Stimpod NMS 460 Masterclass Webinar 2023

Enjoy this webinar, led by Stimpod NM460 innovator, physiotherapist, acupuncturist and associate lecturer in the Physiotherapy Department of the University of the Witwatersrand in Johannesburg, South Africa. This particular webinar was recorded in Fall of 2023.

Webinar transcript below. Pardon any typos as this was created partially with AI.

 

Transcript

[00:00:00] Thank you so much for taking the time to join us tonight for our annual Stimpod Masterclass. We’re going to try to do this once a year, just to update everyone on our research and what’s changed during the year. So tonight is all about Stimpod therapy, how it works, why it as well as patient indications for different types of pathological states.

Our goal at Algiamed is to utilize electromagnetic therapies to regulate the homeostatic control system. Sorry, I can hear myself echoing in someone’s, in someone’s, can everyone maybe just mute if you don’t mind. Thanks. Let me do that sentence again. So our goal at Algiamed, that’s better, is to utilize electromagnetic therapies to regulate the homeostatic control [00:01:00] system, leveraging the body’s natural ability to restore its physiological equilibrium to a non-pathological state.

At Algiamed, we focus on unraveling the scientific basis of pathogenesis. And that is why our CEO is here. All the way dialed in from Vancouver, Canada. So I would like to hand over to him, um, Mr. Corlius Burkill. Thank you. Just thank you so much for facilitating this. Um, Michelle is going to give a proper introduction, but, um, I can just tell you that, um, while Phyllis has been instrumental in, in developing so many of the clinical applications of the, of the 460 and probably the person with the most clinical experience around the world with the 460.

So we’re very fortunate to have you here. Um, and really looking forward to, to hearing all your insights. Uh, there’s been so much, we, there’s so much research happening with the, with the [00:02:00] 460, um, our, our main research team is actually based here in Vancouver and we’re doing a tremendous volume of, of work.

Um, and we’ve got a couple of interesting papers that will be that will be published soon and we’ll keep you informed as they become available. Um, but yeah, uh, in, in that respect, um, uh, Professor Berger has made significant contributions over the years. So very privileged to have you here. Thank you so much for that.

Thank you Corlius. So before I introduce our presenter, I want to tell you of just some house rules. So feel free to ask questions using the Q and A feature because we’re a big group. Um, we might not get to answer all the questions tonight. So I will add Professor Berger’s email address to the chat, and you are welcome to email her individually.

Um, alternatively, feel free to utilize our Stimpod forum. I think most of you are actually on that [00:03:00] forum. Put all your patient related questions and so forth. So, I would like to introduce you to Professor Phyllis Berger. Professor Phyllis is a physiotherapist in private practice with over 40 years of clinical experience in treating musculoskeletal and chronic pain disorders.

She has developed innovative approaches to pain management, electrical technologies, and acupuncture. She was a member of the Pain Council for South Africa for 10 years and has attended and presented at many international congresses. She’s a former chairperson of both the Gauteng Pain Management Physiotherapy Group and the Acupuncture Group of Physiotherapists for South Africa.

In addition, she is a part time lecturer on pain management at the University of the Witwatersrand. She has also lectured, led workshops, and hosted webinars nationally and internationally on advanced medical technologies that expedite treatment outcomes. [00:04:00] Phyllis is also the author of the acclaimed comprehensive book entitled The Journey to Pain Relief, which was published in 2003.

She’s recently published a series of modules on medical electrical technologies, including a comprehensive module on Stimpod therapy, which we will discuss after this presentation. Uh, over to you, Professor.. Thank you very much indeed. I’m just going to Um, I’d like to say good evening to you all and to welcome everyone to this webinar on noninvasive pulse radio frequency known as NMS460 Stimpod to you..

I’ve been observing positive changes in patients conditions for the last 15 years and have presented research on the subject and we now know that unequivocally that we have a new approach and concept to not only accessing and identifying nerves, but we can relieve [00:05:00] neurogenic, nociceptive, neuropathic pain and its symptoms.

And we can intercept neuropathies and neuropraxia and even improve disuse, as in, for example, neurological diseases or even brain trauma. More recently, we can use the Stimpod to intervene in inflammatory and autoimmune disease by treating the vagus nerve, and I believe this will become our most exciting and interesting work in the future.

Michelle, have you got me? I am, I’m opening the presentation right now and then I will share it with you. Give me two seconds, I’m almost there. Okay, did you all hear that message? I’m sure they did. I heard it loud and clear. Good, good. Okay, can you, let’s see, can you all see this? Phil, can you see this? No, [00:06:00] yes, now I can.

Yes, I can. Perfect, perfect. So you just tell me to switch screens. All right. Discussion tonight will be looking at the NMS 460 and I’ll explain a little bit about it. Then I want us to get technical. We’re going to look at the recent research into magnetic fields and the latest info out there. Thanks to Corlius.

The NMS 460 is a non invasive pulse radio frequency, and we want to know what this does to our patient. I’m going to introduce a little bit about case histories, because I want to demonstrate some important points. We’re going to look at the benefits of NMS, and how this could help us treat patients, and vagus nerve effects and clinical observations of conditions that can be treated, and there may be many more out there that you will actually find, and then treatment protocols and what you need to know. Thanks. This is the new version [00:07:00] of the radio frequency and it produces a weak magnetic field that discharges a hybrid current known as non invasive pulsed radio frequency.

The device has a ground or reference electrode, for those that don’t, haven’t yet used it, and is applied at a distance, usually placed on the opposite side of the body. And then there is a pen-like probe that delivers the non interventional pulse radio frequency current to a nerve root and or its branches.

Carry on. Um, it’s hybrid because it’s got three types of current. So the first, first is a pulse, which actually interrupts transmission and that’s why we call it pulse. The second is a direct current that enables us to detect a nerve. And that is also something that That one can actually feel. And then there is a current that trans, [00:08:00] the square wave current which transmits or transports the radio frequency part of the current.

So here in the slide we see the spinal cord with a segmental nerve as it exits the facet joint. And a change in aberrant nerve conduction occurs at this site centrally, I can’t show you because I’m not controlling the slide, but lumbar nerve root compression causing a radiculopathy could be caused at that, would be treated at that particular position.

It can also change a nerve root peripherally. For instance, the perineal nerve for pain in lateral ankle or foot. The above occurs through targeting the biological root cause of the disease states. In fact, that’s what we’re treating with Stimpod. In other types of treatment, we wouldn’t be treating the root cause.

We might be treating circulation, but we’re not being specific. Now [00:09:00] let’s look at the electrical and magnetic effects on the body. Um, the hybrid current, um, can, may travel all the way along the nerve, all the way to the dorsal root ganglion. And it is actually at the same position that a rhizotomy would be treating a segmental nerve, or dress region.

And let’s look at the current. We have got three types of current which I’ve already described as hybrid. The first is the wave component, which is a square wave, which is relatively slow in pulse width of 0. 1 millisecond and / or 0. 2 milliseconds. And this is bioelectric ionization occurs with depolarization and then repolarization, and you’re going to get increases in circulation, and this is the nerve mapping current, which is due to the shape of this wave and the ionic interchange creating the action potentials.

