Tactile Rehabilitation Paired with Vagus Nerve Stimulation: An Ischemic Stroke Patient Case Study

Case Diagnosis: A 65-year-old male with a history of chronic right Posterior Cerebral Artery ischemic stroke.

Case Description or Program Description: This case study investigated the effects of implanted Vagus Nerve Stimulation (VNS) paired with passive and active tactile rehabilitation on sensory recovery in a chronic stroke patient with severe sensory impairment. In the double-blind Phase 1, the participant received sham VNS during tactile rehabilitation for 18 sessions, each 90 minutes. In the open-label Phase 2, 18 sessions included active VNS delivered with 0.5-second bursts (16 pulses at 0.8 mA, 30 Hz, 100 µs).Sensory function was assessed at baseline and after each phase using the US-Nottingham Sensory Assessment (US-NSA), Semmes-Weinstein Monofilaments, Two-Point Discrimination, and Tactile Discrimination Test.

Setting: Baylor & Scott White Institute for Rehabilitation

Assessment/Results: The patient reported no adverse effects during therapy. Interim assessments following Phase 1 showed sensory functional recovery compared to baseline, including tactile sensation (64%), proprioception (33%), and stereognosis (25%) based on the US-NSA score. During Phase 2, the patient recovered an additional 22% in stereognosis, while other gains achieved during Phase 1 were maintained. There was no detectable recovery in Two-Point Discrimination, Tactile Discrimination Test, and Semmes–Weinstein Monofilaments.

Discussion (relevance): VNS, paired with rehabilitation, received FDA approval to enhance motor recovery in chronic ischemic stroke. Preclinical and early clinical case study in a chronic right Middle Cerebral Artery stroke patient support the use of VNS with tactile rehabilitation for sensory recovery. However, differences in stroke location and therapy design in our case study highlight the need for further research to understand factors influencing VNS effectiveness.

Conclusions: This case study supports the safety and feasibility of pairing VNS with tactile rehabilitation in a chronic stroke patient and highlights the need for further research to explore optimal dosing, timing, and patient selection criteria to maximize the therapeutic potential of VNS-assisted sensory recovery.

level of evidence: V