Rewiring Hope: Transforming Stroke Recovery with Vivistim

 Imagine regaining movement after years of immobility. Julie Graham, OT and therapy development specialist at MicroTransponder, discusses her extensive 20-year career in occupational therapy and her work with Vivistim, a device designed for chronic ischemic stroke survivors. Vivistim pairs vagus nerve stimulation with physical and occupational therapy to enhance neuroplasticity and regain motor functions in the affected upper extremity. Julie explains the role of the vagus nerve in rewiring the brain's connections and how Vivistim is different from e-stim (external electrical stimulation). While the FDA has only approved Vivistim for chronic ischemic survivors, there are multiple studies for all types of brain injury, so Julie hopes access will be expanded soon. She also shares real-life success stories of stroke survivors who have regained significant abilities. 

Transcript

Bernard: 0:10

Opinions shared by the guests of the show are their own and do not necessarily represent the views of the hosts buying waves or the Brain injury network. This podcast is for informational purposes only, and it's not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare provider with any questions you may have regarding a medical condition. Thank you.

Carrie: 0:37

Hi, I'm Carrie, a stroke survivor and a member of BIND.

Brittany: 0:41

And I'm Brittany. I'm a brain injury survivor, a member of BIND Fort Worth. And today we have Julie Graham, who is a therapist, a therapy development specialist at Micro Transponder working with Viva stem. Um, she has 20 years experience of professional experience delivering in home services. So how did you get interested in the brain injury world?

brian: 1:08

Welcome to bindwaves, the official podcast of the Brain Injury Network of Dallas. I'm Brian White, BINDs executive director. On each episode, we'll be providing insight into the brain injury community. We'll be talking to members and professionals regarding their stories and the important role of BINDs Clubhouse. We work as a team to inspire hope community and a sense of purpose to survivors, caregivers, and the public. Thank you for tuning into bindwaves. Let's get on with the show.

Julie: 1:40

So I have been, as you said in the intro, an occupational therapist for over 20 years. So I guess you could say I got started. way back in school. Mm-hmm. So it's always been a part of everything I've done, no matter, um, whether the setting was acute care, inpatient rehab, outpatient rehab, all of those things. It's always been a part of what I've done, no matter the setting.

Carrie: 2:04

Okay. So you started as occupational therapist? Yes. And if it's kind of moved around from there? Yes. Okay.

Brittany: 2:10

Mm-hmm. Yeah. Um, were you, um, explain what Viva stem is and how it works.

Julie: 2:18

Sure. So Vivas stem is, um, paired vagus nerve stimulation for chronic stroke survivors. So it is, um, paired being that we pair the vagus nerve stimulation with PT and ot, um, on the backend to help boost patient's neuroplasticity and regain motor functions. Um, in their affected upper extremity.

Carrie: 2:46

Okay. And I think the biggest question that's just gonna back up a little bit that I had Sure. Um, is when I watched the little tutorial on your website mm-hmm. What in the heck is the vagus nerve or vagus?

Julie: 2:57

What is the vagus nerve? Right. So, we'll, we'll, we'll, we, what does it

Carrie: 3:01

do and why do we care?

Julie: 3:03

A lot of different things. So the vagus nerve is a cranial nerve. It's your 10th cranial nerve. The vagus nerve is responsible for a lot of sensory components in the body, as well as a lot of autonomic functions. It's really unique in that it sends signals from the body to the brain and the brain back to the body. Um, why we care about it in relation to Viva stem is anytime that we stimulate the vagus nerve, it releases these fancy things called neuromodulators. Specifically serotonin, norepinephrine, acetylcholine. What that does is when those neuromodulators are released in the brain is it puts the brain in a very awake learning state. It's, it's ready to go. The reason that's important is that that opens up receptors and allows those connections between the brain. And the signal going down to the rest of your body to be reestablished. So we're able to boost the brain's neuroplasticity. and rewire things go around areas of the brain that were damaged by a stroke and help people regain those motor functions that they've been wanting to.

Carrie: 4:12

Okay. Yeah. We all know neuroplasticity, of course, all ttoo well. Yes. Mm-hmm.

Brittany: 4:18

Yeah. And so on your website while watching the video, it says to get the, the stem inside, it's a surgery. So how invasive is the surgery?

