Review Article

Clinical Research Progress of the Post-Stroke Upper Limb Motor Function Improvement via Transcutaneous Auricular Vagus Nerve Stimulation

Table 1

Clinical study of taVNS intervention for motor function after stroke.

Author (reference number)Sample size (N)GroupStimulation siteStimulation parameters and timeCourse of treatment and follow-upAssessment toolsEffects of taVNSType of stroke and motor impairmentAccompanying treatments

Wu et al. [18]21taVNS group and sham taVNS groupThe cymba conchae of the left ear600 pulses (20 Hz, each pulse duration 0.3ms), lasting 30 s each, stimulated every 5 min for 30 min per day. The intensity was selected according to the subject’s individual body tolerance.15 days, 12 weeksFMA-U, WMFT, FIM, BrunnstromtaNVS improves upper limb motor function in subacute ischemia stroke patients without obvious adverse effects.Ischemia stroke; between 0.5 and 3 months postonset; single upper limb motor function impairmentPostural control, proprioception exercises, neuromuscular facilitation, and gait training
Zhu Lin et al. [27]113Control group and observation groupThe cymba conchae of the left earThe current intensity was the maximum value for which the patient did not feel pain. The stimulation interval was 30 s, rest 30 s, and the pulses were set in biphasic waves with 25 Hz and a wave width of 0.1ms for 20–30 min each time, 5 times per week.1 month, noneFMA-U, MFAS, MBIOccupational therapy combined with taVNS regulates the level of norepinephrine, acetylcholine, and dopamine, improve upper limb motor function.Ischemia stroke; between 0.5 and 3 months postonset; single upper limb motor function impairmentUpper limb motor function and activity participation ability training
Redgrave et al. [19]13NoneThe concha of the left earThe intensity was at the patient’s maximum tolerance level, with a wave width of 0.1ms and 25 Hz. The stimulation was turned on when the patient began to move their arm, and the movements were repeated more than 300 times per treatment, three times per week.6 weeks, noneFMA-U, ARAT, MRS, BI, SIS, Motor Activity Log, PHQ9, GAD7, Fatigue Assessment ScaletaVNS combined with upper limb repetitive movements is feasible, and improves upper limb function.Ischemia stroke; at least 3 months postonset; upper limb motor function impairmentLarge- range arm movements and repetitive task-specific movements training
Fioravante Capone et al. [29]14Randomly divided into sham stimulation group and stimulation groupThe left external acoustic meatus at the inner side of the tragusThe pulse frequency was 20 Hz and the pulse duration was 0.3ms, which was repeated every 5 min for 60 min of continuous operation. A current intensity slightly below the patient’s pain threshold.10 days, 2 weeksFMA, NIHSS, Rankin Scale, BI, Modified Ashworth ScaletaVNS combined with robotic training is feasible in stroke patients, and slightly improves upper limb function.Ischemic or haemorrhagic stroke; at least 1 year postonset; hand function impairmentRobotic training delivered at proximal or distal segment of the affected limb according to the degree of impairment
Zhang Liping et al. [25]42Randomly divided into sham stimulation group and stimulation groupThe cymba conchae of the hemiplegic side of the body20 Hz square wave with a current intensity of 0.5mA. Each session lasted 30 s and was stimulated every 2 min. Each treatment lasted 30 min, once a day, five times a week.3 weeks, noneFMA-U, WMFT, FIMtaVNS improves upper limb function with no obvious adverse effects.Ischemia stroke; within 3 months postonset; hemiplegiaInternal medicine treatment and comprehensive rehabilitation training
Li et al. [26]60Randomly divided into taVNS group and control groupThe left auricular cavum conchae5 times a week, once for 20 min. 0.3ms square wave at 20 Hz for 30 s, repeated every 5 min. The current intensity (1.71 ± 0.5 mA) was adjusted according to the tolerance of each patient.4 weeks, 1 year (as well as 1, 3, and 6 months after the start of treatment)WMFT, FMA-U, FMA-L, FMA-S, SIS, HADStaVNS combined with conventional rehabilitation training is safe and effective.Ischemic or haemorrhagic stroke; within 1 month postonsetPostural control, neuromuscular facilitation and sensory integration exercises
Chang et al. [28]34Sham stimulation group and taVNS groupThe left cymba conchae30 Hz, with a pulse width of 0.3ms and a current intensity slightly below the patient’s pain threshold (0.1–5 mA), 3 times a week for 1 hr each treatment.3 days, 3 weeksFMA-U, MRC, WMFT, MTStaVNS combined with robotic training improves upper limb function.Ischemic or haemorrhagic stroke; at least 6 months postonset; upper limb hemiparesisRobotic training
BAIG et al. [20]12NoneThe concha of the left earPulse width of 0.1ms, 25 Hz, and pulse amplitude as maximally tolerated by the participant.6 weeks, noneFMA-UtaVNS combined with motor rehabilitation may improve sensory recovery.Ischemia stroke; at least 3 months postonset; upper limb motor function impairmentRepetitive upper limb task training

Notes: ARAT: Action Recovery Arm Test, BI: Barthel Index, FIM: Functional Independence Measurement, FMA-L: Fugl–Meyer Assessment-Lower Limb, FMA-S: Fugl–Meyer Assessment-Sensory, FMA-U: Fugl–Meyer Assessment-Upper Limb, GAD7: Generalized Anxiety Disorder 7, HADS: Hospital Anxiety and Depression Scale, MBI: Modified Barthel Index, MFAS: Motor Function Assessment Scale, MRC: Medical Research Council Motor Power Scale, MRS: Modified Rankin Scale, MTS: Modified Tardieu Scale, NIHSS: National Institute of Health Stroke Scale, PHQ9: Patient-Health Questionnaire, SIS: Stroke Impact Scale, taVNS: Transcutaneous Auricular Vagus Nerve Stimulation, WMFT: Wolf Motor Function Test.