That’s why we can [00:10:00] actually feel it. And then we’ve got the low frequency neuromodulation, which is, which has a pulse repetition rate between 1 and 10. So it could be 1, 2, 5, 10. It provides the same benefits as TENS and electrical acupuncture modalities with the release of endorphins and increase of circulations, but tens is very slow in onset onset. You actually need to stimulate for 14 minutes, and I know not many people really realize that. And electrical acupuncture is usually given up between two to four milliamps, whereas Stimpod is capable of high intensity, such as 30 millamps. Then the RF waveform is carried on the square wave and we have a bioelectronic effect.

It’s much too fast for ionic flow effects and it capitalizes on the semiconducting properties of soft tissue structures with an [00:11:00] electromagnetic field effect similar to conventional invasional pulsed radio frequency, and there’s no sensation coming from that RF current. Let’s compare it with conventional pulsed radio frequency, that’s the interventional one.

We have, we can give five minute treatments with immediate effects. Patients will tell you immediately, I feel very much better. And then you can actually test it with the movements that they couldn’t do before. I test all the time with my patients to not only make them realize that they feel better, but to show them that they’re better.

Then it’s non interventional, so it doesn’t image, uh, damage the body. We might find that we have one to three treatments for changes, and we’ve proved this scientifically. Um, we have permanent changes brought about at the dorsal ganglion and dorsal horn, and along the nerve itself. And we can [00:12:00] reduce the expression of inflammatory genes, and it’s shortly to be proven to us, and it promotes nerve regeneration.

So what’s the clinical application? It maps nerves and it will detect damage. Um, I say that because when you’re giving a treatment, you will find that when you’re trying to find the nerve and you should find it fairly easily, you can’t find it easily. And that means that the nerve is possibly not functioning at its optimal level because of the damage that has occurred to it.

But it’s not that the, it’s not a damage to the axon itself, it’s just the way the nerve conducts. This, the treatment helps intractable and chronic conditions such as neuropathic pain and symptoms. It stimulates peripheral nerves responsible for pain. It increases nerve conduction. It improves skin wounds.

You would be absolutely amazed if you [00:13:00] used Stimpod just for treating a skin wound after surgery. It almost disappears and you can treat the auricular branch of the vagus nerve.

Now I’m going to get very technical with you. The NMS is a patented electromagnetic field and it’s applied in the high frequency domain of between 100 and 500 kilohertz. And at this radio frequency, electric, electric action potentials along a nerve are not relevant to treatment. And in the ablative radio frequency, which causes a vibration between the molecules, which actually gives us the heat, gives the interventional pulse radio frequency, and the non-ablative.

Therapeutic effects of EMF in the RF domain are targeted. We’ll, we’ll target the physiology and it starts [00:14:00] to mimic solid state physics. And you’re going to get a biological tissue effect, and it takes on the characteristics associated with electronic circuits. So this radio frequency has profound effects on neural tissue.

And the nervous system expresses several gene expression markers when exposed to EMS.

The gene expression markers include CFOS, which is indicative of neuroimmune activity, and it can be expressed up to seven days after this exposure. That’s why we often see change or development of improvement long after we stop, we, or we finished our treatment, or even have stopped treating the patient.

It activates transcription factor three, which indicates neuro neural growth up to 14 days, and the RF selectively targets small [00:15:00] diameter neurons and those are A, are a delta and C fibers, which are the pain fibers and the RF primarily affects the cell body, not its dendrites and axons it, which are the cytoplasmic extensions.

But of course it will have an effect on that once the cell body is affected. And activating transcription factor three, uh, regulates cell growth, apoptosis, invasion, and collagen synthesis, synthesis in keloid fibroblasts. So I just wanted to give you that bit of information. Carry on for me, Michelle. And there’s a controversial Uh, discussion on the pathogenesis of neuropathy.

And this includes a highly intelligent neuroplastic response from the nervous system. It’s attempting to reestablish homeostasis when attacked by [00:16:00] ionic imbalances in its immediate environment, such as with hyperglycemia or other chemical or mechanical assaults. The nervous system eventually maladapts to a state where it develops microstructural changes in the axon.

This produces persisting neuropathy and may include neuropathic pain and symptoms and even paralysis, depending on whether it’s a sensory or motor nerve that is affected. Another system which is modulated by RF is the cholinergic anti inflammatory pathway, SHORT PAIN. As in short, a CAP, we call it CAP, and it’s regulated by the sympathetic nervous system and primarily influenced by the vagus nerve.

This pathway forms part of the body’s neuroimmune response to assaults that require an anti inflammatory response to maintain homeostasis. When CAP is I balance, the [00:17:00] inflammatory response is healing and homeostasis is MA is maintained. When cap is overregulated, we start to get tissue damage, which may occur, especially in the vasculature, and this state produces chronic inflammation which contributes to chronic pain states.

So, vagus nerve stimulation has been shown to be a very effective and safe modality to re de regulate CAP and reduce the inflammatory response. Thank you. So electromagnetic field effects on the body. What does this do to our patients? Um, it actually targets the biological cause of disease states in the central nervous system and peripheral system.

Why is that? Because we get long lasting, and I’ve already mentioned why, because you can see how long it lasts. It, it starts to affect the [00:18:00] nerve. It’s long lasting and fostered by a The bioelectronic effect of these therapies delivers the targeted EMF along the nerves and changes biological activity rather than the conventional ionic flow model such as the action potential due to cell responses to magnetic fields.

So the solid state physical stack structures are affected by quantum interactions and that’s the smallest discrete unit of a phenomenon in electricity. It’s the electron and this occurs between the NIPR wave form and charged biological particles such as water ions and molecules.

The immune system requires metabolic homeostasis to function normally, as we’ve already mentioned, and maladaptive systems will actually create disease states, such [00:19:00] as arthritis, autoimmune disease, among many others, and may be responsible for tissue damage that does not heal within the normal period.

And this may cause aberrant nerve firing and conditions such as neuropathic pain and symptoms. Our weak non thermal magnetic fields produced by Stimpod, um, may influence gene expression and positively affect the immunological electrical control systems. These are safe, leave no pathological residual effects after withdrawing the treatment, and are in addition non invasional, long lasting, and well tolerated by patients.

I will say that over the 15 years I’ve used Stimpod, I have never seen any negative effects on the tissues after treatment. Thanks, Michelle. There you go. Right. Now, you are looking at a [00:20:00] poster of a case series of a nerve stimulation as the sole treatment for pain, improvement of mobility and function following elbow surgery.

And the pilot study involves a case series investigating the Stimpod for the treatment of pain and improvement of mobility and function following elbow surgery function following elbow surgery We took a group of seven patients that received neurostimulation post tennis or golfers elbow surgery as their sole treatment to relieve acute post operative pain, improve elbow mobility, and function.

