The Get Healthy Tampa Bay Podcast

E116: Stroke Recovery with Vivistim Featuring Rachel Pienta, OTR & Han Nguyen, DPT

• Kerry Reller

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Welcome back to the Get Healthy Tampa Bay Podcast! This week, Dr. Kerry Reller sits down with Rachel Pienta, OTR, and Dr. Han Nguyen, DPT, to talk all things stroke recovery, neuroplasticity, and an exciting new device called Vivistim.

In this episode, we break down what actually happens during a stroke, how it affects upper limb function, and what recovery really looks like—from hospital care to rehab and beyond. Dr. Nguyen explains the phases of stroke rehab and why early, intensive therapy matters, while Rachel introduces us to Vivistim, an FDA-approved vagus nerve stimulation device helping stroke survivors regain hand and arm function—even years after their stroke.

We discuss how Vivistim works, what makes someone a good candidate, and how therapy paired with vagus nerve stimulation boosts the brain’s ability to rewire itself. You’ll hear real patient stories, get a better understanding of neuroplasticity, and learn why it’s never too late to pursue recovery.

Whether you're a stroke survivor, a caregiver, or just curious about breakthroughs in neurorehab, this episode is packed with hope, science, and actionable insights. Tune in and discover how innovation is changing the game in stroke recovery.

Han Nguyen ("Hon Win") is a Doctor of Physical Therapy and a Board-Certified Specialist in Neurologic Physical Therapy. Han started her career in intensive rehab at Largo West Hospital seeing patients after acute neurological injuries. During this time, Han recognized that there was a big gap in the community between intensive rehab in the hospital and outpatient rehab once patients get discharged. Han left her full time job in 2023 and started Neubility Rehabilitation and Wellness. Neubility Rehab is a specialized physical therapy and occupational therapy practice that focus on motivated individuals with neurological injuries and disorders, such as stroke, Parkinson's, brain and spinal cord injuries, multiple sclerosis, balance and vertigo/dizziness . Neubility Rehab is located in Pinellas Park and they've been proudly serving the Pinellas county community for the last 2 years.

Rachel Pienta is an Occupational Therapist and a Certified Stroke Rehabilitation Specialist with experience across diverse healthcare settings, including Inpatient Rehabilitation, Acute Care Hospitals, Skilled Nursing Facilities, and Home Health Care.  Throughout her career, she has worked with individuals at various stages of recovery following stroke and other medical conditions.  Recently, she transitioned to the role of Therapy Development Specialist at Vivistim, where she provides education and support to stroke survivors, therapists, and other healthcare providers. Vivistim is the first FDA-approved paired vagus nerve stimulation device specifically designed to improve hand and arm function in chronic stroke survivors.


00:28 - Meet Rachel Pienta & Han Nguyen
02:29 - What is a Stroke?
04:19 - Stroke Symptoms and FAST Acronym
05:04 - How Strokes Affect the Brain
06:33 - Acute Stroke Treatment and Rehab Phases
09:53 - Common Stroke Recovery Challenges
10:57 - What is Spasticity?
12:11 - Why Dr. Han Started Her Practice
15:45 - What is Vivistim and How It Works
22:39 - Clinical Results and Patient Success Stories

Neubility Rehabilitation and Wellness
Address: 9079 Belcher Road N, Pinellas Park FL 33782 
Phone: 727-616-0809 
Website: www.neubilityrehab.com
Instagram: www.instagram.com/neubilityrehab

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Kerry:

Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have two very special guests, Rachel Pienta and Han Nguyen. Welcome to the podcast. I hope I said your name right?

Rachel:

Yes, yes. Thank you.

Kerry:

Okay, very good. Well, I see Rachel on the top of my screen, so why don't you tell us a little bit about who you are and what you do, and then we'll ask the same question.

Rachel:

Okay. So my name's Rachel. I'm from Palm Harbor area originally. I'm an ot. I've been an occupational therapist for about, I think this is eight years now. And I've worked in a variety of settings. So inpatient rehab, acute care, home health, skilled nursing facilities, things like that. But most recently in June, I transitioned where I work with a company called Vivistim Now. So I work as a therapy development specialist and I help support patients, therapists, healthcare providers, and finding more information about this device.

