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bindwaves S7E1 -The Power of the Vagus Nerve
Injuries to the brain can impact our lives in so many different ways. Meet Dr. Collin Cooper, an Occupational Therapist specializing in stroke and brain injuries as well as hand therapy for PAM Health in Allen, TX. Learn how Dr. Cooper utilizes vagus nerve stimulation along with traditional and hand therapies to help ischemic stroke survivors improve their upper limb function. By implanting a small generator, specifically Vivistim, in the left chest and attaching a lead to the vagus nerve in the neck, stroke survivors learn how to regain arm function. Dr. Cooper walks you through the vagus nerve’s functionality and how, over time, these advanced treatments help remap the brain and thereby improve a stroke survivor’s overall quality of life.#PAMHEALTH
Guest Social Media Info - PAM Rehabilitation Hospital of Allen
You can find this episode’s transcript here.
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Okay. Right. So the vagus nerve is a cranial nerve, cranial nerve 10. So that starts all the way up and when it's in there, it's kind of everywhere. Right. Okay. So when those, those chemicals that we were talking about get rereleased up into the brain. They don't just go to one little area, they kind of go everywhere up in the brain, which is why it's so effective because it kind of starts remapping the brain where that injury site was meaning like where the area in your brain that the stroke occurred. Mm-hmm. Uh, kind of remapping all of those connections to go around that area. Right. And then we start kind of. Developing those pathways and getting them nice and strong with the therapy that's paired with the stimulation.
Bernard:Opinions shared by the guests of the show are their own and do not necessarily represent the views of the hosts bindwaves Or the Brain injury network. This podcast is for informational purposes only, and it's not a substitute for professional medical advice, the diagnosis or treatment. Always seek the advice of a healthcare provider with any questions you may have regarding a medical condition. Thank you.
Carrie:Hi, I'm Carrie, a stroke survivor and a member of BIND.
Brittany:And I'm Brittany. I'm a brain injury survivor and member of BIND Today we're excited to welcome Colin Cooper, um, doctor of Occupational Therapy at Pam Health and Allen specializing in stroke and brain injury rehab. But over 10 years experience. He also is certified in Parkinson's care and currently pursuing a fellowship in hand therapy. Colin, thank you so much for joining us.
Collin:Thank you for having me. I'm excited to be here.
Brittany:Oh, cool.
Carrie:We're excited too.
Bernard:Opinions shared by the guests of the show are their own and do not necessarily represent the views of the hosts Bind-Waves or the Brain injury network. This podcast is for informational purposes only, and it's not a substitute for professional medical advice, the diagnosis or treatment. Always seek the advice of a healthcare provider with any questions you may have regarding a medical condition. Thank you.
Brittany:So, first question, what got you interested in the brain injury community and occupational therapy?
Collin:Um, well. In school, neuroscience is a big part of our education, and that's kind of where my brain injury interest began. Uh, it was one of my favorite classes, neuroscience Neuroanatomy. Um, just learning about how complex and how unknown the brain is and, and how injuries related to the brain can impact, uh, people in so many different ways. Uh, it was just very, very fascinating. Hmm,
Carrie:that's, I know a lot of people kinda hear that way about the brain. I mean, we learn so much now. It's more than we should know as a brain injury survivor. But so where, what got you decided in the occupational therapy route?
Collin:Sure. Well, I actually had an injury, um, it's about nine years ago now, where I dislocated my left elbow and broke the bones in my arm and totally lost function. Um, so basically I spent a year relearning how to use my arm at hand, and that was with an occupational therapist. Mm-hmm. And it changed my life, changed my outlook on life. And so as soon as I was cleared medically to go back to normal living. I applied to OT school and got in, and here we are.
Carrie:Oh, that's very cool. Okay, so I'm gonna go off script like I told you I would. Sure. So what is specific? Like you're doing a fellowship for hand therapy? Mm-hmm. What I mean, I'm interested because.
Collin:Yeah,
Carrie:my hand doesn't work.
