Abstract
Using a longitudinal case study design, we have tracked the recovery of motor function following severe traumatic brain injury (TBI) through a multimodal neuroimaging approach. In 2006, Canadian Soldier Captain (retired) Trevor Greene (TG) was attacked with an axe to the head while on tour in Afghanistan. TG continues intensive daily rehabilitation, which recently included the integration of physical therapy (PT) with neuromodulation using translingual neurostimulation (TLNS) to facilitate neuroplasticity. Recent findings with PT + TLNS demonstrated that recovery of motor function occurred beyond conventional time limits, currently extending past 14-years post-injury. To investigate whether PT + TLNS similarly resulted in associated cognitive function improvements, we examined event-related potentials (ERPs) with the brain vital signs framework. In parallel with motor function improvements, brain vital signs detected significant increases in basic attention (as measured by P300 response amplitude) and cognitive processing (as measured by contextual N400 response amplitude). These objective cognitive improvements corresponded with TG’s self-reported improvements, including a noteworthy and consistent reduction in ongoing symptoms of post-traumatic stress disorder (PTSD). The findings provide valuable insight into the potential importance of non-invasive neuromodulation in cognitive rehabilitation, in addition to initial indications for physical rehabilitation.
Highlights
Rehabilitation outcomes following traumatic brain injury (TBI) are often focused on the improvement of motor function to reduce the impacts of long-term disability (Langlois et al, 2006; Strong et al, 2007)
Based on the evidence to-date, we hypothesized that translingual neurostimulation (TLNS) would significantly increase brain vital signs measures of attention and cognitive processing as a function of global neuroplasticity improvements
All p-values were adjusted for multiple comparisons across individual event-related potentials (ERPs) features using the Benjamini-Hochberg False-Discovery Rate (FDR) procedure (Benjamini and Hochberg, 1995; Yekutieli and Benjamini, 1999)
Summary
Rehabilitation outcomes following traumatic brain injury (TBI) are often focused on the improvement of motor function to reduce the impacts of long-term disability (Langlois et al, 2006; Strong et al, 2007). It is possible to monitor progress through functional neuroimaging (Gattu et al, 2016; Epps et al, 2019) and stimulate new progress through neuromodulation to promote enhanced recovery through neuroplasticity (Li et al, 2015; Danilov and Paltin, 2018). In the most recent investigation, this approach was expanded to combine PT with neuromodulation using translingual neurostimulation (TLNS) to facilitate further recovery through facilitated neuroplasticity (D’Arcy et al, 2020). Prolonged stimulation in combination with PT has generated a range of improvements, including improved gait and balance in individuals who have survived TBI (Leonard et al, 2017; Bastani et al, 2018; Danilov and Paltin, 2018; Tyler et al, 2019; Ptito et al, 2020)
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