Patients undergoing the above mentioned surgery have often had chronic pain with and without neuropathic symptoms for a prolonged period before the surgery. And there’s also usually severe injury with active inflammatory processes due to the surgery. So I thought that treating these patients [00:21:00] aggressively early, post operatively, may expedite pain relief and the healing process.

So the method, immediately after surgery, seven patients were given neurostimulation for three treatments of 20 minutes each on the upper and lower brachial plexus during the 10 days before the splint was removed. This was followed by six treatments twice weekly of 20 minutes each after the splint was removed.

At each of these treatments, five minute stimulation were administered to four areas, the nerve supply superior and inferior to the elbow, and on either end of the wound. I will just qualify this, but if we’re treating a wound, you can actually travel along the wound and to give the the Stimpod treatment and very often you’ll pick up a nerve that’s particularly sensitive in that wound and you can stay on [00:22:00] that wound for five minutes and it has profound effects on healing.

Anyway, to go back, patients were evaluated for pain with a visual analog scale, movements of flexion and extension measured with a goniometer, strength and flexibility with a 12 movement activity scale, and status of the wound and satisfaction with treatment, mobility, and function. These measures were re evaluated telephonically at one, three, and six months after the last treatment.

So, all patients had relief of the acute pain by the fourth treatment. Pain relief range of movement and function was achieved by 6 of the 7 patients by the 9th treatment. And, uh, the two patients had to have revised, it was maintained by one month after the last treatment.

And two patients had to have revised surgery due in one patient to a more extensive surgery being required. [00:23:00] And in the other patient, unfortunately, having had a fall and re injuring the operative site. At three and six months, all of the above parameters were maintained in the remaining five patients.

These patients all had excellent wound healing and were highly satisfied with their treatment. This slide shows the pain, the average pain scores. So on the horizontal, we’ve got, um, we’ve got At the fourth treatment, you can see that the pain levels, the average of our scores will show on the vertical scale between 1.5 and 4.25. And then, at nine, at the ninth treatment, you can see how it drops. And then at one month, three months and six months, you can see how the pain levels have dropped. Here we can see the range of flexion and extension and we can get full range of flexion at one month and then it [00:24:00] maintains itself and stays like that for six months and thereafter and with extension the same thing but they actually achieve extension at an at the ninth treatment and it’s fully maintained.

Here we have all the active movements evaluated and you can see that at the ninth treatment we had perfect range of movement except for a slight dip by one month and then it, it, maintained three months and six months, and all these patients had very good function when after the treatment.

So we can conclude that the neurostimulation device has the capacity to relieve acute post operative. pain, reduce pain over the healing period, improve mobility, restore function, and stimulate wound heating, healing. And the treatment is relatively, relatively cost effective of minimal intervention and of short [00:25:00] duration.

And we need to think, could we use this treatment to prevent post operative pain? We need to speak to our surgeons and ask them, we need to, speak to our surgeons and ask them if they would be prepared to send their patients as soon as possible after the surgery even if they’re in a splint, even if they’re in a plaster, because you can reach the nerve supply that’s, that’s most proximal to the pain.

This is a female pediatric patient, age 9, and she presented with a right long thoracic nerve palsy for the second time. That’s when I saw her. The first injury, I did not treat her, and that occurred in 2011, and it was due to a fall with subluxation of the right glenohumeral and although the patient had a paralysis of the serratus anterior muscle and was unable to elevate the arm with rehabilitation and conventional very good therapy she recovered completely. And [00:26:00] this was according to the nerve conduction test that was conducted and compared with the initial nerve conduction test six months post recovery.

The second injury to the long thoracic nerve was due to a ballet movement that occurred in 2012. And besides the nerve palsy that reoccurred, exactly the same as you can see the patient with her, with her scapula in this picture, and she developed complex regional pain. That’s how come she got sent to me.

The second injury was limited by the inability to participate in rehabilitation exercises and physio. Due to pain and hyperesthesia in the distribution of C4 to 6 dermatome, both in the trapezius and shoulder region, the third nerve conduction test deteriorated to those recorded after the first nerve conduction test.

She had pain of 10 out of 10. She had severe [00:27:00] hyperesthesia and red discoloration from the right cervical spine at C3 and 4 to C5 and 6 and into the upper shoulder and arm. In fact, I could not even go near her. As soon as she saw me approach her, she would develop a flare in her neck.

She had severe winging, as you could see, and limited right cervical rotation of the spine. She had absolutely no movement of her shoulder. I’m able to brush the hair right sleep and the arm was held by the side. Here you can see the number of treatments. There were only thirteen over two months two in October nine in November and two in December. And I did use combination of treatments, but Stimpod was the mainstay.

I used electroacupuncture, high frequency, low frequency, laser, microcurrents, and anything else I could try because it was a very difficult case to treat. [00:28:00] Here you can see the treatment dates, and you can see the number of treatments. And then we did, we tested VAS before and after each treatment, and you can see that it was very difficult to get a change in the VAS.

And eventually, I stopped asking her about the 7th treatment. I stopped asking her, what does the pain feel like between, 0 and 10, but then I started to look at mobility and you can see at the 5th treatment she was starting to use her arm and on the 7th treatment she came in holding her teddy bear and then by the 10th treatment we, I was actually able to touch her and she came back to see me on the 7th of January and I expected to treat her.

And this is what I saw on the 7th of January. She had no winging of scapula and you can see the activities she participated in. And just advance the slide a little. [00:29:00] I saw this patient four years later in the supermarket. She had never had another recurrence of the glenohumeral dislocation.

So I think that is a very impressive case. Now let’s look at the benefits of Stimpod. First of all, we get nerve mapping. No other electrical device gives us this facility. This is one of the most important aspects of diagnosis and treatment, and clinicians always focus on restoring function that may be limited by joint dysfunction, muscular stiffness and or weakness pain and paresthesia. Previously we were unable to detect the specific nerve involved in the region of the pain or change aberrant firing of the neuron. It is now possible to target the specific nerve that may supply an area of injury. This has changed the game in treatments of patients.

Being able to actually find that nerve [00:30:00] that the patient has had involved in their condition. makes all the difference. Then of course we get relief of pain. It occurs when the nerve that conducts to the injured or inflamed area is stimulated. If you don’t stimulate that exact nerve or the area of the pain, you don’t get the same results.

When there is a cervical nerve root compression for example, it’s important to target the nerve at the level of the specific facet joint involved or if you can’t do that, use the brachial plexus, and of course the brachial plexus has got a superior and an inferior position, and or a specific nerve cord, depending on the condition of the patient.

As an example, if a patient has some form of injury or local compression of the upper limb, then the Stimpod can be applied at a superficial plexus, or the relevant nerve branch supplying the specific area. [00:31:00] Often a patient will indicate, quite unsolicited, that this is the nerve, this is the one that reminds of the pain, and this approach may well be sufficient to relieve the condition.

This will produce pain relief, may strengthen the hand or arm musculature, and improve and or expedite rehabilitation. The patient will say, oh, I can, I can now flex my fingers. And then the healing period using the Stimpod for any condition usually commences and becomes obvious to both patient and clinician to be between one and three treatments.

