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    Effects of transcutaneous auricular vagus nerve stimulation added to robotic rehabilitation in patients with ischemic stroke: a randomized clinical trial
    (Bmc, 2026) Kizil, Omer Dicle; Ural, Ibrahim Halil; Hatik, Sefa Haktan; Ozden, Ali Veysel; Aydin, Emine Busra
    Background This study aimed to investigate the effects of adding transcutaneous auricular vagus nerve stimulation (taVNS) to robotic rehabilitation on functional outcomes and neuromuscular activity in patients with ischemic stroke. Methods This randomized controlled clinical trial employed a pre-post study design and was conducted in a hospital-based physiotherapy and rehabilitation clinic. A total of 40 patients with ischemic stroke, aged 18-65 years, were randomly assigned to either a robotic rehabilitation group (RRG) or a combined vagus nerve stimulation and robotic rehabilitation group (VRRG). Spasticity, walking speed, motor function, quality of life, muscle activity, and pain were assessed at baseline and after six weeks of treatment. Results Primary outcome measures were walking speed, motor function assessed by the Fugl-Meyer Assessment, and pain intensity. Secondary outcomes included electrophysiological measurements (H-reflex and F-wave parameters) and quality of life. Within-group analyses showed significant improvements in all outcomes in the VRRG (p < 0.05), whereas all outcomes except pain improved significantly in the RRG (p < 0.05). Between-group comparisons demonstrated greater improvements in walking speed in the VRRG compared with the RRG (mean difference - 1.84 s, 95% CI - 3.7 to - 0.7; r = 0.43; p = 0.006) and greater pain reduction in the VRRG (mean difference - 1.55, 95% CI - 2.5 to - 0.1; r = 0.30; p = 0.048). In contrast, a greater reduction in the Hmax/Mmax amplitude ratio-an electrophysiological marker of spinal excitability-was observed in the RRG. Conclusion The findings suggest that transcutaneous auricular vagus nerve stimulation combined with robotic rehabilitation may provide additional benefits in terms of walking speed and pain reduction in patients with ischemic stroke.
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    Immediate effects of cervical spine and sacroiliac joint manipulations on the autonomic nervous system and pedobarographic analysis: Randomized controlled trial
    (Elsevier, 2026) Turgut, Hayriye; Buyukkirli, Lker Lker Can; Hatik, Sefa Haktan; Aydin, Emine Busra
    Background: This study aimed to investigate the immediate effects of cervical and sacroiliac joint manipulations on autonomic nervous system activity and baropodometric parameters. Methods: Participants were randomly assigned to three groups with equal gender distribution. The cervical manipulation group received chiropractic manipulation at the C3-C5 level, while the sacroiliac group received manipulation at the sacroiliac joint. The control group received no intervention. Pre- and post-treatment evaluations were conducted after a 30-minute interval. Plantar pressure was measured via a pedobarographic device. Autonomic nervous system activity was assessed using the Polar H10. Blood pressure and heart rate were manually recorded using a sphygmomanometer and pulse oximeter. Statistical significance was set at p < 0.05. Results: No significant differences were found among groups in terms of age, gender, height, or BMI (Kruskal-Wallis, p > 0.05). The cervical manipulation group showed significant decreases in systolic and diastolic blood pressure and heart rate post-intervention (Wilcoxon, p < 0.05). The sacroiliac group showed a significant increase in heart rate only (Wilcoxon, p < 0.05). No significant changes were observed in baropodometric parameters or autonomic activity within or between groups (Wilcoxon and Kruskal-Wallis, p > 0.05). However, post-intervention comparisons showed cervical manipulation led to a greater reduction in systolic blood pressure, while sacroiliac manipulation led to a greater increase in heart rate compared to controls (Mann-Whitney U with Bonferroni correction, p < 0.05). Conclusion: While no significant changes were observed in baropodometric or autonomic parameters, chiropractic manipulation demonstrated short-term effects on blood pressure and heart rate. The accuracy of heart rate variability assessments should be reviewed, and further studies are needed to evaluate long-term cardiovascular and autonomic outcomes.