Rose colored world here; not seeing reality!
The New Science of Moving Again After a Stroke
Key takeaways
Stevie Dickens was 48 years old and living in Vernon Hills, Illinois, when he woke up one September morning in 2003 and couldn’t get off the couch. The night before, while watching football with friends, his speech had begun to slur and he had felt off balance, but didn’t understand that these were warning signs of a stroke. The next morning, he realized he was paralyzed on his right side. A friend’s son had to help him to the floor.What followed was a yearslong journey through hospitals and rehabilitation centers in which Dickens, a veteran of the Army and the Marine Corps, applied the same mental discipline he had learned in the military to the grinding repetitions of physical therapy. He started in a wheelchair. He graduated to a cane. He eventually discarded the ankle-foot brace strapped around his calf that had helped him walk, after his leg grew strong enough to manage without it. Seeking to push further, he found his way into research.
For nearly two decades Dickens has been a regular participant in motor recovery studies at the Shirley Ryan AbilityLab in Chicago. He’s enrolled in walking and arm studies, robotics trials and exoskeleton experiments. “He came in when I came here about 19 years ago,” says Arun Jayaraman, scientific chair for technology and innovation at the Shirley Ryan AbilityLab. He calls Dickens' experience “a classic clinical scenario.” He was “super impaired when he came in.”
Today, at 71, Dickens walks with a cane. He cooks, mows the lawn and goes to stores. “I understand I ain’t gonna get 100 percent back,” he says. “But I’m gonna get at least 90 percent.”
Intense, repetitive practice
Dickens is a living demonstration of how far the field has come. When he had his stroke, most of what is now available to stroke survivors didn’t exist.
The transformation has been driven largely by more sophisticated understanding of how the injured brain recovers and by technologies that enable clinicians and researchers to apply that understanding in precise new ways.
When a stroke damages the neural circuits that govern movement, the signals that once flowed from brain to muscle at full strength through thousands of fibers are suddenly diminished, rerouted and degraded. The goal of modern rehab is to amplify whatever signal remains — stimulating the nervous system along the injured pathway or pushing the brain to find alternative routes. At the same time, coupling that stimulation to the intense, repetitive, task-specific practice that drives the reforming of brain networks.
In one recent study, Dickens wore a robotic device called an exoskeleton. It’s a powered frame that fits over the limbs and torso and moves the wearer’s body through programmed or guided motions. In stroke rehab, exoskeletons are used to move paralyzed or weakened limbs through repetitive walking and movement patterns to exploit the brain’s neuroplasticity and help rebuild motor pathways. In the study, published earlier this year in Science Robotics, researchers from the Shirley Ryan AbilityLab and Northwestern University introduced what they call therapist-exoskeleton-patient interaction. A therapist and a stroke survivor each wear a lower-limb exoskeleton, the two systems virtually linked at the hips and knees, so that the therapist can guide the patient’s walking through their own leg movements.
The approach produced greater joint range of motion and increased step length and height compared to conventional therapy, while requiring less physical effort from the therapist.
“By combining the hands-on adaptability of physical therapy with the scalability and precision of robotic systems,” says Lorenzo Vianello, a postdoctoral researcher at the Shirley Ryan AbilityLab who coauthored the study, “it can enable more comprehensive whole-body gait training without requiring multiple therapists, while also introducing real-time responsiveness to patient performance.” For patients, that translates to a workout that adjusts to them stride by stride.
Stimulating the vagus nerve
For upper limb recovery — restoring function to a paralyzed arm or hand — one of the most significant developments in recent years has been the Vivistim Paired VNS System, which received U.S. Food and Drug Administration approval in 2021 and became commercially available in 2022. The device, about the size of a small pacemaker, is implanted in the upper chest; a connected lead is implanted against the vagus nerve on the left side of the neck.
During rehab sessions, electrical stimulation pulses through the nerve each time the patient performs a prescribed arm movement. The stimulation triggers the release of brain chemicals that promote synaptic plasticity — essentially telling the brain to pay particular attention to whatever it is doing at that moment and to strengthen the connections within the networks of brain cells involved in performing the task.
In the pivotal clinical trial, published in The Lancet in 2021, patients receiving vagus stimulation during rehab showed two to three times more improvement in upper limb function than those receiving rehabilitation alone; long-term follow-up data published in 2025 found that 66 percent of patients achieved sustained, clinically meaningful improvements at a one-year check.
The pace of development across the field is striking. Jayaraman describes a suite of wearable sensors now being deployed at the Shirley Ryan AbilityLab that can assess a stroke patient’s walking ability in minutes and generate, at the time of admission, a prediction of their likely recovery trajectory for up to a year.
Lightweight robotic exoskeletons can be worn to the grocery store. Shoes with variable-friction soles — which glide when a wearer can’t lift their foot and grip when they put weight on the shoe — were studied by Shirley Ryan AbilityLab researchers and are now sold commercially. They can potentially correct functional balance and stability issues caused by foot drop, dramatically reducing fall risk.
