Frequently Asked Questions

Clinics

ABSOLUTE CONTRAINDICATIONS:

• Patients with pacemakers or internal electronic devices.

• Pregnant women.

• Patients experiencing internal bleeding.

• Patients with acute febrile conditions.

• Patients with acute thrombophlebitis.

• Patients suffering from hysteria or electrical sensitivity.

• Individuals with neurotic addiction to stimulation.

• Avoid vaccinations four months prior to initiating or during treatment.

RELATIVE CONTRAINDICATIONS:

• Cancerous or neoplastic conditions.

• Epilepsy and/or choreic syndrome.

• Sensory impairment.

• Dermatological conditions: Mycosis and pyogenic dermatitis.

• Patients with skin lesions, psoriasis, ulcerations, wounds, or skin irritation should have the fitting of gloves, anklets, and directional padding adapted.

PRECAUTIONS:

• Avoid patient contact with electronic devices.

• Exercise caution regarding exaggerated neurovegetative responses.

• Ensure understanding of the use of gloves, anklets, etc.

• When applying to minors, especially for shorter periods, ensure appropriate supervision.

• Do not place electrodes on endocrine glands without medical supervision.

. • Remove surface metals from the body (such as metal bracelets, rings, necklaces, etc.).

• Adjust programming for highly sensitive individuals.

RARELY:

The potential risks associated with the application are exceedingly low, typically minimal, and predominantly observed during the initial sessions, contingent upon proper application. Nevertheless, they may include:

  • Rarely, some old pain may appear, which disappears with successive sessions. Rarely, there may be a slight feeling of dizziness during the first few sessions. Rarely, there may be a slight feeling of dizziness during the first few sessions.
  • Rarely, it may cause restlessness at bedtime during the first few sessions.
  • Rarely, it may produce a slight increase in momentary pain.
  • Very rarely may cause oedema or erythema.
  • Very rarely may cause micro-burns on the skin.

Due to the utilization of low-intensity and low-frequency electrical stimuli, it is advisable to adhere to the following guidelines to optimize their effectiveness:

  • Regard the treatment period as a time for relaxation and enjoyment.
  • Refrain from using mobile phones or any other portable electronic devices that may cause distractions during your session.
  • Avoid external stimuli that could disrupt your state of relaxation.
  • Prefer a book or other non-electronic resources to aid relaxation.
  • Listen to calming music to enhance your personal relaxation and facilitate recovery time for both you and your family.

NESA® Non-Invasive Neuromodulation is an advanced technique that offers significant benefits to a wide range of patients, particularly those experiencing conditions related to autonomic nervous system imbalances.

Patients who derive the most benefit from this technology include those with:

Chronic pain, neuropathic pain, and inflammatory conditions: Positively impacts the vagus nerve, pivotal in regulating chronic pain and systemic inflammation.

Anxiety and hypervigilance: Improves physical anxiety sensations and reduces hypervigilance, inducing a state of calm and relaxation.

Insomnia and sleep disturbances: Enhances REM and non-REM phases, thereby improving sleep quality.

Overactive bladder and urinary incontinence: NESA® Microcurrents decrease voiding frequency and enhance voiding control.

Fatigue and metabolic issues: Supports mitochondrial metabolism, increasing energy levels and reducing fatigue.

Tissue regeneration: Beneficial for patients undergoing traumatic or post-surgical recovery, facilitating damaged tissue reconstruction.

Specific conditions: Addresses a variety of issues including sexual dysfunctions, nervous atopic dermatitis, bruxism, headaches, neurological disorders, constipation, and more. Offers a systemic and comprehensive approach to patient treatment, ensuring proper vagal tone in the autonomic nervous system.

NESA® Non-Invasive Neuromodulation distinguishes itself by providing an integrative solution, collaborating with the body to promote self-regulation and overall well-being. It represents a valuable therapeutic option for individuals seeking relief from diverse health conditions, exploring alternatives beyond conventional methods, and embracing innovative healthcare approaches.

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Neuromodulation of the autonomic nervous system (ANS) holds paramount significance in clinical practice due to several pivotal reasons directly impacting patient health and well-being:

Regulation of Vital Functions: The ANS governs crucial bodily functions such as heart rate, digestion, respiratory response, and blood pressure. Its precise modulation ensures bodily equilibrium and homeostasis, vital for sustaining health.

Management of Stress Response: ANS neuromodulation aids in managing the body's response to stress. By balancing the sympathetic and parasympathetic components of the ANS, it mitigates the adverse effects of chronic stress, associated with various health conditions including cardiovascular diseases, sleep disorders, and digestive issues.

Enhanced Recovery and Pain Management: ANS neuromodulation proves particularly advantageous in chronic pain management and injury recovery. By influencing the ANS, it accelerates healing processes and diminishes pain perception, facilitating swifter and more efficacious recovery.

Impact on Mental Health: ANS balance significantly impacts mental well-being. Neuromodulation alleviates symptoms of anxiety, depression, and other mental disorders, thereby augmenting patients' quality of life.

Disease Prevention: Maintaining ANS equilibrium contributes to the prevention of chronic diseases. Neuromodulation aids in averting or managing conditions such as hypertension, type 2 diabetes, and certain autoimmune diseases.

Personalized Treatment: ANS neuromodulation enables tailored treatment approaches, addressing individual patient nervous system requirements. This personalized approach is pivotal in achieving optimal clinical outcomes.

Essentially, ANS neuromodulation stands as a potent clinical tool, providing pathways to improve overall patient health and well-being by regulating essential bodily functions, managing stress, alleviating pain, supporting mental health, preventing disease, and implementing personalized treatment strategies.

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The first steps we recommend are:

Start with straightforward cases: We recommend commencing treatment with patients who have few comorbidities and clear, singular goals. This simplifies the use of the technology and helps to bolster confidence.

Example of an ideal patient to start with: A patient experiencing fatigue following prolonged specialization, with no additional symptoms, serves as a suitable starting point. This enables focus on a clear and uncomplicated objective.

Utilize available resources: Emphasize the importance of utilizing basic information, protocols, clinical cases, and testimonials accessible on the clinical guideline’s campus (included in the technology; refer to Training FAQs). These resources are indispensable in supporting the treatment of initial patients.

Building confidence and expertise: Over time, confidence in using NESA® Microcurrents and one's own proficiency will grow. This enables tackling more intricate cases with increased assurance and sharing personal clinical experiences and rationale with patients.

Complex case as an example: Consider the treatment of a patient with chronic fatigue, disrupted sleep quality, headaches, and diagnosed with post-COVID syndrome as a complex case example. While both simple and complex cases are suitable for NESA® Microcurrent treatment and yield positive responses, the latter necessitates deeper clinical reasoning and greater confidence in the process.

From a clinical management perspective, it is crucial to provide a supportive framework and guidance for practitioners embarking on integrating NESA® microcurrents into their practice. We present an adaptation of these guidelines to facilitate their implementation from a clinical management standpoint.

Recomendaciones para la integración de Microcorrientes NESA® en la práctica clínica

Careful selection of initial patients: Encourage practitioners to initiate their experience with NESA® Microcurrents by treating patients with simpler conditions and clear treatment goals. This not only facilitates a smoother learning curve but also helps in building confidence in the technology and in their own clinical skills.

