Abstract Body: INTRODUCTION: Upper extremity motor impairment and hemiparesis are prevalent following stroke, and can impact independence, ability to perform activities of daily living and overall quality of life.1 While the majority of motor recovery post stroke occurs within the initial 3 months, gains can continue through chronic stages.2 Evidence has identified vagus nerve stimulation (VNS) paired with intensive rehabilitation as an effective intervention for improving upper extremity (UE) function in persons with chronic stroke.3 Utilization of gaming-based stroke rehabilitation has been shown to increase engagement and improve UE motor function.4–6 This work reports on a cohort of patients with chronic stroke who participated in gamified UE rehabilitation paired with VNS. METHODS: Data from 6 patients with UE motor impairment due to chronic stroke (> 1 year) were included. Following surgical vagus nerve stimulator implantation, patients participated in UE therapy sessions 3 times a week for 6 weeks. Intervention included gamified rehabilitation with VNS triggered upon each movement attempt. Between sessions, patients were provided with a magnet to activate VNS while performing an UE home activity program up to 8 times per day. Each self-initiated stimulator activation delivered 30 minutes of VNS. At the conclusion of 6 weeks, patients were encouraged to continue their VNS home program. Safety was assessed using adverse event reporting. Feasibility was assessed using time on task reported by the gamified rehabilitation software. Exploratory clinical outcomes included the Action Research Arm Test (ARAT) and Fugl Meyer Assessment (FMA) at baseline following implantation, upon completion of 6 weeks of therapy, and at 4 months post intervention. RESULTS: Patients participated in 64.1 ± 14.9 mins of gamified rehabilitation per session with 29.9 ±8.6 of those minutes being active time on task. No adverse events were reported. FMA-UE motor subscale and ARAT scores increased from baseline to the end of 6 weeks by an average of 9.3±3.6 and 7±7.4 respectively. Average increases from baseline to 4 month follow up for FMA-UE motor subscale and ARAT score were 14±6.3 and 10±8.2 respectively. CONCLUSION: These findings suggest that VNS paired with gamified rehabilitation is a safe and feasible intervention for UE motor impairment post stroke. Future work will investigate short- and long-term feasibility and efficacy of the intervention in patients with chronic stroke.