Understanding stroke and neurological rehabilitation
Stroke is one of the leading causes of adult disability in the UK. When a stroke damages part of the brain, it can affect movement, sensation, speech, and many other functions. Recovery depends on the brain's ability to reorganise itself, a process called neuroplasticity, where healthy areas of the brain gradually take on functions that were lost.
Spinal cord injury presents a different but related challenge. When the spinal cord is damaged, the communication pathways between the brain and body are disrupted. Even in incomplete injuries, where some connections remain intact, the surviving pathways are often too weak to produce functional movement on their own.
Conventional rehabilitation, including physiotherapy and occupational therapy, remains the cornerstone of recovery for both conditions. But there is growing recognition that we need additional tools to enhance the brain and spinal cord's natural capacity for repair. This is where neuromodulation is beginning to make a real difference.
How neuromodulation helps
Two forms of non-invasive neuromodulation are showing promise in neurological rehabilitation: transcutaneous vagus nerve stimulation (tVNS) and transcutaneous spinal cord stimulation (tSCS).
tVNS in stroke rehabilitation works by pairing vagus nerve stimulation with task-specific rehabilitation exercises. When you practise a movement while the vagus nerve is being stimulated, the electrical signals promote the release of neurochemicals that enhance neuroplasticity. In simple terms, it helps the brain learn and rewire more effectively during rehabilitation sessions. The stimulation is delivered through a small clip-style electrode on the outer ear, and you might feel a mild tingling sensation.
tSCS in spinal cord injury takes a different approach. Surface electrodes placed on the skin of the back or neck deliver electrical stimulation to the spinal cord. This activates spinal nerve networks below the level of injury, effectively boosting the signals that travel through surviving connections. For people with incomplete spinal cord injuries, where some pathways remain intact, this can help translate weak residual signals into functional movement.
Both approaches are non-invasive alternatives to surgical implants that have shown benefit in clinical research.
The evidence
The evidence for neuromodulation in neurological rehabilitation is developing rapidly, and several large studies have produced encouraging results. It is important to note that much of this evidence is emerging, which is why this page carries an "Emerging Evidence" label. We believe in being transparent about where the science stands.
tVNS in stroke rehabilitation
The VNS-REHAB trial studied chronic stroke survivors who were at least 6 months post-stroke. Those receiving vagus nerve stimulation paired with rehabilitation showed 9.5-point improvements on the Fugl-Meyer Assessment (a standard measure of motor recovery) compared to 3.8 points with rehabilitation alone. Response rates were striking: 88% of participants in the VNS group achieved a clinically meaningful improvement of 6 or more points, compared to 33% in the control group.
A meta-analysis of 18 randomised controlled trials involving 954 stroke patients found significant benefits in both motor recovery and independence in daily living activities. In 2021, the FDA approved implanted VNS for stroke rehabilitation, marking a significant milestone for the field.
The TRICEPS trial, a two million pound study across 15 UK stroke centres, is currently testing transcutaneous VNS for stroke rehabilitation. Results are expected in July 2026 and will provide important data on whether the non-invasive approach can achieve similar outcomes to implanted devices.
A 2025 study published in Nature demonstrated that closed-loop VNS in chronic incomplete cervical spinal cord injury produced approximately double the functional improvements compared to sham stimulation.
tSCS in spinal cord injury
The Up-LIFT trial showed that 72% of participants achieved clinically meaningful improvement in upper limb function with transcutaneous spinal cord stimulation. This is a notable result for a non-invasive approach that does not require surgery.
tSCS offers a practical alternative to epidural spinal cord stimulation, which requires a surgical procedure to place electrodes directly on the spinal cord. While epidural stimulation has produced remarkable results in some cases, the surgical nature of the approach limits who can access it. tSCS opens the possibility of spinal cord neuromodulation to a much wider group of people.
What treatment looks like
Neuromodulation for neurological rehabilitation is typically delivered as part of a structured rehabilitation programme, not as a standalone treatment.
For tVNS in stroke rehabilitation, stimulation is paired with task-specific exercises during therapy sessions. This means you practise the movements you want to recover while the device is active, allowing the stimulation to enhance the learning process. Sessions are guided by a clinician, and the specific exercises are tailored to your rehabilitation goals.
For tSCS in spinal cord injury, electrodes are placed on the skin over the relevant area of the spinal cord. Stimulation parameters are carefully set by your clinician and may be adjusted as your rehabilitation progresses. The aim is to activate spinal networks that support voluntary movement during functional training.
In both cases, the technology works in partnership with active rehabilitation. The neuromodulation enhances what the therapy achieves; it does not replace the need for rehabilitation itself.
Is this right for me?
Whether neuromodulation is appropriate for your rehabilitation depends on your individual circumstances, the nature and timing of your injury, and your rehabilitation goals. That assessment needs to be made with a qualified clinician.
tVNS paired with rehabilitation may be worth considering if you are a stroke survivor with ongoing upper limb difficulties, particularly if you are beyond the initial acute recovery phase and looking for approaches to enhance your rehabilitation outcomes.
tSCS may be relevant if you have an incomplete spinal cord injury and are working to improve upper limb function, particularly if you have some residual ability that could be enhanced with spinal cord neuromodulation.
It is important to be honest about the current state of the evidence. While the results from clinical trials are genuinely encouraging, many of these studies used implanted rather than transcutaneous devices, and the transcutaneous evidence is still building. The TRICEPS trial results, expected in July 2026, will be an important step in understanding what transcutaneous VNS can achieve in stroke rehabilitation.
Not everyone is suitable for neuromodulation. There are contraindications that your clinician will check for, and a thorough clinical assessment is always the first step.
Next steps
If you would like to find out whether neuromodulation could be part of your rehabilitation, we are here to help. Contact us to arrange a clinical assessment where we can discuss your situation, your goals, and the options that may be available to you. We will be straightforward about what the current evidence supports and what is still emerging.