Kerry:

Awesome. And that's definitely something that we're going to focus on today. And how about Han, how about you?

Han:

Yeah, my name is Han Nguyen and I am a doctor of physical therapy. I am also a board certified stroke neurologic specialist. So I see people. With a wide variety of neurological conditions and injuries. I started an inpatient rehab hospital, so I was a therapist at Largo Medical Center. And in 2023, I started my own practice. And we are an outpatient neurologic rehab and we provide physical therapy and occupational therapy for people with neurological conditions.

Kerry:

And where, where is your practice located?

Han:

We are in Pinellas Park.

Kerry:

Pinellas Park. Okay. Yeah, I love that everybody is so local here. This is obviously the whole point of my Get Healthy Tampa Bay podcast. Okay. So I figured we start with some basics since we're gonna talk about stroke and recovery and everything like that. So, Han, can you go ahead and explain what a stroke is and what are the most common types of strokes?

Han:

So a stroke occurs when the blood flow in the brain is interrupted and it can happen in an ischemic stroke which is the most common type. And 87 to 90% of strokes are ischemic stroke. And this is caused by any kind of blood blockage. So like narrowing of the blood vessel blocking of the blood vessel so that the brain is not receiving any kind of blood or nutrients. And that's damaged and kill the brain cells. And then the other 10% of strokes is hemorrhagic stroke and that caused by bleeding of the brain. So that can be because of a rupture blood vessel. And that cause an increase in pressure in the brain. Then there's another type of stroke that I feel like is not mentioned very often. A TIA or a transient ischemic attack. So it's a temporary blockage of the vessel but usually it resolve on its own so people don't see a whole lot of deficit afterward. But it serves as a warning for any type of future strokes.

Kerry:

Yeah, I'm really glad you brought up the TIA. I mean, I always have patients who are, you know, kind of questioning whether they had it or not. You ended up presenting to the hospital and they don't, can't find anything. There's no answer. So sometimes they say, oh, okay, well you had a TIA let's give you the best medical therapy to help, you know, prevent a further con like stroke or anything that happened. But sometimes everybody's really confused about that because nothing shows up on a CT or an MRI. Right. And even yesterday I had a patient who was wondering if she was having some had a, had a TIA and you know, basically, she was wondering if the vision changes were an issue. So what are some other typical signs and symptoms of a stroke that people should recognize quickly?

Han:

Yeah, so in the. Medical field. We use the acronym FAST to help identify the stroke symptoms. So f stand for face, so any kind of drooping of the phase. A stand for arms, so any type of arm weakness. Usually on one side. And S stands for speech, so any type of speech difficulty, and then T stand for time, so it's time to call 9 1 1 since a stroke is a medical emergency.

Kerry:

Yes, absolutely. I love, you know, the acronyms. I think it really helps. Patients and providers really figure out how to best see things sometimes. So that's really helpful to use those. So you kind of already mentioned this, but like what happens in the brain during a stroke, especially with the upper limb function?

Han:

Yeah. So it's really depending on where the stroke occur in the brain. Right? So the most common things that we see is weakness or hemiparesis. And paralysis or hemiplegia. And it usually occur in one side. But that's not the same for, for everyone'cause it's really just depending where the stroke occurs. And then in the upper extremity, usually we see weakness, we see any type of motor planning issues coordination, fine motor skills. And then we also see increase in muscle tone or spasticity. So this really making the limb stiff. And then it makes the rehab process and any kind of recovery makes it a lot harder.

Kerry:

I always find it interesting. The brain is so complex, right? And having like a picture of it is this would be like much better, right? So you can see like where in the brain the incident happened and then what kind of vessels blocked and then what part of the brain affected it. And I think, this is where we would like to have a nice diagram, but that's okay. We don't have that today. But, okay, so you, you mentioned, you know, the different conditions that can happen with like upper extremity weakness, spasticity and things like that. So how do, well, real quick, before we go to, you know, the, where you guys play a great role, which is in recovery from a stroke, what typically should, you mentioned calling 9 1 1, but what happens acutely for a treatment of a stroke?

