Scientific publications on TLNS

Compiled by RehaLine Group · Scientific supervision: Yuri Danilov, PhD, TCNL, University of Wisconsin–Madison · Updated September 2026

Translingual neurostimulation (TLNS) grew out of the sensory-substitution research of Paul Bach-y-Rita at the University of Wisconsin–Madison and has since been studied in traumatic brain injury, multiple sclerosis, stroke, cerebral palsy and balance disorders. This page lists 54 peer-reviewed publications and clinical trial reports on TLNS and its predecessors, grouped by topic, each with a link to PubMed or the publisher and a one-sentence summary of the finding. Negative and neutral results are included.

Foundations: sensory substitution and the tongue interface · Balance and vestibular disorders · Mechanism and neuroimaging · Traumatic brain injury · Multiple sclerosis · Stroke · Cerebral palsy and pediatric neurorehabilitation · Other neurological conditions · Reviews and conceptual papers

Foundations: sensory substitution and the tongue interface

1. Bach-y-Rita P, Collins CC, Saunders FA, et al. (1969). Vision substitution by tactile image projection. Nature, 221(5184):963-964. DOI 10.1038/221963a0
   experimental / technical report — The founding sensory-substitution paper: blind subjects could recognise objects when camera images were converted into patterns of tactile stimulation on the skin, showing the brain can learn to 'see' through another sense.
2. Bach-y-Rita P, Kaczmarek KA, Tyler ME, et al. (1998). Form perception with a 49-point electrotactile stimulus array on the tongue: a technical note. Journal of Rehabilitation Research and Development, 35(4):427-430. PubMed 10220221
   technical note / experimental — First demonstration that the tongue is an excellent electrotactile interface: five subjects recognised shapes with ~80% accuracy using only about 3% of the voltage needed on the fingertip.
3. Bach-y-Rita P, Tyler ME. (2000). Tongue man-machine interface. Studies in Health Technology and Informatics, 70:17-19. PubMed 10977534
   technical report — Describes the rationale and design of the tongue as a human-machine sensory interface, laying groundwork for later tongue-stimulation devices.
4. Sampaio E, Maris S, Bach-y-Rita P. (2001). Brain plasticity: 'visual' acuity of blind persons via the tongue. Brain Research, 908(2):204-207. PubMed 11454331
   experimental — Blind and sighted subjects achieved measurable 'visual' acuity through a tongue electrotactile display, and acuity roughly doubled after about nine hours of training, illustrating brain plasticity.
5. Tyler ME, Braun JG, Danilov YP. (2009). Spatial mapping of electrotactile sensation threshold and intensity range on the human tongue: initial results. Annual International Conference IEEE Engineering in Medicine and Biology Society, 2009:559-562. PubMed 19964939
   experimental — Mapped how sensitivity to electrical stimulation varies across the tongue surface, informing electrode-array design for tongue stimulators such as PoNS.
6. Lozano CA, Kaczmarek KA, Santello M. (2009). Electrotactile stimulation on the tongue: intensity perception, discrimination, and cross-modality estimation. Somatosensory & Motor Research, 26(2-3):50-63. PubMed 19697262
   experimental — Characterised how people perceive and discriminate the intensity of electrical stimulation on the tongue, providing the psychophysical basis for tongue-display coding.
7. Kaczmarek KA. (2011). The tongue display unit (TDU) for electrotactile spatiotemporal pattern presentation. Scientia Iranica D: Computer Science & Engineering, Electrical Engineering, 18(6):1476-1485. PubMed 28748231
   technical / engineering paper — Describes the design and stimulation waveforms of the Tongue Display Unit, the electrotactile hardware platform from which the BrainPort and PoNS devices descend.

