fugl-Meyer score = 25 ± 2, range 13–48), were randomized receive 9 sessions (1 h length, 3x/week 3 weeks) of active ( N 18) or sham (500 ms bursts, frequency 30 Hz, pulse width 0.3 ms, max intensity 5 mA, ∼250 stimulated movements per session) training. was triggered by onset visual cue prior center-out movements. Clinical assessments surface electromyography (sEMG) measures biceps triceps brachii collected separate test sessions. Significant improvements measured both groups, these robust at month follow-up. Compared group, group showed significant reduction spasticity wrist hand discharge (Modified Tardieu Scale; –8.94% vs. + 2.97%, p < 0.05). The EMG results also demonstrated significantly increased variance bicep peak sEMG amplitude compared (active 26.29% MVC 3.89, 10.63% 3.10, absolute change admission discharge, 0.01), 3-month follow-up, reduced P Thus, robot training improved capacity taVNS, decreased spasticity. movement play role improving coordinated activation agonist-antagonist muscle groups mitigating increasing control following Trial Registration: www.ClinicalTrials.gov , identifier (NCT03592745).