Distal Versus Proximal Arm Improvement After Paired Vagus Nerve Stimulation Therapy After Chronic Stroke.
Isha Vora, Perman Gochyyev, Navzer Engineer and 2 others
PMID 38815953WHAT IT FOUND
Paired vagus nerve stimulation improved distal arm function (hand/wrist) significantly more than sham stimulation in chronic stroke patients.
Proximal arm function (shoulder/elbow) improved similarly in both groups. This suggests VNS specifically targets fine motor recovery when paired with intensive therapy.
Key findings
01The Paired-VNS group showed significantly greater improvement in distal upper extremity impairment scores compared to the Control group at both immediate post-therapy and 3-month follow-up.
02There was no significant difference between the Paired-VNS and Control groups in proximal upper extremity impairment scores at either time point.
03Clinically meaningful response to Paired-VNS was best predicted by improvements in specific items including elbow extension, shoulder flexion/abduction, hand opening, and wrist mobility.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This was a secondary analysis, not the primary outcome of the original trial. Participants had to have some active wrist and thumb movement at baseline, so results do not apply to patients with complete paralysis of the hand. The study population was limited to chronic stroke (9 months to 10 years post-injury), so it is unclear if VNS would be as effective in the acute or subacute phases. The authors noted that proximal scores might have been limited by a ceiling effect, as patients generally had better baseline proximal function.
Declared interests
One author is an employee of MicroTransponder, Inc., the company that makes the VNS device. Another author serves as a consultant for MicroTransponder. A third author consults for Saebo and Enspire. The study was supported by the company that manufactures the treatment.
The easy way to misread this
Do not assume VNS improves overall arm function. The benefit was specific to distal movements (hand/wrist). Proximal improvements (shoulder/elbow) were no better than with standard intensive therapy alone. Additionally, this applies only to patients who already have some active movement in their wrist and thumb; it is not a cure for flaccid paralysis.