Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study

Eric D Kirby; Christina B Jones; Shaun D Fickling; Gabriela Pawlowski; Sonia M Brodie; Lara A Boyd; Jan Venter; Nicholas Moser; Sukhvinder Kalsi-Ryan; George Medvedev; Ryan C N D'Arcy

doi:10.3389/fnhum.2023.1209480

Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study

Front Hum Neurosci. 2023 Jun 9:17:1209480. doi: 10.3389/fnhum.2023.1209480. eCollection 2023.

Authors

Eric D Kirby¹, Christina B Jones^{2

3}, Shaun D Fickling^{1

2}, Gabriela Pawlowski², Sonia M Brodie², Lara A Boyd³, Jan Venter^{2

4}, Nicholas Moser^{5

6}, Sukhvinder Kalsi-Ryan^{5

7}, George Medvedev⁸, Ryan C N D'Arcy^{1

2

9}

Affiliations

¹ BrainNet, Faculty of Applied Sciences, Simon Fraser University, Vancouver, BC, Canada.
² Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada.
³ Brain Behaviour Laboratory, Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
⁴ Healthcode, Vancouver, BC, Canada.
⁵ KITE Research Institute-UHN, Toronto, ON, Canada.
⁶ Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁷ Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
⁸ Royal Columbian Hospital, Fraser Health, Vancouver, BC, Canada.
⁹ DM Centre for Brain Health, Department of Radiology, The University of British Columbia, Vancouver, BC, Canada.

Abstract

Background: Non-invasive neuromodulation using translingual neurostimulation (TLNS) has been shown to advance rehabilitation outcomes, particularly when paired with physical therapy (PT). Together with motor gains, patient-reported observations of incidental improvements in cognitive function have been noted. Both studies in healthy individuals and case reports in clinical populations have linked TLNS to improvements in attention-related cognitive processes. We investigated if the use of combined TLNS/PT would translate to changes in objective neurophysiological cognitive measures in a real-world clinical sample of patients from two separate rehabilitation clinics.

Methods: Brain vital signs were derived from event-related potentials (ERPs), specifically auditory sensation (N100), basic attention (P300), and cognitive processing (N400). Additional analyses explored the attention-related N200 response given prior evidence of attention effects from TLNS/PT. The real-world patient sample included a diverse clinical group spanning from mild-to-moderate traumatic brain injury (TBI), stroke, Multiple Sclerosis (MS), Parkinson's Disease (PD), and other neurological conditions. Patient data were also acquired from a standard clinical measure of cognition for comparison.

Results: Results showed significant N100 variation between baseline and endpoint following TLNS/PT treatment, with further examination showing condition-specific significant improvements in attention processing (i.e., N100 and N200). Additionally, CogBAT composite scores increased significantly from baseline to endpoint.

Discussion: The current study highlighted real-world neuromodulation improvements in neurophysiological correlates of attention. Overall, the real-world findings support the concept of neuromodulation-related improvements extending beyond physical therapy to include potential attention benefits for cognitive rehabilitation.

Keywords: EEG; ERP; attention; cognition; cranial nerve stimulation; neuromodulation; neuroplasticity.