Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: A high-density MEG case study

Abstract

Background: In a recent high-profile case study, we used functional magnetic resonance imaging (fMRI) to monitor improvements in motor function related to neuroplasticity following rehabilitation for severe traumatic brain injury (TBI). The findings demonstrated that motor function improvements can occur years beyond current established limits. The current study extends the functional imaging investigation to characterize neuromodulation effects on neuroplasticity to further push the limits. Methods: Canadian Soldier Captain (retired) Trevor Greene (TG) survived a severe open-TBI when attacked with an axe during a 2006 combat tour in Afghanistan. TG has since continued intensive daily rehabilitation to recover motor function, experiencing an extended plateau using conventional physical therapy. To overcome this plateau, we paired translingual neurostimulation (TLNS) with the continuing rehabilitation program. Results: Combining TLNS with rehabilitation resulted in demonstrable clinical improvements along with corresponding changes in movement evoked electro-encephalography (EEG) activity. High-density magneto-encephalography (MEG) characterized cortical activation changes in corresponding beta frequency range (27Hz). MEG activation changes corresponded with reduced interhemispheric inhibition in the post-central gyri regions together with increased right superior/middle frontal activation suggesting large scale network level changes. Conclusions: The findings provide valuable insight into the potential importance of non-invasive neuromodulation to enhance neuroplasticity mechanisms for recovery beyond the perceived limits of rehabilitation.

Brain Vital Signs Detect Cognitive Improvements During Combined Physical Therapy and Neuromodulation in Rehabilitation From Severe Traumatic Brain Injury: A Case Report

“…The second phase incorporated assistive device technologies following an extended plateau in rehabilitation progress (D’Arcy et al, 2020 ). Following various assistive device trial evaluations, the study phase began in 2018 with the specific goal of investigating whether non-invasive neuromodulation, when paired with continuing physical rehabilitation, could help overcome the plateau of the recovery beyond 12-years post-injury.…”

“…To evaluate whether PT + TLNS could facilitate further recovery, we collected clinical, EEG, and MEG data during a 1-year PT only plateau period (i.e., baseline) and a 14-week PT + TLNS period (i.e., treatment). In a parallel study of motor function, PT + TLNS treatment led to clinically significant motor ability improvements with corresponding significant changes in both EEG and MEG activation suggesting network-level neuroplasticity effects in motor control function (D’Arcy et al, 2020 ). The present study focuses on the associated cognitive changes.…”

“…In particular, it is possible to monitor progress through functional neuroimaging (Gattu et al, 2016 ; Epps et al, 2019 ) and stimulate new progress through neuromodulation to promote enhanced recovery through neuroplasticity (Li et al, 2015 ; Danilov and Paltin, 2018 ). Using a longitudinal case study design, we have previously utilized multimodal functional imaging, including functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and electroencephalography (EEG) to track the neurophysiological recovery of motor function (D’Arcy et al, 2016 , 2020 ). In the most recent investigation, this approach was expanded to combine PT with neuromodulation using translingual neurostimulation (TLNS) to facilitate further recovery through facilitated neuroplasticity (D’Arcy et al, 2020 ).…”

“…Using a longitudinal case study design, we have previously utilized multimodal functional imaging, including functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and electroencephalography (EEG) to track the neurophysiological recovery of motor function (D’Arcy et al, 2016 , 2020 ). In the most recent investigation, this approach was expanded to combine PT with neuromodulation using translingual neurostimulation (TLNS) to facilitate further recovery through facilitated neuroplasticity (D’Arcy et al, 2020 ).…”

“…Accordingly, within the longitudinal case study of motor function (D’Arcy et al, 2020 ), we investigated whether PT + TLNS would also lead to detectable changes in cognitive processing using the brain vital signs framework. Based on the evidence to-date, we hypothesized that TLNS would significantly increase brain vital signs measures of attention and cognitive processing as a function of global neuroplasticity improvements.…”