Paired VNS Therapy May Improve Rehabilitation for Stroke Recovery

As published in the The Lancet,  paired vagus nerve stimulation (VNS) system (Vivistim; MicroTransponder, Austin, TX) with physical therapy  improves hand and arm function for stroke survivors 2 to 3 times more than rehabilitation therapy alone.

"The standard of care in rehabilitation therapy for stroke survivors has limited effect on the restitution of arm and hand function. The Vivistim VNS System paired with intense rehabilitation empowers occupational and physical therapists to enhance the benefits of the treatment they provide," said Teresa Jacobson Kimberley, PhD, PT, FAPTA, a professor at MGH Institute of Health Professions. "The evidence suggests that VNS with rehabilitation therapy harnesses neurophysiology to enhance restitution."

"The challenge we have as neurorehabilitation professionals working with stroke survivors is changing the rate of recovery to make gains last longer before a patient's movement ability plateaus," said Steven L. Wolf, PhD, PT, FAPTA, FAHA, FASNR, a professor in the Division of Physical Therapy at Emory University School of Medicine. "The use of VNS may offer an opportunity to create such changes."

The VNS system enables therapists to guide stroke survivors to significant improvements in upper limb mobility, according to occupational and physical therapists who participated in the clinical trial. This is due to the innovativeness of the technology, the unique in-clinic protocol, and the system's capability to be activated at home by the participants.

A therapist will use a wireless transmitter that communicates with proprietary software to signal the implanted device to deliver a gentle pulse to the VNS as an individual performs a specific mundane task. Through the device’s at-home feature, an individual can continue practicing rehabilitation exercises or practice routine tasks on their own by swiping the magnet over the implant area.

"Paired VNS therapy is targeted to enhance neuroplasticity in the central nervous system of stroke survivors, so the exercises we conduct are more movement- and patient-specific," said Nuray Yozbatiran, a physical therapist and research faculty member at the NeuroRecovery Research Center at TIRR Memorial Hermann and Department of Physical Medicine and Rehabilitation at UT Health McGovern Medical School.

Most therapists in the clinical trial report it's easy to integrate into practice. During the trials, 71% of therapists said it was easy to trigger the VNS during therapy.