Sometimes you can just do one treatment and you can see the patient is better, or you Between 1 and 3, there starts to become a change in the situation. Once the process of healing commences, there is encouragement to continue with the designated treatment protocol, and the condition, in many cases, results completely, never to return.

In many [00:32:00] instances, there are occurrences that take three weeks or a month to resolve, with no change in between, except for a sensation of ease, as recorded by patients, and then the condition may improve exponentially. Thus, the practitioner has the ability to predict the trajectory of treatment. You know, often this is an issue that’s unknown, with many treatments.

We can’t say to the patients, they’ll say, how long is it going to take? You can usually never say, but here you can say, look, within three treatments, we should get a change. And if we do, then we continue until we get resolution.

Nerve regeneration in neuropraxias and disuse is expedited. According to the manufacturers, the PRF wave induced into the axoplasm triggers a metabolic cascade which resets the software of the nerve, as in gene [00:33:00] expression. By a nerve assuming its original characteristics, it re establishes. It establishes its previous axonal as well as myelin sheath anatomy. This information is gleaned by both the recovery of both unmyelinated and myelinated sensory nerves, as well as the myelinated motor nerves.

We can see that in the pediatric patient. Look how fast she improved and with a much more advanced condition. A further example is a patient with a dropped foot, uh, due to a superficial compression injury of the peroneal nerve, creating a neuropraxia, and it was confirmed by nerve conduction testing, and it, it responded to treatment at the relevant point.

Peroneal nerve was treated twice weekly for two weeks. This patient had previously been referred for surgery. Movement started to recover within three treatments, even if treated once weekly, [00:34:00] and this result has consistently been observed in many patients with confirmed neuropraxias by having a nerve conduction test.

And when it comes to disuse in another condition that occurs in many painful conditions and remarkable improvement in strength and mobility, even if incomplete, have been observed even in paralytic conditions that are due to spinal cord or brain injuries, I think we are probably stimulating these incompletely damaged areas from the brain and or spinal cord that can be rehabilitated.

And we wouldn’t have known but because the limb improves in movement, we now see that they actually had more use than what we originally thought. And then the influence on the immune system. Patients may have had interventional procedures that require lengthy healing post treatment, or there may have been a prolonged period before results are obtained when they have [00:35:00] interventional treatment.

But the effect of NI. treatment are often observed immediately, which changes that may be minimal after the first treatment or remarkable for the relief that may occur. This usually augurs well for the general improvement that may be expected, or there may be a certain feeling of improvement that is difficult for a patient to explain, and then three weeks later, the symptoms are observably better, longer lasting, and usually do not recur.

And recent stimulation of the vagus nerve with electrical current, even implantable as we’ve seen with many other types of, of current is known to facilitate upregulation of the autonomic, specifically the parasympathetic nervous system. This stimulation has demonstrated improvement in inflammatory disease states, psychological disorders, and even impacts [00:36:00] upon obesity.

So this opens up our, our profession to many different types of treatment. The PRF is able to access a branch of the vagus nerve in the auricle of the ear, the auricular branch of the vagus nerve, and it is notable that patients achieve a sense of relaxation and ease of joint pain post application of the above mentioned current.

You can actually see the patient relax. Thanks. Michelle, next. So what are the effects of other currents? TENS, as we know, is an analgesic. It closes the spinal gait and may improve descending inhibition in pain management. Direct currents will reduce inflammation, edema, and pain by activating local circulation.

And as far as the Stem Pod is concerned, there is no other electrical current that could suppress aberrant nerve conduction, nor facilitate healing in both central or peripheral nerve [00:37:00] conditions. Now let’s take a look at the vagus nerve. Here we are having the diagram of the ear, and you can see that you’ve got the helix of the ear, sorry I can’t use my little pointer, but, and then you’ve got the antihelix.

And you’ve got your tragus and your ear canal, but surrounding that you’ve got the concha, and here you can see my area, and that’s exactly where you need to target your vagus nerve. Um, I actually find that if I hold my finger, finger over the part of the helix that comes near to the concha, I can feel the stimulation as it develops when I’m starting to treat the patient and then I can interact with the patient and discuss how they’re feeling if I can take it to them. I can even take the current up to 9 milliamps sometimes, but I usually start on 2 milliamps because it’s a very sensitive [00:38:00] area.

And in the diagram next to it, you can actually see where the nerve is. And this is the only superficial branch of the auricular nerve. the vagus nerve, the auricular branch of the vagus nerve. So it can be, uh, you can be reached in the neck, but that then involves many muscles. And this is much safer to treat in this region.

We can treat the area between five and 10 minutes, and you should definitely treat the left vagus nerve for 10 minutes, and you can treat The right vagus nerve for five minutes. But I often find that if I’m treating a right trigeminal neuralgia, um, if I treat, I can treat the right vagus nerve for 10 minutes in that situation, um, as well as or of course, as the left, because I want to get an overall anti inflammatory effect.

So let’s think about the vagus nerve and it’s [00:39:00] inflammatory reflex.

The electrical stimulation modulates of the vagus nerve modulates the nervous system at central peripheral and autonomic levels. The vagus nerve has both sensory and motor fibers from the autonomic nervous system. And the innate immune response is the body’s mechanism for controlling inflammation for the prevention and treatment of diseases.

So we know that the autonomic nervous system consists of the sympathetic chain, the parasympathetic nervous system, and the vagus nerve. The vagus nerve is the main nerve of the parasympathetic division, and it regulates metabolic homeostasis by influencing heart rate, gut motility and secretion, pancreatic endocrine and exocrine secretion, hepatic glucose production, and other visceral functions.

The neural reflex [00:40:00] mechanism, the inflammatory reflex, controls innate immune responses and inflammation during pathogen invasion and tissue injury. Both adrenaline and noradrenaline are secreted from the adrenal gland and released by the sympathetic nerve axons that modulate the release of cytokines and inflammation through alpha and beta adrenal receptors on the immune cells.

The afferent vagus nerve fibers convey peripheral inflammatory signals to the brain and this triggers our sickness responses. The efferent vagus nerve signals suppress the pro inflammatory cytokine release and inhibit inflammation. And this novel vagus function is termed the cholinergic anti inflammatory pathway.

If the innate immune regulation process is disrupted, it results in continual pro inflammatory cytokine activity and [00:41:00] excessive or chronic inflammation and underlies the pathogenesis of disease symptoms such as sepsis, rheumatoid arthritis, inflammatory bowel disease, autoimmune disorders and other inflammatory states.

And dysregulation and metabolism and immune function and obesity are also associated with chronic inflammation and we can assist patients in that, with that type of condition as well. Vagus nerve may act as a modulator of the brain gut axis in psychiatric disorders and interaction between the gut axis and brain is complex and involves neural immune and humoral links.

The vagus nerve, besides inflammation and homeostasis, regulates food intake and safety, diabetes, pathogenesis of psychiatric disorders, and stress induced inflammatory conditions. [00:42:00] Now, let’s look at the clinical observations of conditions that will respond to non interventional pulse radio frequencies.