Training and utilization of resources: Ensure that all staff acquaint themselves with available educational resources, including protocols, clinical guidelines, and patient testimonials. Clinical leadership is committed to providing access to these materials and fostering a culture of continuous learning.

Building confidence through experience: Acknowledge that confidence and competence develop over time. Encourage professionals to gradually transition to more complex cases as their experience and confidence grow, always with the support of clinical management and experienced healthcare colleagues.

Sharing experiences and best practices: Stress the importance of collaboration and knowledge sharing for clinical success. Promote case discussions, experience sharing, and peer mentoring to enrich the clinical approach and enhance patient outcomes.

Continuous evaluation and practice improvement: Commit to regularly evaluating the efficacy of NESA® Microcurrents within the practice, adjusting protocols and treatment strategies as necessary to optimize patient care and outcomes.

Supporting professional development: Recognize the significance of continuous professional development. Support staff in their learning journey with NESA® Microcurrents by offering advanced training and skills development opportunities.

Through the implementation of these guidelines, clinical management aims to create an environment conducive to the successful integration of NESA® Microcurrents into the practice, ensuring that both the team and the patients fully benefit from this innovative technology in daily clinical practice.

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Utilization of the directional electrode in clinical practice with NESA® Microcurrents:

Significance of the directional electrode: It is indispensable for the efficacy of NESA® Microcurrent treatment. Incorrect utilization or omission of the directional electrode can lead to ineffective treatment.

Accurate positioning of the electrode: The placement of the electrode should be guided by thorough clinical rationale. Maria Gonzalez underscores three primary options for electrode placement: central, metameric, and focal.

Central (C6-C7): Employed in the initial phase of treatment and in scenarios where a global effect is desired, such as ameliorating sleep quality, chronic fatigue, generalized pain, and stress.

Metameric: Selected to target specific regions or core segments. This placement may follow the central location during the impulse phase, though it is not strictly requisite.

Focal: Employed to concentrate electrical impulses on a precise point, ideal for addressing delimited areas of pain or influencing specific systems such as the gastrointestinal tract.

Recommendations for clinical practice:

  • • Initiate treatment with the central placement of the electrode to acclimate to the technology and its effects.
  • • Advance to metameric and focal placements as confidence and expertise grow.
  • • Contemplate employing focal treatments directly on patients previously exposed to NESA® Microcurrents or as an adjunct to other therapies.
  • As proficiency is gained, integrate the three electrode placements (central, metameric, and focal) to enhance outcomes and expedite the recovery process.

Continuous training and knowledge dissemination: It is imperative that clinical management promotes ongoing training in the utilization of NESA® Microcurrents and the directional electrode. Sharing experiences and best practices among staff can enrich collective knowledge and enhance treatment outcomes.

Personalization of treatment: Bear in mind that each patient is unique, and treatment should be customized to their individual needs. The selection of the targeting electrode location is a pivotal aspect of this customization.

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Existing treatments with NESA® medical technology are as follows:

(EN) WATCH VIDEO Treatments possible with NESA® medical technology. Global, Metameric and Focal 2024

CENTRAL TREATMENT WITH NESA® NEUROMODULATION

What does central treatment involve?

Central treatment is a method for neuromodulation of the autonomic nervous system, focusing on the brachial plexus and the cervical spinous processes C7 to C5. This approach is used to optimise the central nervous system, improving sleep quality, relieving chronic pain, reducing stress and anxiety, and increasing slow brain waves associated with the parasympathetic autonomic nervous system.

Clinical applications of central treatment

Applications include its use as a complement to other therapies for global modulation of the nervous system and as a stand-alone therapy for specific conditions such as stress or sleep problems. Depending on the chronicity of the dysfunction, a minimum of 10 sessions is recommended, and the treatment can be extended as needed.

Reason for electrode placement at C7

The location of the electrode at C6-C7 is strategic, allowing a global effect without directly affecting any specific structure. This position is key to intensifying treatment and focusing on target areas, facilitating effective and global neuromodulation.

METAMERIC TREATMENT WITH NESA® NEUROMODULATION

What is metameric treatment?

Metameric treatment uses NESA® Non-Invasive Neuromodulation to maximise the functionality of body structures by influencing the afferents and efferents of the main nerves of the spinal cord. This method focuses on the structures directly innervated by the target metamere, applying the treatment to the spinous or transverse process of the corresponding vertebrae.

Main applications of metameric treatment:

  • • Neuropathic pain
  • • Influence on the autonomic nervous system in organs and viscera innervated by the spinal nerves (example L3 and S1-S2 for the influence of the autonomic branches of the bladder) (example C4, for the autonomic influence of the phrenic nerve).

This treatment is effective for the relief of neuropathic radiating pain, improvement of overactive bladder, and enhancement of tissue thixotropy, among other applications. It is based on addressing the pathology from the specific metamere, i.e. the vertebral segment that provides innervation to the affected anatomical structure or plane.

How are metameric treatment applications determined?

Applications are based on detailed clinical reasoning and treatment goals, considering the neuroanatomy and functionality of the 31 spinal nerves. This treatment can be used either as an adjunct to other therapies for specific modulation of structures or viscera involved in the autonomic nervous system, or as a stand-alone therapy in settings designed for specific clinical targets.

General reminder of the metameric nerve branches:

Structural: Cervical nerves (C1-C8)

C1-C4: Innervate the back of the head, neck, and shoulders. C3-C5 are especially important for the innervation of the diaphragm, crucial for breathing.

C5: Innervates the deltoids (shoulder muscles) and biceps, allowing abduction and flexion of the arm. Injury here can result in paralysis of the deltoids and biceps (arm palsy).

C6: Affects the muscles of the forearm, allowing flexion of the wrist and extension of the elbow. Injury can cause loss of control of these movements.

C7: Operates a crucial role in wrist and elbow extension, innervating the triceps. Injury to C7 can impede these movements.

C8: Controls fine movements of the hand, innervating the intrinsic muscles of the hand. Injury can result in difficulties with manual dexterity.

Functions in the autonomic nervous system: Cervical nerves (C1-C8)

Cervical nerves and autonomic innervation

C1 to C4 (Cervical Plexus): Although their main contribution is towards somatic innervation of the neck, upper shoulders and back of the head, the upper cervical nerves also have sympathetic fibres that join with cranial nerves to influence functions such as pupillary dilation and facial sweating. These fibres form the cervical plexus, which can indirectly affect autonomic function in the head and neck.

C3, C4, and C5: Contribute to the phrenic nerve, which is crucial to respiration by innervating the diaphragm. Although primarily somatic, it is vitally important in the autonomic function of maintaining respiration.

C5 to C8 (Brachial Plexus): These segments form the brachial plexus, which mainly innervates the upper limbs. However, sympathetic fibres passing through the brachial plexus can influence sweating, blood flow and piloerection (hair erection) in the arms and hands.

Contribution to the sympathetic nervous system

The cervical nerves also play a role in the sympathetic nervous system through the cervical sympathetic chain, which runs the length of the neck. This chain contains three main sympathetic ganglia:

Upper cervical ganglion: Affects the eyes (pupillary dilation), the lacrimal and salivary glands, and the skin of the head and neck (sweating and piloerection).

