Ep 137 - Get the Arm Back with Vagus Nerve Stimulation

A lot of the attention in stroke research is paid to the acute phase. How can we treat a stroke in the ER? What can we do so it doesn’t get worse? How can we prevent strokes from happening? What can we do in inpatient rehab to help folks get better?

Those are all important things,  and the stunning innovations happening around us are amazing, newsworthy, and truly impacting people’s lives in a meaningful way.

But there’s not as much attention given to chronic stroke. Sure, there’s some. There are people working really hard to help stroke survivors recover even years after stroke. But not as much makes it into the news.

That’s one reason I was interested in Dr. Jesse Dawson’s work at the University of Glasgow. The recently published a study in the Lancet about using Vagus Nerve Stimulation to drive recovery in patients years after stroke. And their procedure looks promising.


Dr. Jesse Dawson headshot. He directly faces the camera against a white background

Dr. Jesse Dawson is a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital. His research portfolio includes prevention and rehabilitation clinical trials in stroke survivors. His main interest is in improving the long-term outcome after stroke. Dr. Dawson holds a BHF/Stroke Association programme grant, HTA NIHR funding and NIH funding and runs a large outcomes adjudication system for multi-national stroke trials. He is the NHS Research Scotland lead for stroke research and sits on the editorial board of Stroke.

Dr. Dawson is currently researching the role of xanthine oxidase inhibition as a novel preventative treatment after stroke. This is the focus of a UK wide clinical trial, funded by a programme grant from the BHF/Stroke Association.

He is also studying novel treatments for upper limb weakness after stroke, including vagus nerve stimulation and robotic therapy. These studies included a large NIHR funded study, funding from Chest Heart Stroke Scotland and a collaboration with industry. 

Dr. Dawson is the Medical Outcomes Manager for the endpoint committee of the large NIH funded CLEAR III trial, the NIH funded MISTIE III study, the European Union FP-7 funded EuroHYP study and the international SITSOPEN collaboration. This involves review of all trial endpoints and co-ordination of the endpoint adjudication process for these large phase III studies.

He supervises several PhD and MD students, including students with competitive government and charitable funded fellowships. He co-directs a large MSc programme in Clinical Pharmacology and is Director of the Vertical Theme for Clinical Pharmacology and Therapeutics for the MBChB programme. He is a regular MRCP PACES examiner and external higher degree examiner for several UK univeristies.

The Research

This is a fascinating study because even though they are stimulating the Vagus nerve, they are not actually treating it. Instead they are using it as a messenger to the brain to say, “Wake up! It’s time to learn something.” Essentially, it’s trying to get the brains attention so traditional Occupational and Physical Therapy can work. And it seems to be working. It will be interesting to see if in future studies they can get similar results with Speech Therapy.

The other important take away here is that this work with chronic stroke survivors — folks who had strokes years ago — even in the control group. Granted the experimental group that got the Vagus Nerve Stimulation got better results.

The point is, though, that intense physical and occupational therapy gets results even years after as stroke, demonstrating once again that the 6 or 12 month caps on recovery are complete and utter nonsense.

Hack of the Week

Pick a small thing to focus on. Perhaps it’s a small task. Or part of a small task. Or maybe it’s a new goal you haven’t done before but it seems within reach. Do that. Focus on that. Achieve that. The look for more small challenges. Lots of wins on small challenges adds up to big success in the long run.


Dr. Jesse Dawson at the University of Glasgow

Dr. Dawson on Google Scholar

Dr. Dawson on Neuro News

Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke

Where do we go from here?

Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

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Here is the latest episode of The Strokecast


Ep 136 -- AFO Shoes Don't have to be Ugly


AFOs (Ankle-Foot Orthotics) offer many stroke survivors freedom by letting us safely walk. They lift our affected feet as we take our steps so our toes don't drag on the ground and trip us. They give us the mobility that foot drop threatens to take.

But they're not usually very attractive. And finding shoes that work with them is a challenge because they need to be bigger and wider so we can squeeze a weak foot and brace into the show.

A common question I hear from survivors is, "Where can I get shoes that aren't so ugly?"

