Auricular Vagus Nerve Stimulation Combined With Rehabilitation in Parkinson's Disease

Investigation of the Effects of Auricular Vagus Nerve Stimulation Combined With Neurological Physiotherapy and Rehabilitation on Balance, Gait, and Clinical Symptoms in People With Parkinson's Disease

Parkinson's disease (PD) is a progressive, neurodegenerative movement disorder characterized by a combination of motor and non-motor symptoms. Auricular vagus nerve stimulation (aVNS), one of the physiotherapy methods used in PD, has been shown in studies to have a positive effect on symptoms such as motor symptoms, gait disturbance, freezing, and cognitive impairment, and is considered a safe and feasible method. The aim of this study is to investigate the effects of neurological physiotherapy and rehabilitation, in combination with aVNS application, on balance, gait, and clinical symptoms in individuals with PD.

Parkinson's disease (PD) is a progressive, neurodegenerative movement disorder characterized by a combination of motor symptoms such as bradykinesia, rigidity, tremor, and postural instability, and non-motor symptoms such as depression, anxiety, and cognitive impairment. Neurological physiotherapy and rehabilitation are among the most important components of PD in the literature to prevent progression, alleviate symptoms, and slow neurodegeneration. Auricular vagus nerve stimulation (aVNS), one of the physiotherapy methods used in PD, has been shown in studies to have a positive effect on symptoms such as motor symptoms, gait disturbance, freezing, and cognitive impairment, and is considered a safe and feasible method. Looking at PD studies in the literature, it is seen that participants applied aVNS at home on their own, in an isolated study design, and individuals were not included in any rehabilitation program. The aim of this study is to investigate the effects of neurological physiotherapy and rehabilitation, in combination with aVNS application, on balance, gait, and clinical symptoms in individuals with PD. The study will include individuals diagnosed with Parkinson's disease. Individuals will be divided into two groups: a control group and a study group. In this blinded study, individuals in both groups will be included in a physiotherapy and rehabilitation program at the Neurological Physiotherapy and Rehabilitation Unit. Individuals in the control group will receive sham aVNS, while individuals in the active treatment group will receive active aNVS. Individuals will be evaluated twice, before and after their three-week, five-day-a-week program. Balance, gait, and clinical symptoms will be assessed using tests and scales.

Inclusion Criteria:

• Diagnosis of Parkinson's disease confirmed by a neurologist according to the United Kingdom Brain Bank criteria
• Age 40 years or older
• Hoehn and Yahr stage between 1 and 3 according to the Modified Hoehn and Yahr Staging Scale
• Stable pharmacological treatment regimen
• Ability to turn 180 degrees and walk 30 meters independently without assistance

Exclusion Criteria:

• Score below 21 on the Montreal Cognitive Assessment (MoCA)
• Presence of uncorrected visual or hearing impairments
• Presence of additional neurological (e.g., migraine), orthopedic (e.g., osteoarthritis), or cardiovascular conditions (e.g., myocardial infarction, uncontrolled hypertension, arrhythmias)
• Presence of a cardiac pacemaker
• Presence of metallic implants in the head or neck region
• History of deep brain stimulation surgery