US stroke guideline takes up implanted vagus nerve stimulation

The American Heart Association and the American Stroke Association published the 2026 Guideline for Adult Stroke Rehabilitation and Recovery in Stroke on 27 August 2026, replacing the 2016 edition. The writing group was chaired by Lorie Gage Richards of the University of Utah, and its headline instructions are about timing and staffing: rehabilitation should start as soon as a patient is medically stable, ideally within 48 hours, delivered by a team covering physical, cognitive, communication and emotional needs.

Mobia Medical — formerly MicroTransponder — announced the next day that the guideline also names vagus nerve stimulation paired with high-dose task-specific training, saying the text reads that paired VNS “may be considered to improve upper-limb function and impairment for eligible patients”. The company’s Vivistim system is the FDA-approved implant that delivers that pairing. That wording could not be checked here: the guideline sits behind a subscription wall, and neither the AHA’s own announcement nor the trade coverage of it mentions VNS at all, so the recommendation’s class and level of evidence remain unread.

What is independently on the record is thinner than the announcement suggests. A Cochrane review published 13 March 2026 pooled 10 studies and 547 participants and found the evidence for VNS added to rehabilitation “very uncertain” on upper-extremity motor function and quality of life in the short term, while noting little to no added risk of serious harm.