Balance and vestibular disorders

1. Tyler M, Danilov Y, Bach-y-Rita P. (2003). Closing an open-loop control system: vestibular substitution through the tongue. Journal of Integrative Neuroscience, 2(2):159-164. PubMed 15011268
   case study / proof of concept — Feeding head-tilt information to the tongue restored postural control in a patient with vestibular loss, the first demonstration of vestibular substitution via the tongue (the BrainPort concept).
2. Danilov YP, Tyler ME, Skinner KL, et al. (2006). Efficacy of electrotactile vestibular substitution in patients with bilateral vestibular and central balance loss. Conference Proceedings IEEE Engineering in Medicine and Biology Society, 2006(Suppl):6605-6609. PubMed 17959464
   open-label clinical series — Among 40 patients trained with the BrainPort tongue device, those tested showed consistent, statistically significant improvements in balance after tongue-based vestibular substitution training.
3. Danilov YP, Tyler ME, Skinner KL, et al. (2007). Efficacy of electrotactile vestibular substitution in patients with peripheral and central vestibular loss. Journal of Vestibular Research, 17(2-3):119-130. PubMed 18413905
   open-label clinical series — Twenty-eight patients with peripheral or central vestibular loss showed significant improvements in balance, posture and gait after training with tongue electrotactile vestibular substitution, with gains persisting after the device was removed.
4. Vuillerme N, Pinsault N, Chenu O, et al. (2008). Sensory supplementation system based on electrotactile tongue biofeedback of head position for balance control. Neuroscience Letters, 431(3):206-210. PubMed 18166270
   experimental (healthy subjects) — Delivering head-position information to the tongue improved postural control in healthy adults, supporting the tongue as a channel for balance biofeedback.
5. Vuillerme N, Pinsault N, Fleury A, et al. (2008). Effectiveness of an electro-tactile vestibular substitution system in improving upright postural control in unilateral vestibular-defective patients. Gait & Posture, 28(4):711-715. PubMed 18632272
   controlled experimental study — Patients with one-sided vestibular loss stood more steadily when head-position feedback was delivered through a tongue electrotactile system.
6. Robinson BS, Cook JL, Richburg CM, et al. (2009). Use of an electrotactile vestibular substitution system to facilitate balance and gait of an individual with gentamicin-induced bilateral vestibular hypofunction and bilateral transtibial amputation. Journal of Neurologic Physical Therapy, 33(3):150-159. PubMed 19809394
   case report — A double amputee with drug-induced vestibular loss improved balance and walking after training with a tongue-based vestibular substitution device.
7. Barros CG, Bittar RS, Danilov Y. (2010). Effects of electrotactile vestibular substitution on rehabilitation of patients with bilateral vestibular loss. Neuroscience Letters, 476(3):123-126. PubMed 20398733
   clinical series — Brazilian patients with bilateral vestibular loss gained balance and quality-of-life improvements after a course of tongue electrotactile vestibular substitution training.
8. Ghulyan-Bedikian V, Paolino M, Paolino F. (2013). Short-term retention effect of rehabilitation using head position-based electrotactile feedback to the tongue: influence of vestibular pathology. Gait & Posture, 38(4):777-783. PubMed 23623605
   clinical study — Balance gains from tongue electrotactile feedback rehabilitation were retained in the short term, with the degree of benefit depending on the type of vestibular pathology.
9. Chisholm AE, Malik RN, Blouin JS, et al. (2014). Feasibility of sensory tongue stimulation combined with task-specific therapy in people with spinal cord injury: a case study. Journal of NeuroEngineering and Rehabilitation, 11:96. PubMed 24906679
   case study — Combining tongue stimulation with task-specific training was feasible and accompanied by improved walking and balance in a person with incomplete spinal cord injury.
10. Yamanaka T, Sawai Y, Murai T, et al. (2016). Long-term effects of electrotactile sensory substitution therapy on balance disorders. NeuroReport, 27(10):744-748. PubMed 27213931
    clinical study (follow-up) — Japanese patients with chronic balance disorders kept improved postural stability for months after a course of tongue electrotactile sensory substitution therapy.
11. Bastani A, Cofré Lizama LE, Zoghi M, et al. (2018). The combined effect of cranial-nerve non-invasive neuromodulation with high-intensity physiotherapy on gait and balance in a patient with cerebellar degeneration: a case report. Cerebellum & Ataxias, 5:6. PubMed 29556411
    case report — A patient with cerebellar degeneration improved gait and balance after PoNS tongue stimulation combined with intensive physiotherapy, suggesting the approach can help even progressive cerebellar disease.
12. Cofré Lizama LE, Bastani A, Panisset MG, et al. (2018). A novel neuromodulation technique for the rehabilitation of balance and gait: a case study. Journal of Clinical Neuroscience, 54:140-142. PubMed 29764702
    case study — Describes clinically meaningful gait and balance recovery in a single patient treated with PoNS cranial-nerve neuromodulation plus targeted physiotherapy.