Han:

Yeah. So I think of it as there are three phases. So in the Q phase someone would get into the hospital as quickly as possible. And it's really depending on how severe the stroke is. But early mobilization is highly recommended so that we can get people up and moving as soon as possible. And this also help prevent any complications that can happen that comes with bed rest also. And then in the subacute phase. So after a few days in the hospital and everything stabilized we always recommend people to going into intensive inpatient rehab. I always want to stress the difference between inpatient rehab. And then a skilled nursing rehab. A lot of the time people are recommended to go to rehab but they don't understand that there are two different settings. So in an intensive inpatient rehab, which is where I used to work, the patient receive 90 minutes of therapy per day, and pretty much every day. So at least six days a week. So that's really helped with the recovery'cause we know that we'll talk about this later, but intensity and repetitions is huge when it come to ma making any kind of brain changes and recovery after any type of neurological conditions or injuries. And then you have skilled nursing rehab, which the patient's still getting PT, OT in speech. But the repetition and the intensity is not as high. So. So that can be maybe 45 minutes to an hour a few days a week. But the intensive rehab is highly recommended usually in, especially in inpatient rehab setting, the average length of. Stay is 14 to 20 days. So after that, the patient will be discharged home with a recommendation for home health or outpatient therapy. So with home health they are receiving nursing care also on top of therapy. So then that's a good transition between inpatient and outpatient. Making sure that patients are safe in the home and that they can do your basic transfer, like getting in and out of bed and then getting into the car so that they can be transported to their medical appointments and outpatient setting. And then in the outpatient setting, which is what our clinic Is they receive therapy depending on the severity and the recovery somewhere up to like three or four times a week. And for our clinic, we see everyone one-on-one for an hour.

Kerry:

Mm-hmm. Okay. So real quick, circling back to the acute thing, like, so one, what do they say? Time is brain or something like that. I forget what the, what they say about it, but like when you, you're thinking that someone might have had a stroke, you're calling 9 1 1 and part of the thing is to get them in quickly because they may be able to administer, you know, the TPI to if there is a clot or anything to get that out. So I just wanted to mention that as well because you know, like you mentioned. I think you said that time is very critical in this case too. So definitely different options, which I don't think I'm aware of, of the recovery journey after having, you know, a stroke. So what are some of the typical challenges that stroke survivors face during recovery?

Han:

So I would say the fine motor and as spasticity are probably the most difficulty that we've seen. Because the weakness, a lot of the time you can do exercises to improve the weakness, but we see most of the recovery proximal to distal. So proximal meaning like closer to the trunk. So you'll see like shoulder improvement elbow improvement, but then a lot of the time the hands are the, the last to recover. And then with that you see a lot more difficulty with fine motor activities. And then on top of that spasticity really makes everything much harder. And there are different medical intervention that we recommend for patients for spasticity.'cause from a therapy standpoint, we can recommend a stretching a stretching program, but that will need a lot more medical intervention if the spasticity is very severe.

Kerry:

What exactly is spasticity in case you know somebody doesn't actually know?

Han:

it is an increase in muscle tone. So we all have muscle tones. That's what help us move regularly and normally. But. An abnormal increase in muscle tone can cause stiffness, stiffness, and rigid movements. So usually the the arm will get into a certain position, so the elbow will flex to the face and then the finger will occur into a fist. And that's the most common pattern that we see with the increase in muscle tone in the upper extremity.

Kerry:

Obviously these things make it very difficult to, you know, function and do your daily activities of living. Right. So that's the whole point is to get them back to where they were if possible. Anything else that you wanna touch on, on kind of the basics before we jump into kind of why you started your thing and how Vivas STEM has also been help is helpful.

Han:

I don't think so. I think that was a pretty good basic review of stroke and any type of deficit that we see post-stroke.

Kerry:

Okay, so you, you noticed this like gap in care with the inpatient, outpatient things, things I, you know, obviously am not aware about as well. How did that lead you to starting your practice?

