44.5. Conceptual framework

There are a several widely accepted axioms about rehabilitation after brain injury. Our approach differs from these in several ways.

First of all, although conventional physical rehabilitation therapy does employ retraining with the intention to return the patient to normal function, this occurs primarily during the acute and postacute period after trauma (typically up to 1 year). CN-NINM technology is oriented primarily on rehabilitation during chronic stages (years after traumatic incident), when conventional thinking assumes that there is no further capacity for change.

In situations when patient internal resources are not sufficient to activate the neurorehabilitation process (naturally or with help of physical therapy), our technology can provide an additional “boost,” reinforcing the process of neurorehabilitation. Another distinctive feature of our technology is its integrative nature and multidirectional rehabilitation effect. The physical medicine (the primary therapeutic pathway) has not, until recently, recognized or given significant attention to the profound and interrelated cognitive and emotional impact of TBI and even less to rehabilitation of them. Most practitioners also consider the oculomotor consequences of brain injury untreatable.

For many years, Paul Bach-y-Rita was a lone voice pointing out the obvious inconsistencies in the contemporary view of neurorehabilitation. His pioneering journey, and those of others like him (e.g., Edward Taub) is captured in a book titled The Brain That Changes Itself (Doidge, 2007). They called for a more holistic, integrated, and targeted approach to treating brain injury, and gave special attention to the need for cognitive and psychosocial training in conjunction with the physical rehabilitation.

Integrated CN-NINM therapy intends to restore physiological and cognitive functions affected by brain injury beyond traditionally expected limits, by employing both newly developed and novel therapeutic mechanisms for progressive physical and cognitive training, while simultaneously applying brain stimulation through a device we call the Portable NeuroModulation Stimulator (PoNS, Figure 44.1d). Based on our previous research and recent pilot data, we believe a rigorous in-clinic CN-NINM training program, followed by regular at-home exercises also performed with PoNS, simultaneously enhances, accelerates, and extends recovery from multiple impairments from brain injury (e.g., movement, vision, speech, memory, attention, mood), based on divergent, but deeply interconnected neurophysiological mechanisms (Wildenberg et al., 2010, 2011a, 2011b, 2013).

Go to:

44.6. Technical description of the PoNs device

The PoNS device evolved from a related set of technologies aimed at stimulation of the human nervous system to achieve beneficial results. These include information delivery as well as broad activation and modulation of large-scale neural networks. This section describes how this technological evolution parallels the conceptual and theoretical evolution of applications summarized in Section 44.3.