Collin:Right. So, um, so there is a specialty certification within occupational therapy. Physical therapists can also obtain that certification, and it's essentially certified hand therapist. So what a certified hand therapist is, is a specialist from the shoulder down to the fingers. Okay. And they basically specialize in every. Almost every condition, um, known, whether that's a fracture or a neurological condition, um, muscle weakness, that sort of thing. Post-surgical, basically anything and everything related to the arm and hand. It's just a specialty where you can design splints or, um, do specialty wound care, you know, stitches, stuff like that after surgery. And so for me. Uh, that's kind of what actually got me into being an ot.'cause I was with a hand therapist relearning how to use my arm. So I feel like it's just kind of my natural progression. Okay. Um, to continue, um, pursuing that. But I love what I do at Pam, uh, working with our neurological stroke brain injury population. So my kind of idea is to bridge the gap between the two. Mm-hmm. Um, because oftentimes, you know. When you're going through therapy after those sort of things, there isn't a whole kind of holistic approach to the recovery, right? They kind of just focus on one thing, right? Mm-hmm. So by having this extra knowledge related to the function of the arm and hand, I'm hoping I can kind of bridge that gap between our neuro and stroke population and with the information that I have, or education for the hand, how I can make things a lot better for my patients.
Brittany:That's, that's pretty cool. I like it. All right. So, um, I know when you work with it, it comes up as you work with the vagus nerve, so there's vagus nerve stimulation and vivi stem. Mm-hmm. So how does that work?
Collin:Sure. Um, so Vivas stem is, uh. Therapy supplement, if you will, part of a company called Micro Transponder, actually got their start here in Dallas and it's basically designed to put a little, um, generator in the, the left chest, right under the clavicle or the collarbone. And there is a lead that attaches to the vagus nerve up in the neck. And so what the patient does then is. Uh, do some therapy with me after that process has been started and we stimulate the vagus nerve to help regain function in the arm, in the hand after a stroke.
Carrie:Okay, so, and I kind of have, we did have, I think her name was Julie. Julie from Viva Stemm on a couple of episodes back. Um, so we learned a little bit about Viva Stem and I think that's how we got you. Yeah. So we're excited to have someone that actually works with the patients doing it. Mm-hmm. I mean, not that we didn't like Julie, don't say don't get it wrong. Um, but something that came up like we ask our other members for, to help us come up with questions that I don't think we ask this of Julie is, so when you have. A stroke or whatever, traumatic brain injury is the va, is the vagus nerve actually damaged or that's just, it just actually helps all those other little things in your Correct.
Collin:Correct.
Carrie:For your fine motor function skills. But it's not actually that, that is damaged.
Collin:No. Um, I mean obviously there's always the, a possibility that it could be, that it could be impacted in some way, but. For the most part, it is not involved with, uh, with a stroke. Um, so you basically have two parts, right? So you have one that goes down, the one that goes down on that right side of the body basically helps with everything. That your body does kind of automatically, right? So your digestion, your heart rate, your breathing, all of that. So we stay away from that one.'cause we don't want to interrupt any of that stuff. Right? Right. Yeah. But the one on the left side actually is the one that goes from down the lower part of your body all the way back up into the brain. So that's one of the main reasons why they target the left vagus nerve is because that is where those neurotransmitters or neuromodulators that I'm sure Julie had talked about, uh, um, that that's where those are going back up into the, into the brain and getting released. And that's where some of that, that new learning, um, the, all of the, uh, neuromodulators, like the serotonin, acetylcholine, dopamine, all of that is getting released, but it's going up that left side. So that's why we're targeting the left and not the right'cause we don't want to disrupt any of the other stuff. Right.
Carrie:Yeah. That, that's not Okay. So now that, that brings me to another question. Like I told you, I get sidetracked. Not sidetracked, but you know. Sure. So you're targeting the left, left side of vagus nerve. Mm-hmm. That controls both sides, the right and the left side because like I know my stroke was on the left, my stroke was on the right side, so my left side is affected. I still always wanna say that wrong. Yeah. But. So that left side vagus nerve controls both sides. Mm-hmm.
