AUTHOR=Kirby Eric D. , Jones Christina B. , Fickling Shaun D. , Pawlowski Gabriela , Brodie Sonia M. , Boyd Lara A. , Venter Jan , Moser Nicholas , Kalsi-Ryan Sukhvinder , Medvedev George , D’Arcy Ryan C. N. TITLE=Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study JOURNAL=Frontiers in Human Neuroscience VOLUME=17 YEAR=2023 URL=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2023.1209480 DOI=10.3389/fnhum.2023.1209480 ISSN=1662-5161 ABSTRACT=Background

Non-invasive neuromodulation using translingual neurostimulation (TLNS) has been shown to advance rehabilitation outcomes, particularly when paired with physical therapy (PT). Together with motor gains, patient-reported observations of incidental improvements in cognitive function have been noted. Both studies in healthy individuals and case reports in clinical populations have linked TLNS to improvements in attention-related cognitive processes. We investigated if the use of combined TLNS/PT would translate to changes in objective neurophysiological cognitive measures in a real-world clinical sample of patients from two separate rehabilitation clinics.

Methods

Brain vital signs were derived from event-related potentials (ERPs), specifically auditory sensation (N100), basic attention (P300), and cognitive processing (N400). Additional analyses explored the attention-related N200 response given prior evidence of attention effects from TLNS/PT. The real-world patient sample included a diverse clinical group spanning from mild-to-moderate traumatic brain injury (TBI), stroke, Multiple Sclerosis (MS), Parkinson’s Disease (PD), and other neurological conditions. Patient data were also acquired from a standard clinical measure of cognition for comparison.

Results

Results showed significant N100 variation between baseline and endpoint following TLNS/PT treatment, with further examination showing condition-specific significant improvements in attention processing (i.e., N100 and N200). Additionally, CogBAT composite scores increased significantly from baseline to endpoint.

Discussion

The current study highlighted real-world neuromodulation improvements in neurophysiological correlates of attention. Overall, the real-world findings support the concept of neuromodulation-related improvements extending beyond physical therapy to include potential attention benefits for cognitive rehabilitation.