Julie: 4:29

So it is a surgery with general anesthesia. It's a 45 to 90 minute outpatient day procedure. Um, so. I guess in terms of how invasive it is, is really gonna depend on every single person and their medical history. Um, that's something that our surgeons work with, with each individual patient to determine, you know, safety, things like that. Um, so it's, I would say not, not incredibly invasive because it is just a short outpatient day procedure. Very, uh, commonly done. The surgery itself, um, has, the procedure has been around for 25 to 30 years. So the surgical procedure used for vivas stem is not new.

Carrie: 5:16

Okay. So it just like goes somewhere in your chest. Mm-hmm. And then. Somehow it gets to your brain.

Julie: 5:23

So the way that it, that, no, that's a good question. The way that it works is the, um, what we call the generator, which, um, is small, is implanted just inside the chest wall. It's usually implanted on the left side underneath a collarbone. Um, for some patients who may have another implantable device, like a loop recorder or a pacemaker, surgeons can place it on the right side. Um, then what happens is that there is a lead with coils on the end, and that lead with the coils. The coils are attached to the left vagus nerve. So the little generator that goes in underneath your collarbone is actually what sends the, excuse me, that sends the impulse and then that is transmitted. Through the coils to your vagus nerve, then that's what.

Carrie: 6:10

Okay and so helps to realize you're pointing. So the vagus nerve is somewhere in your neck?

Julie: 6:14

It is, yeah. So the portion that we're attaching, um, the coils to is in your neck. It's, uh. Just near the, um, vocal cords. Okay. Just underneath that tissue there. That's where we attach that coil.

Carrie: 6:29

Interesting. It's always so weird to me that where you're actually the thing you're getting, you don't have to, you don't go right into it. Like, when I get Botox for my arm and my leg, you know, he's poking somewhere and they're like, that's not anywhere near my fingers, and you're telling me that's gonna work on my fingers. So yeah. That's why I'm asking.

Julie: 6:47

Anatomy and science is fun. Yeah. Yeah, absolutely.'

Carrie: 6:51

It's quite Kinda okay. And I know we might get into this a little bit more, but, so in my brain mm-hmm. Again, I only know what I know until I learn. So, um, I had, um, an e-stem in the beginning with my, um, Day Neuro in my therapy, you know, and so I, in my brain, I think it's kind of like an e-stem Is, is it similar to that? I mean, and then

Julie: 7:14

So in terms of you're using stimulation, it's, it's a different kind of stimulation. What makes Viva stem so powerful is that we are rewiring the brain. So with e-stem you're, you're targeting the muscles groups. Okay. And so you're targeting muscles which are not your brain, right? Instead of

Carrie: 7:33

the nerve.

Julie: 7:33

Correct. And so with the vagus nerve and releasing the neuromodulators in the brain. And that neuroplasticity, that neuroplasticity, once that pathway is rewired, stays with you. Whereas oftentimes with e-stem, yes, it's effective and it allows you to make progress in therapy in some of your movements. However, it's hard to keep it. To keep it lasting.

Carrie: 7:56

Sure. Okay. So with that being said, um, again, I told you we'll give you questions, but we're gonna have lots. Do you, once you have the Viva stem implanted, is that forever now?

Julie: 8:09

So the idea being Yes, and that's one of the things that I love about Vivas stem is it's a very, um, it's a portable modality, if you will, for lack of a better term. Okay. It is a super modality, so it is with you. All of the time. So in terms of being able to use it, you're not lugging around a piece of equipment. Sure you are not. You don't necessarily have, you're not in the clinic, in the therapy clinic in order to use it. You have it with you all the time, which is fantastic. So in terms of being able to use it forever. The battery life of the implant is five to seven years, so patients are able to use it for the life of the battery when that battery starts to dwindle. If they choose to, they can have a new generator put in, fresh battery. Um, it can just, the battery can, uh, quit working and patient, you can leave it in. It's no harm to your body or you can choose to have it taken out at that time, if you've really met all of your goals. Lots of different options and ways to go.

Brittany: 9:14

Oh, right. Wow. Yeah, so it's, we just talked about e-stem and electrical like pulses, so mm-hmm. What's the different voltages that levels that go throughout the therapy?