Han:

Yeah. So when I was a PT in inpatient rehab, a neuro has always been my passion. Even in PT school. My granddad had a stroke when I was in high school and he did not receive any type of rehab at all, so he was pretty much bed bound, wheelchair bound for the rest of his life. And he was also aphasic, so we couldn't even communicate with him. So I had always wanted to be a neuro therapist. Started in inpatient rehab because that's where you. See the, the, the majority of acute injuries. So it was very rewarding'cause you get to see how fast people recover after a stroke, a brain injury, a spinal cord injury. But when I was trying to discharge my patient home, I wouldn't know where to send them. Because there are a lot of PT practice out there that are general practice. So it's great for any type of orthopedics issue. So like knee pain, back pain and things like that. But treating someone post neurological injuries can be so different. It's not just looking at the issues and fixing the issues. A lot of the time we looked at everyone from a big picture standpoint a lot more holistic. Stick a lot more total body versus you know, looking at the knee issues, any type of issues related to that one spot of pain. We need to be able to be a lot more creative with our interventions. A lot of the time out patients don't move as well. So having the equipment to be able to get people up and moving in a safe manner is really helpful. So I didn't really know where to send my patient to after I discharged them from the hospital. And especially after they leave home health also. So I know that there was a gap in the community to be able to provide quality neurological rehab. So I started my practice in 2023.

Kerry:

I mean, definitely an acute need. So I think that's an amazing thing that you've done there. So that's great. Do you, so well, one. How did you guys meet and how did you partner? And briefly what is the difference between occupational therapy and physical therapy? Because you're both taking this approach on stroke recovery, but how does, I just, I'm kind of curious what you would say, how they differ to everybody.

Han:

So I connected with Terry who is now the regional manager, right Rachel? So I can't really remember how I connected with Terry. I think she just reached out one day and say, Hey, there's a new technology that you guys should know about, and this was right when I started my practice. This was like probably April of 2023. And at this time I was still mobile, so I was going to people houses for therapy. So we met in Tampa and she showed me like the presentation and the device. I can't remember if at this time they were still going through FDA approved or if it just got FDA approved.

Rachel:

August, 2021, we got our FDA approval, but we were just getting established with like hospital systems in the area at the time that she met with you.

Han:

Yeah. Yep. So in 2020, end of 2023 was when I hired my first occupational therapist. So we got reconnected again. And then for this past year together, we've been trying to grow the Vivy STEM program in Pinellas County.

Kerry:

So why don't we tell everybody what Vivistim is and what the heck does it do, and let's just start with that.

Rachel:

Okay. So what vivastim is, like we said, it's FDA approved, it was FDA approved as of August, 2021. It's for patients in the chronic ischemic stroke phase who have slowed in their progress in improving their arm and hand function. And so the way it works is a patient gets a vagus nerve stimulation device implanted, which this device has actually been around for about 25 years for epilepsy and depression. So the procedure itself stimulating the vagus nerve itself is not a new technology. But what makes Vivistim innovative is the after. So it's the pairing of the vagus nerve stimulation with either occupational therapy or physical therapist can also do this protocol. It's just with an upper extremity focus. So it's pairing the vagus nerve stimulation with a patient doing functional tasks. So if a patient wants to work on handwriting, they'll get vagus nerve stimulation from a therapist providing stimulation at the exact movement that they wanna make stronger while the patient is handwriting. And the way it works is it's kind of building a bridge around. So when you get the vagus nerve stimulation, your brain is firing during active movement. Those active movement after the stroke. The cord, the connections aren't as strong as they once were. So vagus nerve stimulation allows those connections to become much stronger and make new connections at a faster rate than they would typically do with neuroplasticity. Because after a stroke, what Han's doing in her clinic, even before Viti, is neuroplasticity with patients. And it works like therapy works with patients, but it eventually kind of slows down. So Vivistiim is just allowing it to happen at a faster rate.

Kerry:

So why the vagus nerve?

Rachel:

They found the vagus nerve has the attention system of brain. It's the rest digest. It does so many different things, but with the left vagus nerve especially it has 80% afferent to the brain. So the right vagus nerve has more cardiac functioning, but the left vagus nerve, when you stimulate it, because there's so many impulses that go to the brain, when you stimulate that vagus nerve, it releases neurotransmitters. And those neurotransmitters are now released during the functional task that the neurons are firing.

Kerry:

Yeah. I mean I definitely don't remember all the details of it, but I definitely remember rest and digest. Right. It does that, and then I know when I do a lot of, like with obesity medicine, we're talking about the, you know, the body, the gut is talking to your brain too, so. I remember that, but I don't remember all the details of how, how you guys are describing it now. So the, yeah, the vagus nerve is probably the most popular nerve in the body. And you've, they found effective ways to stimulate it, to make this recovery faster. That's pretty cool. So how do you use it, I guess, with the, during the therapy and at home? And just tell me more.

