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Breaking Through the Stroke Survivor Plateau

May 31, 2023

Imagine the struggle of everyday activities if you only had full use of one hand — fastening a button, tying shoelaces, cutting food, typing or writing — the list goes on and on, and none of it is easy. This is often the case for stroke survivors who never regain full function of their arm and hand after a stroke.

But Ronald Benitez, MD, an Atlantic Health System neurosurgeon and medical director of endovascular neurosurgery at Overlook Medical Center, is helping to change this. In fact, he recently became the first neurosurgeon in New Jersey to use a promising new FDA-approved breakthrough technology for ischemic stroke survivors. And Kathy R., a retired special education teacher, was his first patient. She experienced a stroke at her vacation home in Nantucket and was helicopter lifted to a nearby hospital in 2020 for immediate ischemic stroke intervention.

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A New Chance at Regaining Function: Paired Vagus Nerve Stimulation at Atlantic Health

The Vivistim® System is a clinically proven medical innovation and a true breakthrough,” says Dr. Benitez. “We’re excited to bring this life-changing treatment to stroke survivors and give them a renewed sense of hope.”

For Kathy, despite swift medical care and 18 months of intense physical and occupational therapy, her progress was plateauing and leaving her right arm with severe limitations. She was coming to terms with a lifelong physical deficit, until her annual visit with John Hanna, MD, a vascular neurologist and medical director of Atlantic Health System’s Comprehensive Stroke Center at Overlook Medical Center, where she learned about the new Vivistim technology.

Hope Awaits

Vivistim Paired VNSTM System therapy is a treatment designed for people like Kathy — ischemic stroke survivors experiencing ongoing hand and arm impairment. When used in conjunction with occupational therapy, the implantable Vivistim device paired with vagus nerve stimulation (VNS) can generate two to three times more hand and arm function for survivors of ischemic stroke than traditional rehabilitation therapy alone.

In late February 2023 at Overlook Medical Center, Kathy underwent a same-day procedure where Dr. Benitez implanted the device. Within 12 days, she was cleared to begin six weeks of rehabilitation at Newton Medical Center, which was closer to Kathy’s Succasunna home and staffed with Atlantic Health System therapists specially trained in paired VNS rehabilitation.

Exceeding Expectations

“I was both nervous and excited,” says Kathy, “because I knew I needed to work hard while keeping my expectations realistic. Maybe I’d see changes a week or two into therapy. Maybe improvement would happen at the very end, or in the weeks following therapy. I just told myself to take it as it comes, always hoping for a full recovery, if at all possible.”

Kathy’s hand function began to return within two therapy sessions. Even more function developed in the successive weeks using the Vivistim device during home therapy. “This experience has gone far beyond my expectations,” says Kathy who is now more than two months into therapy and continues to set new goals for herself. “I think pinching with my forefinger and thumb has been the most useful skill I have gained, and I am thrilled to be knitting again. Now, I’m working on straightening my arm so I can reach the top of my head to wash my hair.”

Nerve Stimulation in Action

Using a wireless transmitter, Kathy’s occupational therapist Paige Mattera, signals the Vivistim device to deliver a gentle pulse to Kathy’s vagus nerve while performing specific tasks such as zipping up her jacket, combing her hair, and cutting food. The vagus nerve is the longest nerve in the body, and it carries information between your brain and many parts of the body. Pairing these exercises with nerve stimulation helps create and strengthen the neural connections that improve Kathy’s limb function and increase her success during therapy.

“The idea behind pairing VNS therapy with Vivistim is akin to giving traditional rehabilitation techniques a boost from within, by strengthening the patient’s motor pathways through nerve stimulation,” says David Scott, manager of Atlantic Rehabilitation Outpatient Services. “This approach has exponentially enhanced Kathy’s ability to recover function during her therapy sessions.”

Paige adds, “Kathy’s end goal is to use her right arm just as she did before the stroke. What makes her a great candidate for this treatment is that she already has all the movement, she just needs to build and strengthen existing motor pathways to make the movements more fluid.”

Kathy is now using her right hand to fold laundry, write, set the table, cook and eat and, of course, knit. “Despite the struggles and challenges, I am constantly meeting new goals and improving,” says Kathy. “I am so grateful to Dr. Benitez, Dr. Hanna, Paige, and my entire medical and therapy teams for this life-changing opportunity and all that they’ve done to help me succeed.”

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