Middle cervical ganglion: Influences the salivary glands and the skin of the neck.

Inferior cervical ganglion (often fused with the first thoracic ganglion forming the stellate ganglion): Has effects on the heart (increased heart rate) and lungs (dilatation of the bronchi).

Clinical relevance

Cervical autonomic innervation is crucial for the "fight or flight" response, preparing the body for stress or emergency situations. Dysfunction in this innervation can lead to conditions such as Horner's syndrome (ptosis, miosis, anhidrosis) due to disruption of sympathetic fibres to the eye and face, or problems with heart rate regulation and breathing.

In summary, although the cervical nerves are more associated with somatic innervation, their contribution to the autonomic nervous system is vital for autonomic function in the head, neck, and upper limbs, as well as for the regulation of vital functions such as respiration and the cardiovascular response to stress.

Structural: Thoracic nerves (T1 to T12)

T1: Involved in the innervation of the lower arm and hand, especially on the medial side. It contributes to the brachial plexus and is essential for hand motility and sensation. Injury to T1 can affect dexterity of the hand.

T2-T6: Innervate the rib cage and are mainly involved in the innervation of the intercostal muscles, which play a crucial role in respiratory mechanics. Skin sensation over the thorax also depends on these nerves.

T7-T9: They continue to innervate the rib cage and begin to contribute to the innervation of the upper abdominal wall. These nerves are important for the structural integrity and function of the abdomen.

T10: Innervates the skin around the umbilicus and plays a role in the sensation of this area. It is a key reference point for dermatomic distribution.

T11-T12: Innervate the lower abdomen and pelvic region. These nerves are important for sensation and motility in these areas, including contributions to the control of the lower abdominal muscles.

Functions in the autonomic nervous system: thoracic nerves (T1 to T12)

T1 to T4: These segments are primarily involved in the innervation of the heart and lungs via the sympathetic nervous system. The nerves of these segments contribute to the formation of the cardiac plexus, which regulates the rate and strength of the heartbeat, and the pulmonary plexus, which affects bronchodilation and bronchoconstriction.

T5 to T9: Innervate the upper abdominal viscera, including the stomach, liver, pancreas, and spleen. These nerves form part of the celiac and superior mesenteric plexus, regulating functions such as gastric secretion, gastrointestinal motility, and blood flow to these viscera.

T10 a T12: Affect the lower abdominal viscera, such as the intestines and, in part, the kidney. These segments contribute to the lower mesenteric plexus, which regulates intestinal motility and the function of organs involved in food absorption and processing.

Sympathetic innervation of these organs and viscera is via the paravertebral ganglia of the sympathetic chain and the prevertebral ganglia. Sympathetic nerves prepare the body for "fight or flight" situations by increasing heart rate, expanding the bronchi, inhibiting gastrointestinal motility, and directing blood flow to skeletal muscles.

Importantly, autonomic innervation also includes the parasympathetic nervous system, which generally has an opposite effect to the sympathetic, promoting "restoration and digestion". However, the main parasympathetic nerves for the thoracic and abdominal organs do not emerge from the thoracic nerves, but mainly from the vagus nerve (cranial X) for the thoracic and upper abdominal viscera, and from the sacral segments for the lower abdominal and pelvic viscera.

The interaction between the sympathetic and parasympathetic systems ensures a proper balance for optimal functioning of the body, adapting to the changing needs of the organism and maintaining homeostasis.

Structural: Lumbar (L1 to L5) and Sacral (S1 to S5) Nerves

L1: The iliohypogastric nerve emerges from L1, innervating the skin over the pubis and lateral thighs. This nerve plays a role in the sensation of these areas and in abdominal tension.

L2, L3, L4 (Lumbar Plexus): Innervate the thigh muscles, allowing flexion of the thigh over the pelvis (L2-L3) and extension of the leg at the knee (L3-L4). These nerves also contribute to the sensation of the skin of the thigh and the medial part of the leg.

L4, L5 (Lumbosacral Plexus): Together, they innervate the muscles that allow dorsiflexion of the foot (lifting the foot upwards) and extend the toes. Injury can result in foot drop and difficulty walking.

S1, S2: Innervate the muscles of the back of the thigh, leg and foot, facilitating knee flexion and plantarflexion of the foot (pushing down, like stepping on the accelerator). They also contribute to the sensation of the back of the leg and foot.

S2, S3, S4: These nerves are essential for the control of urination, defecation, and sexual function, innervating the sphincters and pelvic organs.

Functions in the autonomic nervous system: Lumbar (L1 to L5) and sacral (S1 to S5) nerves.

Via the lumbar plexus, L1 and L2 contribute to the autonomic innervation of the lower abdominal viscera and external genitalia. Sympathetic fibres from these levels are directed to the upper hypogastric plexus, affecting the function of organs such as the uterus, bladder, and parts of the bowel.

L2, L3, y L4: These segments also participate in the formation of the lumbar plexus, which sends sympathetic fibres via the inferior mesenteric plexus and the superior hypogastric plexus to innervate the pelvic and perineal viscera, including the bladder and rectum, as well as sexual function.

S2, S3, and S4 (sacral plexus): The sacral nerves are vital to the parasympathetic nervous system. The sacral plexus, formed by these segments, is essential for the parasympathetic innervation of the pelvic viscera, including the descending colon, rectum, bladder, and sexual organs. These nerves facilitate functions such as urination, defecation, and erection.

S4 y S5: Although their contribution is more limited, these lower levels of the sacral plexus also participate in the parasympathetic and somatic innervation of the perineum and sexual organs, supporting functions such as sphincter control and genital sensation.

Clinical relevance

The autonomic innervation provided by the lumbar and sacral nerves is crucial to overall health and well-being. Dysfunction in these nerves can lead to a variety of conditions, including urinary or faecal incontinence, sexual dysfunction, and chronic pelvic pain. Detailed knowledge of autonomic innervation is essential for the diagnosis and treatment of these conditions.

In summary, the lumbar and sacral nerves play indispensable roles in the autonomic innervation of the lower body, regulating vital functions related to the abdominal and pelvic viscera, as well as the mobility and sensation of the lower limbs. Their study and understanding are fundamental to address a wide range of medical conditions related to the autonomic nervous system.


FOCAL TREATMENT WITH NESA® NEUROMODULATION

Focal treatment is an advanced technique in neuromodulation that focuses on intensifying the modulation of specific structures via the peripheral nerves that innervate them. This approach causes bioelectrical reorganisation at the site of application, optimising mechanotransduction and improving tissue tensegrity. It is performed by placing the neuromodulation device directly on the peripheral nerve, trigger point, or specific pain area.

What are the main benefits of focal treatment?

This treatment is designed to provide direct, localised relief of radiating neuropathic pain, improve conditions such as overactive bladder, and enhance tissue thixotropy, among others. By acting directly on the affected area, the focal treatment not only relieves pain, but also contributes to the recovery and strengthening of the treated structures.

How is focal treatment applied?

