How Does the PoNS Neurostimulation Device Help With Walking in MS?

Therapy with a device called the portable neuromodulation stimulator (PoNS) can address some of those deficits and significantly improve gait in people with MS. This small device sits on your tongue and delivers gentle electrical pulses designed to “wake up” the brain and help it relearn how to control movement.

Small studies and “real-world” patients have shown that major improvements are possible for some people who complete the therapy — they may even, for example, progress from requiring a wheelchair to getting around with a walker or cane instead.

Keep reading to learn more about the PoNS device, including how it works, what the therapy involves, and how much it costs.

PoNS (short for portable neuromodulation stimulator) is a nonsurgical medical device approved for people ages 22 and older who struggle with walking because of mild to moderate MS symptoms.

Unlike peripheral devices that stimulate the arm or leg, the PoNS delivers stimulation directly to the brain via the mouthpiece by targeting two specific nerves connected to the tongue — the lingual nerve and the chorda tympani, says Antonella Favit-Van Pelt, MD, PhD, the chief medical officer at Helius Medical Technologies in Newtown, Pennsylvania. This process is called translingual neurostimulation, or TLNS.

The electrical stimulation of these cranial nerves creates a flow of neural impulses that are delivered directly into the cerebellum, which is the body’s movement control center, and the brain stem, which also plays a role in movement and balance.

From the brain stem, these impulses travel throughout the brain and activate neurons and structures involved in a variety of bodily functions. Over time, this helps the brain “rewire” itself and find new ways to send messages to the body that MS has disrupted.

Think of the brain as a city with roads carrying messages. In MS, some of those roads (nerve pathways) are damaged or blocked. PoNS uses neuromodulation, which is gentle stimulation of the nerves in the tongue, to encourage the brain to “reroute traffic” by building new pathways. This is based on the concept of neuroplasticity, a term that describes the brain’s ability to learn and adapt.

By combining the device with daily movement exercises, PoNS may help people regain steadier walking and better balance.

PoNS therapy is not something you just pop in your mouth while walking around the house. It’s part of a structured 14-week rehabilitation program led by a specially trained physical therapist.

After the device is prescribed, you will meet a PoNS-certified therapist who will complete an evaluation of your walking and endurance and then create a plan according to your goals, says Christina Arbogast, a physical therapist and a registered PoNS trainer at Elliot Rehabilitation Services in Manchester, New Hampshire.

“At the first follow-up appointment, we typically review the protocol, make recommendations for specific exercises for motor control and balance, and prepare the patient for the next visit, when we will start the first phase of the therapy,” says Arbogast.

First Two Weeks Typically, people using PoNS meet with a rehabilitation professional who activates the device, provides training, and supervises early exercise sessions.

Ongoing Program (Weeks 3–14) After about two weeks, the therapy is performed mostly at home with periodic check-ins with the therapist on progress and to make any exercise adjustments. Occasional clinic visits are used for data collection and retraining if needed.

Daily Routine and “Dosing” Device use is measured in minutes during exercise, and an average of 100 to 120 minutes per day is recommended to get the best results. Clinical studies show that the therapy’s effectiveness depends on adherence to the schedule of daily exercise, combined with device use.

A typical daily training schedule might include morning and afternoon sessions that would include:

• 20 minutes of balance training
• 20 minutes of gait training
• 20 minutes of breathing and awareness training

The combined time for the twice-daily sessions would add up to two hours a day.

To complete the 14-week program, people should be ready to dedicate a significant amount of their time to improving their health, says Arbogast. “Without that understanding, people can easily be overwhelmed and may potentially give up,” she says.

• 50 percent of people who were most consistent in their therapy (85 to 100 percent adherence) averaged nearly 7 points higher on the DGI.
• People who completed the therapy 70 percent of the recommended time improved by about 5 points.
• In the “real world,” a 5-point gain could mean a person could climb stairs without the railing, or step over small obstacles when walking without having to stop. “For some people, it can mean the difference between a patient using a wheelchair and walking independently with a cane — or even without one,” says Favit-Van Pelt.
• People who used PoNS consistently improved gait scores by more than 200 percent over those who engaged in physical therapy alone.

As with any treatment, not everyone responds the same way, and more research on the device is under way.

PoNS therapy is currently prescribed as a 14-week program. “The good news is that once patients reach improvement, they maintain it after treatment ends, with effects lasting at least six months and often longer,” says Favit-Van Pelt.

If a patient loses some of their gains because of disease progression, retreatment with PoNS has been shown to help them regain their earlier improvement, she says. Researchers are still studying the long-term effects to see how durable the improvements are once daily use of the device ends.

Additionally, traditional physical therapy can supplement the gains people achieve during the PoNS training and help in targeting more specific activities that they want to improve, says Arbogast.

If you have MS and have trouble with your gait, PoNS therapy may help. The device website offers a downloadable gait self-assessment to determine if you should take the next step and talk with your provider about the program.

Other factors to consider about PoNS:

• You need a prescription. You need a doctor’s prescription to get the device.
• The device can be expensive. The device itself currently costs about $28,000. Coverage varies widely, and many insurers do not yet cover PoNS. You may need to explore financial assistance programs or clinical trials.
• You may need to travel for the therapy. Most states have at least one physical therapy clinic that offers the treatment, but travel to see a professional trained in PoNS could be an issue. Helius Medical Technologies, the developer of PoNS, provides a map with PoNS clinic locations.

• PoNS is a device held in the mouth that uses gentle stimulation of the tongue, combined with daily physical therapy, to help people with MS improve walking, balance, and independence.
• Research and real-world results show that consistent use can lead to meaningful improvements — sometimes allowing people to move from wheelchair use to walking with a cane.
• The program is intensive, requiring about 100 to 120 minutes of daily use over 14 weeks.
• Many people are able to maintain gains for months after treatment, especially if they continue to work on their own with a physical therapist.