PoNS Treatment – Who, What, Why, Where, When

The landscape of neurological rehabilitation techniques is wide and varied, with many methods and technologies available for use. One of the newest and most promising technologies on the market is the Portable Neuromodulation Stimulator, or PoNS unit and protocol presented by Helius Medical Technologies. This new technology has been approved in Canada to treat patients who suffer from chronic balance deficits or gait deficits due to mild-to-moderate traumatic brain injury and multiple sclerosis respectively. Let’s explore this impressive new technology more in-depth.

What is it?

The PoNS unit is an innovative medical device, inclusive of a controller and a mouthpiece. The controller gently rests on the back of a patient’s neck and acts as the control hub for the device. The mouthpiece rests on the front 2/3rds of a patient’s tongue and is the piece that provides the device’s effect. Additionally, there is a software application that is used to program the device, and record and track progress made by patient. The PoNS device is to be used in conjunction with a comprehensive 14-week physical therapy program, encompassing rehabilitation exercise including balance and gait retraining, guided breathing and mindfulness training, and corrective rehabilitation exercise.

How does it work?

When the device is in action, the mouthpiece delivers a mild electrical stimulation to the surface of the tongue. Although an odd sensation at first, the patient quickly adapts to the feeling and it becomes unnoticeable. This is all happening as the patient performs their prescribed rehabilitation protocol specific for them. The reasoning for the tongue stimulation is as follows:

  • An injury such as a TBI or condition such as MS affects the brain’s ability to effectively communicate with certain regions of the body
  • The tongue is a highly dense region of nerve endings, which flows directly to the brainstem (the body’s control centre). Because of these facts, the tongue is an ideal region for stimulation to attenuate the nervous system
  • The stimulation provided by the PoNS, combined with the rehabilitation program, allows the brain to possibly become “rewired”, which may restore function. This is founded in the principles of “Neuroplasticity” (see our previous blog for more information on that!)

Check out the link below for more on how the PoNS device works:

What does the research say?

The PoNS device is relatively new to the neurorehab world, and new research is continuing to be performed. However, there are promising landmark studies already completed, providing us with evidence of the device’s efficacy:

  • TBI Research:
    • In patients with chronic balance deficit due to mild-to-moderate traumatic brain injury (mmTBI, including concussion or post-concussive syndrome), PoNS™ was studied in conjunction with targeted physical therapy in two clinical trials involving 165 patients1,2
    • Of those who completed the 14 weeks of PoNS Treatment™ in the Long-Term Treatment Trial, approximately 74% of patients experienced significant improvement in their balance¹. Patients also showed meaningful improvements in their gait and walking endurance, which they maintained after the 12-week withdrawal of treatment2.
    • Both clinical trial results to date indicate the effectiveness of the PoNS™ device, when paired with physical exercise, to meaningfully improve the balance and gait of most patients after their mmTBI1,2
  • MS Research
    • The PoNS™ device was studied in two clinical trials in relation to multiple sclerosis.
    • In a study of 20 patients with multiple sclerosis, it was shown using the PoNS™ device in combination with physical therapy over 14 weeks led to a significant improvement in gait, as compared to physical therapy alone. 95% of all study patients experienced improvement in their gait however, the PoNS Treatment™ group, on average, had 2x improvement in their gait scores3.
    • A neuroimaging study of 14 MS patients tested the effects of non-surgical tongue stimulation using the PoNS™ device, combined with cognitive and physical rehabilitation, on their memory, gait, balance and concomitant changes in the brain. The PoNS Treatment™ group showed significant improvement from the baseline, suggesting that PoNS™ stimulation can enhance motor performance and working memory, while also driving neuroplasticity4.

PoNS and CIR

Complex Injury Rehab is a fully certified PoNS clinic, able to provide treatment in accordance with the research for mild-to-moderate TBI and MS. The experienced and highly trained clinicians of CIR can provide a custom-tailored PoNS program for your specific needs. If you would like more information or to see if you qualify for the program, please contact us.

-Shawn Gargoum

References:
1. Helius Medical Technologies. Data on File. 2019 Post Hoc Analysis – Long Term Treatment Trial – Responder rate – Pharma Data Associates
2. Tyler M, et al. Arch Res Rehabil Clin Transl. 2019; 1(3-4):10026.

3. Leornard G, et al. Multiple Sclerosis Journal-Experimental, Translational and Clinical. 2017; 3(1):2055217317690561.

4. Tyler E, et al. Journal of Neuroengineering and Rehabilitation. 2014; 11(1):79.