44.1. Introduction

Cranial-nerve non-invasive neuromodulation (CN-NINM) is a multi-targeted rehabilitation therapy that initiates the recovery of multiple damaged or suppressed brain functions affected by neurological disorders. It is deployable as a simple, home-based device (portable tongue neurostimulator, PoNSTM) and targeted training regimen following initial patient training in an outpatient clinic. It may be easily combined with all existing rehabilitation therapies, and may reduce or eliminate need for more aggressive invasive procedures or decrease the total medication intake. CN-NINM uses sequenced patterns of electrical stimulation on the tongue. CN-NINM induces neuroplasticity by noninvasive stimulation of two major cranial nerves: trigeminal, CN-V, and facial, CN-VII. This stimulation excites a natural flow of neural impulses to the brainstem (pons varolli and medulla), and cerebellum, to effect changes in the function of these targeted brain structures. CN-NINM represents a synthesis of a new non-invasive brain stimulation technique with applications in physical medicine, cognitive, and affective neurosciences.

It is difficult to find a more challenging problem in rehabilitation medicine than recovery of neurological function, either fully or partially, that is lost through injury, disease, or aging. Despite intensive scientific effort, the need for greater understanding of both physiological and psychiatric brain dysfunction and effective clinical applications has thus far overwhelmed existing rehabilitative tools and methods. This situation has grown particularly acute with increasing life spans and dramatically increasing survival rates for major diseases and trauma, leading to ever increasing numbers of people with substantial neurological dysfunction.

At present, the primary approach for treating traumatic brain injury (TBI) is through physical medicine, yet a systematic and unified approach has not been universally established. Recent studies have demonstrated that neuroplasticity and functional benefits are stimulated through specific forms of motor-behavioral interventions (Nudo et al., 2001; Weiller et al., 1993), whereas others have determined that early, intensive, targeted cognitive skill training after injury, even in older adults, is clinically effective (Cicerone et al., 2000; Rohling et al., 2009). Concomitant scientific efforts have identified the potential for noninvasive electrical stimulation of the brain to improve patients’ ability to learn and retain a motor task (Reis et al., 2009).

Additionally, there has been an emerging call for an integrative approach to developing clinical applications that draw on the latest understanding of the interactive factors affecting the potential for functional physical, cognitive and psychological recovery from TBI (Bach-y-Rita, 1990, 2001, 2003a, 2003b; Bédard, 2003; Taub et al., 2002).

In this chapter, we will introduce the emerging neurorehabilitation technology developed at the University of Wisconsin-Madison, Tactile Communication and Neurorehabilitation Laboratory (TCNL).

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