Mechanism and neuroimaging

1. Wildenberg JC, Tyler ME, Danilov YP, et al. (2010). Sustained cortical and subcortical neuromodulation induced by electrical tongue stimulation. Brain Imaging and Behavior, 4(3-4):199-211. PubMed 20614202
   fMRI study — In 12 balance-impaired people, one week of tongue stimulation reduced postural sway and visual-motion sensitivity while fMRI showed increased activity in the dorsal pons, indicating lasting brainstem neuromodulation.
2. Wildenberg JC, Tyler ME, Danilov YP, et al. (2011). High-resolution fMRI detects neuromodulation of individual brainstem nuclei by electrical tongue stimulation in balance-impaired individuals. NeuroImage, 56(4):2129-2137. PubMed 21496490
   fMRI study — High-resolution fMRI in nine balance-impaired subjects localised the effect of tongue stimulation to the trigeminal nucleus and nearby pontine nuclei, with reduced anterior cingulate response to visual motion.
3. Wildenberg JC, Tyler ME, Danilov YP, et al. (2011). Electrical tongue stimulation normalizes activity within the motion-sensitive brain network in balance-impaired subjects as revealed by group independent component analysis. Brain Connectivity, 1(3):255-265. PubMed 22433053
   fMRI study — Five days of tongue stimulation calmed the over-active visual-motion processing network in 12 balance-impaired subjects, bringing activity closer to that of healthy controls.
4. Wildenberg JC, Tyler ME, Danilov YP, et al. (2013). Altered connectivity of the balance processing network after tongue stimulation in balance-impaired individuals. Brain Connectivity, 3(1):87-97. PubMed 23216162
   fMRI connectivity study — Tongue stimulation reduced abnormally strong connections between visual cortex regions and increased brainstem responsiveness to visual motion in balance-impaired subjects, suggesting network-level rebalancing.
5. Frehlick Z, Lakhani B, Fickling SD, et al. (2019). Human translingual neurostimulation alters resting brain activity in high-density EEG. Journal of NeuroEngineering and Rehabilitation, 16(1):60. PubMed 31133021
   experimental (EEG) — A single 20-minute session of TLNS measurably changed resting brain activity on high-density EEG in healthy adults, with high- and low-frequency stimulation producing different patterns.
6. Smith CJ, Livingstone A, Fickling SD, et al. (2020). Brain Vital Signs Detect Information Processing Differences When Neuromodulation Is Used During Cognitive Skills Training. Frontiers in Human Neuroscience, 14:358. PubMed 33117138
   controlled experimental study — Healthy adults who trained with TLNS maintained a strong N400 brain response over cognitive-skills training sessions, whereas the control group's response faded, suggesting TLNS sustains attention and engagement.
7. Kirby ED, Jones CB, Fickling SD, et al. (2023). Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study. Frontiers in Human Neuroscience, 17:1209480. PubMed 37362950
   real-world observational cohort (EEG) — Thirty-three clinic patients with varied neurological conditions showed significant improvements in attention-related brain responses after 14 weeks of TLNS paired with physical therapy.

