TLNS for stroke recovery
Translingual neurostimulation (TLNS) is a non-invasive method that delivers patterned electrical impulses to the surface of the tongue while the patient performs rehabilitation exercises. After a stroke it is used to support recovery of walking, balance and arm function in patients who have reached a plateau with standard physiotherapy. This page explains how the method is applied in stroke, what the studies show, and how a course is organised.
Who this page is for
TLNS is used in the chronic stage of stroke, usually six months or more after an ischemic or hemorrhagic event, when spontaneous recovery has slowed and further progress depends on training. Typical problems at this stage are a slow, asymmetric gait with poor stability, fear of falling, and a weak or spastic arm that is not used in daily activities. The method is combined with, not substituted for, the standard rehabilitation program.
How TLNS helps after stroke
The tongue is innervated by the trigeminal and facial nerves, whose fibres terminate in the trigeminal and solitary nuclei of the brainstem. These nuclei are densely connected with the cerebellum, the vestibular nuclei and the reticular formation, the structures that regulate posture, balance, muscle tone and the automatic components of walking. In stroke the primary lesion is in the hemisphere, but walking and balance depend on these intact brainstem-cerebellar circuits. Functional MRI shows that tongue stimulation changes activity in the pons and cerebellum for hours after the device is switched off; exercises performed in this window, whether gait training, balance tasks or repetitive arm movements, produce a larger and more lasting effect. Stimulation is never applied on its own: the exercise decides what the nervous system learns.
What the evidence shows
Stroke is a more recent indication than traumatic brain injury, and the studies are smaller. Their results are consistent in direction, and in 2026 the PoNS® device received U.S. FDA clearance for gait deficit in chronic stroke, in addition to its earlier Health Canada authorisation.
| Study | Design | Main finding |
|---|---|---|
| Galea et al., 2017, Brain Stimulation | Pilot randomised controlled trial in chronic stroke survivors | Tongue stimulation with intensive physiotherapy produced larger gait and balance improvements than the same physiotherapy with sham stimulation. DOI 10.1016/j.brs.2017.08.011 |
| Ahiatsi et al., 2025, BMC Neurology | Feasibility study, 12 chronic stroke survivors, affected arm | All sessions of stimulation plus arm training were completed without adverse effects; significant gains in arm motor function. PMID 40380081 |
| Ahiatsi et al., 2026, BMC Neurology | Feasibility study, 13 chronic post-stroke patients and 13 healthy volunteers | 100% adherence, no adverse effects; effect on pain inconclusive. PMID 41484860 |
A scoping review of 40 studies (Boughen et al., 2022) found TLNS with rehabilitation associated with improved balance and gait across stroke, TBI and MS, while noting that study designs vary widely. Larger controlled trials in stroke are still needed, and we say so to every patient. The complete list is on our Scientific publications page.
How a course is organised
A session is 20 minutes of stimulation combined with exercise, 2–3 times a day. The first two weeks are supervised in a clinic: a therapist selects the gait, balance or arm program and trains the patient and a family member. The following 12 weeks are continued at home, for a total of 14 weeks. The device stays with the patient, and our specialists follow progress remotely. Outcomes are measured with the Berg Balance Scale, Dynamic Gait Index and Sensory Organization Test before and after each phase.
Who is a candidate
- Adults after ischemic or hemorrhagic stroke with residual gait, balance or upper-limb deficit, typically six months or more after the event.
- Able to stand with or without an aid, to follow instructions, to exercise daily and to hold the electrode in the mouth for 20 minutes.
- Not used during pregnancy, with known sensitivity to nickel, gold or copper, with active or suspected malignancy, with open wounds or bleeding in the mouth, or with absent sensation of the tongue.
- Epilepsy is not a contraindication in itself; post-stroke seizures are discussed with the treating neurologist.
Where TLNS for stroke is available
The RehaLine TLNS device is registered in Russia, Mexico (COFEPRIS), 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. Clinics that want to add TLNS to their services can read about our partnership program.
PoNS® is a separate commercial TLNS device, cleared in the United States for gait deficit in MS and chronic stroke and authorised in Canada for MS, TBI and stroke, adults only; list price $28,270 per the manufacturer's FAQ. RehaLine's system covers more indications, including upper-limb rehabilitation and a pediatric program, the device stays with the patient, and a course costs several times less. PoNS® and PoNS Therapy® are trademarks of their respective owner; 4STIM is not affiliated with Bioness Medical, Helius Medical Technologies or their partners.
Frequently asked questions
How long after a stroke can TLNS be started?
Most published data are in the chronic stage, six months or more after the event. Earlier cases are assessed individually with the treating physician.
Does TLNS help the arm as well as walking?
The 2025 feasibility study in 12 chronic stroke survivors showed significant gains in arm function when stimulation was combined with arm training. Our program includes upper-limb tasks when this is the patient's goal.
Is it safe after a hemorrhagic stroke?
TLNS does not pass current through the skull and does not use magnetic fields; no serious device-related adverse events have been reported. The decision is made individually with the neurologist.
How do we start?
Send the date and type of stroke, current mobility and current therapy to our Telegram assistant; a specialist will review the case and arrange an online consultation. General information is on the TLNS therapy page.