• Jessica N Redgrave, Lucy Moore, Tosin Oyekunle, Maryam Ebrahim, Konstantinos Falidas, Nicola Snowdon, Ali Ali, and Arshad Majid.
• Sheffield Institute of Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom. Electronic address: Jessica.redgrave@sth.nhs.uk.
• J Stroke Cerebrovasc Dis. 2018 Jul 1; 27 (7): 1998-2005.

BackgroundInvasive vagus nerve stimulation (VNS) has the potential to enhance the effects of physiotherapy for upper limb motor recovery after stroke. Noninvasive, transcutaneous auricular branch VNS (taVNS) may have similar benefits, but this has not been evaluated in stroke recovery. We sought to determine the feasibility of taVNS delivered alongside upper limb repetitive task-specific practice after stroke and its effects on a range of outcome measures evaluating limb function.Materials And MethodsThirteen participants at more than 3 months postischemic stroke with residual upper limb dysfunction were recruited from the community of Sheffield, United Kingdom (October-December 2016). Participants underwent 18 × 1-hour sessions over 6 weeks in which they made 30-50 repetitions of 8-10 arm movements concurrently with taVNS (NEMOS; Cerbomed, Erlangen, Germany, 25 Hz, .1-millisecond pulse width) at maximum tolerated intensity (mA). An electrocardiogram and rehabilitation outcome scores were obtained at each visit. Qualitative interviews determined the acceptability of taVNS to participants.ResultsMedian time after stroke was 1.16 years, and baseline median/interquartile range upper limb Fugl-Meyer (UFM) score was 63 (54.5-99.5). Participants attended 92% of the planned treatment sessions. Three participants reported side effects, mainly fatigue, but all performed mean of more than 300 arm repetitions per session with no serious adverse events. There was a significant change in the UFM score with a mean increase per participant of 17.1 points (standard deviation 7.8).ConclusiontaVNS is feasible and well-tolerated alongside upper limb repetitive movements in poststroke rehabilitation. The motor improvements observed justify a phase 2 trial in patients with residual arm weakness.Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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