Julie: 9:27

So the amplitude, the intensity of the stimulation is gonna be a little bit different for every patient. This is a customizable Sure. Mm-hmm. Technology, if you will. Very similar to what you guys are familiar with e-stem. Right? Right. Mm-hmm. That's customizable. So we, um, will adjust it based on patient's comfort level. The stimulation is not painful at all. Um, oftentimes when patients initially feel it, it feels like a little bit of a tickle near their throat. Um, a little bit of a, you know, butterflies if you will, for lack of a better description. Um, so generally speaking, patients land in about at 0.8 in terms of the amplitude, but we're able to adjust it based on their comfort level.

Carrie: 10:13

Okay. I mean, we kind of get that because every brain injury is different, so we know nothing is. Set in stone for a brain injury patient. So it makes perfect sense that, you know, it's adjustable per patient. So that makes, um, so kind of explain to us when you first get it, obviously that's gonna be in traditional therapy setting. Mm-hmm. How does it work? How does that work versus when I'm done with therapy and now I'm on my own with it. Can you kind of explain that concept?

Julie: 10:38

Absolutely. So initially after patients, they start, we have a protocol after patients have the surgery that's three times a week for six weeks. Their therapy sessions are 90 minutes. Um. So they are, uh, committed to that. The therapists are committed to that. What is kind of, kind of unique is that the protocol is not necessarily specific exercises and activities. The protocol is based on high repetitions of activities. Mm-hmm. What's great is that those activities and exercises are individualized, so patients', therapists are gonna take their goals. That they've already established and they're gonna break down those goals into different movement patterns and activities. Um, and then be able to incorporate, uh, the hyper repetitions in those tasks. So patients go all the way through, get done with the six weeks. At that point in time, it's a conversation to have patient, family therapist. What makes the most sense? Patients are able to continue in therapy if their schedule allows. The clinic schedule allows. Insurance benefits allow all those types of things, they can absolutely continue in therapy and continue to use, uh, the viva-stem. In the clinic with the therapist, this is probably my favorite part about Vivas stem, is that patients have the ability to activate the vagus nerve stimulation on their own. So the implant is programmed, pre-programmed, patients cannot program the implant. So there's no, there's no potential for mishaps, but it's programmed in the clinic and then patients can activate their implant. At home doing their own things, their home exercise program given by their therapist up to eight times a day. Okay. The um, activation is set for a time period of 30 minutes. Um, that's really important because it forces people to rest instead of going full throttle all of the time. It's a forced rest break so patients can get started on their home exercise program, daily activities, you know, just getting dressed, um, showering, doing things around the house. Working. Um, and that turns on for 30 minutes and they get a stimulation that's equal to the same amplitude as what they get in the clinic every, uh, 10 seconds or so. And so they're able to continue to build on that benefit of the vagus nerve stimulation all of the time. Okay. Yeah.

Brittany: 13:10

That's nice. Yeah. So what are the side effects of it? Of the stimulation.

Julie: 13:15

Uh, so there are no, um, noted side effects of the stimulation itself, uh, sometimes right after surgery because the vagus nerve is close, uh, to, uh, the throat. Patients may have a little bit of a hoarse voice right after surgery, but that resolves on its own in a few weeks. Um, but sometimes patients are tired from the therapy sessions. Oh

Carrie: 13:39

yeah. We're always tired from the therapist. Yeah. Then your therapists

Julie: 13:42

are good. You don't leave exhausted.

Carrie: 13:47

Well, and I'm gonna back up a little bit. So, I mean, I know I asked specifically what's the difference between therapy and home, but like we were talking earlier, y'all. Or y'all have traveled, but you do have a clinic, so it's not. The therapy's not home therapy, it's in a clinic setting.

Julie: 14:02

Correct. So the way that it works, and I, I need to back up as well, is when you're in that protocol, the three times a week for six weeks, our therapists in the outpatient clinics have a laptop with the Viva stem software. That, uh, laptop also has a wireless transmitter. The wireless transmitter communicates with the patient's implant. Um, so when the patient is working with the therapist, they are giving extremely targeted stimulation of that vagus nerve during different points of those movement patterns and activities. There's the big difference between the in-clinic and the at home, because the at home it's set to give you a stimulation every, every 10 seconds or so. Mm-hmm. Mm-hmm. Whereas in the clinic, you're getting actually more stimulations because the therapist is able to judge where that stimulation belongs in those movement patterns.