Well, I don't always have great answers to that, but Lainie Ishbia does. Laine runs the Trend-Able blog and is one half of the emBRACE IT podcast. She's an expert on finding and making accessible fashion, and she joins us this week to share her story.


Lainie Ishbia looks at the camera over her left shoulder. She has long black hair and wears a dark leather jacket.

Lainie Ishbia is a blogger and podcaster helping people with invisible and visible disabilities look good and feel good. Her website at Trend-Able.com offers tips and strategies for literally and metaphorically  balancing fashion and physical needs. She develops tips for find accessible clothing options. If you can't find it, she offers tips on modifying clothes to make them work.

Lainie lives with Charcot-Marie-Tooth disease. It's a hereditary, degenerative nerve condition that today impacts her hands and feet. She began wearing AFOs on each foot at age 30 and mourned the loss of sleek heels at the time.

Since then, she's turned around her perspective, leveraged skills acquired through a career in social work and now helps folks with disabilities live their best lives with confidence, self esteem, and passion.

You can find more details of Lainie's story here.

Disability and Lifestyle

Living with disability (visible or not) is a lifestyle. It shapes what we wear, the careers we pursue if able, and the social activities we pursue. And we learn so much along the way.

I often say I now know way more about neurology and neuroplasticity than any marketing guy should ever know.

And now I know the foot bed in a shoe may be removal. And I know there is a thing in a shoe called a foot bed.

Lainie's fashion blog goes well beyond just the particulars of clothing and includes tips and strategies on how to navigate the world, like 5 Cocktail Survival Tips for Unsteady Girls or A Girlfriend's Guide to Dating with an Invisible Disability.

Disability Pride Month

July is Disability Pride Month.

I'm a little fuzzy on the origins and scope of the celebration, but my understanding is it started in 2015 in New York City to recognize the importance of the Americans with Disabilities Act.

How ought we celebrate it in 2021?

It will depend largely on your personal comfort level. Don't let anyone tell you you're doing it wrong.

The first thing is to recognize, accept, and believe with all your heart (original, mechanical, acquired from someone else, etc.) that there is no shame in being disabled.

Say it out loud if you can. There is no shame in disability.

We are people with lives to live. Sure, those lives may be different from the lives of the temporarily abled, but they are no less valuable.

Second, you can celebrate disability pride by simply being visible. By being a part of the world, participating in it and taking up space in it just like any temporarily-abled person. Don't let people pretend we don't exist. Don't hide from people just because our presence makes them uncomfortable.

Third, when someone talks about diversity and inclusion, make sure they are talking about disability in that, too. A diverse organization with no disabled people is not a diverse organization.

Fourth, share your story with folks. You don't have to share it with the world in a podcast, blog or YouTube channel if you don't want to. But you can share it with people in your community and family.  The woman who hosted the graduation party Lainie talked about in our interview (probably) wasn't trying to keep disabled people from having a good time at the party. It's likely the challenges Lainie faced never even occurred to her. The more we tell our stories, the more people will think about accessibility.

That's just a few ideas to consider. Ultimately, you can celebrate in the manner that feels most comfortable to you. If that means you walk, roll, or hobble down the street in a parade or protest, great. If it means all you can do is remind yourself there is no shame in disability, that's great, too.

Disabled is not a bad word. There is no shame in it.

Have a fantastic Disability Pride Month!

Hack of the Week.

Lainie suggests picking up (no pun intended) mini-lint-rollers, like these.*

These have sticky sheets used for getting lint or pet hair off your clothes. If you struggle with manual dexterity, though, they can also be great for picking up change at a store counter. They can also be a nice solution when that pill box spills on the floor and Plaxix and Lisinopril go everywhere!

"But, Bill, why wouldn't I just pick things up with my unaffected hand?"

There are a few reasons.

First, a toned or spastic hand can probably still hold a lint roller, and if you have some shoulder control, you can move it. One of the most important tools in recovery is to use your affected limb as much as possible in practical way. Just because it's no longer fully connected to your brain is no reason not to make it work.

Second, especially when I need to get something on the floor, I often need to use my unaffected arm to balance or stabilize myself. If I get in an awkward position and my unaffected hand is busy, it's much more difficult to not fall.

Everything in life can be therapy!


Where do we go from here?

Here is the latest episode of The Strokecast