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Neurological Rehabilitation

Sparking Recovery: Vagal Nerve Stimulation in Neurorehabilitation

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Aaron Wilson, MD

    Resident Physician
    Stony Brook Medicine/University Hospital PM&R Program
    Commack, New York

    • Co-Author(s)

  • JG

    Jennifer Gray, DO

    Program Director
    Stony Brook Medicine/University Hospital PM&R Program
    Port Jefferson, New York

Disclosure(s):
Aaron Wilson, MD: No financial relationships to disclose
Case Diagnosis: Improvements in physical and cognitive function following vagal nerve stimulation.

Case Description or Program Description: 69 year old male with residual right upper extremity weakness and gait impairment secondary to a left internal capsule stroke initially improved with therapy but since plateaued. He was selected as a candidate for vagal nerve stimulation (VNS) to further improve upper extremity function. He completed a rigorous therapy program for 6 weeks post-implant with significant gains in upper limb function.

Setting: Outpatient clinic

Assessment/Results: Prior to implant his Fugl Meyer score was 50, improving to 58 post-implant. He became independent with tying shoelaces, turning the car ignition, and buttoning shirts. He gained confidence in dining in public places and using small tools. In addition to upper limb function, he also noticed improvements in gait, with better right foot control. Patient also reported less cognitive fogginess and frustration. These improvements have been maintained to date.

Discussion (relevance): Vagal nerve stimulation (VNS) is an approved modality to treat stroke rehabilitation, epilepsy, and depression. In stroke rehabilitation, it has been shown to improve patients’ limb function, movement, and coordination. Our patient not only improved functionally in these areas, but also reported an improvement in “brain fog”. Estimates suggest that up to 70% of stroke patients experience cognitive deficits. Recent studies demonstrate that VNS, via vagal afferent fiber stimulation, may activate forebrain and locus coeruleus neurons leading to the release of acetylcholine and norepinephrine, respectively. These neurotransmitters are known to promote information processing and activity level within the brain. There have also been animal studies suggesting that VNS may induce secondary cascades inducing a hyperglycemic state, providing the brain with more available glucose, enhancing overall cognition.

Conclusions: Post-stroke rehabilitation consists of both physical and cognitive recovery. Our case highlights the potential of VNS-mediated improvement in cognitive recovery post-stroke, in addition to its well-documented effect on physical function.