I’ve tried to sort of divide it up into sections. Neuropathic pain and symptoms, we know, we’ve discussed diabetic, peripheral, post chemotherapy induced neuropathy, in fact, any kind of neuropathy, it doesn’t matter what the etiology is. Then I put together complex regional pain syndromes and fibromyalgia, but that’s, they don’t belong to each other.

But, um, I find that Stimpod is brilliant for ,complex regional pain, as long as you use it far away from the injured area. For instance, brachial plexus, femoral nerve. If you’re treating the ankle, go for the femoral nerve in the groin. And you’ll find that very often you’ll get very good results. You might even wish to stay for the first three treatments on, let’s say, the groin region for an ankle [00:43:00] condition or pain in the lower leg. With fibromyalgia, you will treat your local regions and the plexus supplying the area. Um, and then you’ve got your persistent post surgical pain, any kind of pain, uh, any kind of surgery you can treat. your, your patient’s pain and particularly the post surgical pain syndromes that may occur.

And especially herniorrhaphy. I’ve seen so many of those patients and mastectomy and sesamoidectomy and bunionectomy, many, many conditions. And then you’ve got your degenerative spinal diseases, your spondylosis, failed back syndrome. Um, it’s very impressive to see our patients who’ve had painful years, have had many spinal surgeries actually respond particularly well to Stimpod locally on the spine and also on the sciatic nerve.

Nerve root compression and chronic cervical [00:44:00] thoracic lumbar pain. And then we’ve got our vestibular conditions, uh, with dizziness and nausea. You would treat your occipital nerve in these conditions. Perineum. Anal pain, inability to pass urine. Very exciting to see patients get better. Vagus nerve stimulation for inflammatory disease, psychological disorders, control of obesity, and from the brain fog and malaise of lung covid.

We get post stroke spasticity and flaccidity, injury, any form of injury to any joint and stiffness. You can actually treat the local joint with your, with your probe. For instance, your glenohumeral joint, you can treat that. Use five minutes of treatment moving your probe around the joint, pelvic pain and women’s health issues, any form of muscle weakness such as Bell’s palsy, disuse of muscles, post acoustic neuroma [00:45:00] removal affecting a nerve, damage to the facial nerve, from any other condition.

TMJ, joint dysfunction, trigeminal neuralgia, post radiation for cancer of the mouth, throat, xerostomia, I would treat the vagus nerve here, compression of the perineal nerve as you, as we’ve mentioned, long thoracic nerve injury, and post hepatic neuralgia. Now, that’s a difficult one. I’m just going to discuss a case history with you.

We all know how difficult it is to treat herpes zoster. And sometimes if you actually, um, place your probe on the very painful area, it can make it worse. It might make it better after a while, but it’s better not to irritate these patients. Recently, I’ve just had a patient who had herpes zoster in 2020, that’s almost three years ago.

And, she did, develop the vesicles and severe pain in her thoracolumbar area. And [00:46:00] you can see I’ve marked it on the chart, the patient chart. And, um, she had it in the spine from T10 down to L1 and severe referral into the right rib cage and abdomen to her belly button. She could barely walk and the pain was so severe it was 10 out of 10.

She was treated with cortisone and she had a COVID vaccine and it made the pain worse. So she didn’t have her booster. At the first consult, her pain range still on the 17th of October this year, from 2 out of 10 to 10 out of 10. She had burning with the DN4 test and numbness, hyperesthesia to touch and pinprick.

She couldn’t lie down to sleep and lying was the worst. Her general health, she had asthma and genetic high cholesterol. She was on epilim and trepilene and she was highly sensitive to any touch. So here you can see the treatments I gave [00:47:00] her. On the 8th, I treated her the next day, and the pain went down to 2 to 3 out of 10.

It did not go up to 10. She had the low grade burning. She had more sensation in her thoracolumbar areas before. She didn’t feel it, but she had the burning. I mean, she couldn’t touch us. When she touched herself, she couldn’t feel. We treated with a Stimpod and we were able to treat her in prone and the first time we could only treat her in sideline.

We did add acupuncture and high frequency, but the mainstay of the treatment was the Stimpod. And then, on the 23rd, one week later, she went down to 1-2 out of 10, and the pain area had receded right down to T10, and only along the rib of T10. So we realized that it was actually the T10 that had been And then on the 31st, a week later again, the pain had sparked up a bit, but it never went up to 10.

But it still, but it [00:48:00] went again into the rib, but it did not go into the abdomen. She could still sleep very well. And then I saw her today, and again, it had, the pain had dropped. To 2 to 3 out of 10, and the progress continues, and I just had a little, I just showed you the different parameters.

This is another patient that I saw, and I was very interested in it. Because the patient had nerve conduction test. He was a 68 year old gentleman. And he had surgery for his L3-4 lumbar and decompression with endoscopic for a monotony at L5 S1 in August 2022. And he had, he had weakness at, uh, in his right plant flexion and he had absent ankle reflexes.

And his right was more affected than the left. This was after the surgery, it was not like that before. And he had a radiculopathy with residual symptoms. [00:49:00] His right, as I say, was worse than his left. But he had very persistent numbness in both feet. And the right foot was more numb. And he had pain in the back of his leg.

So, we looked at sensory and motor nerve pain. But what we saw on the 18th of January, before I started treating him, he had extreme low, this was the sensory nerves, the sural nerve, and the superficial peroneal sensory. He had extreme low volt voltage, right equals lift snap amplitude with normal peak latency, latency, but slowed, nerve conduction voltage.

And the same thing with the superficial peroneal sensory nerve. So We started treating him in May. I did 20 treatments. I gave one in May, six in July, six in August, two in September and [00:50:00] October and one in November. He’s now going away. He’s going to have surgery to his eyes. So we stopped and you can see that they redid the nerve conduction test, and we got a normal peak latency and nerve conduction voltage on both of those nerves.

There was no interval deterioration, which there had been before. And the patient has no pain in his, both his legs. and the left has improved more than the right. So I thought that was a very interesting, uh, patient to describe to you. So what do you need to know? I would like you guys to become researchers.

I would like you to compare the strength of fasiculation before and after treatment. So, you can see when you start, how the patient is fasiculating once you get the nerve, and see how it is at the end of the treatment. Because what you’ll find is the nerve sort of [00:51:00] learns to improve as the treatment goes along.

And we start off with basically, very little for fasiculation. By the end of that treatment, you will notice that there’s much stronger fasiculation. Look at the intensity changes. You might find that you can actually drop your intensity as the fasciculation improves because you may not, the patient might find it’s, it’s too strong for them.

So that’s very interesting and that, that augurs well for you. That indicates to you that you are making an improvement for this patient. And then note how many treatments you have done before you actually see improvement. Write it down.

So your practical information. It’s very important that you should know your anatomy.

Now I know you all know your anatomy, but it’s good to have your anatomy books out because sometimes we need to look and see what, what muscle that nerve supplies and make sure that you are treating the right area. Have a clear [00:52:00] understanding of how to determine the treatment site with your diagnosis and your assessment.

