TLNS for cerebral palsy
Translingual neurostimulation (TLNS) is a non-invasive method that delivers mild electrical impulses to the surface of the tongue while the child performs therapeutic exercises. In a controlled study of 134 children with spastic cerebral palsy, adding TLNS to standard rehabilitation improved gross motor function nearly three times faster than standard rehabilitation alone. This page explains how the method works, what the data show, and how a course is organised.
Why the tongue
The tongue is one of the most densely innervated areas of the body — about 20,000–25,000 nerve fibres in a small area, connected through the trigeminal and facial nerves directly to the brainstem. Stimulating the tongue activates the brainstem and cerebellum, the structures that control posture, balance, muscle tone and coordination of movement. That is exactly the set of functions affected in cerebral palsy. Unlike methods that stimulate the cerebral cortex through the skull, TLNS reaches these deep structures through the body's own sensory pathways, without surgery or magnetic fields.
How a session looks
The child holds a small electrode array on the tongue — most children describe the sensation as "sparkling water" or light tingling. While the device is running, a physiotherapist works with the child on the tasks that are the goal of rehabilitation: standing, balance, walking, reaching, fine motor tasks. A session lasts 20 minutes and is repeated 2–3 times a day. The stimulation makes the nervous system more receptive to the exercises, so the same amount of training produces a larger and more lasting effect.
A course is organised in cycles of about 10 days. The first cycle is run in the clinic under supervision; the following cycles can be continued at home by the parents after training, with the device staying in the family and remote follow-up by our specialists.
What the clinical data show
The largest published study of TLNS in cerebral palsy was conducted at City Hospital No. 40 in Saint Petersburg (Ignatova et al., 2019). It enrolled 134 children aged 2–17 with spastic diplegia: 94 received standard rehabilitation plus TLNS, 40 received standard rehabilitation only. Outcomes were measured over three treatment cycles.
| Outcome | Standard rehabilitation + TLNS | Standard rehabilitation only |
|---|---|---|
| Gross motor function (GMFCS level, lower is better) | 3.5 → 2.4 over three cycles (−34%) | 3.7 → 3.4 (−8%) |
| Balance (Berg Balance Scale) | 16.8 → 31.1 points over three cycles | Smaller gains, returning toward baseline between cycles |
| Walking 5 m / 50 m / 500 m after the first cycle | +59% / +51% / +31% | +30% / +17% / minimal |
| Spasticity, cumulative after three cycles | 40–60% reduction (arms 13–17% and legs 17–23% per cycle) | Returned to baseline between cycles |
| Safety | No serious adverse events; no seizures and no worsening of seizure disorders | |
The key finding is not only the size of the effect but its persistence: in the TLNS group, improvements accumulated from cycle to cycle, whereas in the control group spasticity and balance tended to return to baseline between courses. Individual cases in the study showed cumulative Berg scale improvements of 144–229% over four cycles.
Publication: Ignatova T.S. et al. Translingual neurostimulation in the rehabilitation of children with spastic cerebral palsy. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 2019;7(2):17–24. Read the paper. The complete list of TLNS publications is in our Clinical Evidence section.
Which children are candidates
- Age from 2 years; the study population was 2–17 years, and the method is used in adults as well.
- Spastic forms of cerebral palsy (diplegia, hemiparesis, tetraparesis); GMFCS levels I–IV. Children at level V are assessed individually.
- The child can hold the electrode in the mouth for 20 minutes and tolerate the sensation — most children adapt within the first one or two sessions.
- No active oral wounds, no known sensitivity to nickel, gold or copper, no active malignancy. Epilepsy is not an exclusion: no seizure worsening was recorded in the study.
A previous plateau in rehabilitation is not a reason to exclude a child; on the contrary, children who had stopped progressing on standard programs are the typical group in which TLNS is added.
What parents can expect
Changes usually appear within the first 10-day cycle — more stable standing and sitting, easier walking over short distances, lower muscle tone in the legs. The most important results — a change in the GMFCS level, walking longer distances, less assistance in daily activities — come with repeated cycles over several months. TLNS does not replace physiotherapy; it makes physiotherapy work better. The child's daily exercise program remains the core of the treatment.
Where TLNS for cerebral palsy is available
The RehaLine TLNS device is registered in Russia, Mexico, Uzbekistan and New Zealand; registration is in progress in Brazil, Vietnam and the Philippines. Courses are run in our own rehabilitation centers in Moscow and Tashkent and by partner clinics. The device is not cleared by the U.S. FDA and is not offered in the United States. Cerebral palsy is not among the indications of other TLNS systems currently marketed in North America.
Frequently asked questions
Is the stimulation painful for a child?
No. The impulses are set to the level the child feels as light tingling, similar to sparkling water on the tongue. The intensity is adjusted individually and can be reduced at any moment.
How long is a course?
A cycle is about 10 days of daily sessions, 2–3 sessions of 20 minutes each. Three cycles over 3–6 months is a typical program; the interval between cycles is used for home exercises.
Can we continue at home?
Yes. After the first supervised cycle parents are trained to run sessions at home. The device stays with the family, and our specialists follow the child remotely.
Does it work together with botulinum toxin or orthopaedic surgery?
TLNS is combined with standard treatment, including botulinum toxin injections and post-surgical rehabilitation. The timing is planned individually with the treating physician.
How do we start?
Send us a short description of the child's condition — age, form of cerebral palsy, GMFCS level if known, current therapy — through our Telegram assistant or the form below. A specialist will review the case and contact you to arrange an online consultation.