Researchers have identified an innovative method of restoring arm mobility for patients who have suffered a stroke. Physicians affiliated with TIRR Memorial Hermann are on the forefront of the discovery, investigating the effect of vagus nerve stimulation (VNS) combined with intensive upper-limb rehabilitation therapy. The result: The majority of stroke survivors in the study regained a significant amount of the arm and hand function they had previously lost.
TIRR Memorial Hermann is one of only several rehabilitation programs in the nation to offer this new, FDA-approved treatment option for patients whose arm and hand function has not fully recovered after a stroke. VNS, when combined with rehabilitation therapy, has been proven to increase upper-limb mobility and function, offering new hope to stroke survivors.
VNS is a treatment that affects the way the brain communicates with the nerves. The vagus nerve is located on the side of the neck and is responsible for sending signals up through the brainstem to various parts of the brain. Signals sent via the vagus nerve affect many different organs and body functions in addition to limb motion, including heart rhythm, heart rate and the digestive system.
By stimulating the vagus nerve with an implanted device, physicians can send mild electrical signals deep into the part of the brain that controls motor skills. When VNS is combined with rehabilitation therapy, the brain can be “re-trained” to learn arm and hand function that was lost after stroke. The VNS device is sometimes referred to as a “pacemaker for the brain” because it modifies brain function with low levels of electrical energy.
The Food and Drug Administration (FDA) recently approved VNS therapy for stroke rehabilitation, but the treatment has been used for many years as a safe and effective way to treat depression and epilepsy.
According to the Centers for Disease Control (CDC), more than 795,000 people in the United States suffer from stroke each year, which means someone has a stroke every 40 seconds.
One of the most common effects of stroke is the loss of arm or hand function. About 80% of stroke survivors experience limited or impaired use of an upper limb, and half of those affected are still left with significant dysfunction six months later.
According to the American Stroke Association, rehabilitation therapy gives patients the best possible chance for recovery. However, for many patients, it is not enough to restore function to a level that allows them to enjoy life. Without sufficient use of their arm and/or hand, many stroke survivors cannot drive, return to work or live independently.
Until recently, therapy to restore arm function had limited success, and stroke patients often experienced a declining quality of life because they were unable to do the things they used to do.
After conducting research and clinical trials, experts concluded that stroke survivors can experience improvements in arm impairment and function with a combination treatment of VNS and rehabilitation therapy. This research, published in The Lancet, determined that VNS is safe and effective for patients who have recently suffered a stroke and also for chronic stroke patients who may be many years post-stroke. This new option is a bright opportunity for patients who may have experienced a plateau in the effectiveness of therapy and assume they will never see additional improvement.
In clinical studies, stroke patients saw two to three times better results with a combined VNS therapy program than with therapy alone. Not only did patients see improvements during treatment, but the benefits were also sustained for the three years they were followed and evaluated by researchers. These results were documented after patients were evaluated by both the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment for Upper Extremity (FMA-UE), pre- and post-treatment. The WMFT and FMA-UE are the industry standards for evaluating upper-limb function.
After suffering a stroke in August 2017, Hector Alvarez started physical therapy at TIRR Memorial Hermann-The Woodlands Outpatient Rehabilitation.Read Hector's Story
To see improvement, rehabilitation therapy must be done in conjunction with VNS. VNS has not been proven helpful for stroke patients without also participating in therapy.
After completing the VNS therapy program, stroke patients can enjoy a better quality of life. Patients reported improvements including new ability to move their arm and fingers in additional directions and distances, and an increased ability to grasp and hold onto items. With new movement, patients can get back to many of their normal, daily activities, including using a smart phone, driving and enjoying family activities.
VNS includes an implanted electrical device connected to an insulated wire with electrodes. During a same-day, outpatient procedure, the small device is implanted through an incision in the chest, and the insulated wire is guided to and placed on the vagus nerve.
When the device and insulated wire are in place and the surgical incision heals, the system is ready for use. During rehabilitation therapy, the therapist will activate and calibrate the device to deliver the appropriate amount of stimulation. Patients will use the device while participating in clinic-based rehabilitation as well as home therapy.
Many stroke survivors are candidates for VNS therapy, whether their stroke occurred very recently or many years in the past. A physician will evaluate each potential patient to be sure they are healthy enough for the same-day implantation procedure.
Patients who have no movement of an upper limb are usually not candidates for VNS. Additionally, patients who are already high-functioning post-stroke may not see enough benefit to justify the procedure.
The Rehabilitation Solution Center schedules appointments for inpatient rehabilitation, outpatient medical clinic and outpatient rehabilitation.
Dr. Gerard Francisco discusses the landmark trial that investigated the potential of VNS to increase the ability of some people with post-stroke weakness.
TIRR Memorial Hermann is one of only a few hospitals nationwide to provide this cutting-edge treatment option for stroke patients who have lost upper-limb function. Our affiliated physicians were integrally involved in the research and clinical trials and are uniquely qualified to bring this personalized care to patients, targeted specifically for their post-stroke needs.
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