You need to know where to put your electrodes and where to place the reference electrode. So you usually should place the reference electrode on the opposite side of the body because you don’t want the current to go between the probe and the electrode and not go all the way to the actual nerve that you’re treating and then to the spine where it makes the changes.

And we were asked this question by Laurie, I think. Are there any settings to be included? Yes. I would like to be able to compare nerve conduction before and after treatment. I think this is too much for Corlius to do. So I think we have to get another machine that might do that for us. Another different machine that doesn’t do Stimpod, I mean.

Anyway, how do you know how to find the optimal point of stimulation for any [00:53:00] given treatment? The fasciculation muscle movement to expect while looking for most superficial treat, aspect of a motor nerve? How much pressure to apply? How to determine the correct current setting for any given treatment for any given patient?

And how long the stimulation session should last for any given treatment? And how long to determine it?

Decision making on the type of neural condition. Is it sensory and or motor symptoms? Is it neuropathic, neurogenic, or nociceptive? You have to be able to decide on that in order to give the best treatment. Where would you then treat? What is the diagnosis? Is it an inflammatory condition? If it is, include vagus nerve treatment.

Even if it’s just five minutes on the left vagal nerve, it will enhance your treatment. If it’s a neuropraxia, is it just disuse as an essential condition for instance, [00:54:00] injury, a disease, or a stroke, then you need to start working with the whole limb. You start with the brachial plexus and work your way down every single, um, branch of those nerves.

Even to the hand, for instance. From brachial plexus to hand to help the patient have a better use and quality of life. So your assessments and your tests are very important. That is your history, and I do recommend that you use the DN4 test for neuropathic pain and symptoms to determine if you get four out of 10 in your DN4 test, then you know the patient’s got neuropathic symptoms.

If you get less, then you know it’s more likely to be neurogenic rather than neuropathic. So, most sensory symptoms will have a good range of movement, and most motor symptoms will actually demonstrate weakness and stiffness and or disuse. But you very often get a combination of both sensory and motor nerve [00:55:00] injuries. So most sensory symptoms and pain will respond or demonstrate change within three treatments. And most, most motor symptoms that are acute will also respond within or in three treatments. And most chronic symptoms or motor symptoms may take 6 to 12 treatments to demonstrate improvements. But once you’ve got your improvement, you can carry on for as long as necessary.

And we can actually maintain patients and prove that nerves can respond even if they’ve been dormant for a long time. And if you maintain the muscle, the muscle contraction in, in a patient, let’s say, with the hemiplegia, you are helping circulation in that, that limb and improving quality of life for that patient.

So the treatment of various regions in the body. You need to treat the relevant nerve [00:56:00] supply that influences the area of pain with the active probe connected. This may be a nerve root emanating from the relevant facet joint, plexus, e. g. brachial plexus, made up of roots from C4 to 8 and even T1, the cords, the trunks and the individual nerves.

So, go to your anatomy books and look whether it’s radial, median, median or ulnar nerves. large nerve branches, and then proceeding to the smaller branches, as soon as you get relief of pain, of pain, then start going down to the smaller branches. You can go right onto the hand, as long as you don’t get exacerbation, but by then you should not be, and you’re probably going to get an excellent result.

If pain is severe, commence with a section of nerve tissue that is more proximal, upstream to the painful area. Don’t go onto the painful area if you can help yourself is if treatments applied on a very [00:57:00] sensitive nerve area, then pain may increase. It may increase, uh, increase, improve over time, but it may also exacerbate the condition.

You know, we always try not to irritate a patient. I always try, but sometimes it actually helps when you do irritate, but it’s rare for us to actually go to do that.

So in this diagram you’re seeing the sciatic nerve and I’m just allowing myself to let you look at it so that we can discuss what we gain, how we’re going to treat it.

So you can see the sciatic nerves from L, it’s from L4 as we know down to S1. And, um, you can see the different nerve supply, the common peroneal, the inferior gluteal, superior gluteal, and you’ll also be able to see the pudendal nerve and the anococcygeal nerve, which is situated in the lumbosacral, trunk and plexus and you can [00:58:00] even see the sympathetic trunk in the picture next door and you can see you can treat the anus you can treat vagina you can treat testicles you you can treat many different areas that are very difficult to treat and you don’t have to get so close to the the area you can treat the pudendal nerve you can also treat the tibial nerve in the medial aspect of the ankle.

And here again, I just show you diagram of the sciatic nerve because if even if you can’t activate the nerve in some circumstances, you might even want to go, and you might actually want to go lower down into the leg where you can activate your, your sciatic nerve and it, it, it will help to stimulate the sciatic nerve in the just underneath the piriformis in the buttock.

So you are helping the nerve get, get stimulation all the way to the spinal cord. Again, I’ve just, I’ve just [00:59:00] demonstrated to you how complex the sciatic nerve is in the posterior aspect of the knee and how it bifurcates to form the common peroneal quite high up and sometimes you can’t get any stimulation at that point and you actually have to go laterally to pick up the peroneal nerve.

Okay, Michelle. And then let’s look at the normal placement of electrodes. In this patient to get the sciatic nerve in the, the buttock, I like to get to the gluteal fold first. Very often I’ll stimulate that because I can pick that up more easily than if I go into the buttock. So I’ll put my probe in this region.

I’ll put the round square electrode on the opposite side. I might even place it on the leg, the opposite leg, or anywhere else but far away so that I know that the nerve conduction is going to go into the spine rather than just [01:00:00] going between the electrodes. So this is the normal way to do it.

Okay, so I don’t need to mention that because now we’ve spoken about that. Now I’m going to show you, um, how I’ve managed to find the sciatic nerve when it’s very difficult. I’ve placed my, I placed the ground or reference electrode centrally on the spine between L5 and S1, or I placed it on the sacrum between S1 and S2.

And then I might have even placed it laterally, adjacent to the spine at the appropriate, appropriate levels above. And then I placed the, active electrode, the probe on the crease on the, crease between the upper thigh and the buttock, the gluteal fold. And now that means that the two electrodes are very close together.

I will use gel on the skin. And then I’ll move my electrode along the gluteal [01:01:00] fold until I pick up a pulse. It might be, closer to the, middle of the buttock, or it might be further out. Every patient is different and sometimes patients have got one side different to the other with the sciatic nerve.

Once I’ve picked up the actual stimulation, then I will switch off the current and move the reference electrode to the other side. And you will still see this, and you’ll then turn up the current again, and you’ll still see the same type of nice pulse that you’ll get along the gluteal fold as you had before, when the electrodes were close together.

And that’s the, and then you will be able to give a really good treatment because you’ve been much more accurate in actually finding the sciatic nerve. Then you may proceed up along that gluteal fold. You can decrease or increase your parameters to provide a comfortable and definitive fasciulation with the pulse [01:02:00] emanating from the sciatic nerve.

So now place the ground electrode as mentioned in the previous slide for the gluteal fold Move cephalad more superiorly and vertically into the buttock with your probe, from the point, previously detected on the gluteal fold. It’s almost in a straight line above that. Until a point of fasiculation is observed.

