{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:58:23Z","timestamp":1785437903842,"version":"3.56.0"},"reference-count":72,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"School of Health Professions Junior Faculty Grant"},{"name":"Center for Engagement in Disability Health and Rehabilitation Science at the University of Alabama at Birmingham"},{"id":[{"id":"https:\/\/ror.org\/008s83205","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Background: Both neuromodulation and physical therapy have been shown to mitigate motor and non-motor symptoms of Parkinson\u2019s disease. To date, no studies have examined the integration of transcutaneous auricular vagus nerve stimulation (taVNS) with physical therapy approaches for improving Parkinsonian symptoms. The purpose of this study was to investigate the safety, tolerability, and feasibility of combining taVNS with physical therapy to enhance the therapeutic benefits of exercise as medicine in a clinical setting. Methods: Participants were randomly assigned to receive active or sham bilateral taVNS in combination with PT for 12 visits over 6 weeks. Safety, tolerability, and feasibility outcomes were primary. Secondly, exploratory analyses of changes in cardiovascular and motor function over time were also performed. Results: Overall, taVNS was safe and well-tolerated prior to PT. Cardiovascular analyses suggest that active taVNS may augment HR response to exercise compared to sham. For motor outcomes, both groups showed significant overall improvements; however, no significant between-group differences were found. Conclusions: The preliminary results obtained in this pilot trial confirm that taVNS combined with physical therapy for individuals with PD is safe and feasible. The exploratory cardiovascular and motor findings support the need for larger, adequately powered clinical trials investigating the integration of taVNS into PT and exercise methods for improving PD symptomology. Trial registration: ClinicalTrials.gov NCT05871151.<\/jats:p>","DOI":"10.3390\/neurolint18060118","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T08:22:56Z","timestamp":1781684576000},"page":"118","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Auricular Vagus Nerve Stimulation Combined with Physical Therapy for Individuals with Parkinson\u2019s Disease: A Pilot Randomized Sham-Controlled Trial"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6850-8316","authenticated-orcid":false,"given":"Alexandra","family":"Evancho","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA"},{"name":"Center for Engagement in Disability Health and Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA"},{"name":"Center for Neuroengineering and Brain Computer Interfaces, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Dawson","sequence":"additional","affiliation":[{"name":"Birmingham Veterans Affairs, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4601-3486","authenticated-orcid":false,"given":"Harrison C.","family":"Walker","sequence":"additional","affiliation":[{"name":"Center for Neuroengineering and Brain Computer Interfaces, University of Alabama at Birmingham, Birmingham, AL 35294, USA"},{"name":"Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7839-8894","authenticated-orcid":false,"given":"Christopher G.","family":"Ballmann","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA"},{"name":"Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-5022","authenticated-orcid":false,"given":"William J.","family":"Tyler","sequence":"additional","affiliation":[{"name":"Center for Neuroengineering and Brain Computer Interfaces, University of Alabama at Birmingham, Birmingham, AL 35294, USA"},{"name":"Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cger.2019.08.002","article-title":"Parkinson Disease Epidemiology, Pathology, Genetics, and Pathophysiology","volume":"36","author":"Simon","year":"2020","journal-title":"Clin. 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