Systematic Review and Meta-Analysis of Noninvasive Cranial Nerve Neuromodulation for Nervous System Disorders

    Authors

    L. Papa; A. LaMee; C. N. Tan;C. Hill-Pryor

    Comments

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    Abbreviated Journal Title

    Arch. Phys. Med. Rehabil.

    Keywords

    Ataxia; Brain injuries; Gait; Magnetic resonance imaging; Nervous; system; Neuronal plasticity; Postural balance; Rehabilitation; Rehabilitation, brain injuries; Trauma; Vertigo; DEEP BRAIN-STIMULATION; ELECTRICAL TONGUE STIMULATION; MAJOR DEPRESSIVE; EPISODES; PARKINSONS-DISEASE; SUBTHALAMIC NUCLEUS; NEUROPLASTICITY; REHABILITATION; EFFICACY; VNS; MODALITIES; Rehabilitation; Sport Sciences

    Abstract

    Objective: To systematically review the medical literature and comprehensively summarize clinical research done on rehabilitation with a novel portable and noninvasive electrical stimulation device called the cranial nerve noninvasive neuromodulator in patients suffering from nervous system disorders. Data Sources: PubMed, MEDLINE, and Cochrane Database of Systematic Reviews from 1966 to March 2013. Study Selection: Studies were included if they recruited adult patients with peripheral and central nervous system disorders, were treated with the cranial nerve noninvasive neuromodulator device, and were assessed with objective measures of function. Data Extraction: After title and abstract screening of potential articles, full texts were independently reviewed to identify articles that met inclusion criteria. Data Synthesis: The search identified 12 publications: 5 were critically reviewed, and of these 5, 2 were combined in a meta-analysis. There were no randomized controlled studies identified, and the meta-analysis was based on pre-post studies. Most of the patients were individuals with a chronic balance dysfunction. The pooled results demonstrated significant improvements in the dynamic gait index postintervention with a mean difference of 3.45 (95% confidence interval, 1.75-5.15; P < .001), Activities-specific Balance Confidence scale with a mean difference of 16.65 (95% confidence interval, 7.65-25.47; P < .001), and Dizziness Handicap Inventory with improvements of 26.07 (95% confidence interval, -35.78 to -16.35; P < .001). Included studies suffered from small sample sizes, lack of randomization, absence of blinding, use of referral populations, and variability in treatment schedules and follow-up rates. Conclusions: Given these limitations, the results of the meta-analysis must be interpreted cautiously. Further investigation using rigorous randomized controlled trials is needed to evaluate this promising rehabilitation tool for nervous system disorders. (C) 2014 by the American Congress of Rehabilitation Medicine

    Journal Title

    Archives of Physical Medicine and Rehabilitation

    Volume

    95

    Issue/Number

    12

    Publication Date

    1-1-2014

    Document Type

    Review

    Language

    English

    First Page

    2435

    Last Page

    2443

    WOS Identifier

    WOS:000345954000027

    ISSN

    0003-9993

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