Collin:Okay. Right. So the vagus nerve is a cranial nerve, cranial nerve 10. So that starts all the way up and when it's in there, it's kind of everywhere. Right. Okay. So when those, those chemicals that we were talking about get rereleased up into the brain. They don't just go to one little area, they kind of go everywhere up in the brain, which is why it's so effective because it kind of starts remapping the brain where that injury site was meaning like where the area in your brain that the stroke occurred. Mm-hmm. Uh, kind of remapping all of those connections to go around that area. Right. And then we start kind of. Developing those pathways and getting them nice and strong with the therapy that's paired with the stimulation.
Brittany:Yeah. Yeah. So like speaking of pathways and the vagus nerves. So I had drop foot or a foot drop. Mm-hmm. And so basically where my foot and my brain were not connecting and not communicating. And so after my accident, so I was in a car wreck where someone. Slammed into me and like I went like going to the left. So, okay. I obviously hit that, but it's like my brain started remapping itself and rewiring, so like didn't finish those connections, so, right. Yeah. Yeah.
Collin:So very, very similar. Yeah. Mm-hmm. Yeah.
Brittany:Mm-hmm. So, um. When should someone consider vagus nerve simulation slash recovery?
Collin:Okay. Uh, well, it is for patients that have had, uh, an ischemic stroke. So with the FDA process, with this, um, technology you have to follow or, or you have to fall under, you know, there are guidelines in that criteria. So you have to be an ischemic stroke survivor and you have to be six months. Post stroke, right? So we can't do anything for trying to get you or the patient, uh, qualified for the, the surgical piece until it's been at least six months. Because the big piece is you gotta be considered chronic, right? So beyond six months, 10 years, 20 years, it can really be anything as long as you meet all of the little checkbox criteria that are, that are required. So it's
Carrie:definitely not acute. It's not
Collin:acute. More
Carrie:outpatient and error. It could, what you're saying is. So like I'm, I mean, one, I don't qualify'cause I had a hemorrhagic stroke, so. Sure.
Collin:Well, well you don't qualify right now.
Carrie:Yeah, I know. We talked about that. Yeah. So in general, for, you know. Sake of the podcast. Let's say I had an ischemic stroke. I am 16 years post-stroke. I've just learned about this. Mm-hmm. I can come in, I guess you're, I'm gonna come to you and I'm like, I wanna try this. We're gonna go, we need doctor referral and then start that process, or whatever it may be.
Collin:Exactly right. So you would go to your neurologist most of the time, um, and you would come in for, uh, an occupational therapy evaluation with say somebody like myself. And I do a special test, it's called a ugal. My assessment, basically looking at the motor function of your arm, um, you know how well you can move it. What you can do with your wrist. Can you grab a ball, pick up a pen, you know, all of that kind of stuff, right? That's all part of the test. And I score all of that and then it kicks out that final score. And the hope is that you are around like 20, outta 66, give or take a couple. Um, and then we get that secondary process started, which would be then I send all of your paperwork to Viti. That gets you set up with a, uh, surgical consultation with one of the surgeons. And they make sure you're safe to actually have the surgery. And then it goes to insurance. And then that process can take a couple weeks to a couple months. And then the hope is that it goes through and then you come back and see me and we do the, the protocol, which is six weeks, three times a week, 90 minute sessions each. Okay. So it's very intense, but a lot of fun.
Carrie:Right?
Collin:Sure.
Carrie:There would be a lot of fun.
Collin:I make it fun.
Carrie:I know, I'm just kidding. Um, so. Kinda not related to Vivas stem, but still vagus nerve. Are there everyone's, you know, making the supplements these days? Yeah. Are there supplements that you could take specifically if you don't qualify yet for this simulation that would be beneficial to take or.