Traumatic brain injury

1. Tyler M, Skinner K, Prabhakaran V, et al. (2019). Translingual Neurostimulation for the Treatment of Chronic Symptoms Due to Mild-to-Moderate Traumatic Brain Injury. Archives of Rehabilitation Research and Clinical Translation, 1(3-4):100026. PubMed 33543056
   RCT (double-blind, two-arm; NCT02158494) — In 43 people with chronic mild-to-moderate TBI, both high- and low-frequency TLNS combined with physical therapy significantly improved balance, with gains still present 12 weeks after treatment stopped.
2. Hou J, Kulkarni A, Tellapragada N, et al. (2020). Translingual neural stimulation with the portable neuromodulation stimulator (PoNS) induces structural changes leading to functional recovery in patients with mild-to-moderate traumatic brain injury. EMJ Radiology, 1(1):64-71. DOI 10.33590/emjradiol/200901
   imaging study (pre/post) — Nine chronic TBI patients showed grey-matter volume changes in the cerebellum and other regions after TLNS plus physical therapy, and these structural changes correlated with balance and gait improvement.
3. Fickling SD, Greene T, Greene D, et al. (2020). Brain Vital Signs Detect Cognitive Improvements During Combined Physical Therapy and Neuromodulation in Rehabilitation From Severe Traumatic Brain Injury: A Case Report. Frontiers in Human Neuroscience, 14:347. PubMed 33132868
   case report — A severe-TBI survivor treated with PoNS plus physical therapy showed measurable gains in attention-related brain responses (EEG 'brain vital signs') alongside reduced PTSD symptoms.
4. D'Arcy RCN, Greene T, Greene D, et al. (2020). Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: a high-density MEG case study. Journal of NeuroEngineering and Rehabilitation, 17(1):158. PubMed 33261623
   case study (MEG) — Years after a severe brain injury, PoNS-assisted rehabilitation re-started motor recovery, and magnetoencephalography revealed large-scale reorganisation of motor-network activation.
5. Ptito A, Papa L, Gregory K, et al. (2021). A Prospective, Multicenter Study to Assess the Safety and Efficacy of Translingual Neurostimulation Plus Physical Therapy for the Treatment of a Chronic Balance Deficit Due to Mild-to-Moderate Traumatic Brain Injury. Neuromodulation, 24(8):1412-1421 (published online 2020). PubMed 32347591
   RCT (multicenter, double-blind, high- vs low-frequency; NCT02429167) — Across 122 TBI patients at multiple centres, TLNS plus physical therapy was safe and about two-thirds of participants achieved clinically meaningful balance improvement, with fewer falls and less headache disability.
6. Hou J, Mohanty R, Chu D, et al. (2022). Translingual neural stimulation affects resting-state functional connectivity in mild-moderate traumatic brain injury. Journal of Neuroimaging, 32(6):1193-1200. PubMed 35906713
   imaging study (pre/post) — In nine people with mild-to-moderate TBI, TLNS plus physical therapy increased functional connectivity between sensorimotor and parietal regions, in parallel with improved balance and gait scores.
7. Chu DY, Hou J, Hosseini T, et al. (2025). Translingual neural stimulation induced changes in intra- and inter-network functional connectivity in mild-moderate traumatic brain injury patients. Frontiers in Human Neuroscience, 19:1481474. PubMed 39925723
   imaging study (pre/post) — In nine TBI patients, TLNS treatment improved balance and gait scores and increased connectivity within and between visual, default-mode and somatosensory brain networks.

Multiple sclerosis

1. Tyler ME, Kaczmarek KA, Rust KL, et al. (2014). Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. Journal of NeuroEngineering and Rehabilitation, 11:79. PubMed 24885412
   RCT (double-blind pilot) — In 20 people with MS, 14 weeks of active PoNS tongue stimulation plus exercise improved gait and balance significantly more than sham stimulation with the same exercise.
2. Leonard G, Lapierre Y, Chen JK, et al. (2017). Noninvasive tongue stimulation combined with intensive cognitive and physical rehabilitation induces neuroplastic changes in patients with multiple sclerosis: a multimodal neuroimaging study. Multiple Sclerosis Journal - Experimental, Translational and Clinical, 3(1):2055217317690561. PubMed 28607750
   controlled pilot with MRI — MS patients who received tongue stimulation with intensive rehabilitation showed greater working-memory gains and neuroplastic changes on fMRI and diffusion MRI than those given sham stimulation.
3. Ploughman M, Melam GR, Buragadda S, et al. (2023). Translingual neurostimulation combined with physical therapy to improve walking and balance in multiple sclerosis (NeuroMSTraLS): Study protocol for a randomized controlled trial. Contemporary Clinical Trials, 127:107142. PubMed 36878390
   RCT protocol — Describes the design of a 52-participant sham-controlled trial testing whether TLNS adds benefit to physical therapy for walking and balance in MS.
4. Donkers SJ, Lohse KR, Melam GR, et al. (2026). Translingual neural stimulation to improve gait and balance in multiple sclerosis: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, Online ahead of print (2026). PubMed 42150723
   RCT (sham-controlled) — In 44 people with MS, physical therapy improved gait and balance but adding TLNS at the dose used did not confer extra benefit over sham stimulation, a negative result that tempers earlier pilot findings.

