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Cerebellum Ataxias. 2018 Mar 5;5:6. doi: 10.1186/s40673-018-0084-z. eCollection 2018.

The combined effect of cranial-nerve non-invasive neuromodulation with high-intensity physiotherapy on gait and balance in a patient with cerebellar degeneration: a case report.

Author information

1Department of Rehabilitation Medicine, Royal Melbourne Hospital, RMH-Royal Park Campus, 34-54 Poplar Rd Parkville, Melbourne, VIC 3052 Australia.
2Australian Rehabilitation Research Centre (ARRC), Royal Melbourne Hospital, Melbourne, Australia.
3Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Melbourne, Australia.
4The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia.
5Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
6Department of Surgery, The University of Melbourne, Melbourne, Australia.



Cranial-nerve non-invasive neuromodulation (CN-NINM) using the portable neuromodulation stimulator (PoNS™) device has been proposed as a novel adjuvant intervention to improve efficacy of gait and balance. This device modulates input and output signals during motor tasks which prompts neuroplastic changes. In this study, we investigated the efficacy of physiotherapy using the PoNS™ in a case with cerebellar degeneration.

Case presentation:

The PoNS™ was used during a high-intensity physiotherapy programme delivered over 2 weeks (2 × 1.5 h sessions daily). Clinical and instrumented gait and balance tests were applied pre- and post-intervention.


The patient improved in all tests without any adverse effects.


This study showed the efficacy and feasibility of combined high-intensity physiotherapy and CN-NINM for gait and balance rehabilitation. Further studies should explore CN-NINM effects in larger and more diverse samples of neurological patients.


Neuroplasticity; Portable neuromodulation stimulator; Stroke; Tongue stimulator

Conflict of interest statement

Prof Fary Khan was the authorised prescriber of CN-NINM approved by the Therapeutic Goods Administration (TGA) of Australia and the Melbourne Health Human Research Ethics Committee.Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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