Collin:Um, well, there's always going to be some vitamins and supplements that are gonna help the body. Um, but in the grand scheme of things, the, the improvements that I think you're kind of looking for aren't gonna be that great. Okay. But it's definitely gonna help with just overall health and function. Right.
Carrie:Okay. But isn't specifically targeting that? No.
Collin:So like magnesium, vitamin B, like B12, B complex, um, zinc, those sorts of. F minerals, vitamins, supplements are really good for the neuromodulator function, for your just general nerve health. Um, but it's not gonna help improve overall function. Okay. If that's what you're looking for. Yeah. But all of those things that I mentioned, you just obviously want to make sure you clear it with your, your doctor just to be on the safe side. Right. I
Carrie:think that question may have come more when people were thinking that the vagus nerve is what actually gets damaged. Mm-hmm.
Collin:Yeah.
Carrie:Okay.
Collin:Mm-hmm. Okay.
Brittany:Um, so what setting the, is the vagus nerve stimulator used in and how does it work?
Collin:Sure. Uh, primarily we use, uh, the viti vagus nerve simulation in outpatient. Mm-hmm. There have been a few cases where it's done inpatient, right. So maybe a patient had, uh, a stroke a couple years ago and they got the nerve. Um, the nerve stimulator put in and then something else happened and then they got put back into the hospital kind of thing. So then as long as that therapist at that facility has been trained on how to use it, it can definitely be used in an inpatient kind of setting. Um, but the most. I would say most of the time it's gonna be in an outpatient kind of situation where patients are coming in, do a few, the few days a week, and then back to wherever they're living. Yeah.
Carrie:But then, but they also, it works at home for themselves. Correct. Is it's not just
Collin:Correct.
Carrie:And for the outpatient therapy.
Collin:Correct. So the main, the main, um, deliverance of stimulation is gonna be in. The therapy setting because myself or another therapist that is using this technology has the ability to deliver a stimulus every few seconds. We also train the patients to be able to do this at home. They get a little device, it's a little magnet that they can swipe over the left chest and turn it on and it can run. Um. Uh, for 30 minutes. And so you can turn it on about eight times a day. Okay. So a total of four hours. So that way when you're doing stuff at a house or if they're in here, like at the clubhouse, they can turn it on and do things around here or at the house, whatever it might be. Getting dressed, laundry, brushing their teeth, that sort of thing. So the therapy doesn't just happen in. The session, I can just give more during that time. Right.
Carrie:You can bypass
Brittany:the resting period. Exactly. Exactly.
Collin:Okay,
Brittany:so again, um, you have to be six months post,
Collin:correct. Screw. Yes. Have to be six months. At least that's what it is right now. There's a ton of research going on with them to look at how it affects people with, um, you know, like walking leg function. And then they're also exploring other versions of strokes, like a hemorrhagic stroke. Right. Yeah.
Carrie:So that's a good, that's what I was saying that too. So right now it strictly focuses on the arm and the hand. Mm-hmm. So it's not, not yet ready to help with foot dropper.'cause like, I'm like Brittany. I kinda have foot job, but more of my foot rolls. Rolls. Yeah. So I can't put it down flat without the A FO, so, right.
Collin:Yeah. All of that research is kinda under, under wraps, I guess.
Carrie:Right. But that vagus nerve still affects all those things.
Collin:Everything. Right, because the brain controls everything. Right? So even though weed focus mostly on the arm. That's, because that's what, um, the, the labeling for, for the FDA approved protocol is for That doesn't mean that the rest of the body is not getting affected. Right. Right. Just,
Carrie:we're just not focusing on that yet. It's
Collin:not, yeah, exactly. And that research hasn't been published yet, so we don't have that support to say Yes, it can sure. Affect the, the like. Right.
Carrie:Yeah. Okay. I'm gonna take a quick little break and just remind our listeners while you're listening to go ahead and click that like button, that follow button, that subscribe button. Whatever button you see that has a thumbs up, go ahead and click that button. And then so, um, do you know like kinda where they are in the research process of when they might be able to branch out to other be, you know, hemorrhagic stroke or even are they looking at, I guess just not even stroke?'cause it sounds like right now it's strictly ischemic stroke. So is the goal not just maybe hemorrhagic stroke, but also. Traumatic brain injury, brain tumor, brain cancer, I mean, right. Is the goal to hit all those areas or Right.
