At-Home Delivery of Vagus Nerve Stimulation Paired With Task-Specific Training Improves Performance of High-Priority Activities in Persons With Chronic Spinal Cord Injury or Stroke

OBJECTIVE: Vagus nerve stimulation during rehabilitative training can improve motor function years after stroke or spinal cord injury. This open-label study examined whether vagus nerve stimulation paired with participant-selected activities of daily living in a home environment can improve task performance in participants with chronic stroke or incomplete cervical spinal cord injury. DESIGN: Fourteen participants were recruited from our previous randomized studies involving months of vagus nerve stimulation delivered during in-clinic therapy. Seven participants with chronic stroke and seven with chronic incomplete spinal cord injury completed 36 additional sessions of vagus nerve stimulation paired with training on a set of self-selected, high-priority activities of daily living at home. Each participant trained on 5-10 tasks. Performance was measured before and after vagus nerve stimulation + ADL therapy. RESULTS: Vagus nerve stimulation + activity of daily living therapy reduced time to complete trained activities of daily living by 19.8 ± 5.2% for participants with stroke and 33.8 ± 4.9% for participants with spinal cord injury. CONCLUSIONS: The observed gains are clinically meaningful and suggest a reduction in the functional burden of injury, which has the potential to improve independence and reduce reliance on caregivers. These initial results are sufficient to justify a randomized, sham-controlled study to evaluate whether vagus nerve stimulation during task-specific training can improve task performance and independence.