Rachel:

So there's two components. So when a patient gets the device implanted it's nothing without the therapy. So if the patient just has the device in, they're not gonna see the changes that they're looking for. It has to be with therapy. So the protocol. For the beginning stage is six weeks. It's three times a week for 90 minutes. During that time, a patient's in an outpatient clinic where the therapist has a computer system where they have a clicker. So just kind of like a little ring clicker that the therapist, or just a clicker that the therapist has. Where each time the patient, so if I'm working on brushing my hair, each time I'm moving my arm to brush my hair, the therapist is providing a stimulation at each individual joint movement that they wanna see stronger, that they want the connection to happen. So it's very paired, very specific, and that's one of the benefits of having the occupational physical therapist as they're analyzing the movement pattern that the patient has, so they can guide the patient through up movements and provide stimulation at the exact time. That they want to see stronger. And then the other benefit of viti is a patient gets home homework a little bit, so they can do up to four hours a day. So typically it's 30 minute sessions up to eight times. So four hours a day where they swipe, they have a little magnet that they get and they swipe that magnet over the device. Whenever they swipe in a magnet on it turns it on for 30 minutes. So they're just getting kind of a cyclical stimulation. They do that when they're doing things like getting dressed, taking a shower, laundry, or we kind of talked about handwriting. If someone wants to work on their garden again, anything, anytime they're functionally using that arm and those nerves in the brain are firing to make that arm move, they're turning their device on to give it an extra boost to make any movement stronger and more coordinated. But one of the nice things is that you don't have to have the device on for those changes to be there afterwards because it's making lasting permanent changes in the brain. If after six weeks you have this new ability to write your name, you don't have to have the device stimulating in order for the name to be written. Now. It's a change that is yours to keep as long as you keep working on it.

Kerry:

Interesting. So how does the implanting of the device work.

Rachel:

So it's an outpatient procedure. It's about 45 to 90 minutes. We have different surgeons in the area who, because like I said, it's been around for epilepsy and depression, most of these surgeons that are doing it have done it for years for epilepsy and depression. So the procedure that they do is something they've done many of times. But it's under general anesthesia. There's two incisions, one in the neck. Like I said, it's always on the left vagus nerve'cause that's the one that sends more impulses to the brain. And then the, the battery or what turns the device on goes in the chest. So similar placement to a pacemaker. It'll go in the left chest wall. If someone does have a pacemaker or loop recorder, they can still qualify for vivistim. The battery just goes on the right side of the chest wall Still on the left vagus nerve. So the procedure itself, most patients go home same day and then they wait about two weeks because there is typically like bruising, soreness, swelling around the incision site just like there is with any procedure before starting their therapy. Because the therapy's so intensive, we wanna make sure that their rest and recovered and get the most out of their six weeks of therapy.

Kerry:

So when stimulating the left vagus nerve, is there any I guess is there any side effects?

Rachel:

So with the stimulation so epilepsy is actually at a higher setting than it is for us. So our setting, it goes a lot lower than what it is for epilepsy. And so most people don't feel it. If they do feel it, it feels like a tickle in their throat. Like they need to clear their throat or sometimes they need to cough when it stimulates it. But the actual stimulation itself, because it's such a low setting. It doesn't typically have any other side effects.

Kerry:

That's interesting you mentioned the cough and the tickle because you know, we have a lot of patients on our allergy side with like chronic cough and things like that, and some of the therapies are to reduce that response from the the vagus nerve. Yeah, it's really

Rachel:

Yeah. The vagus nerve just does so many things. It's, it's working all the time.

Kerry:

I know, I feel like I need to go read up more on everything so I can remember it all, but that, that's pretty cool. Okay, so can you share some like clinical results or research highlights on how Vivistim is effective in improving basically hand and arm function after stroke.