Now you’re very close to your reference electrode. This point may appear above the sciatic nerve on the gluteal fold on the buttock. And. you will be able to get exactly the same effect. As soon as you see the fasiculation, you switch off the current, you move the reference electrode to the opposite side, and then you increase your current again.

But maintaining your probe on that same point in the buttock as you had, and you will then see the stimulation again. But your point of reference is the sciatic [01:03:00] nerve on the gluteal fold, and thereafter in a line above this point. It is very useful to use this. And, I won’t go on to speak about the difference because we’ve now discussed it, but once the sciatic nerve has been located, you will find that, that you will have a very good treatment for this patient.

Now, this is a patient who is 86 years old and had severe pain and degenerative changes in his spine. He didn’t have pain, in his leg. He was in a wheelchair, he was emaciated, and he was sedentary on his bed. So you can see that the square, the ground electrode is placed on his sacrum. And there I am very, very close to it.

I started off on the gluteal fold and then I moved directly up. You will see. He had poor fasiculation, [01:04:00] very poor at first, and then it improved and it was very difficult to find the correct area. Usually you will see the stimulation, but it seems that you can’t get it on your slide. It was moving absolutely beautifully.

And after five treatments, he was able to exercise, use a walker, socialize, and he had a better quality of life. So, critical information for treatments with Stimpod are: Use a gel or even a disinfectant on the surface to be stimulated. Most patients respond to 2 hertz and 2 millisecs, 0. 2 millisecs of current in the, with their parameters.

Most patients respond to 5 or 10 minutes of treatment time. You know, sometimes if a patient has got a really severe problem, I might do 20 minutes on the actual nerve. It depends on what’s wrong with them. Severe pain or chronic pain or disuse may have a weak or no response to Stimpod stimulation.

This then requires [01:05:00] very accurate anatomical placement and sometimes I actually chase the nerve. I was discussing this with Corlius yesterday. I will bring my reference electrode very close to my active electrode, my probe. So I will follow down the nerve as far as the nerve allows me to go. And then I’ll place my reference electrode on that point, and then I’ll move down with my active electrode further down the leg, for instance, to the area that’s actually not activating and sometimes I can get activation, but that’s just to wake up the nerve. And then I’ll go back to my usual position of at a great distance from the nerve. So it’s just, it’s experimenting with the nerve as you work to get patients to get improved, fasiculation in that nerve and nerve conduction.

As pain or disuse [01:06:00] improves, fasciculation will spontaneously improve, even during one treatment. This implies that the nerve is recovering or changing as we stimulate it, and over time the fasciculation response spontaneously, due to resetting of nerve responses, improves. It can be even with once weekly treatment, and sometimes I actually like the patient to have treatment at a once a week because I find that activities improving and improving.

It gives a chance for the nerve to get better on it from the stimulation you’ve given on its own without interference. And then you might even get the patient getting better faster. Once responses have normalized pain is reduced or relieved completely. And many patients have demonstrated even years later they’ve never had any further pain from or symptoms.

So a generic treatment is treat the nerve supply that influences the area of [01:07:00] pain. Treat for five minutes on each nerve site. Make sure it’s comfortable for the patient. Increase the current if it’s not uncomfortable. Start with a width of 0. 1 millisec and 1 hertz at 30 milliamps and proceed to 0. 2 millisec and 2 hertz and try to get 15.

to plus milliamps, and that’s what’s recommended by Algiamed. And if it’s uncomfortable, decrease the current intensity. Treat three times a week if acute, treat twice or once weekly if chronic, and after three treatments, changes should occur, or even resolution. If I treat once weekly and continue if progress is made until resolution.

It doesn’t matter if you have to do 20 or 30 treatments. If the patient’s getting better, that’s fine. Then resolution sometimes occurs in three to four weeks. Even if If they haven’t had relief [01:08:00] initially. If there’s no improvement after six treatments, then give it a month, a month before you start to treat again, or change the position of the treatment completely.

But if there’s some improvement, it’s usually all goes well for the future. The process of progress continues after treatment is given due to changes occurring in the nerve fiber. You actually are improving. healing the patient by giving this treatment. So, how to treat? Most nerves have both motor and sensory components, except for the senses.

In sensory conditions, you usually have full range of movement. Sensory nerve are the afferent fibers, which are usually mixed sensory and motor nerve bundles. And if you have neuropathic pain, you’re going to have burning, twinging, electric shocks, and even painful cold. With neuropathic symptoms, you’ll have [01:09:00] tingling, pins and needles, numbness.

Touch may send signals proximally and even centrally, and may give you problems with positional awareness. That’s with your neuropathic symptoms, and if it’s a neurogenic injury, such as with spondylosis, it may include nerve root compression. You may get tingling, numbness, and even burning. And measure, you should measure or note the level of current intensity, and measure or note the changes in sensation.

The results of treatment decrease pain and allodynia. This may take between one to three treatments and it may only occur after three to four weeks. If it’s motor conditions you’re treating, they may not have full range of movement and pain may be the limiting cause of lack of range of movement due to stiffness from arthritis, damage to bone, joints and muscles, and then you should treat the joints as well with [01:10:00] Stimpod.

And neuropathic and allogenic conditions. The results of treatment should be decreased pain and increased range of movements and strength because you’ve stimulated nerve supply to the muscles. This may take between one to three treatments or even occur after three to four weeks. and weakness or disuse due to stroke, traumatic brain injury, para or quadriplegia.

Start the treatment as soon as possible. If you can get in there and treat the first week or 10 days after the impact or injury, you should, because then the nerve can heal. may have a chance of recovering more than what you would have got if you leave it to become dormant. Although, I do notice with, Stimpod treatments, it doesn’t matter how long you, you wait before you actually start treatment, you still get improvement.

So the motor nerves will be the efferent fibers [01:11:00] will fasiculate when stimulated, will stimulate a muscle twitch. You must notice the muscle twitch that you are getting stimulated from the nerve. Measure or note changes in the fasiculation and level of intensity and expect increase of strength and functional movements and note those improvements.

Thanks Michelle. So treatment protocols. Determine the type of nerve condition. If only sensory changes are the main target, pain or sensory symptoms, select the relevant nerve site that supplies the area. Select a nerve branch that is not in the affected area of the pain. It will be a mixed nerve. You may see a fasiculation.

Start with low current intensity, increase only if comfortable for the patient, and it could be 5 to 10 minutes. Note the highest level of intensity achieved, and treat once, twice, or three times [01:12:00] weekly. If there’s improvement in sensation, proceed to a more direct area of the nerve supplies I already mentioned.

Repeat and progress, and progress will either continue, or continue. or decrease temporarily or resolve the condition with one to three treatments or more treatments. I do want to mention that when you use, when the patient is very sensitive and that they start to tell you that the probe is burning, just use more gel and then you might find that you may not actually be touching the skin, but you’ll be working on the gel and it will still stimulate or fasciculate the nerve and the patient will find that more comfortable and then after a while you’ll be able to rest on the skin itself. So If only motor changes are the main target, disuse or weakness, select the relevant large nerve site that supplies the area first, such as brachial plexus.

