Neuromodulation
David Leonard, DO
Resident Physician
University of Kentucky Physical Medicine and Rehabilitation
Lexington, Kentucky, United States
Stephen Porter, MD
Attending Physician
University of Kentucky Physical Medicine and Rehabilitation
Lexington, Kentucky, United States
David Leonard, DO
University of Kentucky Physical Medicine and Rehabilitation
Lexington, Kentucky, United States
A 63-year-old male with history of medullary ischemic stroke in February 2021 presented with persistent left upper extremity deficits despite extensive rehabilitation. Neurologic impairments included ataxia, spasticity, impaired sensation, and fine motor dysfunction. He remained motivated to pursue independence in activities requiring dexterity. Given ongoing deficits and the recent FDA approval of vagus nerve stimulation paired with rehabilitation for post-stroke motor recovery, he underwent evaluation and was deemed appropriate for Vivistim implantation.
Case Description:
In May 2025, the patient underwent left cervical Vivistim implantation without perioperative complications. The device was activated with initial settings of 0.8 mA, 30 Hz, 0.5 s train, and 100 μs pulse width. Postoperative protocol included 90-minute occupational therapy sessions three times weekly. Stimulation counts ranged from 800–2000 per session. Over six weeks, the patient demonstrated measurable gains: Fugl-Meyer Upper Extremity score improved from 55/66 pre-implant to 61/66, left nine-hole peg test time improved from 2:19 to 0:39 seconds, and Box-and-Block test increased from 31 to 39 blocks. Grip strength improved modestly (49.2 → 53.5 lbs). He tolerated therapy well with no stimulation-related adverse effects.
Discussions:
This case demonstrates clinically meaningful upper extremity motor improvements with Vivistim paired rehabilitation in a chronic stroke survivor, consistent with outcomes reported in the VNS-REHAB trial. Gains were notable with fine motor control, dexterity, and coordination as captured by standardized outcome measures. Importantly, this case highlights real-world application of Vivistim outside of a clinical trial setting, underscoring feasibility, safety, and interdisciplinary collaboration between neurosurgery, PM&R, and rehabilitation therapy. Minor musculoskeletal complaints during rehabilitation were unrelated to Vivistim use.
Conclusions:
Vivistim paired with rehabilitation was associated with quantifiable improvements in upper extremity function more than four years post-stroke. This case supports the growing evidence for neuromodulation as an adjunct in stroke rehabilitation and suggests meaningful motor recovery may be achieved beyond the traditional recovery window.
