Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study

Abstract

BackgroundNon-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.MethodsBrain 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.ResultsResults 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.DiscussionThe 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.

Brain vital sign monitoring of sleep deprivation detects situational cognitive impairment

“…In 2016, we developed a brain vital sign framework that incorporates the N100, P300, and N400 into a rapid, standardized, intuitive, and easy to use approach to evaluate cognitive brain function ( Ghosh Hajra et al, 2016 ). The brain vital sign framework has since been validated increasingly in both health individuals as well as individuals with brain injury (including concussion) and brain disease ( Ghosh Hajra et al, 2018 ; Fickling et al, 2019b , Smith et al, 2020 ; Carrick et al, 2021 ; Fickling et al, 2021 ; Kirby et al, 2023 ). Sleep deprivation can lead to a wide decline across domains of cognitive performance, such as response speed, attention, memory, verbal comprehension, mood, et cetera ( Pilcher and Huffcutt, 1996 ; Kim et al, 2001 ; Philibert, 2005 ; Walker, 2008 ).…”