[ARTICLE] Vagus nerve stimulation and upper limb rehabilitation – Full Text

The Upper Limb and Stroke

Arm weakness is common after stroke and its treatment is recognised as an area of considerable need.¹ Approximately 85% of patients with stroke present with arm weakness² and 60% of stroke survivors with poorly functioning arms at one week do not recover meaningful function by six months.³ Arm weakness is a major factor contributing to disability following stroke.⁴Current treatment for arm weakness typically comprises intensive, task-specific and repetitive rehabilitative interventions or occasionally methods such as constraint induced movement therapy and robotic therapy.⁵ A recent meta-analysis and large-scale trials show the effects of current treatments for arm weakness to be modest.^6,7  Improvement in arm function should improve quality of life for stroke survivors, reduce co-morbidities associated with loss of independence, and reduce cost to the health care system.⁸ 

Neuroplasticity and Recovery

Neuroplasticity is the brain’s ability to form new neural pathways in response to injury or disease. It has been a target for the treatment of many neurological disorders including epilepsy and tinnitus. Recent studies have suggested that augmentation of neuroplasticity is required to more fully recover motor function.⁹ Novel techniques that drive the growth of new neural pathways related to motor function are needed;  vagus nerve stimulation (VNS) may achieve this.

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Figure 1: © Images copyright of MicroTransponder The stimulation electrodes of the leads are placed on the left vagus nerve in the left carotid sheath, and the lead is then tunnelled subcutaneously to a subcutaneous pocket created in the left pectoral region where it is attached to the pulse generator. A wireless control interface is used to communicate with the VNS device and deliver stimulation during therapy sessions.

 

[ARTICLE] Anodal tDCS Combined With Radial Nerve Stimulation Promotes Hand Motor Recovery in the Acute Phase After Ischemic Stroke

Abstract

Background and Objective: The question of the best therapeutic window in which noninvasive brain stimulation (NIBS) could potentiate the plastic changes for motor recovery after a stroke is still unresolved. Most of the previous NIBS studies included patients in the chronic phase of recovery and very few in the subacute or acute phase. We investigated the effect of transcranial direct current stimulation (tDCS) combined with repetitive peripheral nerve stimulation (rPNS) on the time course of motor recovery in the acute phase after a stroke.

Methods: Twenty patients enrolled within the first few days after a stroke were randomized in 2 parallel groups: one receiving 5 consecutive daily sessions of anodal tDCS over the ipsilesional motor cortex in association with rPNS and the other receiving the same rPNS combined with sham tDCS. Motor performance (primary endpoint: Jebsen and Taylor Hand Function Test [JHFT]) and transcranial magnetic stimulation cortical excitability measures were obtained at baseline (D1), at the end of the treatment (D5), and at 2 and 4 weeks’ follow-up (D15 and D30).

Results: The time course of motor recovery of the 2 groups of patients was different and positively influenced by the intervention (Group × Time interaction P = .01). The amount of improvement on the JHFT was greater at D15 and D30 in the anodal tDCS group than in the sham group.

Conclusion: These results show that early cortical neuromodulation with anodal tDCS combined with rPNS can promote motor hand recovery and that the benefit is still present 1 month after the stroke.

Source: Anodal tDCS Combined With Radial Nerve Stimulation Promotes Hand Motor Recovery in the Acute Phase After Ischemic Stroke