Stroke

1. Galea MP, Cofré Lizama LE, Bastani A, et al. (2017). Cranial nerve non-invasive neuromodulation improves gait and balance in stroke survivors: a pilot randomised controlled trial. Brain Stimulation, 10(6):1133-1135. DOI 10.1016/j.brs.2017.08.011
   RCT (pilot) — In chronic stroke survivors, PoNS tongue stimulation combined with intensive physiotherapy produced larger gait and balance improvements than physiotherapy with sham stimulation.
2. Paltin D, Tyler M, Danilov Y. (2017). Cognitive enhancement: exciting discovery using trans-lingual neuro-stimulation. Journal of Neurology and Neurorehabilitation Research, 2(1):39-45. Publisher page
   case study — An 80-year-old woman four years post-stroke showed marked improvements in memory and thinking during 15 months of PoNS stimulation with physical training, with cognitive scores rising and falling in step with treatment phases.
3. Ahiatsi M, Léonard G, Riesco E, et al. (2025). A feasibility study on the use of cranial nerve non-invasive neuromodulation to improve affected arm function in people in the chronic stage of a stroke. BMC Neurology, 25(1):208. PubMed 40380081
   feasibility pilot — Twelve chronic stroke survivors completed every CN-NINM plus arm-training session without adverse effects and showed significant gains in arm motor function.
4. Ahiatsi M, Milot MH, Flaive A, et al. (2026). Tasting pain-relief through tongue stimulation: results from a feasibility study looking into the use of cranial nerve non-invasive neuromodulation in healthy individuals and chronic poststroke patients. BMC Neurology, 26(1):72. PubMed 41484860
   feasibility pilot — CN-NINM was feasible and well tolerated (100% adherence, no adverse effects) in 13 stroke patients and 13 healthy volunteers, though its immediate effect on pain was inconclusive.

Cerebral palsy and pediatric neurorehabilitation

1. Ignatova TS, Skoromets AP, Kolbin VE, et al. (2016). Translingual brain neurostimulation in treatment of pediatric cerebral palsy. Bulletin of Rehabilitation Medicine (Vestnik Vosstanovitel'noi Meditsiny), 15(6):10-16. Publisher page
   controlled pilot trial — In 65 children with CP, adding ten daily PoNS tongue-stimulation sessions to standard physiotherapy reduced lower-limb spasticity and improved gross motor function more than physiotherapy alone.
2. Ignatova TS, Ikoeva GA, Kolbin VE, et al. (2019). Effectiveness evaluation of translingual neurostimulation in motor rehabilitation in children with spastic diplegia. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery (Eco-Vector, St. Petersburg), 7(2):17-24. DOI 10.17816/PTORS7217-24
   RCT — In 134 children with spastic CP, adding PoNS translingual neurostimulation to standard rehabilitation produced greater reductions in spasticity and larger motor-function gains, which accumulated over repeated courses whereas control-group gains tended to fade.
3. Gaudin-Drouelle D, Houx L, Lempereur M, et al. (2022). Improvement in Gait and Participation in a Child with Angelman Syndrome after Translingual Neurostimulation Associated with Goal-Oriented Therapy: A Case Report. Children (Basel), 9(5):719. PubMed 35626896
   case report — A child with Angelman syndrome walked better and participated more in daily activities after TLNS combined with goal-directed therapy.

Other neurological conditions

1. Webeck JA, Laing K, Andrews DM. (2025). Improvement in gait and functional abilities in an adult with posterior cortical atrophy after translingual neuromodulation with neurorehabilitation physical therapy: a case report. Physiotherapy Theory and Practice, 41(9):2002-2010. PubMed 39922688
   case report — An adult with posterior cortical atrophy showed marked gait and mobility improvements exceeding clinically meaningful thresholds after translingual neuromodulation combined with physical therapy.

