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- MakaleAçık Erişim2026Effects of transcutaneous auricular vagus nerve stimulation added to robotic rehabilitation in patients with ischemic stroke: a randomized clinical trial
Kızıl, Ömer Dicle; Ural, İbrahim Halil; Hatık, Sefa Haktan; Özden, Ali Veysel; Aydın, Emine Büşra
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. Trial registration: The study was registered at ClinicalTrials.gov on April 19, 2024. (Identifier: NCT06381089).
- MakaleAçık Erişim2025Comparison of drop table and diversified chiropractic techniques in patients with non-specific neck pain; [Comparação das técnicas quiropráticas drop table e diversified em pacientes com dor cervical inespecífica]
Kızıltoprak, Dünya Tajik; Hatıp, Sefa Haktan; Kızıl, Ömer Dicle; Aydın, Emine Büşra
Introduction: Neck pain is a common musculoskeletal disorder associated with pain, reduced cervical mobility, and decreased muscle strength, often leading to functional limitations. Chiropractic manipulation is widely used as a conservative treatment, yet the comparative effects of different techniques remain unclear. ## Objective To compare the effects of the diversified and drop table chiropractic techniques on pain, cervical range of motion, and muscle strength in individuals with non-specific neck pain. ## Methods This randomized controlled clinical trial included 45 participants with non-specific neck pain, randomly assigned to three groups: diversified (DG; n = 15), drop table (DTG; n = 15), and control (CG; n = 15). Interventions were applied twice weekly for four weeks. The primary outcome measure was pain level assessed using the McGill Pain Questionnaire. Secondary outcome measures were cervical joint range of motion assessed with a goniometer and isometric neck muscle strength assessed using a microFET2 dynamometer. Outcomes were assessed pre- and post-intervention. ## Results Both DG and DTG demonstrated significant increases in cervical range of motion compared with the CG. Pain levels significantly decreased in both intervention groups. DG showed significant improvements across all isometric muscle strength measures, while DTG demonstrated selective improvements in flexion and right lateral flexion. CG showed no significant changes, except a decrease in extensor strength. ## Conclusion Chiropractic interventions effectively reduce pain and enhance cervical function in individuals with non-specific neck pain. The diversified technique provided broader muscle strength improvements, while the drop table technique showed more selective effects, emphasizing the need for individualized technique selection in clinical practice. Open access and CC-BY licensed.