Rachel:

Yeah. So what led to our FDA approval was actually a study that was published in The Lancet in April of 2021. So the study was a very clean study, so it was triple blinded and that the patient, the therapist, and the assessor did not know which group they were in. So actually all patients got the device implanted. Kind of, we talked about like, that feels like a tickle in your throat, but most people don't feel it when it's on. So you can't tell if you're in the control group or if you're in the vagus nerve stimulation group. It was also a clean study in the fact that it was very narrow. So right now our FDA approval is just for ischemic strokes'cause that's what we included in our study. So as ischemic strokes, it was nine months to 10 years post-stroke. And what they did was in therapy, they did a six week therapy protocol where the control group and the vagus nerve stimulation group did the exact same six exercises. So this way they knew these are the exercises each person did. And these are the results that we saw based on this exercise. And they found the vagus nerve stimulation group to make a two to three times improvement compared to rehab alone. So it's not two to three times compared to their baseline, but it's two to three times compared to the exact same rehab protocol. And then they actually did a crossover. So the control group, because they had the device implanted after the initial study, they crossed over and went back into the rehab protocol again. So they did the six weeks of in clinic, the 90 days of the home protocol, and they made similar progress that the initial vagus nerve group did. So one of those things, as you can kind of show is it's not just that the people that were in the vagus nerve stimulation group responded better to therapy because the control group, once their device got turned on, they made similar improvements of the vagus nerve group. And some other things that are important to note is we did a subgroup analysis. So gender, age but most right left side of the brain because a lot of people ask, oh, is left vagus nerve? Does it matter which side of the brain? But no, because it's releasing it on both sides of the brain. It doesn't matter if which side was affected by the stroke. But one of the big things was that. There's no statistical significance in whether the stroke was nine months or 10 years in their ability to respond to vivistim, which I think is something that's so important to these patients because for so long they're told you're gonna make progress in that acute stage. And then eventually you're just gonna slow down. You might regress, you might make progress because your brain is constantly trying to change, but it's just not happening at a faster rate. So it's allowing people that are in that 10 years now, we've had someone whose stroke was a little over 40 years ago and she made great progress with Biva stem. So it's one of those things that it's giving mm-hmm Giving people really good hope that just because their stroke was so long ago and this new technology is out here, they can still make a change with it.

Kerry:

It's pretty amazing. I think everything that we've been learning about neuroplasticity, that this is just like something that's speeding it up. It's, it's pretty cool. Nine months to 10 years, that's a really long time. So how you can't do it in a sooner setting or is that I don't

Rachel:

so commercially now we can do six months. So the FDA approved us'cause they considered six months or longer as an isch. As a chronic stroke is six months. So, commercially we can do six months, but we don't typically wanna do it in that acute stage because like we said, patients are still making progress on their own in the first couple months. And you don't want someone to go through a procedure medically'cause they just went through a big medical event as well as they're still making progress on their own. So you wanna get them to as much as they can organically with therapy before having to look at these other options.

Kerry:

Those are really, really good points. Yeah. Why go through the procedure if you're already still, you know, making progress? Yeah. So, Han, what kind of patients are ideal candidates that you see in your practice for Vivistim?

Han:

I think the biggest thing for us is people who are motivated, right? Because they're getting so much therapy. And then on top of that, they would have to do home exercise program at home also. So we tend to see that people who are motivated tend to get better result, but that's not just with Vivistim, that's just with any type of rehab in general.'cause the, you know, your, the, you get the result of what your, your effort that you put in. And then during the screening and Rachel can probably talk more about this we are also looking for a certain score on an outcome measure that we use called the fugl meyer. So they have to be able to have some function of the finger, and I think like finger extension is one of the, the bigger factor. Is that right Rachel?

Rachel:

Yes. That usually is what kind of limits someone for qualify from qualifying for Vivistem is there has to be a little bit of finger movement because figure, say if your hand's fully in a flexed fist when you're providing stimulation to the vagus nerve, it doesn't have a neuron to open the hand to connect to, to make stronger. So it has to have something to build off of. So that's what's so important about going to the therapy site first, is the therapist evaluates them, determines whether or not they have enough movement. Shoulder elbow is important, but really that finger, at least one finger and one thumb to be able to open some is what kind of keeps people from being able to qualify. But what we do,

Kerry:

not just pushing the button, but to actually make progress.