Collin:I can't say for sure. Okay. Um, just because I
Carrie:You're on the therapy side. Yes. Right.
Collin:Um, but I'm gonna go with Yes, because just working closely with this company and the people that work there, their main objective is to help as many people as they can. So. Yes. Right now it's geared just towards ischemic stroke survivors, right? Mm-hmm. And the arm function and the hand function. But they are trying to branch it out, right? Okay. And trying to get it so that. Other patients can, can take advantage of this, this technology as much as possible. Yeah.
Carrie:Okay. And one other thing I was just thinking about too for,'cause we do have some therapists that listen, you know, that mm-hmm. Know us so they listen. Um, what, as a therapist, if you're in the day neuro program somewhere, or you're an outpatient program somewhere, what do you as a therapist. Need to do to become Vivas STEM certified therapist?
Collin:Sure. There's a little, uh, training program that Viti will put you through. Um, if your clinic or hospital system, wherever you're working, wants to get involved with this, um, Julie, uh, would be a great person to get in touch with. Julie Graham. She is their, um, therapy development specialist, and so she would be the one to get that new therapist onboarded to get trained. Teach them how to use all of the software and the technology and all that good stuff. Yeah.
Carrie:Okay.
Collin:Mm-hmm. Cool. Mm-hmm.
Brittany:Um, so what are some smaller steps to gain momentum to reach larger goals, whether you use Viva stem or not.
Collin:Sure. I think the, the biggest thing that I have learned working with patients going through, whether it's a stroke recovery or a brain injury recovery, is to keep. Fighting. Right. And to keep working hard. I think that sometimes during recovery it is, um, very difficult, sometimes dark, right? Mm-hmm. And it's, it's tough to see the light at the end of the tunnel when you're in that, and you feel like you're alone in that sort of thing. And so, my biggest piece of advice, you know, small steps, all of that good stuff would be to continue to work as hard as possible, whether that's with family, friends, therapists. A place like this, you keep continuing to work hard because I feel like a, a big common misconception is you only have a certain amount of time to get better, which in my experience is not true. Right. In our state, we definitely
Brittany:not.
Collin:So the biggest thing is you just take it day by day and you keep trying and you don't give up because you got a life to live. Right. It's just a different life now. But you still got lots to live for.
Carrie:Absolutely. Yeah. So, okay. We've talked a lot about Viva and Sure. We really haven't talked much about your organization, Pam. So tell us a little bit about Pam. You said it's, I don't remember what it stands for now. So medical I know is the last word I think. Uh,
Collin:post-acute medical. Okay. We were rebranded to Pam Health a few years ago, so basically. Um, there are, I want to say 70 to 80 hospitals around the country. Mm-hmm. Started out on the East coast. Um, there are lots in Texas and we've kind of branched all the way out west to around Las Vegas. And the main deal is, like I said earlier, was the stroke, traumatic brain injury, and neurological, uh, rehabilitation. Um, here in Allen where I work, we have a 40 bed inpatient hospital, and then I'm in the outpatient department, so. We try to do as much as we can for our patients, which is why we also have the outpatient department. Okay. So they do their time inpatient, then they come and hang out with me for however long we need to get them back on their feet and moving and groove in the way that they need to. Yeah. Okay.
Carrie:And so that, that I, I think I've heard of Pam, but not very much. Like we know a lot about paint and CNS, I mean, but so y'all are similar to that?
Collin:Very similar. So
Carrie:like someone goes to whatever hospital they go to and it. They've done their, maybe they're not done with inpatient. They need more and they're wanting somewhere to go. Yes. They're, you're just another option for, um,
Collin:right.
Carrie:Okay.
Collin:Right.