The application of focal treatment is performed on the pain point, trigger point, or directly on the peripheral nerve involved. This technique is particularly useful both for pain relief and for improving tissue function by optimising mechanotransduction and thixotropy in the treated area.

In which cases is focal treatment recommended?

The choice of focal treatment depends on detailed clinical analysis and specific treatment goals, based on the neuroanatomy and functionality of the peripheral nerves. It is commonly used:

• As a complement in the clinical approach to other therapies, to enhance the specific modulation of peripheral nerves.

• As a single therapy in pre-treatment or post-treatment, depending on the objectives and the main therapy applied.

Clinical conclusion

Focal therapy is a powerful tool in the arsenal of non-invasive neuromodulation, offering a targeted solution for pain management and improvement of tissue-specific function. Its precise application, based on a thorough understanding of neuroanatomy and individual patient needs, allows for effective and targeted intervention, opening new avenues for the treatment and recovery of neurological and musculoskeletal conditions.

NESA® Microcurrents offer two treatment modalities to suit the needs and preferences of each patient: passive therapy and active therapy. Both options can be combined throughout the sessions to maximise the benefits.

Passive Therapy:

In passive therapy, the patient comes to the clinic and is placed in a room equipped with the necessary technology. During treatment, the patient can remain seated or lying down in a comfortable position, being free to change position if desired. A healthcare professional customises the treatment based on the patient's answers to a series of daily questions, adjusting the programmes and the location of the electrode addresser. Sessions are usually at least twice a week and last approximately 60 minutes, as in treatments to improve sleep quality.

Active Therapy:

Active therapy allows the patient to combine NESA® Microcurrent treatment with other therapies or exercises they are already doing, thus enhancing the results. This modality is compatible with a wide range of techniques, such as manual therapy, cognitive-behavioural therapy, functional work, balance exercises, speech therapy, etc. It can be used in conjunction with other technologies, excluding some such as high frequency. An example would be any musculoskeletal treatment.

How to choose between passive and active therapy?

The choice between active and passive therapy depends on personal preferences, specific treatment needs and individual patient goals. Both options are valid and can be tailored to provide the best possible outcome.

Conclusion:

Both passive and active NESA® Microcurrent therapy offer flexible and customisable pathways to recovery and wellness. The choice between the two should be based on careful consideration of individual circumstances and treatment goals.

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Anamnesis is a fundamental process in clinical practice that allows healthcare professionals to gather essential information about their patients' health status and medical history. Through a set of detailed questions, they seek to better understand the patient's conditions, symptoms, and life context, which is crucial for accurate diagnosis and effective treatment planning.

How is an effective anamnesis carried out?

We emphasise that beyond the technique, what is important is the quality of the questions asked during the anamnesis. Although health professionals are trained to perform this process, we suggest broadening the focus to aspects that reflect the state of the patient's autonomic nervous system.

Key questions for an anamnesis focused on the autonomic nervous system:

Sleep quality: Do you consider yourself to have a good quality of sleep? Do you rest well?

Recommended test: The Pittsburgh Sleep Quality Index (PSQI) assesses sleep quality and has been used in several studies to analyse the relationship between sleep and autonomic nervous system function (Sato et al., 2014).

Daily energy: Do you have enough energy to function throughout the day or do you feel tired?

Stress management: How well do you manage stress, and have you experienced anxiety?

Chronic pain: Do you suffer from any kind of permanent pain?

Toilet frequency: Do you need to go to the toilet very often, and is your night's rest interrupted by this?

Digestion: How is your digestion? Do you suffer from constipation?

Mood: How do you consider your mood, and do you feel irritable?

Immune system: How would you say your immune system is doing?

Recommended scientifically validated questionnaires or measurements:

Sleep quality and stress:

Pittsburgh Sleep Quality Index (PSQI) and Medical Student Stress Questionnaire (MSSQ): used to assess sleep quality and stress in medical students, showing how stress affects sleep quality (Itagi et al., 2021).

Chronic pain:

Numeric Rating Scale (NRS): used together with the assessment of sleep quality (PSQI) and mood tone (PHQ-9) to analyse the impact of chronic pain on quality of life in patients with systemic sclerosis (Carandina et al., 2021).

Evaluation of autonomous functioning:

Heart Rate Variability (HRV): a measure of heart rate variability as an indicator of autonomic function, used in several studies to correlate with stress and sleep quality (Hirten et al., 2020).

Stress and autonomic regulation:

Various HRV measures and stress assessment scales are used as tools to assess autonomic regulation in different clinical and research contexts, showing their application in the diagnosis and management of conditions related to stress and autonomic dysfunction (Okawa et al., 2019).

SF-36 (Medical Outcomes Study Short Form-36 Health Survey):

One study compared the feasibility and appropriateness of the SF-36 with the EQ-5D-5L version in geriatric rehabilitation patients. The overall feasibility of both questionnaires was confirmed, but the EQ-5D-5L was found to be more suitable for routine use, although the SF-36 could provide a more complete representation of mental health compared to the EQ-5D-5L (Grund et al., 2017).

EQ-5D-5L (EuroQol 5-Dimensions 5-Level Questionnaire):

In a study of patients with femoral neck fractures, both the EQ-5D and the SF-36 showed good levels of responsiveness, being able to capture significant changes in health-related quality of life. Both questionnaires proved to be effective tools for measuring quality of life in younger populations affected by fractures (Honkavaara et al., 2016).

SF-36v2 (Medical Outcomes Study Short Form-36 Version 2):

It was validated in a study in Switzerland to provide normative data, allowing for future comparisons in clinical and population-based studies. Este cuestionario mide la calidad de vida relacionada con la salud en ocho dominios, permitiendo una evaluación integral de la salud física y mental (Roser et al., 2019).This questionnaire measures health-related quality of life in eight domains, allowing for a comprehensive assessment of physical and mental health (Roser et al., 2019).

SF-36 (Medical Outcomes Study Short Form-36 Health Survey):

One study compared the feasibility and appropriateness of the SF-36 with the EQ-5D-5L version in geriatric rehabilitation patients. The overall feasibility of both questionnaires was confirmed, but the EQ-5D-5L was found to be more suitable for routine use, although the SF-36 could provide a more complete representation of mental health compared to the EQ-5D-5L (Grund et al., 2017).

EQ-5D-5L (EuroQol 5-Dimensions 5-Level Questionnaire):

In a study of patients with femoral neck fractures, both the EQ-5D and the SF-36 showed good levels of responsiveness, being able to capture significant changes in health-related quality of life. Both questionnaires proved to be effective tools for measuring quality of life in younger populations affected by fractures (Honkavaara et al., 2016).

SF-36v2 (Medical Outcomes Study Short Form-36 Version 2):

It was validated in a study in Switzerland to provide normative data, allowing for future comparisons in clinical and population-based studies. Este cuestionario mide la calidad de vida relacionada con la salud en ocho dominios, permitiendo una evaluación integral de la salud física y mental (Roser et al., 2019).This questionnaire measures health-related quality of life in eight domains, allowing for a comprehensive assessment of physical and mental health (Roser et al., 2019).

Advice for professionals:

Make your own list of questions: Customise your anamnesis to suit the specific needs of your patients and the focus of your practice.

