Optimization of closed-loop taVNS for motor rehabilitation

在美国，每年有近80万人中风，运动障碍是最常见的长期功能性残疾。85%的中风病例会导致上肢功能下降，这对日常生活产生了严重的负面影响。运动恢复最常见的是通过专业辅助的运动康复训练，并在实验中通过各种机器人、虚拟现实和脑刺激技术实现。许多康复技术试图恢复中风后病理上不足的神经活动，以恢复功能，因为中风会导致脑组织损伤，并随后在周围未受损组织中重组皮质运动表征。迷走神经刺激(VNS)通过增加神经可塑性和促进神经活动和功能的恢复来促进运动康复。迷走神经迷走神经的左侧颈束周围包裹着一个袖带电极，在过去的十年里，在几个有希望的动物模型发现证明了以靶向依赖的方式诱导神经可塑性的能力之后，迷走神经痉挛再次出现。在动物模型中，VNS爆发的时间配对加上运动康复可以恢复中风后病理上缺乏的神经活动。这种VNS和恢复性行为干预的复杂组合被称为“靶向可塑性”，是治疗神经精神干预的一种有前途的方法，在中风后康复方面具有潜在的变革潜力。最近，一种被称为经皮耳迷走神经刺激(TaVNS)的非侵入性替代疗法已经成为传统植入迷走神经刺激术的一种有前途的替代方案。然而，taVNS的目标是迷走神经的耳支，它支配人的耳朵，激活传入和传出的迷走神经网络，允许对颈部植入的VNS结果进行无创、简单和快速的翻译。这项建议旨在发展无创的、闭环式tavns作为神经可塑性的增强剂，并加速中风后上肢运动的恢复。 康复。

Nearly 800,000 people in the United States have a stroke annually, with motor impairments being the most common long-term functional disability. 85% of stroke cases result in reductions in upper limb function, and this has a severe negative impact on daily living. Motor recovery is achieved most commonly through professionally assisted motor rehabilitation training, and experimentally through various robotic, virtual reality, and brain stimulation techniques. Many of these rehabilitation techniques attempt to restore pathologically insufficient neural activity post-stroke to regain function, as the stroke induces damage to brain tissue and subsequent reorganization of cortical motor representations in surrounding undamaged tissue. Vagus nerve stimulation (VNS) can enhance motor rehabilitation by increasing neuroplasticity and accelerating the restoration of neural activity and function when paired in a temporally synchronized manner. VNS involves wrapping a cuff electrode around the left cervical bundle of the vagus nerve and has seen a reemergence in the past decade following several promising animal model findings demonstrating the ability to induce neuroplasticity in a target-dependent manner. In animal models, the temporal pairing of VNS bursts paired with motor rehabilitation can restore pathologically insufficient neural activity post-stroke. This intricate pairing of VNS and restorative behavioral intervention is known as “targeted plasticity” and is a promising approach to treatment of neuropsychiatric interventions, with potentially transformative potential in post stroke rehabilitation. Recently, a noninvasive alternative known as transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising alternative to conventionally implanted VNS. taVNS, however, targets the auricular branch of the vagus nerve, which innervates the human ear and activates the afferent and efferent vagal networks, allowing for a noninvasive, simple, and rapid translation of cervically implanted VNS findings. This proposal aims to develop noninvasive, closed- loop taVNS as an enhancer of neuroplasticity and accelerate upper limb motor restoration in post-stroke rehabilitation.