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Why is Paired Vagus Nerve Stimulation Effective for Stroke Recovery ?Throughout her esteemed career as a board-certified neurological physical therapy specialist, lecturer and researcher, Kay Wing, PT, DPT, NCS, has always been interested in new technology that has the potential to benefit stroke survivors in her practice, SWAN Rehab (Phoenix, Arizona). When she learned about the Vivistim Paired VNS System, Wing was eager to enroll stroke survivors in the clinical trial based on the research supporting vagus nerve stimulation for ischemic stroke recovery. The results are clear; stroke survivors who participate in paired vagus nerve stimulation in conjunction with their physical therapy improve their hand and arm mobility two to three times more than those who had physical therapy alone. In this post, Wing explains how the FDA-approved Vivistim System works and why its a gamechanger for stroke recovery.By Kay Wing, PT, DPT, NCSWhat is the Vivistim Paired VNS System?The FDA-approved Vivistim Paired VNS System is a vagus nerve stimulation device that stroke rehabilitation therapists pair with rehabilitation exercises to help improve outcomes (or gains) for stroke survivors even years after theyve had a stroke, potentially generating two to three times more hand and arm function for ischemic stroke survivors than therapy alone.The small pacemaker-like device is placed just under the skin in the upper left chest area during an outpatient procedure. Soon after, the stroke survivor will begin physical or occupational therapy. The therapist will have the stroke survivor repeatedly perform specific rehabilitation exercises designed around each persons specific needs and goals to help them improve their function. During these exercises, the therapist will be sending signals to the persons Vivistim device to send a pulse through the vagus nerve to the brain that helps tell the brain what to relearn.This highly repetitious pairing of vagus nerve stimulation with stroke rehabilitation helps to increase what is known as neuroplasticity , the process of engaging other undamaged parts of the brain to take over the work that had previously been done by the parts of the brain damaged in the stroke.Surviving an Ischemic StrokeAbout 60% of stroke survivors experience persistent upper limb issues for 6 months or more. This fact has both inspired and challenged me personally and professionally. My grandfather survived a stroke when I was in high school but never fully recovered. The feeling that more couldve been done for my grandfather to regain function has guided me throughout my career specializing in neurological physical therapy. The passion that inspired me to open my private practice clinic, Southwest Advanced Neurological Rehabilitation (SWAN Rehab), 25 years ago has consistently been reinvigorated throughout my career as technology evolves and new medical devices are developed that make stroke rehabilitation more effective.My goal is to help stroke survivors experience a better quality of life, especially as it helps them regain the ability to do activities of daily life, such as brushing their teeth, getting dressed, cooking or enjoying a meal. Beyond that, I know its equally as important for stroke survivors to get back to the hobbies that are important to them.Like Joe, who came to SWAN Rehab through Vivistim and really wanted to be able to play his guitar again, restore his antique cars, swing a hammer, squeeze a screw gun and pull a tape measure for his construction projects.Kay performing Joes first assessment.Getting Back to Doing What You LoveThe Vivistim Paired VNS System enabled our SWAN Rehab team to help make these gains, that were so important to Joe, a reality. In traditional physical therapy, we concentrate on improving motor function in the hand and arm with repetitive tasks, such as reaching, buttoning, flipping, stacking, grasping and releasing. With Paired VNS Therapy, however, we incorporate these tasks as we signal the Vivistim device