| Research background and purpose:Stroke is an acute cerebrovascular disease,which usually leaves various functional disorders.The incidence rate of upper limb motor dysfunction is as high as80%,which seriously affects the activity of daily living of stroke patients.Therefore,how to effectively improve the upper limb motor ability and ADL of stroke patients has always attracted the attention of the society and families,and is also the research direction of rehabilitation workers.Transauricular vagus nerve stimulation that is a new therapeutic technique has the advantages of simple operation and portability.At present,there has been a small amount of initial judgment on the rehabilitation effect of taVNS combined with upper limb training on upper limb motor function of stroke patients,but the evaluation on its comprehensive rehabilitation effect is not perfect enough,and the mechanism of effect realization from the perspective of brain plasticity still needs to be further analyzed.The purpose of this study is to explore the effect of taVNS combined with upper limb training on upper limb motor function and brain plasticity of ischemic stroke subjects.To verify the safety of taVNS applied in stroke subjects.Research methods:Thirty subjects with stable subacute ischemic stroke(2 weeks ? onset time ?3months)were recruited and randomly divided into T-taVNS group(n=15)and F-taVNS group(n=15).Finally,26 subjects completed the study(13 subjects in T-taVNS group and 13 subjects in F-taVNS group).The T-taVNS group received taVNS combined upper limb training(60min/ day,5times/week,4 weeks),while the F-taVNS group received sham taVNS combined upper limb training(stimulation intensity was 0m A,and other operations were the same as those of the T-taVNS group).Follow-up was conducted for 4 weeks after the treatment of taVNS.Fugl-Meyer score of upper limb,Brunnstrom stage of upper limb and hand,motor function evaluation scale,hemiplegic hand function grade and modified Asworth grade were used to evaluate upper limb motor function of subjects in the two groups before treatment,4 weeks after treatment and during follow-up.Barthel index score was used to evaluate ADL of all subjects before treatment,4 weeks after treatment and during follow-up.Before treatment and 4 weeks after treatment,bilateral motor cortex motor evoked potentials latency and central motor conduction time were recorded on abductor pollicis brevis and brain neurotransmitters function were recorded to evaluate brain plasticity.The heart rate of all patients was monitored and adverse reactions were recorded before and after each treatment to evaluate the safety of treatment.Research results:1.Changes in Fugl-Meyer score of upper limb:after 4 weeks of treatment and during follow-up,the U-FM scores of the two groups of subjects were significantly higher than before treatment(P < 0.05),and the T-taVNS group was significantly higher than that of the F-taVNS group(P<0.05);During follow-up,the U-FM scores of the two groups of subjects were significantly higher than that after 4 weeks of treatment(P<0.01).2.Changes in Brunnstrom stage of upper limb and hand :(1)after 4 weeks of treatment and during follow-up,Brunnstrom stage of upper limb in the two groups of subjects was significantly higher than that before treatment(P < 0.05),and the T-taVNS group was significantly higher than that of the F-taVNS group(P<0.05);(2)During follow-up,Brunnstrom stage of the two groups of subjects was significantly higher than that before treatment(P<0.01).3.Changes in MFAS score : after 4 weeks of treatment and during follow-up,MFAS scores of the two groups of subjects were significantly higher than that before treatment(P<0.01),and the T-taVNS group was significantly higher than that of the F-taVNS group(P<0.05);During follow-up,MFAS scores of the two groups of subjects were significantly higher than that after 4 weeks of treatment(P<0.01).4.Changes in hemiplegic hand function grade:after 4 weeks of treatment and during follow-up,the hemiplegic hand function grade of the two groups of subjects were significantly higher than that before treatment(P < 0.05),and there was no significant difference between the two groups(P>0.05).5.Changes in modified Asworth classification:after 4 weeks of treatment and during follow-up,the modified Asworth classification of elbow and wrist flexors of the two groups of subjects were significantly lower than that before treatment(P<0.05),and there was no significant difference between two groups(P>0.05).6.Changes in BI score:after 4 weeks of treatment and during follow-up,BI score of the two groups of subjects were significantly higher than that before treatment(P<0.01),and the T-taVNS group was significantly higher than that of the F-taVNS group(P<0.05);During follow-up,BI score of the two groups of subjects was significantly higher than that after 4 weeks of treatment(P<0.01).7.Changes in MEP latency and CMCT of bilateral motor cortex:(1)Compared with before treatment,there was no significant change in MEP latency and CMCT of contralateral motor cortex in the two groups after 4 weeks of treatment(P>0.05),and there was no significant difference between two groups(P>0.05);(2)after 4 weeks of treatment,11(84.6%)subjects in the T-taVNS group led out motor cortex MEP on the affected side,which was higher than that of 6(46.2%)subjects before treatment.8(61.5%)subjects in the F-taVNS group led out motor cortex MEP on the affected side,which was higher than that of 5(38.5%)patients before treatment,but there was no statistical significance in the two groups and no significant difference between two groups(P>0.05).8.Changes in brain neurotransmitters power:(1)after 4 weeks of treatment,the brain 5-HT power of the two groups of subjects increased compared with that before treatment,but the difference was not statistically significant(P>0.05);There was no significant difference between the two groups(P>0.05);(2)after 4 weeks of treatment,the brain NE power in the T-taVNS group was significantly higher than that before treatment(P < 0.01),the F-taVNS group was slightly higher than that before treatment but the difference was not statistically significant(P>0.05),the T-taVNS group was significantly higher than that of the F-taVNS group(P<0.05);(3)after 4weeks of treatment,the brain Ach and DA power in the T-taVNS group were significantly higher than that before treatment(P<0.01),the F-taVNS group was slightly higher than that before treatment but the difference was not statistically significant(P>0.05),there was no significant difference between the two groups(P>0.05).9.Correlation analysis of difference between U-FM score difference and neurotransmitters power difference before and 4 weeks after treatment: U-FM score difference is positively correlated with NE power difference(r=0.497,P<0.05),Ach power difference(r=0.438,P<0.05),DA power difference(r=0.478,P<0.05).10.Changes in heart rate and adverse reactions:(1)no significant changes in heart rate occurred in the two groups of subjects during treatment;(2)two subjects in the T-taVNS group had adverse reactions(slight nausea and vomiting,slight pain in the left ear),while no adverse reactions were observed in the F-taVNS group.Research conclusion:taVNS combined with upper limb training can safely and effectively improve the recovery of upper limb motor function and ADL of patients with early ischemic stroke by modulating the levels of NE,Ach and DA in cerebral cortex,with lasting curative effect and superior to simple upper limb training. |
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