Stroke Patients Increase Upper Limb Function Using Breakthrough Treatment

People with moderate to severe upper extremity paralysis often experience a plateau in rehabilitation progress between nine months and one year following their stroke, according to Gregory Davis, MD, neurosurgeon with Lehigh Valley Fleming Neuroscience Institute. Progress tends to slow or halt due to limitations in the brain or nerves in forming new neural pathways. Today, a breakthrough technology, the Vivistim Paired VNS System – which uses vagus nerve stimulation – is allowing for ongoing improvement in certain people.

“It reopens the neuroplasticity window. By increasing or enhancing [individuals’] plasticity after one year, we are able to see better gains with continuing rehabilitation therapy,” Dr. Davis says.

Lehigh Valley Health Network (LVHN) is the first in the region to offer the safe and effective new technology, which sends electrical impulses to the brain via the vagus nerve to strengthen neural connections, enhancing rehabilitation to improve arm and hand function. Paired VNS uses a surgically implanted medical device to deliver stimulation during therapy sessions, Dr. Davis explains.

“Collaboration is so important. It’s not possible without a multidisciplinary team,” he says, noting the occupational therapy (OT) team turns the device on to provide stimulation during rehab exercises. “Once the OTs figure out a good regimen and what exercises you respond to and you start to get comfortable with the stim, you can potentially do VNS therapy at home.”

The relatively new paired VNS therapy has strict FDA inclusion and exclusion criteria for eligibility. All potential Vivistim patients require a screening workup by LVHN’s OT group. It is not indicated for people who have had hemorrhagic strokes, and individuals must be more than nine months – but less than 10 years – out since their stroke, Dr. Davis explains.

“[Individuals also] can’t be 100 percent paralyzed. They have to have retained some sensation and movement in the arm and hand because they have to be able to participate in the therapy. For the same reason, they can’t have severe or extreme spasticity,” Dr. Davis says.

While the therapy has only been in use at Lehigh Valley Fleming Neuroscience Institute since the end of 2023, Vivistim manufacturer MicroTransponder reports that stroke survivors who participate in paired VNS in conjunction with their rehabilitation exercises experience two to three times greater improvement in hand and arm mobility than those who had rehab alone.