Free CEU: Vagus Nerve Stimulation Improves Arm & Hand Function Following Chronic Stroke

NeuroRehab Team
Thursday, June 19th, 2025

Electrical Stimulationvagus nerve stimulation

What Is Vagus Nerve Stimulation?

Vagus Nerve Stimulation (VNS) uses a small, surgically implanted pulse generator placed under the chest skin. Electrodes connect to the vagus nerve in the neck. When patients perform targeted arm or hand movements, the device delivers precise electrical pulses. As a result, it activates the brain’s learning pathways and reinforces motor circuits.

How VNS Boosts Motor Recovery

First, VNS taps into key neuromodulatory systems – cholinergic, noradrenergic, and GABAergic pathways. These systems enhance synaptic plasticity, making the brain more responsive to therapy. Then, pairing VNS with task-specific exercises strengthens the exact neural circuits needed for arm and hand function. Consequently, patients see bigger gains than therapy alone can provide.

Key Clinical Evidence

• Dawson et al. (2021)
  A double‐blind, randomized trial in The Lancet showed that VNS patients gained an average of 5 points on the Fugl‐Meyer Upper Extremity scale versus sham controls. Nearly half of the VNS group achieved clinically meaningful gains (≥6 points), compared to 25% of controls.
  Read abstract
• Kimberley et al. (2018)
  In a pilot RCT, 88% of VNS participants made meaningful improvements by day 90, compared to only 33% of the control group. No serious device‐related adverse events occurred.
  View abstract
• Dawson et al. (2022)
  A pivotal Phase III trial led to FDA clearance. Patients receiving paired VNS achieved 3 points more improvement at 90 days and doubled the rate of ≥6-point gains versus controls.
  See abstract
• Vora et al. (2024)
  A secondary analysis found that VNS paired therapy produced stronger hand and wrist improvements than proximal arm gains over 12 months.
  Read abstract

Why Paired VNS Works

• Event-Triggered Stimulation – VNS fires a pulse exactly when patients move, linking stimulation with the intended motor action.
• Enhanced Neurochemical Signaling – Activating cholinergic and noradrenergic systems boosts the brain’s learning chemicals and optimizes motor memory.
• Long-Lasting Results – Improvements persist up to 12 months, and in some cases for three years after therapy ends.
• Fine Motor Focus – Studies highlight especially strong gains in hand and wrist function, so protocols often emphasize fine motor tasks.
• Strong Safety Profile – Across multiple trials, participants tolerated VNS well with no serious device-related issues.

Clinical Implementation

To adopt paired VNS, clinicians must coordinate surgical referrals and track outcomes carefully. Even so, the rapid, durable gains make it a game-changer. For patients who’ve plateaued, VNS offers renewed hope. Moreover, it shifts rehabilitation from compensatory approaches to truly restorative therapy.

Next Steps for Clinicians

Enroll in our free AOTA-approved CEU course to learn:

• Patient eligibility criteria
• Surgical and post-op pathways
• Rehabilitation protocols and outcome benchmarks

Equip your practice today with science-backed neuromodulation strategies. Then, help patients reach recovery well beyond traditional limits – one well-timed pulse at a time.