The art of listening: Remember that, just as it is important to know how to ask questions, it is also important to know how to actively listen to your patients' answers. This not only improves the doctor-patient relationship but can also reveal crucial information for diagnosis and treatment.

Conclusion:

The anamnesis is more than just a simple form; it is a powerful tool that, when used correctly, can open new perspectives on the patient's health. By concentrating on the autonomic nervous system and other potentially less explored aspects, practitioners can obtain a more comprehensive and integrative view, leading to more effective and personalized treatments.

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Why is it important to set goals with the patient?

As Seneca rightly pointed out, "There is no favorable wind for those who do not know where they are going." In the context of NESA® Microcurrent treatments, both the health professional and the patient must be clear about the goals to be achieved. Establecer estos objetivos de manera conjunta y clara es fundamental para guiar el tratamiento hacia los resultados deseados.Establishing these goals together and clearly is fundamental to guide the treatment towards the desired results.

How are NESA® treatment goals set?

Goals must be precisely defined by both the healthcare professional and the patient. It is crucial that these goals are common and documented. Sometimes, the patient may have a single clear goal, such as the treatment of anxiety with sporadic palpitations. However, it is common for a thorough history taking to identify multiple symptoms that can be treated.

What to do when there are multiple targets?

In cases where the patient presents with several treatable symptoms, it is necessary to set goals together with the patient, establishing an order of treatment. This order should be agreed; if the practitioner and patient have different priorities, it is the practitioner's task to explain his or her clinical reasoning to establish an effective treatment plan. Primary and secondary objectives should be defined, as well as an order of approach.

What are the secondary benefits of NESA® Microcurrent treatments?

During treatment with NESA® Microcurrents, you may experience what are called "secondary benefits". These are improvements that are not specifically intended but arise because of the overall approach to neuromodulation with NESA®. It is important to communicate to the patient that, although the treatment is focused on specific targets, the benefits can be wide-ranging and surprising.

Conclusion:

Setting clear, shared goals is essential in NESA® Microcurrent treatments. By working together, practitioner and patient can chart a clear path towards improvement, considering both the primary goals and the secondary benefits that may arise. This collaborative approach not only optimises treatment, but also fosters a relationship of trust and mutual understanding between patient and practitioner.

Recommended Videos:

(EN) WATCH VIDEO: María González, physiotherapist and NESA® expert - Setting goals with the patient

(EN) WATCH VIDEO: Dr. Santiago Garfias, neurosurgeon and NESA® expert Setting goals with the patient

Why is objective assessment important in NESA® Microcurrent treatments?

Objective assessment before, during, and after NESA® Microcurrent treatment is crucial to accurately measure the effectiveness of the treatment. Since we are dealing mainly with symptoms, which are subjective manifestations, it is essential to collect objective data so that the evaluation of the treatment is as little influenced by personal perceptions as possible.

How does the patient's perception influence treatment?

The patient's perception of their condition can be influenced by multiple factors, including previous experiences with other treatments, the length of time their condition has been evolving, their personality, and their general expectations towards treatment. These factors can affect how patients report their progress, which underscores the importance of obtaining objective data.

What methods are recommended for collecting objective information?

It is advisable to conduct a thorough anamnesis and use tools such as scales, questionnaires, and objective measurement devices (e.g. heart rate variability) at the beginning, during, and especially at the end of treatment. This allows a reliable record of the patient's progress and the effectiveness of the treatment.

Why is a final evaluation crucial?

Often, in daily practice, the final assessment may be overlooked due to the improvement observed in the patient during treatment. However, performing this final assessment is essential to confirm the effectiveness of the treatment and to document the patient's progress in an objective manner.

How can objective data benefit the practitioner and the patient?

Objective data provide valuable feedback for both the practitioner and the patient. They facilitate the understanding of the real impact of treatment and help to adjust therapeutic strategies, if necessary. In addition, these data can serve as a guide for the treatment of future patients with similar profiles.

Conclusion:

Objective assessment is a cornerstone of NESA® Microcurrent treatment, enabling accurate evaluation of its effectiveness. By focusing on collecting and analysing objective data, practitioners can offer more personalised and effective treatments, ensuring that patients receive the best possible care. As Socrates said, "The secret of change is to focus all your energy not on fighting the old, but on building the new". We encourage you to adopt this objective approach in your practice to maximise the therapeutic benefits of NESA® Microcurrents.

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(EN) WATCH VIDEO: https://www.youtube.com/watch?v=S9oAIC6pKmo

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Why is it important to educate the patient about the functioning of the ANS?

Patient education about the functioning of the autonomic nervous system (ANS) is critical to their active participation in treatment. Understanding how the ANS works and its impact on health allows the patient to collaborate more effectively in their own care and recovery process.

How should patients be informed about their condition and treatment?

It is crucial to explain to the patient, in an understandable way, what is wrong with them and how NESA® Microcurrent treatment can benefit them. This includes providing daily guidelines, healthy hygiene habits, and making sure the patient understands the information so they can apply it in their daily life.

What is the patient's role in NESA® Microcurrent treatment?

The patient is not a mere recipient of treatment; he or she is an active participant in his or her health process. Patient involvement in their treatment, including understanding and implementing the recommendations given by the healthcare professional, is essential to the success of the treatment.

How can the patient's understanding be facilitated?

Using analogies and tailoring language to the individual patient are effective strategies to ensure that the message is understood. It is important to address key concepts such as bioelectricity, the importance of good coping skills, the role of the vagus nerve, and different ways of caring for oneself that fit the patient's lifestyle.

What concepts should be prioritised in patient education?

Bioelectricity: Explain how bioelectricity works in the body and its relevance to health.

Adaptability: Emphasise the importance of having a good capacity to adapt to different situations and stimuli.

Autonomic nervous system: To report on the role of the ANS in the regulation of involuntary bodily functions.

Vagus nerve: Clarify what the vagus nerve is and its importance in the regulation of the ANS and the relaxation response.

Conclusion:

Educating the patient about the functioning of the ANS and its role in NESA® Microcurrent treatment is a crucial step towards recovery and wellness. By understanding these concepts, the patient becomes an active partner in their care process, which can significantly improve treatment outcomes. We encourage you to prepare your own list of key concepts and make a conscious effort to ensure that your knowledge is accessible and understandable to all your patients.

Recommended Videos:

(EN) WATCH VIDEO María González, physiotherapist and NESA® expert - Objective pre and post treatment assessment

(EN) WATCH VIDEO Dr. Santiago Garfias, neurosurgeon expert in NESA® - Pre- and post-treatment assessment

Why is continuous reassessment and communication with the patient important?

Regular reassessment and effective communication with the patient are essential to ensure that the NESA® Microcurrent treatment is progressing as planned. These processes allow treatment to be adjusted according to the patient's progress and ensure that both practitioner and patient maintain a clear common goal.

How is the reassessment carried out?

Reassessment should take place at key points in the treatment, such as at mid-course or when the expected endpoint is reached. This process involves a detailed assessment of the patient's progress, comparing the current state with the goals initially set.

What role does communication play in treatment?

