TLNS for traumatic brain injury
Translingual neurostimulation (TLNS) is a non-invasive method that delivers patterned electrical impulses to the surface of the tongue while the patient performs balance and gait exercises. Traumatic brain injury is the condition with the strongest evidence for TLNS: in two randomized trials with 44 and 122 participants, about two-thirds of patients with chronic balance deficit after mild-to-moderate TBI achieved a clinically meaningful improvement, and the gains were maintained 12 weeks after treatment ended.
Who this page is for
TLNS is used in patients with persistent symptoms after mild-to-moderate traumatic brain injury, including concussion, when balance and gait problems have not resolved with time and standard therapy. Typical complaints are unsteadiness, dizziness in busy visual environments, difficulty walking on uneven ground or in the dark, headache and poor sleep. In the trials, participants were at least one year post-injury.
How TLNS helps after brain injury
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 interconnected with the cerebellum, the vestibular nuclei and the reticular formation, the structures that integrate visual, vestibular and proprioceptive input into posture and gait; they are frequently disturbed after diffuse brain injury even when structural imaging is normal. Functional MRI in balance-impaired subjects shows that tongue stimulation increases activity in the dorsal pons and normalises the over-active visual-motion network typical of these patients. In TBI patients, imaging before and after a course of TLNS with physical therapy has shown cerebellar grey-matter changes and increased functional connectivity in parallel with better balance scores. Stimulation is always paired with exercise: the balance and gait tasks performed during the session determine what is relearned.
What the evidence shows
| Study | Design | Main finding |
|---|---|---|
| Tyler et al., 2019, Archives of Rehabilitation Research and Clinical Translation | Randomized double-blind trial, University of Wisconsin, 44 patients with chronic mild-to-moderate TBI | TLNS combined with physical therapy significantly improved balance (Sensory Organization Test); gains still present 12 weeks after treatment stopped. PMID 33543056 |
| Ptito et al., 2021, Neuromodulation | Prospective multicenter double-blind trial, seven US and Canadian sites, 122 patients | About two-thirds of participants achieved a clinically meaningful balance improvement (SOT gain of 15 points or more); fewer falls and less headache disability; no serious adverse events. PMID 32347591 |
| Hou et al., 2022; Chu et al., 2025 | MRI before and after TLNS plus physical therapy, nine TBI patients | Increased network connectivity in parallel with improved balance and gait. PMID 35906713, PMID 39925723 |
| Safety across studies | No serious device-related adverse events; the typical side effect is mild tingling or transient soreness of the tongue. | |
The trials also recorded improvements in headache and sleep in a proportion of participants, and case reports have described gains in attention and motor recovery after severe TBI (Fickling et al., 2020, PMID 33132868; D'Arcy et al., 2020, PMID 33261623). The primary and best-documented effect is on balance and gait. The full list is on our Scientific publications page.
How a course is organised
The program follows the trial protocol. A session is 20 minutes of stimulation combined with balance, gait and, where needed, cognitive tasks, 2–3 times a day. The first two weeks are supervised in a clinic; 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. In the trials most of the improvement appeared within the first two weeks and continued to grow over the home phase. Outcomes are measured with the Sensory Organization Test, Berg Balance Scale and Dynamic Gait Index.
Who is a candidate
- Adults and adolescents with persistent balance or gait deficit after mild-to-moderate TBI or concussion; earlier cases assessed individually.
- Able 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.
- Post-traumatic epilepsy is not an exclusion in itself; the treating neurologist is involved in the decision.
Where TLNS for TBI 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 the device used in the TBI trials above. It is authorised by Health Canada for TBI, MS and stroke in adults; in the United States it is cleared for gait deficit in MS and chronic stroke, and TBI is not among its FDA-cleared indications. Its list price is $28,270 per the manufacturer's FAQ. RehaLine's system is used for TBI in adults and adolescents and has 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
Does TLNS work for concussion symptoms years after the injury?
Yes, this is the population studied: participants were at least one year post-injury with unresolved symptoms, and about two-thirds responded with a clinically meaningful balance improvement.
What happens after the 14 weeks?
In the trials, gains were maintained at the 12-week follow-up. Since the device stays with the patient, sessions can be resumed if symptoms return or a new goal is set.
Does it help headache and sleep?
Improvements in headache disability and sleep were recorded in a proportion of participants. They are secondary outcomes; the primary evidence is for balance and gait.
How do we start?
Send a short description of the injury, current symptoms and previous rehabilitation to our Telegram assistant; a specialist will review it and arrange an online consultation. General information is on the TLNS therapy page.