Could a new device called a portable neuromodulation stimulator (PoNS) help improve your mobility and balance with multiple sclerosis?
PoNS is a device that delivers mild electrical pulses to two nerves in your face and tongue. It’s a short-term treatment for adults with walking (gait) and motor control problems. PoNS is available by prescription only for use alongside physical therapy.
This therapy is also called translingual neurostimulation. PoNS has been tested on a small number of people with walking or motor problems caused by MS, and a larger number of people with strokes or traumatic brain injury. PoNS sends electrical signals through your tongue to stimulate nerves that go to the brainstem. It triggers a response in your brain called neuroplasticity. That’s when your brain adapts to nerve and tissue damage caused by diseases like MS. It can stimulate new and improved pathways and changes the messages it sends to your muscles and limbs.
PoNS devices are noninvasive. You don’t need surgery to implant any part of the device. Combined with physical therapy, PoNS may improve your balance and walking, although it doesn’t work the same for everyone.
MS can cause lesions or scars in your brain and central nervous system that cause you to lose control of your motor functions, like walking. While physical therapy and rehab can help you learn to adapt and manage your symptoms, there haven’t been effective treatments in the past. That’s why PoNS may be a good addition to physical therapy.
Why Do People With MS Develop Walking Problems?
People with MS often deal with walking and balance problems. You may develop a slow, unsteady, or swaying walk that makes you more likely to trip, fall, and hurt yourself.
Walking difficulty in MS may be caused by different things:
- Muscle tightness or spasms
- Leg muscle weakness or pain
- Loss of balance, coordination, and limb control called ataxia
- Sensory ataxia, or numbness in your limbs and feet that interferes with standing and walking
Ataxia is caused by damage to certain areas of your brain that control muscle movements and senses. Some people with ataxia and unsteady gait need to use a cane or walker so they don’t fall.
Falls are a serious health and safety risk for people with MS. Research shows that up to 70% of people with MS report at least one fall over a period of 2 to 6 months, and 30% of those people fall multiple times and hurt themselves. People with MS could use more effective treatments to help steady their walk and improve their balance.
People with MS who have walking and balance problems can injure themselves even when they do simple tasks, like cooking dinner, getting dressed, or shopping. Falls can cause painful broken bones and muscle injuries for people with MS. Your mobility may get even worse after falls.
Loss of balance, unsteady gait, and fear of falling can make you less independent. On average, 40% of people need some type of walking assistance within 15 years of being diagnosed with MS. Walking problems can reduce your quality of life and productivity.
What Happens in PoNS Therapy?
You’ll get a series of PoNS treatments from a physical therapist for 14 weeks.
The PoNS device has two parts: a stimulating electrical mouthpiece with a rectangle-shaped tab that lies on your tongue and a controller that goes around your neck. The mouthpiece and controller are connected with an electrical cord. Your therapist places the mouthpiece and tab on the flat center of the top of your tongue. They’ll show you how to lightly hold the mouthpiece in place with your lips and teeth.
Your therapist operates the controller to send mild electrical pulses to your tongue to gently stimulate your trigeminal and facial nerves for 20 minutes. You’ll feel these sensations.
When these nerves are stimulated, they send millions of communication signals called neural impulses through pathways to your brain. Your brain then sends signals to muscles involved in walking and balance to give you more control over your movements. Your therapist can also download a readout from the PoNS device at each session to refine and improve your treatment.
Does PoNS Really Work?
PoNS was approved based on the positive results of clinical trials and real-world use in people with MS that showed the device is safe and effective.
The first study included 20 people diagnosed with MS who had walking difficulties, divided into two groups. Everyone had 2 weeks of gait physical therapy training and treatment with a tongue stimulation device, followed by doing the same daily routine and treatment on their own at home for 12 weeks. Ten people were treated with the actual PoNS electrical stimulation, while the other 10 people were treated with a sham device.
Everyone was given a standard walking test called the Dynamic Gait Index (DGI) at the beginning of the study and the second, sixth, tenth, and final week. At the end of the study, people who were treated with PoNS had significantly improved walking test results compared to people who had the sham treatment.
In the second study, 14 people with walking difficulties caused by MS were divided into two groups of seven each: one receiving PoNS stimulation for 14 weeks, and the other receiving treatments with a sham device. Everyone in the study had intense physical therapy and working memory training along with their stimulation treatments. They were given brain MRI scans and working memory, walking, and sensory tests at the beginning and end of the study.
People who were treated with PoNS had significant improvements on their sensory tests, and their MRIs showed improved signal activity in their brains. People treated with PoNS improved their posture control more than those who were treated with the sham device.
These results show that PoNS treatment, combined with physical therapy, can improve motor control and trigger neuroplasticity for people with MS, although nobody in this trial had significant increases in their DGI walking scores.
After PoNS came on the market, its manufacturer studied its use among volunteers with MS who received PoNS therapy in physical therapy. They found that PoNS was safe and caused no serious side effects.
Who Can Be Treated With PoNS?
PoNS treatments are approved for use in people 22 and older, and only to be given along with a supervised therapeutic exercise program.
PoNS was approved by the FDA in 2021 as a breakthrough device, a program to speed up review and approval of new products that may be more effective treatments for irreversible, debilitating diseases like MS.
Anyone with these health conditions or implanted devices shouldn’t use a PoNS device:
- Penetrating brain injuries
- Neurodegenerative diseases
- Oral health problems
- Chronic infectious diseases
- Unmanaged high blood pressure or diabetes
- History of seizures
- Active or suspected malignant tumor
- People who are sensitive to nickel, gold, or copper shouldn’t use a PoNS device.
- PoNS and other electrical stimulation devices shouldn’t be used in areas of the body where there are recent or open bleeding wounds, or any numb areas.
- PoNS hasn’t been tested on people who are pregnant. If you’re pregnant or think you may be pregnant, you shouldn’t try this therapy.
How Can You Get PoNS Therapy?
Talk with your doctor or physical therapist about PoNS to see if it’s right for you.