to send an electrical pulse through the vagus nerve to the brain.We repeat these specific repetitive movements over and over again. This repetition is continued with a home exercise program to help achieve the large number of repetitions required to help induce neuroplasticity and relearn how to move. The Vivistim Systems repetitive simultaneous pairing of hand and arm therapy with vagus nerve stimulation is a gamechanger in helping stroke survivors get better results faster because it directly stimulates the brain.Ive seen it firsthand in my clinic. Stroke survivors engaging in traditional therapy see incremental improvement in their hand and arm function over several months. For comparison, stroke survivors who do traditional therapy in conjunction with vagus nerve stimulation get greater improvement in their affected hands and arms within just six weeks.To help Joe get back to doing the things that are important to him, we dedicated some sessions to practice picking up, grasping and using a guitar pick while his therapist signaled the vagus nerve stimulation device with each hand and arm motion. We also had him practice picking up, grasping and swinging a hammer.As a car enthusiast, Joe didnt immediately recognize the correlation between practicing opening jars or cleaning the windows in our clinic as we signaled the Vivistim device during activities that he wanted to get back to, but when he was able to get in his garage and open the gas caps on his car or wash and polish the cars, he was excited about how the benefits of Paired VNS therapy related to his personal goals.Joe will tell you, though, its not an overnight change and doesnt just happen with a couple of hours of in-clinic therapy a few days a week. The Vivistim System also requires stroke survivors to engage in stroke therapy at home, using a magnet that activates the VNS device for 30 minutes at a time while theyre cooking, washing dishes, folding laundry, playing with their children, getting dressed, or any other daily activity.Video PlFirst Success, Then ProgressFirst Success, Then ProgressIts always been my philosophy that therapy has to be challenging to keep stroke survivors motivated. I like the Vivistim Paired VNS System because it fosters this philosophy by helping stroke survivors first achieve success by completing tasks in therapy and then continuing to make progress toward their functional goals with the at-home therapy. With Vivistim, stroke survivors are actively engaged, challenged and motivated throughout the recovery process.Paired VNS Therapy is such a breakthrough medical technology for stroke rehabilitation because it helps stroke survivors improve their hand and arm function two to three times more than traditional stroke rehabilitation alone. Of the hundreds of medical devices and innovative therapy techniques Ive implemented in my practice, nothing else has been clinically proven to help stroke survivors achieve this level of improvement in such a short timeframe and in the chronic phase of stroke.If youre a stroke survivor who wants to improve your level of hand and arm mobility even if its been some time since you had your stroke, I hope my experience, Joes improvements as well as those of other stroke survivors encourage you to take the Vivistim survey to see if Paired VNS Therapy is right for you.About Kay Wing PT, DPT, NCSKay Wing, PT, DPT, NCS, is the founder of Southwest Advanced Neurological Rehabilitation (SWAN Rehab) and an adjunct professor at Northern Arizona University and A.T. Still University. As a board-certified specialist in neurological physical therapy, Dr. Wing is passionate about working with clients recovering from strokes, traumatic brain injuries and other neurological diseases. Keen on innovation and advancing whats possible in neurological physical therapy, Dr. Wing has authored several peer-reviewed journal articles and led numerous clinical trials. As such, shes won prestigious awards throughout her 40-year-career, leading her peers to regard her as an esteemed physical therapist.

