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

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 discus...

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Autores principales:	Johanna L. Chang, Ashley N. Coggins, Maira Saul, Alexandra Paget-Blanc, Malgorzata Straka, Jason Wright, Timir Datta-Chaudhuri, Stavros Zanos, Bruce T. Volpe
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	stroke vagus nerve stimulation (VNS) transcutaneous auricular vagus nerve stimulation (taVNS) hemiparesis rehabilitation robotic therapy Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/e98802ac070542e093c6b731de955e4d
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spelling	oai:doaj.org-article:e98802ac070542e093c6b731de955e4d2021-12-01T00:49:36ZTranscutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke1662-453X10.3389/fnins.2021.767302https://doaj.org/article/e98802ac070542e093c6b731de955e4d2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fnins.2021.767302/fullhttps://doaj.org/toc/1662-453XImplanted 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).Johanna L. ChangAshley N. CogginsMaira SaulAlexandra Paget-BlancMalgorzata StrakaJason WrightTimir Datta-ChaudhuriStavros ZanosBruce T. VolpeFrontiers Media S.A.articlestrokevagus nerve stimulation (VNS)transcutaneous auricular vagus nerve stimulation (taVNS)hemiparesisrehabilitationrobotic therapyNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENFrontiers in Neuroscience, Vol 15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	stroke vagus nerve stimulation (VNS) transcutaneous auricular vagus nerve stimulation (taVNS) hemiparesis rehabilitation robotic therapy Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	stroke vagus nerve stimulation (VNS) transcutaneous auricular vagus nerve stimulation (taVNS) hemiparesis rehabilitation robotic therapy Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Johanna L. Chang Ashley N. Coggins Maira Saul Alexandra Paget-Blanc Malgorzata Straka Jason Wright Timir Datta-Chaudhuri Stavros Zanos Bruce T. Volpe Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke
description	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).
format	article
author	Johanna L. Chang Ashley N. Coggins Maira Saul Alexandra Paget-Blanc Malgorzata Straka Jason Wright Timir Datta-Chaudhuri Stavros Zanos Bruce T. Volpe
author_facet	Johanna L. Chang Ashley N. Coggins Maira Saul Alexandra Paget-Blanc Malgorzata Straka Jason Wright Timir Datta-Chaudhuri Stavros Zanos Bruce T. Volpe
author_sort	Johanna L. Chang
title	Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke
title_short	Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke
title_full	Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke
title_fullStr	Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke
title_full_unstemmed	Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke
title_sort	transcutaneous auricular vagus nerve stimulation (tavns) delivered during upper limb interactive robotic training demonstrates novel antagonist control for reaching movements following stroke
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e98802ac070542e093c6b731de955e4d
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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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