Rachel:

Yes. Yeah, just to have something to build off of it. So it shows that the connection is still present to build off of. When I'm on the phone with a patient, I usually ask them, can you put your arm on a table? Can you pick up a Kleenex and release? It doesn't have to be pretty, doesn't have to be coordinated. Doesn't have to be all the fingers, but do you have that slight open and close of the hand to be able to do that?

Han:

And if spasticity or increasing in muscle tone. Is a factor, then we would recommend them seeing a physiatrist or a neurologist to take a look at that and see if Botox is an option for any type of spasticity treatment. Sometime if we can just loosen the muscle tone and they can do some prehab before vivistim screening again just to get some more extension. And then they can later on be qualified for Vivi sim.

Kerry:

So otherwise spasticity wouldn't like, I mean, you mentioned being able to open the hands, so that would disqualify them for the time being.

Han:

if they don't have that finger or thumb extension that we

Kerry:

Okay. What? So any like success, success stories or patient feedback that you've had either one of you.

Rachel:

So especially we have what's nice thing too is so when a patient's interested in vitti, we put them in contact with a patient ambassador. So it's someone who's been through Vitti. So one of our patient ambassadors, she really wanted to write letters to her grandkids. So I. One of the tasks that she would work on in therapy or swiping the magnet is writing. So in the beginning we have kind of a photo, I believe it's on our website as well, where the writing initially was on a unlined paper, kind of large. You could see it says the name, but it's not very clear. And then at that was at the two week mark. At the five week mark, she was writing her name on two lines and that at the eight week mark, she was writing her name very clearly on one lined paper. So I think that's a big one that we kind of show and then patients are making different gains that you wouldn't think as goals.'cause it's one of the things you don't notice as a challenge of, I've had a lot of patients whose goal was to be able to turn their light switch on and off. Something that you don't even realize is a challenge until you're in the outpatient setting where you see these patients who've had difficulties with things for years. So like that, or being able to tie their shoes again. Like when I go to a therapy session and they come in and they show me their new shoes with the laces where they've had to wear, they haven't worn shoes with laces in the two years since they've had a stroke. I think those are the victories that mean the most to people. Not I've increased my shoulder flexion by 30 degrees. It's, I can now tie my shoes again. I can now write letters to my grandkids. Stuff like that.

Kerry:

That's amazing.

Han:

And we just discharged our first Vivi stem patient I think last week. So he's on the maintenance route now. So we still see him for occupational therapy, but it's at a reduced frequency. And one of his goal was to be able to use power tools, so. During his, one of his sessions, we have a patient garden at our clinic, so he put together our raised bed so that like other people can put dirts in and we put more plants in in the front of the clinic. so that was fun to see.

Kerry:

That's pretty cool. Definitely some, you know, giving back too. That's, I really like that story. This is, this, I mean, amazing. I know you, it's pretty new, like 2021 is new and then I know you said it has been used for your, this vagal nerve simulation has been used for a while. And then you're just bringing that into your practice too, so obviously a lot of room to grow, but where can people learn more about it or how would they know if their doctor is aware of it, and how would that all work?

Rachel:

Yeah, so on our website there's few different options. So there's a find a provider, so if someone's interested and wants to see if it's in their area, they can put in their zip code and then it'll show them all the therapy sites as well as implanting sites in their area. They can also put their information on the website and then we will contact them to give them more information. And then I'm not sure if, like in the bio we can put my information, but our emails are pretty easy. Mines rachel@microtransponder.com, so R A-C-H-E-L at. M-I-C-R-O-T-R-A-N-S-P-O-N-D-E r.com where they can contact me directly and if they're in my area, I'm the one that's helping guide them through the therapy site, the surgery, consult insurance questions and stuff like that.'cause that's one thing that I hear a lot after a stroke is when people discharge home, they just don't know what's next. There's so much going on in the hospital and then. Especially during Covid. I've had patients who didn't'cause all stroke support, groups were closed, outpatients were closed, and they just kind of felt lost and disconnected. So that's one thing that we really work hard on. We have a nurse education team that provides full education on Viti. We guide them through helping them get the referrals, what questions to ask when they go to their doctor. If their doctor wants to learn more information, we go and do inservices there too, so that the doctor feels comfortable with writing the script and things like that. So we're just kind of helping as a full system help improve that quality of care for patients after a stroke. I.

