If you have been reading about the autonomic nervous system — perhaps because you live with a spinal cord injury, or you work with people who do — you will almost certainly have encountered the idea of "autonomic balance." The image is seductive: sympathetic on one side, parasympathetic on the other, and health is achieved when the two sit neatly level, like a set of scales in equilibrium.

It is a useful teaching shorthand. It is also, as modern physiology has demonstrated over the past three decades, an oversimplification that can actually mislead both clinicians and patients.

The fundamental question is this: does the autonomic nervous system ever truly achieve "balance" — and if not, what should we be aiming for instead? The answer has direct implications for how we think about autonomic dysfunction after spinal cord injury and for emerging interventions such as transcutaneous vagus nerve stimulation (tVNS) that aim to improve autonomic regulation.

This article focuses partly on a specific device: the tVNS® system, manufactured by tVNS Technologies GmbH in Germany. This is not a wellness gadget or an unregulated consumer product. The tVNS device is approved as a Class IIa medical device under the EU Medical Device Regulation (EU-MDR) with CE marking—currently the only non-invasive VNS device with this level of EU-MDR approval. It is registered for four specific clinical indications: epilepsy, depression, chronic migraines, and Prader-Willi syndrome. Anatomical Concepts (UK) is delighted to distribute and support the tVNS® system in the UK.

Why does this matter for rehabilitation? Because the same mechanisms that make vagus nerve stimulation effective for these approved conditions—neuroplasticity enhancement and anti-inflammatory action—are precisely the mechanisms that show promise for neurological rehabilitation. The ongoing research into stroke recovery, spinal cord injury, multiple sclerosis, and other conditions builds on a foundation of established science and regulatory-grade engineering.

In the world of neurorehabilitation, two approaches have emerged as prominent tools for helping patients regain mobility and function: Functional Electrical Stimulation (FES) Cycling and Passive Movement Training (PMT). While both have their place in rehabilitation settings, understanding their distinct benefits and limitations is crucial for healthcare professionals and patients alike. PMT, utilising motorized bikes like the Thera or MOTOmed, has long been a staple in hospitals and homes due to its ease of use and accessibility. However, the integration of electrical stimulation in FES Cycling has opened new doors in rehabilitation, particularly for those with spinal cord injuries, stroke, cerebral palsy, and multiple sclerosis. With over three decades of research backing its efficacy, FES Cycling represents a significant advancement in rehabilitation technology – but what makes it truly different from traditional PMT, and why should clinicians and patients take notice? Let's delve into the science behind these approaches and explore their comparative benefits for patient outcomes.

Recovery and progress often seem daunting, especially when facing significant physical challenges or lifestyle changes. Whether you're an injured patient working through rehabilitation or someone who has fallen out of healthy habits, the gap between where you are and where you want to be can feel overwhelming. This article explores why taking that first small step - no matter how modest it may seem - is the most crucial part of any journey toward recovery or positive change. Drawing from both clinical experience with rehabilitation patients and personal insights about motivation, we'll examine how the compound effect of small, consistent actions can lead to remarkable transformations, even when the path ahead appears insurmountable.

At Anatomical Concepts, we look to other fields for insight and inspiration that we can bring to rehabilitation. For example, elite athletes like our rehabiliation clients will set training goals, undergo rigorous physical training and adhere to strict plans to achieve peak performance. This article explores the potential benefits of applying the principles of elite athlete training to help individuals recover from neurological conditions.

In the intricate world of rehabilitation, the challenges posed by human complexity exceed those found in high-performance systems like Formula 1 cars. This article explores the multifaceted nature of rehabilitation, emphasising the importance of systems thinking in addressing individual variability and interconnected factors that impact recovery. As we delve into how each person's unique biological and psychological makeup influences their path to recovery, we will uncover the critical need for tailored treatment approaches. By recognising the interrelationships among various components—be it physiological, psychological, or social—healthcare providers can optimise rehabilitation strategies and enhance patients' recovery outcomes.