Carrie: 14:59

Okay. That, that makes sense. That's why. Mm-hmm. When you were talking, we were like you said, you know, you all kind of work from home. I was like, well, so because we, there are a lot of programs now that go to your home there. There certainly are. Y'all do y'all, is this. Your own clinic or do y'all work with other therapists? That's

Julie: 15:16

the beauty of it. That is the beauty of it.

Carrie: 15:18

And Frisco Rehab and or rehab with walls or whoever mm-hmm. Decide they want viva stem, whatever program they're in.

Julie: 15:25

Absolutely. The, the great thing is, is that this is, um, uh, a technology that is available to any. Outpatient therapy clinic that wants to learn about viva stem and wants to be able to administer it to their patients. Um, when we talk about the laptop, that is, um, simply a loaner agreement between the clinic and our company. So it doesn't cost the, the, the therapy sites anything to be able to be a part of this technology, which is absolutely fantastic for clinics. Um. So we work with a lot of different clinics in the area, and we are always, um, willing to educate, build that awareness as far as that this technology is out there. Um, we've had a lot of patients who have come to us and said, I really like my therapist. I, this is where I go to therapy. Um, all of those things. And so oftentimes we'll reach out and educate those therapists and. Everybody meets together and is on the same page, and we're able to really spread the awareness and offer this. M as close to patients as we possibly can.

Carrie: 16:34

That's cool. Yeah, I know for, I don't know if it's because it's not the same computer, so I don't know, but somehow, bit of a stem has been shown up in my Facebook field a lot lately, but I don't,

Julie: 16:45

I don't know. I, you know, I don't know how that works, but

Carrie: 16:48

I'm sure that the computer here and buying does not talk to my computer at home, and I don't get on Facebook here, so I don't know. Someone's listening. Someone's listening somewhere. I'm just kidding. I'm gonna take a quick little break and just remind our listeners to, um, go ahead and click that like button, that share button and that subscribe button and the notify button if you're on YouTube. Just remember, click all the good buttons. Keep on listening. So, okay. Um, now one thing that we are curious about that I want to go back and that, so like I am a stroke survivor. I'm a brain injury survivor is just a traumatic brain injury survivor. She was in the car wreck. Mm-hmm. Is Vivas stem only for stroke survivors

Julie: 17:27

Currently? Yes. Short answer is currently yes. So our FDA approval is for, uh, chronic ischemic stroke survivors. Um, as.

Carrie: 17:39

They're not even hemorrhagic there

Julie: 17:40

currently. No. Mm-hmm. So, exactly. Yes. So, however, yet, so as Liz, my counterpart likes to say, we have a long way to go in a really good way. Research takes time to compile data and studies take time Sure. To complete. And so there are a lot of things in the works, um, with our research department as far as, um. Based off of what we've seen with our patients who have gotten this implant and the um, off-label benefits that they have seen, there are a lot of studies coming down the pipeline. Um Okay. So we're really excited about it. So currently in terms of FDA approval, yeah, it's for chronic is ischemic stroke survivors. Um, who knows what we'll learn over the next few years as far as it being applicable to other things. Definitely a lot more to come. Good. Yeah.

Brittany: 18:36

Hm. So I guess it's for, um, those type of categories of people. So how do you know if it will work, or how do you know if it's working?

Julie: 18:47

Uh, in terms of for our stroke survivor patients? Yes.

Carrie: 18:51

Yeah. Or like how do you decide this stroke survivor? Is a, it's a viable option for them. Mm-hmm. Or maybe it's not a viable option. Right. Yeah. How do you determine that?

Julie: 19:02

So currently with our FDA labeling, we're looking at ischemic stroke survivors. Um, and we're looking at those patients who have really have done all the initial therapy because we like for the body to recover as much as possible on its own. And hopefully people don't need us.