Communication is essential to keep patients informed and committed to their treatment. It is important to openly discuss progress, resolve concerns, and adjust expectations, if necessary. Clear and open communication encourages patient adherence to treatment, especially in cases that require a medium to long-term commitment.

What to do if the objectives have not yet been achieved?

If the objectives have not been achieved within the expected timeframe, it is crucial to rethink the treatment strategy. This may involve modifying the techniques used, adjusting the frequency of sessions, or even setting more realistic goals. It is important to communicate any changes to the patient and ensure that they understand and agree with the new plan.

How does lack of continuity and commitment affect the success of treatment?

Lack of continuity and commitment on the part of the patient can lead to treatment failure. It is essential that the patient understands the importance of following the health professional's recommendations and staying actively involved in their recovery process. La ineficacia del tratamiento rara vez se debe a la tecnología en sí, sino más bien a la falta de adherencia al plan de tratamiento establecido.Ineffective treatment is rarely due to the technology itself, but rather to a lack of adherence to the established treatment plan.

Conclusion:

Re-evaluation and effective communication are fundamental pillars in the success of NESA® Microcurrent treatments. These processes not only help to adjust treatment according to the patient's progress, but also reinforce the patient's commitment to their recovery. As healthcare professionals, it is our responsibility to ensure that the patient is informed, engaged, and motivated throughout the entire treatment process.

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(EN) WATCH VIDEO: María González, physiotherapist expert in NESA® Educating the patient on the functioning of the ANS

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What is cervical radiculopathy and how does it manifest itself?

Cervical radiculopathy is a condition that arises due to compression or irritation of a nerve root in the cervical region of the spine. It typically manifests as pain radiating from the neck down the arms, in this specific case, from the neck to the third to fifth finger of the left hand. Patients may experience pain, weakness, or sensory disturbances along the path of the affected nerve.

Case Description:

Patient: 45-year-old woman.

Symptoms: Cervical pain radiating to the third to fifth finger of the left hand, with an intensity of 7 out of 10.

Diagnosis: Herniated disc C6-C7 with stenosis of the left foramen, but without spinal cord involvement. Electromyogram showing chronic C7 radiculopathy.

Proposed treatment: Surgery, which was rejected by the patient. Subsequently, rehabilitation was chosen without significant improvement in symptoms.

NESA® Microcurrent Treatment:

Objectives: To improve sleep quality, reduce fatigue and anxiety. It was explained to the patient that neuromodulation aims to improve symptoms without treating the underlying cause.

Evolution and assessment: WeCardio analysis was used to plan the sessions based on heart rate variability and parasympathetic tone.

Treatment plan: Three sessions per week for the first two weeks, followed by two sessions per week. Initiated with programmes to improve adaptation to treatment and subsequently focused on improving pain and sleep quality.

Results: Improved sleep quality and reduced fatigue. Radicular pain decreased but was not eliminated. The patient opted for surgery at the end of treatment due to persistent pain.

Key findings:

Importance of planning: It is crucial to set clear and realistic goals with the patient to match expectations about the benefits of treatment.

Comprehensive management: Although NESA® microcurrent therapy may not resolve the underlying cause of radiculopathy, it can offer significant improvements in associated symptoms such as pain, sleep quality and anxiety.

Informed decision: Patients should be fully informed about available treatment options, including their benefits and limitations, to make informed decisions about their care.

This case report highlights the importance of a comprehensive and personalised approach in the treatment of complex neurological conditions, where communication and patient education play a key role in therapeutic success.

(EN) WATCH VIDEO: Clinical case with NESA®: Cervical radiculopathy. Dr. Santiago Garfias, neurosurgeon expert in NESA®

What is rheumatoid arthritis and how does it manifest itself in this case?

Rheumatoid arthritis is a chronic inflammatory disease that mainly affects the joints, causing pain, swelling, stiffness and, over time, can lead to loss of joint function. In this clinical case, we present a 63-year-old woman diagnosed since 2014, with significant pain in her hands and knees, difficulty walking and a history of several oncological processes.

Case Description:

Patient: 63-year-old woman.

Symptoms: Pain in joints, especially hands and knees, sleep problems, restless leg syndrome, fatigue, and weakness in lower limbs.

Previous treatment: Corticoids for rheumatic disease and benzodiazepines for sleep.

Treatment approach with NESA® Microcurrents: Passive treatment focused on improving quality of life, symptom perception, and sleep quality. It is stated that the treatment is palliative, and improvements may be temporary.

Treatment plan and results:

Objectives: To alleviate generalized pain and improve sleep quality.

Initial Assessment: Use of WeCardio for analysis, EuroQol questionnaire for general quality of life, and PITB for sleep quality.

Frequency of sessions: Intensive at the start, with adjustments according to the patient's response.

Reported improvements: Noticeable improvement in sleep quality from the first week and decrease in pain perception, especially in the wrists.

Evolution of the treatment: Adjustments in the programming of the microcurrents according to the predominant symptoms of the day, focusing on pain, fatigue, and improvement of the autonomic nervous system.

Key findings:

Personalisation of treatment: It is crucial to adapt the treatment to the specific needs of the patient, in constant dialogue to adjust the objectives and techniques used.

Importance of communication: The patient's predisposition and openness towards the treatment enhance the effects of microcurrents and any other technique applied.

Long-term results: At four months, a 20% improvement in quality of life was observed. By eight months, this improvement increased to 30% of the baseline, accompanied by enhancements in pain perception.

This clinical case highlights the importance of a personalised approach and effective communication in the treatment of complex chronic diseases such as rheumatoid arthritis. Through careful and tailored use of NESA® Microcurrents, significant improvements in the patient's quality of life can be achieved, even in long-term cases with additional complications.

(EN) WATCH VIDEO: Case Report: Long-standing Rheumatoid Arthritis. Fabiola Molina, Physiotherapist Expert in NESA®

What is fibromyalgia and how was it addressed in this case?

Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, fatigue, and sleep problems, among other symptoms. In this clinical case, a patient with fibromyalgia was treated using NESA® non-invasive neuromodulation technology, focusing on improving symptoms such as pain, fatigue, and sleep quality.

Case description:

Patient: Woman with a diagnosis of long-standing fibromyalgia.

Main symptoms: generalised pain, fatigue, and poor sleep quality.

NESA® treatment: An approach focusing on neuromodulation of the autonomic nervous system was chosen, with sessions twice a week initially, moving to once a week in later phases.

Treatment objectives and evaluation:

Objectives: To reduce pain and fatigue and improve sleep quality.

Assessment: Several tools were used to assess the patient's evolution, including Wecardio for cardiac variability, the modified Borg scale for fatigue, the SF-36 for quality of life, and the Pittsburgh questionnaire for sleep quality.

Treatment results:

Significant improvements: The patient experienced noticeable improvements in the three main goals from the fifth session, using a combination of treatment-focused programmes.

Assessment data: Significant changes were observed in cardiac variability, metabolic stress, vagal tone, quality of life, chronic pain, and fatigue scales.

Key findings:

Simplicity and efficacy: Despite the complexity and duration of fibromyalgia, NESA® Microcurrent treatment proved to be effective, highlighting the importance of simple but well targeted approaches.

