Post-Vivistim Therapy at Shirley Ryan AbilityLab at Silver Cross Gives Frankfort Woman Hope for Stroke Recovery

Nearly eight years ago, Cheryl Smithgall and her husband, Scott, were walking their dog Marco. 

“I became confused, lost my balance, and I just collapsed,” said Smithgall, now 54, of Frankfort. “My husband is an ER physician; he recognized what was happening and called 911.” 

She was brought to Silver Cross Hospital in New Lenox, where she underwent emergent removal of a large clot that caused her stroke. 

Despite being left with apraxia, aphasia and partial paralysis, with one functional hand Smithgall is still able to drive, clean house, walk the dog, cook and bake. However, she misses playing piano with two hands, waving while driving and putting her hair up. 

Even though she had a variety of therapies since her stroke, Smithgall’s right arm wasn’t responding. Then, she heard about Vivistim® Paired VNS™ Vagus Nerve Stimulation (VNS) Therapy. Shirley Ryan AbilityLab at Silver Cross has offered post-implant occupational therapy on an outpatient basis for the past two years.  

How Vivistim Works

Vagus nerve stimulation has been used for years to treat patients with seizures, depression and other neurological disorders. In August 2021, the FDA approved Vivistim – an implantable vagus nerve stimulator that is paired with occupational therapy – to help bring stroke patients’ hand and arm function to the next level. 

If a patient qualifies for Vivistim, a doctor implants a device under the left side of the chest in an outpatient procedure. The device delivers a gentle pulse to the vagus nerve while the patient performs a specific task such as putting on a hat, brushing hair or cutting food. 

This simultaneous pairing of rehab exercise with vagus nerve stimulation provides a boost to the brain that helps strengthen and create new neural pathways, improving upper limb function and increasing the relevance of occupational therapy. 

Smithgall learned she qualified for the procedure after completing a pre-evaluation with one of the occupational therapists. The implant was performed at a participating facility in early December. 

About a month later, she had her first post-implant occupational therapy evaluation at the Shirley Ryan AbilityLab at Silver Cross.

“Cheryl didn’t have much function of her right arm and hand,” said Deborah Jacob-Maas, an occupational therapist at the AbilityLab who has worked with Smithgall for 18 sessions. 

“It was very difficult for her to do anything with her right arm. As a result, I had to help her unlearn her dependence on her left arm, as well as her tendency to lean over, rather than use her arm to reach for something.” 

Working Together

For each 90-minute session three times a week, Jacob-Maas would activate the Vivistim device using a computer while Smithgall attempted to do different tasks, all the while working on rebuilding the connection between her brain and the nerves in her arm and fingers. 

“I would have her try to unscrew a cap from Chapstick, which of course was very difficult. Every 3 to 5 seconds, I would activate the Vivistim to retrain those nerves. 

“Cheryl is such a great patient. She has such wonderful focus when we’re doing the exercises. And very importantly, she follows through at home with the exercises, using a magnet to activate the Vivistim. She even brought in a video from home to show me!” 

Smithgall said she started noticing improvement weekly after those intense therapy sessions. 

While she still has difficulty opening her right hand at times, Smithgall said the therapy has improved the uncoordinated movements in her arm. 

“I have improved with picking up objects with my affected arm and moving them from one place to another,” Smithgall said. 

While some patients may get discouraged with slow progress, Jacob-Maas said Smithgall has been realistic about what she needs to do and her outcomes. 

“It’s natural for people to get discouraged, or maybe give up on the therapy, especially at home. They also need to know it’s likely they’re not going to get back to where they were before the stroke. But Cheryl does not give up. She’s very flexible and is up for any challenges we’ve had for her.” 

Smithgall has great things to say about Jacob-Maas as well. 

“Debbie is always upbeat and has a lot of great ideas that I use daily. She asks if I have any questions and looks at my whole body, not just my affected arm. She is an amazing therapist.” 

More Work to Do

As her 18 therapy sessions wound down, Smithgall knows the hard work isn’t over, especially if she wants to build on the progress she’s made. 

“I’m still hopeful that there will be improvement over time. We are still increasing the strength of the device, and I continue to work hard for results.” 

That will include multiple self-activated daily therapy exercises using the Vivistim magnet at home, and home training with an exercise physiologist, supplemented by Occupational Therapy at Silver Cross. 

She’ll also be getting care from Dr. Ross Coolidge, who specializes in Physical Medicine and Rehabilitation for Shirley Ryan AbilityLab at Silver Cross. 

“I like the team approach…between him and Debbie, that will help me improve even more.” 

To learn more about Vivistim Therapy at Silver Cross Hospital, visit silvercross.org