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.