Carrie:Trying to wonder why we don't hear more about you guys.
Collin:Yeah. Um, the outpatient department is kind of new. Um, we're trying to get that word out a little bit more because we're basically known for the inpatient side. Mm-hmm.'cause we also have a smaller facility in Richardson that does inpatient as well. Um, but the outpatient department has been there for, I don't know, seven years. Okay. Probably. Um, it's just. One of those where most of the time patients come for inpatient, but the outpatient we are are thriving. And like I said, we are stroke, uh, neurological and traumatic brain injury certified for all of our programming there. That's great. And like I said, we, we deliver everything we can do. Orthopedic conditions, hip replacements, knee replacements, all that stuff too. Um, kind of a one stop shop. Everything under the sun is basically what we can do at Pam. Yeah. Up in Allen. It's great.
Carrie:That's awesome. We'll need to come visit y'all. Learn more about you. Yeah, come on in. So, um, do you have any success stories you could share with us? Like for someone that's. You used Vivas, dim that.
Collin:Sure. Um,
Carrie:and we can change all the names to protect those and I'm just Right. Right.
Collin:Um, so for, for us at Pam and Alan, we've only had one patient so far, go through that whole program. Um, I have I think six patients in the process right now. Okay. So, um. Whether that's going through surgical consultation, insurance approval, appeals, all of that kind of stuff. So I don't have a ton of success stories for this right now just because it is really new for our facility. We've only been doing it for about a year. Okay. Um, that patient that, uh, I was referring to, she was about 11 years post-stroke and she actually was able to get that arm back up on a shopping cart. Wow. Still have a long way to go for her, but that shoulder motion started to improve with our time together. So she was able to lift it up high enough to get it on a shopping cart and be able to kind of push that shopping cart around, which was a big deal for her, you know, during her recovery, especially being so far out from having the stroke.
Carrie:Yeah, that's awesome. And that's, I like to hear those stories where it's that far post.'cause like I said, I'm 16 post and yeah,
Collin:Viti has some really cool success stories. I, um, I could be misspeaking, but I believe there was an individual that was 20 plus years, I think outta Chicago that has made some really, really good gains. That's really, really cool to, to check out. Yeah.
Carrie:Awesome. Yeah. Well, is there any last little piece of advice? I know you kinda said it already, but, um, that you'd like to share with our listeners? We know, don't give up.
Collin:Yeah.
Carrie:You can always get better. Yeah. There's not a limitation.
Collin:Um, I would just say that, you know.
Carrie:Just
Collin:ignore him. How, how, uh, life presents you with those challenges. You just, you just keep going. Right. It could be a little rocky and a little bit bumpy, but at the end of the day, you're still here. Right? Right. And so not to give up and, um, not to toot our horn over at Pam, but, but we love everybody and anybody, so any listener out there that thinks that they need a little bit of therapy or needs a little push, come and see me. Our doors are always open. We're willing to take anyone and everyone because our main objective over there is to get people back on their feet and living in life.
Carrie:That's awesome. I love to hear that. And so thank you so much, Colin, for coming in and sharing your experience with us. Just your experience and then also your experience with the booth stem. And like I said, we'll have to get the Clubhouse more involved with Pam so we can come out. That'd be great. And talk to your survivors.
Collin:Awesome.
Carrie:Do more of that and thank you to our listeners for listening.
Collin:Thank you guys.
Brittany:And remember, you can find all our new episodes on all your favorite platforms. Until next time.
Carrie:Until next time.
Rick:Continue to support Brain Injury Network in our nonprofit mission, we support brain injury survivors as they reconnect into life, the community, and the workplace. And we couldn't do that without great listeners like you. We appreciate each and every one of you. Please remember to click the like button, the share button, and the subscribe button on YouTube. And follow us on Instagram at BIND Waves and Brain Injury Network on Facebook. You can email us at BIND waves at the BIND dot org or go to our website BIND waves.org or call us at(972) 769-2463. Please continue watching. Until next time.