Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke.
Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke.
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DOI：
10.3389/fnins.2021.767302
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发表时间：
2021
影响因子：
4.3
通讯作者：
Volpe BT
中科院分区：
文献类型：
--
作者：
Chang JL;Coggins AN;Saul M;Paget-Blanc A;Straka M;Wright J;Datta-Chaudhuri T;Zanos S;Volpe BT
植入迷走神经刺激（VNS）与上肢康复同时进行，已被证明可以改善中风后手臂功能。经皮耳廓VNS（taVNS）提供了植入VNS的非侵入性替代方案，并可提供类似的治疗获益。关于结合VNS和物理治疗的最佳方法有很多讨论，因此我们试图确定在机器人训练期间给予的taVNS，特别是在手臂伸展运动的运动前计划阶段期间给予的taVNS，是否会使慢性卒中患者的运动得到额外改善。36例慢性中重度上肢轻偏瘫患者（6个月以上; Fugl-Meyer评分上限平均值= 25 ± 2，范围13-48），随机分为9组（1小时，每周3次，持续3周）活性（N = 18）或假手术（N = 18）taVNS（500 ms脉冲群，频率30 Hz，脉冲宽度0.3 ms，最大强度5 mA，每次训练10250次刺激运动）。taVNS由在中心向外手臂伸展运动之前的视觉提示的开始触发。临床评估和表面肌电图（sEMG）的肱二头肌和肱三头肌的措施，收集在单独的测试会议。主动和假taVNS组均测量到显著的运动改善，并且这些改善在3个月随访时是稳健的。与假手术组相比，活性taVNS组显示出出院时手腕和手的痉挛显著减轻（改良的Tardieu量表; taVNS = -8.94% vs.假手术=+2.97%，p < 0.05）。EMG结果还表明，与假手术组相比，活动taVNS组在放电时伸展期间二头肌峰值sEMG振幅的方差显著增加（活性= 26.29%MVC ± 3.89，假= 10.63%MVC ± 3.10，入院到出院的平均绝对变化，p < 0.01），并且在3个月随访时，活动性taVNS组肱二头肌表面肌电峰值振幅明显降低（P < 0.05）。因此，机器人训练提高了两组的运动能力，taVNS减少了痉挛。在运动前计划期间给予taVNS可能通过减轻痉挛和增加中风后的运动控制，在改善激动剂-拮抗剂上臂肌群的协调激活中发挥作用。临床试验注册：www.ClinicalTrials.gov，标识符（NCT 03592745）。
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 to implanted VNS and may provide similar therapeutic benefit. 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. 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. taVNS was triggered by the onset of a visual cue prior to center-out arm extension movements. Clinical assessments and surface electromyography (sEMG) measures of the biceps and triceps brachii were collected during separate test sessions. Significant motor improvements were measured for both the active and sham taVNS groups, and these improvements were robust at 3 month follow-up. 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. sham = + 2.97%, p < 0.05). 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). Thus, robot training improved the motor capacity of both groups, and taVNS, decreased spasticity. 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. Clinical Trial Registration: www.ClinicalTrials.gov, identifier (NCT03592745).
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影响因子：
4.2
作者：
Khodaparast N;Hays SA;Sloan AM;Fayyaz T;Hulsey DR;Rennaker RL 2nd;Kilgard MP
通讯作者：
Kilgard MP
影响因子：
2.5
作者：
Fernandez-Pena, Eneko;Lucertini, Francesco;Ditroilo, Massimiliano
通讯作者：
Ditroilo, Massimiliano
影响因子：
8.3
作者：
Cramer, SC;Nelles, G;Rosen, BR
通讯作者：
Rosen, BR
影响因子：
3.3
作者：
Capone, Fioravante;Assenza, Giovanni;Di Lazzaro, Vincenzo
通讯作者：
Di Lazzaro, Vincenzo
影响因子：
2.1
作者：
COLGATE, JE;HOGAN, N
通讯作者：
HOGAN, N