Reviews and conceptual papers

1. Bach-y-Rita P, Kercel SW. (2003). Sensory substitution and the human-machine interface. Trends in Cognitive Sciences, 7(12):541-546. PubMed 14643370
   review — A landmark review arguing that the brain can incorporate information from artificial sensors (such as tongue displays) as if it were a natural sense, thanks to neuroplasticity.
2. Bach-y-Rita P. (2004). Tactile sensory substitution studies. Annals of the New York Academy of Sciences, 1013:83-91. DOI 10.1196/annals.1305.006
   review — Summarises decades of tactile sensory-substitution work, including tongue-based vision and vestibular substitution, and the plasticity mechanisms that make it possible.
3. Danilov Y, Kaczmarek K, Skinner K, Tyler M. (2015). Cranial Nerve Noninvasive Neuromodulation: New Approach to Neurorehabilitation (Chapter 44). In: Kobeissy FH (ed). Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Boca Raton: CRC Press/Taylor & Francis, Chapter 44. PubMed 26269928
   book chapter (review) — Lays out the CN-NINM concept: patterned electrical stimulation of the tongue activates trigeminal and facial nerve pathways to the brainstem, priming neuroplasticity that targeted training can then exploit.
4. Danilov Y, Paltin D. (2017). Translingual Neurostimulation (TLNS): A Novel Approach to Neurorehabilitation. Physical Medicine and Rehabilitation International, 4(2):1117. Publisher page
   review — Overview of the CN-NINM/TLNS approach, describing how PoNS tongue stimulation paired with targeted training is intended to treat movement and cognitive deficits across neurological conditions.
5. Danilov Y, Paltin D. (2018). Translingual Neurostimulation (TLNS): Perspective on a Novel Approach to Neurorehabilitation after Brain Injury. In: Srivastava AK, Cox CS (eds). Pre-Clinical and Clinical Methods in Brain Trauma Research (Neuromethods vol 139). New York: Springer, pp. 307-327. DOI 10.1007/978-1-4939-8564-7_19
   book chapter (review) — Reviews the theory, stimulation parameters and early clinical results of TLNS for brain injury, framing it as a way to 'prime' the brainstem and cerebellum so that rehabilitation training works better.
6. Diep D, Lam ACL, Ko G, et al. (2021). A Review of the Evidence and Current Applications of Portable Translingual Neurostimulation Technology. Neuromodulation, 24(8):1377-1387 (published online 2020). PubMed 32881193
   narrative review — Reviewing 15 studies (5 RCTs, 3 quasi-experimental, 7 case reports), the authors concluded that portable TLNS shows promise for balance and gait deficits in TBI and MS, but that larger high-quality trials are still needed.
7. Boughen K, Neil T, Dullemond S, et al. (2021). Cranial Nerve Noninvasive Neuromodulation in Adults With Neurological Conditions: Protocol for a Scoping Review. JMIR Research Protocols, 10(7):e29965. PubMed 34319251
   scoping review protocol — Sets out the methods for the first comprehensive scoping review of CN-NINM/TLNS in adults with neurological conditions.
8. Boughen K, Lutowicz K, Neil T, et al. (2022). Translingual neural stimulation in adults with neurological conditions: a scoping review. Journal of Rehabilitation Research and Practice, 3(1):20-40. DOI 10.46439/rehabilitation.3.015
   scoping review — Mapping 40 studies, the review found that TLNS combined with rehabilitation is associated with improved balance and gait across TBI, MS, stroke and other neurological populations, though study designs vary widely.
9. Officer L, Armon C, Barkhaus P, et al. (2024). ALSUntangled #75: Portable neuromodulation stimulator therapy. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 25(5-6):648-652. PubMed 38666601
   evidence review — The ALSUntangled group found encouraging PoNS data in MS, stroke and TBI but no ALS-specific studies, so it could not endorse the device for ALS.

How to read this list

Study types range from foundational psychophysics to randomized controlled trials. The strongest evidence for TLNS today is in chronic balance and gait deficits after mild-to-moderate traumatic brain injury (two randomized trials, one of them multi-center with 122 participants) and in spastic cerebral palsy in children (a controlled study of 134 patients); evidence in multiple sclerosis is mixed, with positive early trials and a recent randomized trial that did not confirm an added benefit. We update this page as new studies are published. Questions about the evidence for a specific condition: info@4stim.com.