Theres a quote about the importance of setting goals that says, If you dont know where youre going, any path will take you there. You probably have dreams about retirement, vacations, hobbies and more. But if you dont have a strategy with financial goals in place, you may not make the choices that can best set you on the path to achieve those dreams. Setting goals helps define and showcase your purpose, passions and priorities. And establishing your own strong financial goals can help you earn and enjoy a wide variety of short- and long-term achievements throughout your life. When you reach your financial goals, you can feel a sense of accomplishment in seeing your efforts literally pay off. But how do you get started?            Prioritize your needs and wants. Think about the things that are most important to you and then outline them as financial must-haves and wish-list targets. Start with the big-ticket items and work through to ideas that may not cost as much. A must-have for many people is having enough to live comfortably through retirement. Being able to afford the college of your child's choice, without incurring mounds of debt, is another. Your wish list, on the other hand, may include things like saving for vacations, hobbies or entertainment expenses. Create detailed short- and long-term goals within your financial strategy. Its important to be specific about the goals you want to achieve and how much youll need to achieve them. One way to do this is by making your goals measurable. Assign estimated dates and costs to each goal so you can plan how much to save and how much time you have before you need the money. For example, for your retirement goal, be specific about how many years before you want to retire. And once you do, how you plan to spend your time perhaps traveling the world, turning your hobby into a business or taking your grandkids on outings. These can have vastly different price tags.Be willing to compromise. Reaching one, or more, of your goals may mean compromising. If your must-have is building your dream home but it's not looking quite affordable, you may need to make a trade-off build it a bit smaller, work a year or two longer or trade in some of your wish-list goals so you can stay focused on your must-haves. Hold yourself accountable to stay on track. Once your strategy is in place, its not a set-and-forget exercise. Actively tracking your progress and managing your decisions and actions can help you be better positioned to reach your goals. Use time-tested principles for making financial decisions, not predictions. Diversify, own quality investments and keep a realistic perspective, especially for your long-term goals. Maintain your focus and dont let your emotions control your investment decisions. It can be helpful to meet with a financial advisor at least annually to review your full financial strategy, address any changes in your life or your goals, and discuss your progress and new ideas.As you achieve certain milestones, celebrate them. You may even want to refresh your outlook with new goals. Take pride in your ability to strategize and accomplish a personal financial goal for yourself by following the path you envisioned and created. Chad Choate III, AAMS 828 3rd Avenue West Bradenton, FL 34205 941-462-2445 chad.chaote@edwardjones.comThis article was written by Edward Jones for use by your local Edward Jones Financial Advisor. Edward Jones, Member SIPC 

Will Federal Medicaid Changes Affect Colorados Long-Term Care Medicaid? Heres the Answer President Trumps One Big Beautiful Bill (OBBBA) certainly includes far-reaching revisions to Medicaidcuts to provider taxes, new work requirements, tighter eligibility checks, and billions in savings over a decade. But Colorados long-term care Medicaidcovering nursing homes, home health, and other LTSS (long-term services and supports)has unique state safeguards that ensure it remains insulated from these changes. 1. Federal Cuts Mostly Affect Expansion and Non-Elderly AdultsThe OBBBAs primary targets are Medicaid expansion, non-disabled adults, and children, via work requirements and cost-sharing policies. These reforms are expected to phase in during 20272028. In contrast, long-term care beneficiariestypically seniors and people with disabilitiesfall under separate eligibility categories that the bill doesnt restructure. 2. States Can Shield Long-Term Care FundingColorado funds long-term care services through its Medicaid waiver system. The OBBBA reduces providers taxes and places new caps on expansion enrollment, but it does not limit waivers for nursing homes or home- and community-based services. Even without adjusting, Colorado can preserve funding by prioritizing these essential services over general expansion. 3. Colorados Bipartisan Commitment to Aging ServicesColorado has a long-standing commitment to supporting seniors and people with disabilities. In recent years, the state has steadily increased its share of state funds to match or exceed federal contributions, especially for the elderly population. With broad political consensus, any state-level attempt to curtail waivers would be unlikely. 4. Historical Stability Through Waiver ProtectionsSince implementing the Home- and Community-Based Services (HCBS) Medicaid waiver in 2004, Colorado has used it to support aging in place and reduce institutional costs. These waivers have remained stable across administrations and funding changes. Theres no indication that Trump-era reforms would dismantle this proven framework. 5. National Context Supports StabilitySources like KFF confirm that while OBBBA cuts the Medicaid expansion rate from 90% to 80%, and imposes red tape on enrollment, it does not overhaul LTSS (long-term services and supports). Even health-policy experts acknowledge the targeted nature of the reformfocused on non-elderly groups, not those needing long-term care. Bottom Line for Coloradans Trumps Medicaid changes will significantly affect parts of the system serving non-disabled adults, especially in expansion states. But Colorados long-term care Medicaiddriven by federal waivers, state obligations, and a bipartisan mandatestands apart. Residents access to nursing home care, home-based services, and support for people with disabilities is not at risk.