Comparison of the effects of vagus nerve stimulation and respiratory exercise on autonomic nervous system in mothers of children with cerebral palsy

Cerebral palsy (CP) is a neurological condition characterized by permanent impairments that occur during early brain development and often requires long-term care. This caregiving responsibility is typically undertaken by mothers, which over time may lead to physical and psychosocial strain and limit their participation in rehabilitation processes. This study aims to investigate the effects of Vagus Nerve Stimulation (VNS) and Deep Breathing Exercises (DBE) on physiological and psychosocial parameters in mothers of children with CP. A total of 38 mothers aged between 18 and 50 who had children diagnosed with CP were included in the study. Participants were randomly assigned to two groups: VNS and DBE. Physiological parameters were assessed using the Polar H10 device for Heart Rate Variability (HRV), the Composite Autonomic Symptom Score-31 (COMPASS-31), and the Nordic Musculoskeletal Questionnaire. Psychosocial parameters were measured using the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index (PSQI), and the Caregiver Burden Scale (CBS). The VNS group received transcutaneous auricular vagus nerve stimulation, while the DBE group performed structured deep breathing exercises over a 3-week period (10 sessions total). According to the results, within-group analysis revealed that the VNS group experienced a statistically significant reduction in pain after treatment in the neck (p = 0.035), shoulder (p = 0.002), back (p = 0.004), lower back (p = 0.006), hip/thigh (p = 0.047), knee (p = 0.002), and ankle/foot (p = 0.011). Similarly, in the DBE group, significant pain reduction was observed in the neck (p = 0.013), shoulder (p = 0.002), elbow (p = 0.004), lower back (p = 0.005), hip/thigh (p = 0.025), and ankle/foot (p = 0.035). In the VNS group, COMPASS-31 evaluations showed significant improvement after treatment in orthostatic intolerance (p = 0.031), pupillomotor function (p = 0.020), and total score (p = 0.005). In the DBE group, significant improvement was found in the gastrointestinal domain (p = 0.011) and total score (p = 0.032). Both groups demonstrated statistically significant changes in BDI (VNS: p < 0.001; DBE: p = 0.029) and CBS (VNS: p = 0.005; DBE: p < 0.001) scores. PSQI analysis revealed significant improvements in the VNS group in subjective sleep quality (p = 0.002), sleep latency (p = 0.019), sleep disturbances (p = 0.004), daytime dysfunction (p = 0.007), and total score (p < 0.001). In the DBE group, improvements were observed in subjective sleep quality (p = 0.005), sleep latency (p = 0.011), habitual sleep efficiency (p = 0.046), sleep disturbances (p = 0.025), daytime dysfunction (p = 0.014), and total score (p < 0.001). Between-group comparison revealed a statistically significant improvement in BDI scores favoring the VNS group over the DBE group (p = 0.011). In conclusion, both VNS and DBE interventions led to significant improvements in autonomic nervous system symptoms, pain, depression, caregiver burden, and sleep quality among mothers of children with CP. Notably, the VNS group demonstrated a more pronounced improvement in depression levels. These findings suggest that both methods can be used effectively and interchangeably as supportive interventions in this population.