Paired VNS Therapy (Vivistim)

What Is Paired Vagus Nerve Stimulation Therapy?

Paired Vagus Nerve Stimulation (VNS) Therapy is a treatment designed to improve hand and arm function in people who have ongoing impairment after an ischemic stroke. Using the FDA-approved Vivistim implant to stimulate the vagus nerve, patients are able to build more neurological pathways during rehabilitation exercises.

Your vagus nerve carries signals between your brain and other parts of your body. During Vivistim Therapy, a small surgically-implanted device gently stimulates this nerve while you practice hand and arm movements. Combining nerve stimulation with rehabilitation exercises helps strengthen and build the neurological connections that help you move and control your hands and arms.

Who May Benefit from Paired VNS Therapy?

Paired VNS Therapy may be an option for people who have had an ischemic stroke and continue to have moderate to severe problems with their arms or hands following rehabilitation.

You may be a candidate for Paired VNS Therapy with the Vivistim device if you:

• Had an ischemic stroke and have completed the initial rehabilitation phase (at least 6 months)
• Have completed rehabilitation but still have difficulty using your hand or arm
• Have some movement in your hand or arm (not complete paralysis)
• Are healthy enough to be considered a good surgical candidate
• Want to explore additional options for improving your hand and arm function and are committed to an intensive therapy program

Paired VNS Therapy combines vagus nerve stimulation with rehabilitation exercises. Before therapy begins a neurosurgeon surgically implants the Vivistim device, which is designed to stimulate the vagus nerve. After the procedure, your care team will let you know when you can begin the rehabilitation.

During each rehabilitation session, the Vivistim system will stimulate the vagus nerve as you practice specific movements with your affected hand and arm. Pairing additional stimulation with these exercises helps your brain create and strengthen more neural connections through its natural ability to adapt, called neuroplasticity.

The Paired VNS can be used during occupational or physical therapy and during daily activities.

Vagus nerve stimulation has been used successfully for decades to treat other neurological conditions, such as epilepsy, but the Vivistem device is the first FDA-approved implant to help people who have had an ischemic stroke improve hand and arm control and mobility.

Implanting the Vivistim Device

The surgery to implant the Vivistim device is a simple, outpatient surgical procedure where a neurosurgeon inserts the device under the skin and places the wires along the vagus nerve. The procedure to place the device, which is approximately the size of a pacemaker, will result in two small scars – one on the chest and one on the neck.

You will recover from the surgery before your Vivistim device is activated.

Rehabilitation with Vivistim

After you recover from the procedure, you will work with an occupational or physical therapists on exercises designed to improve the movement and function of your affected hand and arm. The therapist will activate the system during the rehabilitation session to stimulate the vagus nerve to promote and reinforce new neural connections.

Riverside offers the Paired VNS Therapy with Vivistim at two outpatient therapy locations:

Riverside Physical Therapy Warwick
11008 Warwick Blvd., Suite 1200
Newport News, VA 23601
757-928-8050

Riverside Physical Therapy Lightfoot
219 Bulifants Blvd., Suite C
Williamsburg, VA 23188
757-378-5090

The device can also be turned on by the patient at home while they practice the exercises or work on specific tasks that require dexterity, such as cooking or tying shoes.

The Vivistim device does not constantly stimulate the vagus nerve. It will be initially activated by your care team as part of the rehabilitation process. You can also activate it at home during specific activities, such as doing home exercises or working on specific tasks, like cooking.

How Do I Know if I Qualify?

A trained therapist at one of Riverside’s outpatient therapy centers will complete a thorough evaluation to determine if the Vivistim implant may be right for you. If the therapist recommends the Paired VNS Therapy, they will refer you to Riverside Hampton Roads Neurosurgical & Spine Specialists for a pre-operative appointment.

Both the therapist and surgeon must recommend the procedure. They will make sure Vivistim is appropriate for you, that you are likely to benefit from the therapy and that you are healthy enough for surgery.

What Does it Feel Like?

Following the initial procedure, you may feel some discomfort in your chest. Not everyone can feel the implant under the skin, but some people do notice it.
When the stimulation is activated, you may or may not feel the pulses with the vagus nerve. The settings can be adjusted by your provider or therapist as needed.

How Quickly Will I See Improvement?

Improvement will be gradual over time and will vary by individual. Clinical studies showed that individuals using the Vivistim saw 2-3 times the improvement than those who did the intense rehabilitation without the vagus nerve stimulation.

As with any surgery or implanted medical device, Vivistim has possible risks. These may include pain after surgery, hoarseness, bruising, swelling, coughing, throat irritation and infection.

Because the Vivistim implant responds to strong medical magnets, special precautions may be needed for future MRI scans. Certain types or MRIs can be performed when specific guidelines are followed.

If needed or desired, the Vivistim dev ice can be removed during another outpatient surgery.

Living with limited hand or arm movement after a stroke can make everyday activities difficult. Paired VNS Therapy with the Vivistim device offers another treatment option for some people with moderate to severe arm impairment following an ischemic stroke.

To determine whether Paired VNS Therapy with Vivistim® may benefit you, ask your primary care provider to refer you to Riverside Health outpatient therapy for a Vivistim Therapy evaluation. Once referred, you can schedule the evaluation at Riverside Therapy Services Warwick at 757-928-8050 or Riverside Therapy Services Lightfoot 757-378-5090.