First in Carolinas: MUSC Health treats stroke patient with vagus nerve stimulation

June 13, 2023
A man wearing a long sleeved red shirt and glasses sits across a table from a woman wearing a white striped sweater. He has a device attached to his right hand. She has a computer screen in front of her.
Occupational therapist Alanna Herman watches as stroke survivor Billy Orbach tries to use his hand to grasp and release items during his therapy session at MUSC Health Neurologic Rehabilitation Institute. Photo by Sarah Pack

Billy Orbach, a former president of a steel parts company, is still hard at work. It’s just that his focus is narrower these days. Orbach, the first person in the Carolinas to receive a Vivistim implant to stimulate his vagus nerve to help him recover from a stroke, wants his right hand to work properly again.

“I used to golf three times a week, and I have a goal of getting back to that,” he said.

There’s no question about his determination. When Orbach woke up one morning in 2019 feeling like he couldn’t keep his balance, he didn’t let it stop him, his wife Carolyn said. He was in their home in Warren, Ohio, while she was in Ravenel, South Carolina, supervising construction of the home to which they planned to retire.

“What did he do? He took a shower, drove to work, went to a meeting. His secretary kept saying, ‘Billy, something's wrong. Something's wrong.’ And so at about 10 o'clock, he sat down and was eating an apple, and she just came in there and said, ‘You're going to the hospital.’ A coworker drove him to the hospital, and when they got there, he went to the bathroom and collapsed, clocked out. And that was it,” she said. 

Closeup of a man's hands. His right hand is wearing a black glove. His left, ungloved, is holding a wooden block up to the right hand. 
The fingers of Orbach's right hand tend to curve inward since his stroke. He's using vagus nerve stimulation to try to get a better range of motion – and maybe, one day soon, hold a golf club again. Photo by Sarah Pack

Her husband had suffered a stroke on the left side of his brain that affected his right arm and leg. Four years later, some of the effects linger. But that hasn’t kept the Orbachs from enjoying life. They now live in Ravenel with their kids and four grandchildren nearby. 

Since their arrival, Billy has been a patient at MUSC Health as he works to regain some of what the stroke cost him. That’s where he connected with neurosurgeon Nathan C. Rowland, M.D., Ph.D., and the rehab team that deemed Orbach the top candidate for receiving the first vagus nerve stimulation device for a stroke patient in the Carolinas.

So what is the vagus nerve? “It’s one of 12 cranial nerves,” Rowland said.

Four men wearing blue scrubs smile while standing together. 
Dr. Nathan Rowland, second from right, and from left: Deron Allen, Rob Hadley and Lionel Dacpano of Vivistim. Photo provided

“In antiquity, the vagus was known as the wandering nerve because it travels all the way from the brainstem down to other internal organs. When the brain needs to send messages to the heart and the gut, for instance, it uses the vagus nerve to do so. However, if you artificially stimulate the vagus nerve itself, you can have beneficial effects the other way around, that is, on the brain. That is what this form of vagus nerve stimulation is attempting to do.”

Orbach was eager to give it a try. “They put the coil in and wrapped the nerve six times,” he said, pointing to his neck. An incision mark showed where Rowland and his team inserted the electrode that connects to a battery-operated square shaped device under the skin of his chest. 

After the surgery with Rowland, Billy began working with a team of occupational therapists at the MUSC Health Neurologic Rehabilitation Institute. They have special training to operate the device. 

Illustration of a man. It highlights his brain. The words motor cortex are beside his head. A closeup on the right side shows the vagus nerve and the spiral cuff lead. Illustration also shows the lead and a battery operated device in his chest. 
Illustration of the vagas nerve stimulation system for chronic stroke patients. Image courtesy of Vivistim

During a recent morning appointment, Alanna Herman, one of Billy’s occupational therapists, worked with him on grasp and release using a stroke therapy glove, as well as electrical stimulation to his forearm, to allow for greater movement. As Orbach worked on straightening his fingers, Herman stimulated his vagus nerve to drive neuroplasticity, the ability of the brain to promote neural recovery. 

Each time the device is activated, it stimulates the patient’s brain to create new pathways, bypassing the damaged stroke area. Herman said by using this combination of techniques, early data has shown modest improvements in the functional scales and assessments that occupational therapists use to measure performance in chronic stroke patients undergoing rehabilitation. 

“The glove helps to keep his fingers extended so he can do more of the repetitive movements. We're trying to isolate his ability to grasp and release,” Herman said. “We are excited to see how beneficial Vivistim becomes as we use it as a supplemental tool to the evidence-based principles of neurorehabilitation performed as part of an occupational therapy plan.”

For additional practice, Orbach does exercises at home, activating the device himself. 

Man wearing a red shirt and glasses raises his gloved right hand. A woman sits across from with a computer screen in front her and wires connecting the man's glove with a monitoring system. 
Orbach tries to pick up and release a golf ball during a vagus nerve stimulation session. His 2019 stroke has had lingering effects. Photo by Sarah Pack

This new option to help stroke survivors is huge, Rowland said. “Over 800,000 strokes occur every year in this country, and at any one time, there are about 6.5 million survivors with what is considered chronic stroke, or people who survive six or more months after the initial stroke. And, unfortunately, the chronic period is when rehabilitation experts believe the brain is less prone to experience improvements.”

That’s why he was happy to be able to offer vagus nerve stimulation to Orbach. 

Nathan Rowland Neurosurgery 
Dr. Nathan Rowland

The neurosurgeon, who is also an associate professor at the Medical University of South Carolina, said the new technology is a good fit for MUSC Health, which has been recognized by The Joint Commission and the American Heart Association/American Stroke Association as a Comprehensive Stroke Center.

That means it can treat patients with the most complex strokes, including offering advanced imaging capabilities, 24/7 availability of specialized treatments and staff with the training and competencies to provide the most advanced level of stroke care achievable.

MUSC Health also offers the latest stroke rehabilitation options, such as the vagus nerve implant. “Most patients have never heard of this until we mention it as an option. They've been told by other physicians or care providers that there's nothing else that can be done. The team at MUSC wants to make sure they understand that, yes, there is hope,” Rowland said.

His team asks stroke patients who show potential for vagus nerve stimulation about medications they’re on, how long it’s been since they had a stroke and what kind of therapies they’ve had. The team also looks at hand and leg function. The implant is covered by insurance in South Carolina.

Orbach encouraged other stroke patients to do everything they can to get better. He’s thrilled to have the vagus nerve implant. “I feel blessed that I was given the first opportunity. It’s pretty amazing. Anything to help me get better.”

Rowland has high hopes for him. “I have no doubt whatsoever he’ll be able to swing a golf club again. And, when he does, we will be first in the crowd to cheer him on."

The Centers for Disease Control and Prevention recommends calling 911 immediately at the first signs of a stroke, which include a sudden loss of balance, sudden numbness or weakness, sudden confusion, sudden trouble seeing and severe headache, as early treatment can minimize long-term effects.

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