Individualized AI-driven neuromodulation enhances tongue motor and sensory control networks: a platform for neurorehabilitation in cancer survivors and patients with neurodegenerative disease.

Abstract

Precise modulation of brain networks responsible for tongue motor and sensory control (TMSC) is critical for restoring functions, such as speech and swallowing in neurodegenerative disease or in treatment-induced chronic cranial neuropathy. We present an individualized, AI-driven fMRI neuromodulation (iNM) platform that adaptively targets subject-specific TMSC networks in real time. To enhance iNM precision and encodability --critical for neurorehabilitation--we mapped each healthy participants individualized TMSC selectivity network, creating a subject-specific TMSC digital twin. iNM increased signal strength, spatial expansion, and consistency across motor, sensory, and attention regions, while it reduced signal variability. The bilateral inferior parietal lobule emerged as key sensorimotor integration hub, as it exhibited exclusive activation under iNM along with highest discriminability, and largest spatial expansion. iNM also significantly strengthened and expanded motor, sensory, and attention-related networks -- medial-middle frontal areas, insula-claustrum, S1, M1, basal ganglia, motor cerebellum, and inferior temporal-- supporting interoceptive and proprioceptive-motor integration. Machine learning and unsupervised hidden Markov modeling revealed that iNM enhanced the decodability and stability of TMSC-neural states, while it suppressed competing swallow-neural state interference. Notably, the iNM effects extended beyond the neuromodulation window, indicating functional persistence--a key requirement for rehabilitation. iNM reconfigured TMSC networks by strengthening cortico-subcortical connectivity and adaptive circuit dynamics. Our findings show iNM as a non-invasive, personalized intervention capable of selectively enhancing sensorimotor control with high spatiotemporal specificity. By demonstrating mechanistic network-precision and functional carryover, iNM offers a promising intervention for individuals with limited treatment options, including head and neck cancer survivors and early-stage neurodegenerative disease patients.