Closed-loop vagus nerve stimulation aids recovery from spinal cord injury

Michael P. Kilgard (), Joseph D. Epperson, Emmanuel A. Adehunoluwa, Chad Swank, Amy L. Porter, David T. Pruitt, Holle L. Gallaway, Christi Stevens, Jaime Gillespie, Dannae Arnold, Mark B. Powers, Rita G. Hamilton, Richard C. Naftalis, Michael L. Foreman, Jane G. Wigginton, Seth A. Hays and Robert L. Rennaker
Additional contact information
Michael P. Kilgard: The University of Texas at Dallas
Joseph D. Epperson: The University of Texas at Dallas
Emmanuel A. Adehunoluwa: The University of Texas at Dallas
Chad Swank: Baylor Scott and White Research Institute
Amy L. Porter: The University of Texas at Dallas
David T. Pruitt: The University of Texas at Dallas
Holle L. Gallaway: The University of Texas at Dallas
Christi Stevens: Baylor Scott and White Institute for Rehabilitation
Jaime Gillespie: Baylor Scott and White Research Institute
Dannae Arnold: Baylor Scott and White Research Institute
Mark B. Powers: Baylor Scott and White Research Institute
Rita G. Hamilton: Baylor Scott and White Institute for Rehabilitation
Richard C. Naftalis: Baylor University of Medical Center
Michael L. Foreman: Baylor University of Medical Center
Jane G. Wigginton: The University of Texas at Dallas
Seth A. Hays: The University of Texas at Dallas
Robert L. Rennaker: The University of Texas at Dallas

Nature, 2025, vol. 643, issue 8073, 1030-1036

Abstract: Abstract Decades of research have demonstrated that recovery from serious neurological injury will require synergistic therapeutic approaches. Rewiring spared neural circuits after injury is a long-standing goal of neurorehabilitation1,2. We hypothesized that combining intensive, progressive, task-focused training with real-time closed-loop vagus nerve stimulation (CLV) to enhance synaptic plasticity3 could increase strength, expand range of motion and improve hand function in people with chronic, incomplete cervical spinal cord injury. Here we report the results from a prospective, double-blinded, sham-controlled, randomized study combining gamified physical therapy using force and motion sensors to deliver sham or active CLV (ClinicalTrials.gov identifier NCT04288245). After 12 weeks of therapy composed of a miniaturized implant selectively activating the vagus nerve on successful movements, 19 people exhibited a significant beneficial effect on arm and hand strength and the ability to perform activities of daily living. CLV represents a promising therapeutic avenue for people with chronic, incomplete cervical spinal cord injury.

Date: 2025
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DOI: 10.1038/s41586-025-09028-5

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