"I Can Do It": Through Innovative Use of Vagus Nerve Stimulation, Stroke Survivor Increases Independence

After surviving multiple strokes, Crystal lives with stroke-related complications known as deficits.

Her right arm and hand lost strength, mobility, and dexterity compared to her other side. Her walking speed and balance were impacted. Her speech became less fluid.

There are four words, though, that Crystal never surrendered while trying to regain what the strokes stole.

Together, they form the motto behind her continued pursuit of progress.

“I can do it,” Crystal, 51, says. “I can do it. I can do it.”

A new use for vagus nerve stimulation

Crystal’s strokes were ischemic, meaning a blockage of blood flow to the brain caused them. More than two decades removed from her first and largest stroke, she still experienced deficits from it despite therapy.

Traditionally, patients like Crystal received frustrating feedback regarding their ability to regain strength and mobility after strokes caused upper-extremity deficits. They were told the effectiveness of rehabilitation diminished as the brain’s window of plasticity—its ability to change its structure, function, and connections—closed. That meant their chances of regaining strength and mobility in their hands and arms declined then leveled off over time.

Not anymore.

Since July 2024, through a combination of vagus nerve stimulation and extensive occupational and physical therapy, a team of WashU Medicine experts at Barnes-Jewish Hospital are giving stroke survivors an extended timeline to make additional gains. This option, available in the St. Louis region only at Barnes-Jewish Hospital, helps patients regain and maintain function in their hands and arms, possibly along with other benefits.

For patients like Crystal, vagus nerve stimulation doesn’t just make daily tasks—combing hair, taking out trash, picking up groceries—easier and faster. It increases their independence through enhanced ability and efficiency.

This treatment represents another step forward for Barnes-Jewish Hospital and WashU Medicine, leaders in stroke care, neurorehabilitation science, and the advancement of innovative and evidence-based treatments for stroke survivors.

“What’s exciting about pairing vagus nerve stimulation with stroke therapy is that this technique allows our patients to break through what was previously considered a plateau,” says Alexandre Carter, MD, a WashU Medicine neurologist specializing in neurorehabilitation at Barnes-Jewish Hospital. “Now we can offer them something else to pursue. This is a message of hope.”

How it works 

Traveling along a winding path through the body, the vagus nerve is involved in many of the involuntary functions of the intestines, heart, and lungs.

The vagus is also an information superhighway back to the brain, constantly updating it on the status of various body systems.

A vagus nerve stimulator, a small, battery-operated implantable device most often used to treat epilepsy and depression, is now an FDA-approved medical therapy for stroke rehabilitation.

When the vagus nerve stimulator is on, painless electrical pulses to the vagus nerve trigger the release of a variety of helpful neuromodulators, chemicals like acetylcholine, norepinephrine, serotonin, and even dopamine. These neuromodulators increase the brain's plasticity, or its ability to learn and adapt by creating and strengthening neural connections, so that when therapists conduct physical or cognitive exercises, the neural pathways that control the successful movement are reinforced.

“The process is a great example of how we collaborate across different departments and specialties at WashU Medicine and Barnes-Jewish Hospital,” Dr. Carter says. “This entire protocol requires collaboration of neurosurgeons, neurologists, rehabilitation clinicians, and physical and occupational therapy providers.”

Vagus nerve stimulation represents just one of the technologies and treatments that have become available for stroke patients.

For the past 20 years, WashU Medicine neurologists and neurosurgeons have investigated how the brain encodes, stores, and executes motor commands, research that has led to a continuum of therapies now used in clinical practice.

Eric Leuthardt, MD, a WashU Medicine neurosurgeon at Barnes-Jewish Hospital, also developed the IpsiHand, a noninvasive robotic orthosis that detects and translates a patient’s brain signals to assist stroke survivors with hand movement. The IspiHand was licensed to Neurolutions, a WashU startup company that Dr. Leuthardt founded. It became the first FDA-cleared device leveraging brain-computer interface (BCI) technology to assist chronic stroke patients in rehabilitation.

“It’s about helping the brain learn to change itself,” Dr. Leuthardt says. “We have a unique series of offerings for patients that can transform the expectations for stroke.”

For patients like Crystal, who are undergoing vagus nerve stimulation, Dr. Leuthardt implants the vagus nerve stimulator in the patient’s chest using two small incisions during an outpatient procedure that sends the patient home the same day. After a brief healing process, the patient begins intensive outpatient therapy with WashU Medicine Occupational and Physical Therapy. For six weeks, patients attend three 90-minute therapy sessions per week and perform at-home exercises. Therapy sessions include many repetitions of hand and arm movements: reaching, grasping, moving objects, and fine-finger movements designed to build dexterity.

During the therapy sessions, the therapist activates the patient’s vagus nerve stimulator device often, especially at the beginning of a task and when certain movements are performed correctly. The stimulation of the nerve releases neuromodulators that reinforce the learning taking place. Sessions are individually tailored to the patient, involving activities that move the patient closer to their goal, whether that’s resuming kayaking, picking up their grandchild, or getting back on their favorite hiking trail.

Crystal’s goal was something most take for granted. She wanted to improve her quality of life and independence by completing day-to-day tasks without relying on assistance from others.

"Through designing patient-specific interventions that are important to an individual’s functional activities and desired goals, we can maximize patient participation,” says Kate Mueth, PT, DPT, a WashU Medicine physical therapist. “Patients carry these tasks into their homes and communities, which improves the results.”

Breaking through a plateau

Since having her first and biggest stroke in 2005, Crystal never stopped trying to improve her stroke-related deficits, but therapy had become less effective for her over time. When she first heard about vagus nerve stimulation, she was eager to try. Her persistence mattered.

“Crystal has the perfect temperament for this,” Dr. Carter says. “She was focused, dedicated, and determined. She would not give up. She was willing to stick with the protocol and was excited about exploring this new treatment. While that’s not something you can measure with any kind of ruler, it has a large impact on the benefit of the therapy.”

After receiving her vagus nerve stimulator, Crystal started her extensive therapy in June 2025. By September 2025, she experienced across-the-board improvement and felt increased independence as a result. Her daily tasks—folding clothes, taking out the trash, driving, cooking, and cleaning—became much easier.

“I don’t like to vacuum,” Crystal says. “But I like that I can do it.”

She could lift her right arm higher than before. Her fingers gained dexterity, making her grip stronger. She could walk with a cup of water without spilling it, wash her hands efficiently, and cook with her air fryer. 

She could even jump rope, something she used to enjoy with her children but feared she would never be able to try again. This opens up the possibility that vagus nerve stimulation could one day be approved for the rehabilitation of walking and perhaps even speech.

“I can do things so much easier,” she says. “It’s been good, good, good.”

Crystal hopes to spread the word about vagus nerve stimulation to fellow stroke survivors.

“You can do it,” Crystal says. “I did it. And you can do it, too. Don’t give up.”

To find out if you or a loved one could be a candidate for this treatment, make an appointment with a WashU Medicine stroke specialist at Barnes-Jewish Hospital by calling 314-362-7382.