It [01:13:00] will be a mixed nerve. You may see no fasciculation, but your aim will be to get as much fasciculation as possible. Start with low current intensity. Increase only if it’s comfortable with the patient. 5 to 10 minutes, even progress here to 20 minutes if your target is strengthening. Note the highest level of intensity achieved, treat once, twice or three times weekly, and if improvement, then progress to treat the more peripheral of the motor nerves and even muscles in spasm.

If pain from joints, tissues or others present, limiting movements, then repeat as for sensory nerves. Repeat for motor nerves as we mentioned in sensory and continue once to once and you should see the condition respond between one to three treatments or even a month later or even a few weeks later. So now you should know when we should start to treat the patient, how to find [01:14:00] the optimal point of stimulation for any given treatment, the fasiculation of muscle movement to expect while looking for a most superficial aspect of a motor nerve.

You could, if you, if you’re treating the femoral nerve, you’re going to expect to see the vastus medialis muscle or even the rectus femoris muscle, you must look to see that you’re getting fasciculation in those and muscle contraction in those areas, how much pressure to apply depending on the patient sensitivity, how to determine the correct current setting for any given treatment for any patient.

If you want to, if you feel it’s, it’s too much for the patient, then you just reduce it, but gradually you will be re-educating the nerve during the treatment and between treatments. How long a stimulation session should last for any given treatment or how to determine, you can decide from what we’ve discussed.

And do you know any mandated [01:15:00] time restrictions for treatment? I would say, I can’t imagine any mandated time restrictions for treatment.

So my conclusion to you is that where there’s pain, treat the neural system first. Where there’s weakness or disuse from any etiology, treat the neural system to assist muscles to strengthen.

Most conditions will benefit from stimulation of the nervous system. I just want to go back to saying that If you treat the neural system, we are affecting the muscles. Usually when we want to treat the muscles, we will use phoretic current, but you are actually assisting muscles in, in a sort of method like phoretic would do, but in a totally different way.

And then when you do use a phoretic current, you’re going to get a much better result. I just wanted to say that I have got a detailed, NMS 460 model, module with [01:16:00] explanations, relevant research diagrams and information on conditions and areas relevant to various treatments. And you can access that from my website, which is phyllisberger.com. And thank you for listening.

Thank you for sharing. You have a vast knowledge of Stimpot and I mean that Phyllis has been using Stimpod for more than 14 years now, am I right? 15 years, yes. And I also want to thank you for always answering the hundreds of questions on the Stimpod forum. Very quick to respond.

And I think the forum has helped so many, uh, of the physios and chiropractors since, um, you’ve been helping. So I’m sure these quite a bit of questions I’m going to open the chat. Let’s see. It’s a little bit slow. Sorry. All right. So the first question is how [01:17:00] high should you, I think you’ve answered most of these questions, but let’s go through it.

How high should you set it until the twitch or as high as the patient can tolerate? Well, if you start off and you can’t, let’s say you know you’re absolutely on that nerve. What I do is I turn it up as high as possible. Let’s say I’m doing the brachial plexus. I will turn it up and I’ll say to the patient, I’m going to turn this up very high until I get a response.

And then I’m going to turn it down to your comfort level. And that’s, that’s how I start. And usually, with the brachial plexus, you will see. Unless they’ve got damage to the brachial plexus, then I’m going to go to the facet joint in the spine, in the cervical spine for that particular region. And I will, I will go down to a comfort level for the patient once I’ve got a fasciculatory response.

Next last question. We only have two questions. I don’t know [01:18:00] what’s going on. Yeah, I think your your presentation was super comprehensive to say the least. So treating the neural spot of a wound. I assume that is once the wound or incision has healed. Absolutely. I never would treat a wound that is open anyway, and you’ll see that in my module.

But the main thing is you can treat at one, at either end of the wound to start with, and you don’t even get onto the wound. You can treat just upstream or downstream of the stream of the wound initially, even if there’s still stitches, even if the wound is not completely healed. And once the wound is healed. Usually by the time we get these post, surgical pains, they have we healed. And there’s a lot of pain from these patients. I actually saw a patient just recently who had many surgeries to his hip joint and they [01:19:00] thought it was coming from the spine. And all I did was go over all those four surgical interventions that he’s had two, three years later, 2019, and the pain resolved in one treatment, one treatment, and it had interventions, injections, surgeries, you name it.

Thank you. So, can Stimpod be used for bone mets pain or fractures? I think it can. I would use the proximal region again, but I would not like to do a fasciculation on the fracture site. I think you should avoid that. You know, we don’t know yet what the nerve will do, the vibration will do to a fracture.

So I would therefore never actually treat over the fracture site until, you know, it’s really healed. [01:20:00] Let’s say it’s six months down the line and it’s a femoral, it’s been a femoral fracture, then I might, but otherwise not, especially if the x ray, shows that it’s, that it’s healed.

All right. Has anyone had any experience in the veterinary physio with the Stimpod?

We have, right? Yes, we have. And, I’ve actually treated animals as well. In the early stages, of the Stimpod development. I treated animals, in the veterinary physio world, but not for, not many. And they did respond. You would have to shave their skin so that you could actually get, to the nerves and especially with these poor animals that have had spinal surgery.

I think they would respond brilliantly. And, I would do that. Sciatic nerve, and brachial plexus.

All right, thank you. Any [01:21:00] suggestions for paresthesia post brachial plexopathy? Stimpod broke the pain but not the, the paresthesia. Yes, I would go to the facet joints, as high as you can go, at, at the relevant level and I would treat.

And, yeah, I would, I would. And you can actually go into the limb itself and treat the nerve that’s affected most. I, I go everywhere. Nothing stops me in any place on, on the limb that requires stimulation. And I’ll do my best to get stimulation with Stimpod because I think it’s a brilliant machine for stimulating nerves in many ways.

I think you will find, you will, you will become researchers in your own right when you start to discover how you can help patients. You must broaden your mind so that you can think of different ways to help patients using the Stimpod.

So I have a compliment for you. [01:22:00] Profs module is extremely informative and this webinar has just added so much value. From Danny.

Thank you, Danny. Thanks. I’m so glad it helped you. And then another question, can you explain how you use Stimpod for long COVID?

Yes, I would use it, I would use it in the ear. I would use the vagus nerve and, I would, that’s where I would use it. And I would use 10 minutes on the left and 10 minutes on the right vagus nerve.

Awesome. And then let me just check the Q and A for last questions. If anyone has any questions, you’re welcome to also just ask. You can switch on your mics if you want to. I think we are done with all the, all the Q and A questions and chat questions. Good. That’s very good. And you can always email me, you can phone me, you can do it on our, our forum.

Any questions, I’m [01:23:00] happy to answer. And if I don’t know, I’ll look them up and find out for you. Thank you. Have a lovely evening everyone. Thank you. Goodbye. Goodbye. Bye.

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