Magee Rehabilitation Hospital

Abstract Purpose of Review This review synthesizes recent developments in vagus nerve stimulation (VNS) for stroke rehabilitation from 2021–2025, emphasizing the transition from experimental approaches to clinical implementation following FDA approval of implantable VNS. Recent Findings The 2021 FDA approval of the Vivistim Paired VNS System marked a watershed moment in stroke neuromodulation, providing the first regulatory-approved VNS therapy for upper extremity motor recovery. Long-term follow-up studies demonstrate sustained benefits at one year, with 66% of patients achieving clinically meaningful improvements. Concurrently, investigational transcutaneous approaches continue to evolve, though they remain limited by protocol heterogeneity and anatomical specificity concerns. Summary Implantable VNS paired with rehabilitation represents a paradigm shift in stroke care, offering evidence-based neuromodulation therapy for patients with chronic upper limb impairment. While transcutaneous approaches show promise in research settings, their clinical translation requires standardization and larger controlled trials. Current evidence strongly supports implantable VNS as a viable therapeutic option for carefully selected patients, while highlighting the importance of distinguishing proven treatments from investigational approaches in clinical practice.

Abstract Purpose of Review Post-traumatic stress disorder (PTSD) and anxiety commonly occur after traumatic brain injury (TBI), and this may be due in part to a unique neurophysiologic mechanism involving the autonomic nervous system (ANS). This paper will review the relationship between TBI induced ANS dysfunction and neuropsychiatric outcomes, commonly used measurements of ANS dysfunction, and the efficacy of ANS focused treatments to alleviate symptoms of PTSD and anxiety. Recent Findings TBI induced elevations in sympathetic activity can be measured through heart rate variability and may contribute to anxiety disorders, including PTSD. Biofeedback, sleep restoration, and yoga have been found to reduce sympathetic activity and effectively treat PTSD and anxiety in individuals with TBI. There is minimal current research supporting the use of vagal nerve stimulation. Summary Managing post-TBI PTSD and anxiety by actively decreasing sympathetic output is a promising treatment modality.

This case report of a veteran with a history of multiple traumatic brain injuries, posttraumatic stress, and chronic pain highlights the MossRehab Institute for Brain Health (MRIBH) model of care: a collaborative, interdisciplinary, intensive outpatient treatment program. Unique to this case was the severity of symptomatology and the concerted engagement by the clinicians, who fully tailored and adjusted their approaches based on team rounds and daily exchanges. The client's main concerns of headaches, difficulty sleeping, difficulty with memory and cognition, depression, anxiety, posttraumatic stress, anger, and chronic musculoskeletal pain were addressed and significantly improved within three weeks. The outcome of this case is promising and suggests that the highly individualized and collaborative interdisciplinary approach provided at MRIBH is particularly beneficial for veterans with chronic TBI and PTSD and can provide a roadmap for the treatment of specific clinical scenarios.

Purpose of ReviewThe purpose of this review is to provide an update regarding recent research and recommendations in the care of mild traumatic brain injury (mTBI).Recent FindingsNew diagnostic criteria for mTBI have recently been developed by the American Congress of Rehabilitation Medicine through the Delphi method and this will help to standardize assessment, diagnosis, and treatment.SummarySymptoms of mTBI are diverse and can sometimes become persistent. Treatment of mTBI should be patient-centered and may require subspeciality referral and coordinated, inter-disciplinary, or multi-disciplinary treatment.

Purpose of reviewTraumatic Brain Injury (TBI) is a complex condition, with outcomes ranging from profound disability to remarkable recovery. Considerable variability in outcomes is observed, even among those with similar injury mechanisms, severity and neuropathological pattern. This indicates a need to explore resilience factors influencing TBI recovery.Recent findingsThis narrative review synthesizes existing literature, focusing on individual, social, and community factors impacting resilience post-TBI. Recent research highlights how individual factors such as personality traits, coping strategies, and premorbid psychiatric history, as well as social and contextual factors, like social support and social determinants of health (SDoH) all impact TBI recovery. We also discuss clinical applications of resilience-focused interventions to promote health and wellbeing after TBI.SummaryAn improved understanding of resilience factors and pathways to recovery post-TBI is crucial for optimizing outcomes. Future research should focus on developing comprehensive interventions addressing individual, social, and community-level factors to foster resilience and enhance TBI recovery.