Closed Loop Neuromodulation in Neurological Rehabilitation: Movement-Paired Vagus Nerve and Spinal Cord Stimulation for Motor Recovery

Suman Pradhan; M.Reshma; N.S.S.N.S.Balaji

doi:10.62177/apjcmr.v2i5.1735

Authors

Suman Pradhan MNR University
M.Reshma MNR University
N.S.S.N.S.Balaji MNR University

DOI:

https://doi.org/10.62177/apjcmr.v2i5.1735

Keywords:

Closed-Loop Neuromodulation, Vagus Nerve Stimulation, Transcutaneous Auricular Vagus Nerve Stimulation, Transcutaneous Spinal Cord Stimulation, Stroke, Neurorehabilitation, Neuroplasticity, Motor Recovery, Neurological Physiotherapy

Abstract

Neurological physiotherapy is increasingly incorporating neuromodulation technologies that aim to enhance activity-dependent neuroplasticity and functional recovery. A recent advancement is the transition from conventional open-loop stimulation toward closed-loop neuromodulation, in which stimulation is temporally linked to voluntary movement, muscle activity, gait events, or neural activity. Movement-paired vagus nerve stimulation (VNS) and transcutaneous spinal cord stimulation (tSCS) represent two emerging approaches with potential applications in neurological rehabilitation. Clinical trials have demonstrated that VNS paired with upper-limb rehabilitation can improve motor impairment after chronic stroke, while recent research has extended this concept toward non-invasive transcutaneous auricular VNS (taVNS), wearable movement-triggered systems, and brain-computer-interface-synchronized stimulation. Similarly, tSCS combined with gait training has shown promising effects on walking-related outcomes, although substantial heterogeneity exists in stimulation parameters and treatment protocols.More recently, electromyography (EMG)-triggered spinal stimulation has introduced a physiological feedback mechanism for timing stimulation during gait.This mini-review discusses the neurophysiological rationale, current evidence, clinical applications, limitations, and future directions of movement-paired VNS and spinal stimulation, with particular emphasis on their integration into neurological physiotherapy.

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