Kerry:

Okay. Do you guys partner with like neurologists? Are they the typical people that are seeing the stroke patients long term or in the primary, or what would you say?

Rachel:

I would say neurologists and physiatrists or PM and r doctors. Physical medicine and rehab doctors are the ones that see the patients the most long term. They definitely follow up with their primary care doctor, but the primary care doctor has to see so many different things at once to treat whereas the neurologist and the physical medicine doctor they're really focusing on the stroke, the deficits, the spasticity, things like that. So we do a lot of inservices there, but we also do them at primary care doctors at stroke coordinator, stroke support groups, things like that.

Kerry:

Well, do you guys have anything else to add about the amazing, you know, Vivistim and your practice?

Han:

We're having. So we're starting to do Vivstim screen at our practice. So it's going to be the second Wednesday of every month. So the first one is going to be April 9th. So all people have to do is to either send an email to us, so it's info@nobilityrehab.com or give us a call at(727) 616-0809. And then we'll be able to book them for an hour of Vivistim screening. So the occupational therapist will go through the OT evaluation and then they will meet with Rachel after to go over the education part of what Vivistim is and what to expect

Kerry:

Is it covered by insurance

Han:

depending on which type of insurance.

Kerry:

Yeah.

Han:

For the occupational therapy evaluation. So our practice takes Medicare. So anyone with Medicare that will be cover up to 80%. And then any type of Medicare advantage or commercial plans with out of network benefits.

Kerry:

But does the actual implant of the device and all of that, is that usually covered by insurance

Rachel:

So we actually have a Medicare pass through currently, and so what that means is Medicare gets to certain new technologies a year where they want people to have access to it. Well, they're still writing the policies and things like that, so Medicare actually automatically approves vivistim currently if the patient qualifies for it. And then if it's a Medicare advantage or commercial insurance, they go through a prior authorization and then our team helps with appeals or things like that. Being a newer technology, we do typically have to go through that, but that's all done on the front end before the patient actually gets the procedure to make sure that insurance is gonna approve it.

Kerry:

Awesome. Well this has been, you know, a wonderful conversation and if you guys don't have anything else to add, I think we'll close it there'cause I we'll put all that information in the show notes. Is there anything else you'd like to add?

Rachel:

I think one thing is for someone after a stroke, especially whose stroke was years ago, is to kind of keep working'cause there's no expiration on neuroplasticity. Your brain is constantly trying to change. I. And there's constantly new technologies out there. So vivistim is a great new technology, but there's other ones that might be a better fit for you if you have a different type of stroke or a different level of movement that you might not qualify for Vivistim. I think it's just important to keep trying to improve, keep trying to improve your daily function, your independence. This way you can kind of get the most out of what you enjoy doing.

Kerry:

I think that's definitely important things to never, you know, don't give up. Right? There's definitely something that too can prove upon every day, even little by little. Anything else Han.

Han:

I don't think so. I think it's a really. Exciting technology and as a therapist, I feel like we're always a little bit skeptic about like new technology out there, but I think Vivistim really embody like what we are looking for when it comes to making any type of new brain changes. Like we talk a lot about neuroplasticity, but it's really. Like a process that is normal in our brain, right? It happens every single day. It's not just after a neurological condition that it happens, like if you learn a new skill. So I've been really into sourdough baking lately, so I'm embracing the neuroplasticity that's happening in my brain right now when learning that new skill. But it happens every day. And really the, the things that really help with making any kind of brain changes is intensity, repetition, use it or lose it, use it, and improve it. So I think and salient things that matters to people. So that's why Visium works so well, is because we're doing tasks that is functional and meaningful and targeting patient goals. So I think using those principles, people can still make gains even if they're not a, a vivistim candidate. And it's go for any type of recovery post stroke and not just when it comes to upper extremity recovery Also.

Kerry:

I mean, I really like what you said. I think, you know, I often use this also with like habit change for patients, you know, when they are, you know, driven to one thing, but you can still teach yourself a different way. So neuroplasticity is a very exciting topic, I think these days. Well, thank you guys so much for being on the podcast. Please everybody tune in next week's for next week's episode and please don't forget to subscribe, like reviews, all that kind of stuff. All right.

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Dr. Kerry Reller

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