Podcasts Health Arm Recovery with Vagus Nerve Stimulation

Arm Recovery with Vagus Nerve Stimulation

Published: Aug. 3, 2021, 1:57 a.m.

A lot of the attention in stroke research is paid to the acute phase. How can we treat a stroke in the ER? What can we do so it doesn't get worse? How can we prevent strokes from happening? What can we do in inpatient rehab to help folks get better?

Those are all important things,  and the stunning innovations happening around us are amazing, newsworthy, and truly impacting people's lives in a meaningful way.

But there's not as much attention given to chronic stroke. Sure, there's some. There are people working really hard to help stroke survivors recover even years after stroke. But not as much makes it into the news.

That's one reason I was interested in Dr. Jesse Dawson's work at the University of Glasgow. The recently published a study in the Lancet about using Vagus Nerve Stimulation to drive recovery in patients years after stroke. And their procedure looks promising.

(If you don't see the audio player below, visit http://strokecast.com/VNS.)



Click here for a machine generated transcript

Bio

Dr. Jesse Dawson headshot. He directly faces the camera against a white background

Dr. Jesse Dawson is a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital. His research portfolio includes prevention and rehabilitation clinical trials in stroke survivors. His main interest is in improving the long-term outcome after stroke. Dr. Dawson holds a BHF/Stroke Association programme grant, HTA NIHR funding and NIH funding and runs a large outcomes adjudication system for multi-national stroke trials. He is the NHS Research Scotland lead for stroke research and sits on the editorial board of Stroke.

Dr. Dawson is currently researching the role of xanthine oxidase inhibition as a novel preventative treatment after stroke. This is the focus of a UK wide clinical trial, funded by a programme grant from the BHF/Stroke Association.

He is also studying novel treatments for upper limb weakness after stroke, including vagus nerve stimulation and robotic therapy. These studies included a large NIHR funded study, funding from Chest Heart Stroke Scotland and a collaboration with industry. 

Dr. Dawson is the Medical Outcomes Manager for the endpoint committee of the large NIH funded CLEAR III trial, the NIH funded MISTIE III study, the European Union FP-7 funded EuroHYP study and the international SITSOPEN collaboration. This involves review of all trial endpoints and co-ordination of the endpoint adjudication process for these large phase III studies.

He supervises several PhD and MD students, including students with competitive government and charitable funded fellowships. He co-directs a large MSc programme in Clinical Pharmacology and is Director of the Vertical Theme for Clinical Pharmacology and Therapeutics for the MBChB programme. He is a regular MRCP PACES examiner and external higher degree examiner for several UK univeristies.

The Research

This is a fascinating study because even though they are stimulating the Vagus nerve, they are not actually treating it. Instead they are using it as a messenger to the brain to say, "Wake up! It's time to learn something." Essentially, it's trying to get the brains attention so traditional Occupational and Physical Therapy can work. And it seems to be working. It will be interesting to see if in future studies they can get similar results with Speech Therapy.

The other important take away here is that this work with chronic stroke survivors -- folks who had strokes years ago -- even in the control group. Granted the experimental group that got the Vagus Nerve Stimulation got better results.

The point is, though, that intense physical and occupational therapy gets results even years after as stroke, demonstrating once again that the 6 or 12 month caps on recovery are complete and utter nonsense.

Hack of the Week

Pick a small thing to focus on. Perhaps it’s a small task. Or part of a small task. Or maybe it's a new goal you haven't done before but it seems within reach. Do that. Focus on that. Achieve that. The look for more small challenges. Lots of wins on small challenges adds up to big success in the long run.

Links

Where do we go from here?

More thoughts from Dr. Jesse Dawson

  • A picture of a model of a brain and a neuron. The text over the image read: What we're actually interested in is using the [Vagus] nerve as a means for us to communicate from the periphery of the nervous system to the brain itself. -- Dr. Jesse Dawson
  • A picture of a man flexing his arm The text over the image read: So [Vagus Nerve Stimulation] doesn't have a direct effect on the arm itself or the brain's ability to make the arm move. -- Dr. Jesse Dawson
  • A picture of a person planting a seedling The text over the image read: What we're doing is we're using the nerve to make the brain temporarily more responsive to the effects of specific high intensity upper limb rehabilitation. -- Dr. Jesse Dawson
  • A picture oif a person sending energy into an illustration of the brain The text over the image read: And really, what we're trying to do is make a higher proportion of people's brains become those that respond to rehabilitation therapy. -- Dr. Jesse Dawson
  • A picture of people skiing down hill in the Alps The text over the image read: Everybody had the chance to receive the active treatment. -- Dr. Jesse Dawson
  • A picture if two pink macrons and a purple rose The text over the image read: We found that the number of people in the control group who had that good outcome was just under 25% and the number of people in the VNS Group who had that outcome was approximately 50%. So the rate doubled. -- Dr. Jesse Dawson
  • A picture of two people in white t shirts shaking hands The text over the image read: And almost half of people treated with VNS had the had a clinically meaningful improvement in the Fugal Myers score. -- Dr. Jesse Dawson
  • A drawing of an archer shooting an arrow at an ethereal target in the night sky The text over the image read: We've learned I think bitterly in in many decades of stroke research that unless we are clever in how we target people, we're unlikely to see benefit even if benefit exists. -- Dr. Jesse Dawson
  • A picture if a chess board with one piece left standing The text over the image read: You only get one chance. You know if you don't show something nobody is interested in funding the next steps you know. Whereas now I think with the position where we've shown that something works in one group of people and we can now say to all the people with the money can we now do a study in hemorrhagic stroke and can we now study people with really severe arm weakness, and try to move things even further forward. -- Dr. Jesse Dawson
  • A picture of a large audience bathed in red light The text over the image read: We've shown in the study that three years after stroke with selection and with careful consideration, a large number of people can improve. -- Dr. Jesse Dawson
  • A picture of an offie worker late at night The text over the image read: And even with just an intensive six week course of upper arm treatment and home exercises, nearly 1/4 of people had what we would think was an important response. Again, that tells us that it's never too late for people to really work on their upper limb and see some improvements. -- Dr. Jesse Dawson
  • A picture of archive boxes lining a shelf The text over the image read: But I think our data tell us that if you're willing to invest, and if your health care service can give you the expertise and the required tools, you can see improvements with or without fancy devices. Even many years after stroke, and I think that's quite encouraging. -- Dr. Jesse Dawson