Importance of neuromodulation: This case highlights the potential of non-invasive neuromodulation to significantly improve the quality of life of patients with complex chronic conditions.

Continuity of treatment: It was agreed with the patient to continue with maintenance sessions to preserve the improvements achieved and to support the continued adaptation of the nervous system.

(EN) WATCH VIDEO Clinical case on Fibromyalgia. Physiotherapist Maria Gonzalez, Poland 2023. NESA® Ft. Meden Inmed

What is painful bladder syndrome and how does it manifest itself?

Painful bladder syndrome, also known as interstitial cystitis, is a chronic condition that causes pain and pressure in the bladder and pelvic region. Symptoms include frequent urination, urinary urgency, and pain during urination or when the bladder is full. These symptoms can be mistaken for recurrent urinary tract infections, leading to ineffective antibiotic treatment.

Case Description:

Patient: Woman with painful bladder syndrome of 2 years' duration.
Symptoms: Chronic pelvic pain, frequent urination, urinary urgency, and pain during urination.
Previous treatment: Multiple courses of antibiotics without improvement due to misdiagnosis of UTI.

NESA® Microcurrent Treatment:

Treatment approach: Initiated with manual pelvic floor therapy and NESA® Non-Invasive Neuromodulation, focusing on pain reduction and improvement of bladder function.

Programmes used: We started with neuromodulation programmes focused on reducing anxiety and chronic pain, adjusting the location of the electrodes and the programmes according to the patient's evolution.

Developments and Results:

Symptom improvement: The patient experienced significant improvement in pain and bladder symptoms after the first few sessions, allowing her to resume normal activities and improve her quality of life.
Maintenance: A regimen of monthly maintenance sessions was established and adjusted according to the patient's needs, especially during periods of increased stress or anxiety.

Key findings:

Importance of personalisation: NESA® Microcurrent treatment requires customisation according to the evolution of each patient, adjusting programmes and electrode placement to maximise benefits.

Impact on Quality of Life: This case study demonstrates how an integrative approach, combining manual therapy and non-invasive neuromodulation, can transform the lives of patients with painful chronic conditions, offering relief and improving their quality of life.

Resilience and adaptability: The ability to adapt treatment to the patient's changing circumstances, such as periods of stress or anxiety, is crucial to sustaining long-term improvements and supporting the patient in the recovery process.

This case report highlights the efficacy of NESA® Microcurrents in the treatment of painful bladder syndrome, offering a hopeful alternative for patients who have experienced years of pain and ineffective treatments, and underscores the importance of a personalised and adaptive approach in the management of complex chronic conditions.

(EN) WATCH VIDEO Case report on painful bladder syndrome. Physiotherapist Ketty Ruiz, Poland. NESA® ft. Meden Inmed

What is central sensitisation and how does it manifest itself in this case?

Central sensitization is a state of hyperactivity of the central nervous system that heightens pain perception. This case report, presented by neurosurgeon Santiago Garfias, describes a patient with a history of migraine and cervicalgia following a traffic accident. After surgery for herniated disc and cervical canal stenosis, the patient experiences a progressive worsening of her condition, including increased cervicalgia, headache, low back pain, paresthesias, depression, and anxiety.

Case Description:

Patient: Female with a history of migraine, post-accident cervicalgia, and multiple surgical interventions.

Symptoms: Cervical and lumbar pain, paresthesias in extremities, inability to work, depression, anxiety, and allergic reaction to analgesics.

Diagnosis: Central sensitization with generalized pain and multiple chemical sensitivity.

NESA® Microcurrent Treatment:

Treatment Approach: Neuromodulation to stimulate the parasympathetic system, improve chronic pain, enhance sleep quality, and reduce fatigue.

Treatment Program: Initially, 10 sessions spread over a month, utilizing specific programs to adapt the autonomic nervous system and address pain, sleep, and fatigue.

Developments and Results:

Initial Improvements: Significant alleviation of pain and improvement in sleep observed from the first sessions, albeit with the persistence of painful spasms and lower back pain.

Treatment Adjustments: Addition of supplementary programs to tackle fatigue, headache, and other specific symptoms, resulting in substantial improvement reported by the patient.

Discontinuation and Resumption of Treatment: The patient temporarily discontinues treatment, experiencing a deterioration of symptoms. However, upon resuming treatment, a more rapid improvement is observed.

Key Findings:

Importance of Continuity: This case underscores the necessity of maintenance sessions to manage symptoms, particularly in chronic conditions with central sensitization.

Benefits of Neuromodulation: Despite the initial challenges and complexity of the case, NESA® Microcurrent treatment proved efficacious in significantly alleviating the patient's symptoms.

Motivation and Continuous Evaluation: It is imperative to motivate patients to continue treatment and continuously evaluate the benefits obtained, adjusting the therapeutic approach as necessary.

This clinical case exemplifies the potential of NESA® Microcurrents in treating central sensitization and other chronic pain disorders, emphasizing the significance of a personalized approach and continuity of care to achieve substantial improvements in patients' quality of life.

(EN) WATCH VIDEO Clinical case: Central sensitization. Dr. Santiago Garfias, neurosurgeon, NESA® Expert

What is epilepsy and how was it addressed in this case?

Epilepsy is a neurological disorder characterized by a predisposition of the brain to generate epileptic seizures, which are episodes of abnormal electrical activity in the brain. This case report describes a patient diagnosed with right prefrontal epilepsy, who was initially seen for lower limb pain that did not improve with conventional physiotherapy treatment.

Case description:

Patient: A male individual presented for consultation in September 2019 due to quadriceps pain exacerbated by physical activity, accompanied by associated episodes of absence.

Diagnosis: While undergoing diagnostic procedures, he experienced an epileptic seizure during a polysomnography, leading to the diagnosis of right prefrontal epilepsy.

NESA® Microcurrent Treatment:

Treatment approach: Treatment with NESA® Microcurrents was initiated initially focusing on lower limb pain, but after the diagnosis of epilepsy, it was adapted to treat centrally, aiming to improve epileptic absences, and affected muscle tone.

Programmes used: Combination of programmes focusing on frontal cutting and specific programmes to reduce epilepsy and elevated muscle tone.

Developments and Results:

Symptom improvement: The patient experienced a significant reduction in seizures and an enhancement in muscle tone in the affected lower limb, as well as a decrease in pain.

Treatment adjustments: The duration of the epilepsy-specific program was refined to 5 minutes, achieving a balance that ameliorated symptomatology without inducing discomfort.

Continuity of treatment: Following a 3-month hiatus in treatment, the patient noted a deterioration in symptoms, underscoring the significance of regular maintenance sessions.

Key Findings:

Adaptability of treatment: This case underscores the necessity of tailoring treatment to the patient's individual needs and progression, even when the initial treatment focus shifts.

Importance of continuity: The cessation and subsequent recommencement of treatment demonstrated the efficacy of NESA® Microcurrents in managing epilepsy and associated pain, emphasizing the importance of consistent maintenance sessions.

Personalized approach: Emphasizes the importance of viewing the patient integrally, adjusting treatment to encompass all their conditions rather than solely addressing the initial presenting symptom.

