Contexts, mechanisms and outcomes of home-based palliative care implementation in low- and middle-income countries: A realist review.

Transcutaneous auricular vagus nerve stimulation (taVNS) is a promising non-invasive neuromodulation technique for addressing gait impairments in patients with Parkinson’s disease (PD) []. Previous studies [] have reported improvements in gait speed, step length, and reductions in gait variability and asymmetry following taVNS—parameters associated with impaired gait automaticity in patients with PD []. Mechanistically, taVNS may enhance gait automaticity by modulating the cholinergic system and decreasing sensorimotor cortex activity during walking []. Importantly, temporal gait abnormalities in PD are often insufficiently improved by pharmacological treatment []. Gait disturbances in PD often worsen in daily-life environments compared to experimental settings, underscoring the importance of evaluating gait under daily-life conditions []. Walking in daily-life contexts is thought to rely more heavily on automatic control than gait in controlled environments. Therefore, taVNS, which may promote gait automaticity, may exert greater effects in daily-life settings than in experimental assessments. However, previous taVNS studies in PD have primarily focused on gait performance under structured experimental conditions, and the effects of taVNS on free-living daily-life gait behavior remain unclear. Therefore, this exploratory single-case study aimed to investigate the feasibility and potential therapeutic benefits of taVNS in improving daily-life gait performance in a patient with PD and freezing of gait (FOG). A 67-year-old cognitively normal woman (Mini-Mental State Examination score: 30) with a 17-year history of PD sought further improvement in walking after a 3-month outpatient physical therapy program. She reported worsened walking and occasional FOG during OFF periods and had no history of deep brain stimulation, cardiovascular disease, or pacemaker use. Baseline clinical characteristics were summarized in . Written informed consent was obtained. This study was approved by the local institutional ethics committee (Kio University, R5-33-2) and conducted in accordance with the Declaration of Helsinki.