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Case Reports
. 2020 Dec 1;17(1):158.
doi: 10.1186/s12984-020-00772-5.

Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: a high-density MEG case study

Ryan C N D'Arcy  1   2   3   4 , Trevor Greene  5   6 , Debbie Greene  5   6 , Zack Frehlick  5   6 , Shaun D Fickling  5   6   7 , Natasha Campbell  5   6 , Tori Etheridge  5   6 , Christopher Smith  5   6 , Fabio Bollinger  5   6 , Yuri Danilov  8   9 , Ashley Livingstone  5   6 , Pamela Tannouri  5   6 , Pauline Martin  6   10 , Bimal Lakhani  11   12
Affiliations
Case Reports

Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: a high-density MEG case study

Ryan C N D'Arcy et al. J Neuroeng Rehabil. .

Abstract

Background: In a recent high-profile case study, we used functional magnetic resonance imaging (fMRI) to monitor improvements in motor function related to neuroplasticity following rehabilitation for severe traumatic brain injury (TBI). The findings demonstrated that motor function improvements can occur years beyond current established limits. The current study extends the functional imaging investigation to characterize neuromodulation effects on neuroplasticity to further push the limits.

Methods: Canadian Soldier Captain (retired) Trevor Greene (TG) survived a severe open-TBI when attacked with an axe during a 2006 combat tour in Afghanistan. TG has since continued intensive daily rehabilitation to recover motor function, experiencing an extended plateau using conventional physical therapy. To overcome this plateau, we paired translingual neurostimulation (TLNS) with the continuing rehabilitation program.

Results: Combining TLNS with rehabilitation resulted in demonstrable clinical improvements along with corresponding changes in movement evoked electro-encephalography (EEG) activity. High-density magneto-encephalography (MEG) characterized cortical activation changes in corresponding beta frequency range (27 Hz). MEG activation changes corresponded with reduced interhemispheric inhibition in the post-central gyri regions together with increased right superior/middle frontal activation suggesting large scale network level changes.

Conclusions: The findings provide valuable insight into the potential importance of non-invasive neuromodulation to enhance neuroplasticity mechanisms for recovery beyond the perceived limits of rehabilitation.

Keywords: Brain vital signs; Electroencephalography (EEG); Functional connectivity; Magnetoencephalography (MEG); Motor function; Neuroplasticity; Portable neuromodulation stimulator (PoNS); Rehabilitation; Translingual neurostimulation (TLNS); Traumatic brain injury (TBI).

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Conflict of interest statement

Several of the authors have financial and/or business interests in Helius Medical Technologies and HealthTech Connex Inc., which may be affected by the research reported in this paper.

Figures

Fig. 1
Fig. 1
Changes in clinical outcome measures for Timed Stand and FIST tests. The shaded area denotes the TLNS treatment period. Note: Timed Stand test was not completed at B3 time point, dotted line indicates B3 measure as the average of B1 and B2. Shaded area represents onset of treatment.
Fig. 2
Fig. 2
EEG motor function changes (contra-lateral beta rebound, mean and 95% confidence interval) for both right and left hand movement over three baseline and two treatment periods. Shaded area denotes the 95% confidence interval for the mean of the three baseline measurements. *p < 0.05
Fig. 3
Fig. 3
MEG activation changes and bootstrapped Z-score plots for right hand movement over baseline (B1, B2, B3) and treatment (T4, T5) time points, revealing convergent activation results across all contrasts and data driven analyses. Top left: Timed Stand contrast-driven PLS. Top right: FIST contrast-driven PLS. Bottom left: Motor EEG contrast-driven PLS. Bottom right: data-driven PLS. Central Sulcus region is shaded for reference. *p < 0.05, **p < 0.01
Fig. 4
Fig. 4
MEG activation changes and bootstrapped Z-score plots for left hand movement over baseline (B1, B2, B3) and treatment (T4, T5) time points, revealing convergent activation results across all contrasts and data driven analyses. Top left: Timed Stand contrast-driven PLS. Top right: FIST contrast-driven PLS. Bottom left: Motor EEG contrast-driven PLS. Bottom right: data-driven PLS. Central Sulcus region is shaded for reference. *p < 0.05, **p < 0.01
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