Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial

Abstract

BackgroundThis study sought to examine the effect of targeted physical therapy with and without cranial nerve non-invasive neuromodulation (CN-NINM), on the walking ability of people with MS who exhibited a dysfunctional gait. We hypothesized that subjects who received electrical stimulation would have greater improvement than those who had a control device after a 14-week intervention. Gait disturbance is a common problem for people with multiple sclerosis (MS). Current management may include exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices. We have developed an effective rehabilitative strategy using neuromodulation of the cranial nerves via electrical stimulation of the tongue to enhance the plasticity of the brain.MethodsThe study is a within-subject blinded randomized control design. Twenty chronic MS subjects with an identified gait disturbance were assigned to either an active or control group. Both groups completed a 14-week intervention program using a standardized combination of exercise and a device that provided electrical stimulation to the tongue. Those in the active group received electrical stimulation on the tongue that they could perceive. Those in the control group used a device that did not provide a physiologically significant stimulus and was not perceivable. Subjects were assessed with the Dynamic Gait Index (DGI).ResultsThe DGI scores improved for both groups. There were significant between-group differences, with the active group showing statistically greater improvement than the control group mean.ConclusionPeople with MS demonstrated improved gait with CN-NINM training in a pilot randomized controlled trial. This study suggests that tongue-based neurostimulation may amplify the benefits of exercise for improving gait in people with chronic MS.

Neurorehabilitation Strategies Focusing on Ankle Control Improve Mobility and Posture in Persons With Multiple Sclerosis

“…16 Therefore, traditional therapies emphasized compensatory techniques that conserved the individual's energy. 17,18 However, this notion has been challenged by prior investigations that have shown that aerobic exercise can result in moderate improvements in the walking speed and endurance of individuals with MS while having no deleterious Neurology Section, APTA. Unauthorized reproduction of this article is prohibited.…”

Noninvasive tongue stimulation combined with intensive cognitive and physical rehabilitation induces neuroplastic changes in patients with multiple sclerosis: A multimodal neuroimaging study

“…7–9 Studies have shown that the tongue can be used as an effective interface for conveying electrical signals to the CNS, 10–13 including sensory substitution in balance-impaired or blind people. 14–17 Individuals with primary vestibular disorders using electrical stimulation of the tongue together with head-position information demonstrated sustained balance improvements beyond their final stimulation session. 13,14 In the present study, we use cranial nerve noninvasive neuromodulation (CN-NINM), a form of electrotactile stimulation delivered by a portable neuromodulation stimulator device (PoNS™ 14 ) that sends a series of small electrical pulses via a tongue electrode array to try to improve balance and gait problems in patients with MS. We also investigated whether this kind of stimulation could improve working memory in these patients.…”

Clinical neurorestorative progress in multiple sclerosis

“…71 The gait of MS patients has been shown to significantly improve with the combination of exercise and a device that electrically stimulated the tongue to enhance the plasticity of the brain. 72 Functional electrical stimulation (FES) produces a contraction in a paralyzed or weak muscle that can improve function through electrical excitation of the innervating nerve. FES can be used clinically to manage foot drop in people suffering from diverse neurological conditions.…”