Vivistim VNS Paired Rehab for the Chronic Post-Stroke Upper Extremity: A Case Series

Research Objectives: To examine the effectiveness of Vivistim Vagal Nerve Stimulation (VNS) Paired Rehab for chronic stroke patients.

Design: In this retrospective case series, chronic ischemic stroke patients who had plateaued with their upper extremity recovery and chose to pursue Vivistim VNS Paired Rehab received at least six weeks of 90-minute occupational therapy sessions three times per week.

Setting: Outpatient neurological rehabilitation clinics within central Florida hospital system.

Participants: 11 patients ranging from 6 months to 14 years post ischemic stroke participated in Vivistim Paired VNS Rehab. All patients were determined potential candidates by their occupational therapist based on initial study parameters that led to FDA approval and were educated on Vivistim. All patients interested in moving forward then met with the neurosurgeon for consultation and surgical clearance.

Interventions: Occupational therapy sessions consisted of task-specific training using only the affected upper extremity except when bimanual tasks were completed, similar to the protocol used in the pivotal study. Unique to this case series, principles of error augmentation, resistance training, and the use of neuromuscular electrical stimulation were also used in conjunction with task-specific training.

Main Outcome Measures: The main outcome measure was the Fugl-Meyer Upper Extremity (FMA-UE), one of the most widely used quantitative measures of motor impairment in post-stroke hemiplegic patients. The minimally clinically important difference is a 5.2-point increase, with the total possible score of 66 points.

Results: Following the initial six-week protocol, participants achieved an average increase of 11.5 points on the FMA-UE compared with an average gain of 5.0 points from the original study.

Conclusions: Vivistim VNS Paired Rehab could be even more effective in clinical practice depending on treatment methods utilized during occupational therapy sessions.

Author(s) Disclosures: Paid consultant for Microtransponder