Carrie: 19:21

As they

Julie: 19:21

recover because their body has done such a great job therapy and physicians have done such a great job. Um, but for those patients who have started to plateau with the traditional, you know, therapy and physician routes, that's where we come in. Um, so anytime we have patients who are interested in us, who either reach out directly to us, their physicians, their therapists have referred them, we always provide. Education we have, not only myself, but we also have a team of nurse navigators. Okay. Who provide background education. That is huge. We want everybody to understand what Vivas stem is, how it works, what the protocol is on the back end, because this is, this is a commitment like you were talking about earlier, lifelong potentially. And so that understanding is a huge, huge component. Sure. Um. To really success for the patients and clinicians. So education is, is, uh, the first component. And then patients go for a therapy evaluation, um, either with a PT and ot. Um, and the reason for that is we get that baseline motor function score. We use a, a motor function assessment called the ugal. My assessment, it's been around a really long time and it was used in our study, uh, that. Led to our FDA approval. So it's a great baseline measure for us to be able to track data long-term for everybody across the country. Um, after that happens, you know, everything looks good. Everybody's on board on the same page. Patients go for a surgical consultation because it is a surgery like we talked about. And so our patients go meet with the surgeon, discuss medical history. The ins and outs of the procedure, medications, things like that. Make sure that everything looks good on that end. Um, and then they go for the surgery and continue on with the protocol. So we get to know all of our patients really, really well because it is, it is all about communication. Absolutely.

Carrie: 21:22

Sure. That makes sense. And yeah, so one of the things that, um, Brittany and I kind of talked about as we were doing it is, I mean, I'm gonna. I guess, you know, it doesn't directly help your mental state of mind, but I've got to guess that this gives some sort of huge boost mentally for those patients that see it working.

Julie: 21:44

Absolutely. To see, to see patients and how they, um, just, you know, like you just said mentally, everything overall when they, when they start to see that, that progress, you know, after, after years of kind of. Being up and down with therapy. Mm-hmm. And yes, I make progress and then kind of declines a little bit to be able when they, when they see that, yeah. It just, it changes everything. It spills over into a lot of o other things in a really great way. Absolutely.

Brittany: 22:15

Can you share any

Julie: 22:16

success stories that you have or, sure. Sure. Absolutely. So we've seen a lot of super cool things. Um. Over the past few years, specifically here locally in the Dallas-Fort Worth area, um, we had one gentleman last summer, uh, who. Was absolutely fantastic. And as a retired air conditioning repairman loved to still do stuff around the house. Mm-hmm. Mm-hmm. Um, and fix things and do things, which made his wife a little nervous. Mm-hmm. Um, but that, so those were really big goals with him and his therapists. And he worked really, really hard and was able to finally, for the first time since his stroke, I think it had been almost seven years, able to, uh, repair. His air conditioner using both hands. Oh, nice. Yes, which was huge. Which was huge. Um, we have had patients who, um, it's been something as simple as I was able to hug my wife with both arms, which is, which is absolutely amazing. Um, big thing, patients going out to eat, able to cut. We had, uh, some patients last year who. Wanted to go out for a steak dinner because they were able to cut their own steak so there was no more, uh. Eating a bowl of soup or a salad or something. They were able to use both hands to cut their own steak.

Carrie: 23:41

Yeah, that's called my dad. I totally get that. Yeah know. Yeah. When I go for a steak, it's like my birthday going for a steak. I'm like, okay, here you go, dad.

Julie: 23:51

Yeah, absolutely. Absolutely. Some of those, some of those things that, um, you know, as they like to say, you take for granted. Mm-hmm.

Brittany: 23:59

Mm-hmm. Yeah. Yep. Well, that's awesome about the stories. Um, thank you for joining us, Julie. Appreciate it. And thank you for all those who are listening.

Carrie: 24:07

And again, if you would like to contact us, you can email us at BIND waves at the BIND dot org or find us are on our website at it's the BIND dot org slash BIND waves. And again, you can always follow us on Instagram. At, you know, at BIND waves. Um, so yeah.

Brittany: 24:25

Yeah. And don't forget to, like, share and subscribe on your favorite platform, and also hit Notify on your YouTube while listening to BIND Waves.

Carrie: 24:35

And remember, you can find us on all your favorite platforms. So, until next time.

Brittany: 24:39

Until next time. We hope you've enjoyed listening to BIND Waves and continue to support BIND in our nonprofit mission. We support brain injury survivors as they reconnect into the life, the community, and their workplace, and we couldn't do that without great listeners like you. We appreciate each and every one of you. Continue watching. Until next time. Until next time.