Date Presented 04/20/2023
Children with unilateral weakness may demonstrate improved functional goal achievement with less dosage requirement when constraint-induced movement therapy (CIMT) is paired with transcutaneous auricular vagus nerve stimulation (taVNS), indicating less burden to participants and encouraging translation to OT clinical practice.
Primary Author and Speaker: Patricia Coker-Bolt
Additional Authors and Speakers: Elizabeth Humanitzki
Contributing Authors: Kelly McGloon, Julia Schoeder Brennan, Annie Cribb, Bashar W. Badran, Mark George, Dorothea Jenkins
PURPOSE: This first-of-its-kind study tests the feasibility of pairing transcutaneous auricular Vagus Nerve Stimulation (taVNS) with Constraint Induced Movement Therapy (CIMT) in infants with hemiplegia. Provision of taVNS & CIMT in infants may take advantage of critical windows for neuroplasticity to improve long term function. Pairing taVNS to CIMT may enhance functional outcomes and produce a better return on investment for intensive therapies like CIMT.
DESIGN: In a prospective, open label, IRB-approved pilot trial we combined 40hours of CIMT with taVNS in infants 6-18mo of age with hemiplegia, after parental consent (NCT05101707). We measured improvements in upper extremity (QUEST) and therapeutic goals with Goal attainment scaling (GAS).
METHOD: One infant has undergone the combined treatment, a male born at 23-weeks gestation who suffered intraventricular hemorrhage resulting in global delays with left-sided hemiplegia at 11-months corrected gestational age. Pediatric CIMT trained therapists manually triggered taVNS stimulation with active movement, using subthreshold taVNS without adverse events. At baseline the infant showed little spontaneous use of his left arm. Significant improvements were seen on the QUEST in dissociated movement (Δ=40.63 CIMT+taVNS vs expected Δ=5.2 with CIMT alone) and grasping (Δ=18.5 vs expected Δ =11.1 with CIMT alone). GAS was better-than-expected (+28.3±9.8, p<0.001). At 4-month follow-up Dissociated Movement scores were maintained (Post 84.38, Follow-up 85.94) and Grasp scores continued to improve (Post 29.62, Follow-up 37.02). Mother reported he was consistently engaged in bimanual play at home after 4 months.
CONCLUSION: taVNS-paired with CIMT appears safe and may boost functional motor recovery when combined with a low dosage CIMT program in infants with hemiplegia. These findings advance CIMT implementation, as using minimal dosage may relieve burden on participants, and support translation to clinical practice.
References
Dawson, J., Liu, C. Y., Francisco, G. E., et al. Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial. Lancet. Apr 24 2021;397(10284):1545-1553. https://doi.org/10.1016/s0140-6736(21)00475-x
Badran, B. W., Jenkins, D. D., DeVries, W.H., et al. Transcutaneous auricular vagus nerve stimulation (taVNS) for improving oromotor function in newborns. Brain Stimul. Sep-Oct 2018;11(5):1198-1200. https://doi.org/10.1016/j.brs.2018.06.009
Gordon, A. M., Hung, Y. C., Brandao, M., et al. Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: a randomized trial. Neurorehabil Neural Repair. Oct 2011;25(8):692-702. https://doi.org/10.1177/1545968311402508
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