Translingual neurostimulation (TLNS)

Medically reviewed by Evgenii Bugorskii, MD, Founder of RehaLine Group · Scientific supervision: Yuri Danilov, PhD, TCNL, University of Wisconsin–Madison · Updated September 2026

Translingual neurostimulation (TLNS) is a non-invasive neuromodulation method in which patterned electrical impulses are delivered to the surface of the tongue while the patient performs targeted rehabilitation exercises. The impulses travel along the trigeminal and facial nerves to the brainstem and cerebellum — the structures that control balance, posture, muscle tone and coordination — and make the nervous system more responsive to training. TLNS is used in the rehabilitation of traumatic brain injury, stroke, multiple sclerosis, cerebral palsy and balance disorders.

Where TLNS comes from

The method was developed at the Tactile Communication and Neurorehabilitation Laboratory (TCNL) of the University of Wisconsin–Madison, founded by Paul Bach-y-Rita — the neuroscientist whose work on sensory substitution first showed that the brain can learn to use the tongue as a high-resolution sensory channel. In the 2000s the TCNL team (Yuri Danilov, Mitchell Tyler, Kurt Kaczmarek) found that electrotactile stimulation of the tongue did more than carry information: it produced lasting changes in brainstem activity and improved balance in patients with vestibular loss. This observation became the basis of cranial nerve non-invasive neuromodulation (CN-NINM), later renamed translingual neurostimulation. The first commercial TLNS device, PoNS®, was built on this research; RehaLine's TLNS system continues the same scientific line, with Yuri Danilov as the scientific lead of our program.

How it works

The anterior two-thirds of the tongue are innervated by the lingual branch of the trigeminal nerve and the chorda tympani branch of the facial nerve. Their fibres terminate in the trigeminal and solitary nuclei of the brainstem, which are densely interconnected with the cerebellum, the vestibular nuclei, the reticular formation and, through them, with the motor cortex. A small electrode array placed on the tongue delivers a stream of microcurrent pulses at a level the patient feels as light tingling. Functional MRI studies show that 20 minutes of such stimulation changes activity in the pons and cerebellum and normalises the over-active visual-motion network typical of balance-impaired patients — and that these changes persist for hours after the device is switched off.

That window of heightened plasticity is what the method uses. Stimulation is never applied on its own: during every session the patient performs the exercises that correspond to the goal of rehabilitation — standing, walking, balance tasks, fine motor training or cognitive tasks. TLNS makes the exercise more effective; the exercise decides what the brain learns.

What a course looks like

• Session: 20 minutes of stimulation combined with exercise, 2–3 sessions a day.
• Supervised phase: the first 1–2 weeks in a clinic, where a therapist selects the exercise program and trains the patient or the family.
• Home phase: the device stays with the patient; sessions continue at home under remote supervision. In adults with brain injury a typical program is 14 weeks; in children with cerebral palsy the course is organised in 10-day cycles repeated over several months.
• Outcome measurement: standard scales — Sensory Organization Test, Berg Balance Scale, Dynamic Gait Index, GMFCS and Functional Mobility Scale in children — before and after each phase.

Indications

The conditions in which TLNS has been studied and in which our program is used:

• Cerebral palsy in children from two years of age — spastic diplegia, hemiparesis and tetraparesis.
• Chronic balance and gait deficits after mild-to-moderate traumatic brain injury.
• Gait and balance deficits in multiple sclerosis — patients with an EDSS score of up to 6.0.
• Gait, balance and upper-limb deficits after stroke.
• Vestibular and postural disorders of peripheral and central origin.
• Movement and balance disorders in Parkinson's disease and cerebellar ataxia — used in our clinics on the basis of the mechanism of action and our own clinical experience (tremor-dominant and rigid forms of parkinsonism are accepted); controlled trials in these conditions are still lacking.

What the evidence shows

More than fifty peer-reviewed publications describe TLNS and its predecessors; the full annotated list is on our Scientific publications page. The strongest data are in traumatic brain injury — a randomized double-blind trial at the University of Wisconsin (44 patients) and a multi-center trial across seven US and Canadian sites (122 patients), in which about two-thirds of participants achieved a clinically meaningful improvement in balance and the gains were maintained 12 weeks after treatment — and in cerebral palsy, where a controlled study of 134 children showed motor function improving nearly three times faster than with standard rehabilitation alone. Results in multiple sclerosis are mixed: early randomized pilots were positive, while a 2026 sham-controlled trial did not find an added benefit at the dose used. Across all published studies, no serious device-related adverse events have been reported; the typical side effect is mild tingling or transient soreness of the tongue.

Safety and contraindications

TLNS is non-invasive and does not use magnetic fields or currents through the skull. It is not used during pregnancy, in patients 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: no seizure worsening was recorded in the pediatric study.

TLNS and PoNS®

PoNS® and PoNS Therapy® are trademarks of their owner and refer to one commercial TLNS device, cleared in the United States for gait deficit in multiple sclerosis and stroke and authorised in Canada for multiple sclerosis, traumatic brain injury and stroke, in adults only. RehaLine's TLNS system is a separate device from the same scientific school, registered in Russia, Mexico, Uzbekistan and New Zealand, with a broader set of indications that includes a pediatric program. It is not cleared by the U.S. FDA and is not offered for sale in the United States. 4STIM is not affiliated with Bioness Medical, Helius Medical Technologies or their partners. A detailed side-by-side comparison and a breakdown of the PoNS device cost are on separate pages.

Where to get TLNS

Courses are run in RehaLine rehabilitation centers in Moscow and Tashkent and by partner clinics in the countries where the device is registered. Clinics and distributors who want to add TLNS to their services can read about our partnership program. Patients and families can describe their case to our Telegram assistant — a specialist will review it and arrange an online consultation.

Other names you may have searched for

In medical documents the method is called translingual neurostimulation, TLNS, translingual stimulation or cranial nerve non-invasive neuromodulation (CN-NINM). Patients almost never search for it that way. They ask about a "tongue device", "electrodes on the tongue", "the mouthpiece that helps you walk", "the tongue stimulation device from that book", or simply "the brain port thing". If any of those brought you here, you are in the right place — it is all the same method.

A word on device names. The stimulator itself is known as PoNS, short for Portable Neuromodulation Stimulator; the abbreviation echoes the pons, the brainstem structure the method acts on. An earlier device of the same family, built for blind users, was called BrainPort. The thin electrode array placed on the tongue is referred to in books and papers as a tongue display. The sensation is usually described as light tingling, like sparkling water — it does not hurt.

Where the method came from

The underlying idea is sensory substitution, proposed by the American neuroscientist Paul Bach-y-Rita: if one channel of perception is destroyed, information can be routed into the brain through another, and the brain will learn to use it. It began as a grid of vibrating stimulators in the back of a chair for blind users and ended as a thin electrode strip on the tongue.

The observation the whole method rests on is the residual effect: improvement persists after the device is removed, and lasts longer than the session itself. The device does not substitute for the lost function — it triggers a reorganisation that the brain then continues on its own. That is why TLNS is delivered as a course and always paired with exercise.

This story is told in the first chapter of Norman Doidge's The Brain That Changes Itself, where Cheryl Schiltz loses her sense of balance after gentamicin treatment — and where Yuri Danilov, now our scientific supervisor, appears by name. We have written the chapter up separately: what happened to the device from Doidge's book.

Conditions we cover in detail

If you are looking for help with a specific condition, these pages are more useful than a general description of the method: recovery after acoustic neuroma (vestibular schwannoma) surgery and ataxia: cerebellar, vestibular and sensory.

Frequently asked questions