This clinical case illustrates how NESA® Microcurrent therapy can serve as a valuable adjunct in epilepsy management, offering a substantial enhancement in the patient's quality of life and underscoring the necessity of a flexible and personalized therapeutic approach.

(EN) WATCH VIDEO Case report on epilepsy. Physiotherapist Fabiola Molina, Poland 2023. NESA® Feat. Meden Inmed

What is multiple sclerosis and how does it manifest itself in this case?

Multiple sclerosis (MS) is a chronic condition of the central nervous system impacting the brain and spinal cord, presenting a diverse array of potential symptoms such as fatigue, mobility challenges, and balance impairments. In this case study, a patient diagnosed with MS undergoes treatment for enduring intercostal pain stemming from shingles, alongside addressing symptoms of fatigue and balance impairment.

Case description:

Patient: A woman with multiple sclerosis, experiencing intercostal pain, fatigue, and impaired balance.

Symptoms: Right intercostal pain of two and a half years' duration, fatigue, and impaired balance. The patient attended the initial sessions on crutches.

NESA® Microcurrent Treatment:

Treatment Approach: An initial intensive treatment utilizing NESA® Microcurrents was selected, with a focus on enhancing the autonomic nervous system, alleviating pain, reducing fatigue, and improving balance.

Frequency of Sessions: Initially scheduled three times weekly for the initial three weeks, followed by a reduction to twice weekly, and eventually once weekly as improvements became evident.

Developments and Results:

Observed Improvements: The patient reported significant enhancements in fatigue levels and balance, achieving the ability to walk unaided. Additionally, improvements in concentration and cognitive abilities were noted.

Treatment Adjustments: Treatment protocols were adjusted in accordance with the patient's progress, emphasizing pain management through tailored programs and sustaining central stimuli for the autonomic nervous system.

Key Findings:

Importance of personalisation: This case highlights the need to personalise treatment to the specific needs of the patient, adjusting treatment frequency and schedules according to evolution

Long-term benefits: Despite being a chronic disease, NESA® Microcurrent treatment was shown to be effective in significantly improving the patient's symptoms, including pain, fatigue, balance, and concentration.

Continuity of treatment: The patient decided to continue with neuromodulation treatment due to the improvements observed, which underlines the importance of maintenance sessions in the management of chronic diseases such as multiple sclerosis.

This case study illustrates how NESA® Microcurrent therapy can offer a significant improvement in the quality of life of patients with multiple sclerosis, addressing complex symptoms such as pain, fatigue, and impaired balance and concentration.

(EN) WATCH VIDEO Clinical case on multiple sclerosis. Physiotherapist Maria Gonzalez, Poland. NESA® & Meden Inmed

What are sleep disturbances and how do they manifest themselves in this case?

Sleep disturbances are conditions that disrupt the ability to achieve optimal sleep during the night, often resulting in daytime fatigue, diminished performance, and mood disturbances. This case report, presented by neurosurgeon Santiago Garfias, details the experience of a woman who suffers from frequent awakenings throughout the night, obtaining only three hours of sleep, consequently experiencing morning exhaustion.

Case description:

Patient: Woman with a history of frequent nocturnal awakenings since the birth of her daughter, with no improvement with the use of hypnotics and no apparent causes of stress or sleep disorders identified on polysomnography.

Symptoms: Continuous awakenings, poor deep and REM sleep, anxiety, and dependence on hypnotics..

NESA® Microcurrent Treatment:

Treatment approach: An intensive treatment with NESA® microcurrents was chosen, using specific programmes to improve sleep quality, reduce anxiety and increase deep and REM sleep.

Frequency of sessions: 10 sessions in a month, with adjustments to the programmes and electrode placement based on the patient's evolution.

Developments and Results:

Improvements observed: : The patient reported a significant improvement in anxiety and began to sleep continuously for 6 hours without awakening, which allowed discontinuation of hypnotics.

Treatment adjustments: Adjustments were made to treatment programs, and the use of actigraphy was introduced to objectively monitor changes in the patient's sleep pattern.

Key Findings:

Importance of personalization: This case highlights the need to personalize treatment to the specific needs of the patient, adjusting treatment programs and electrode placement according to the patient's progress.

Long-term benefits: The NESA® Microcurrent treatment proved to be effective in significantly improving the patient's sleep disturbances, enabling her to regain a healthier sleep pattern and reduce her dependence on medication.

Use of objective tools: The implementation of tools such as actigraphy is crucial for monitoring changes and adjusting treatment effectively, enabling patients to become aware of the benefits obtained.

This case study illustrates how NESA® Microcurrent therapy can offer an effective solution to sleep disorders, addressing not only the symptoms but also improving the patient's quality of life through a personalized approach and the use of advanced technology.

(EN) WATCH VIDEO Clinical case: Sleep. Dr. Santiago Garfias, neurosurgeon, expert in NESA® Non-Invasive Neuromodulation

What is painful bladder syndrome and how does it manifest itself?

Painful bladder syndrome, also known as interstitial cystitis, is a chronic condition that causes pain and pressure in the bladder and pelvic region. Symptoms include frequent urination, urinary urgency, and pain during urination or when the bladder is full. These symptoms can be mistaken for recurrent urinary tract infections, leading to ineffective antibiotic treatment.

Case Description:

Patient: Woman with painful bladder syndrome for 2 years.

Symptoms: Chronic pelvic pain, frequent urination, urinary urgency, and pain during urination.

Previous Treatment: Multiple courses of antibiotics without improvement due to misdiagnosis of UTI.

NESA® Microcurrent Treatment:

Treatment Approach: Initiated with manual pelvic floor therapy and NESA® Non-Invasive Neuromodulation, focusing on pain reduction and improvement of bladder function.

Programs Used: We started with neuromodulation programs focused on reducing anxiety and chronic pain, adjusting the location of the electrodes and the programs according to the patient's progress.

Developments and Results:

Symptom Improvement: The patient experienced significant improvement in pain and bladder symptoms after the first few sessions, enabling her to resume normal activities and improve her quality of life.

Maintenance: A regimen of monthly maintenance sessions was established and adjusted according to the patient's needs, especially during periods of increased stress or anxiety.

Key findings:

Importance of Personalization: This case highlights the necessity of tailoring treatment to the specific needs of the patient, adjusting programs and electrode placement to maximize benefits

Impact on Quality of Life: This case study demonstrates how an integrative approach, combining manual therapy and non-invasive neuromodulation, can positively impact the lives of patients with painful chronic conditions, providing relief and enhancing their quality of life.

Resilience and Adaptability: The ability to adapt treatment to the patient's changing circumstances, such as periods of stress or anxiety, is crucial for sustaining long-term improvements and supporting the patient in the recovery process.

This case report underscores the efficacy of NESA® Microcurrents in the treatment of painful bladder syndrome, providing a promising alternative for patients who have endured years of pain and ineffective treatments. It also emphasizes the importance of a personalized and adaptive approach in managing complex chronic conditions.

(EN) WATCH VIDEO Case report on painful bladder syndrome. . Physiotherapist Ketty Ruiz, Poland NESA® ft. Meden Inmed

What are cluster headaches and how do they manifest themselves in this case?

Cluster headaches are a type of headache characterized by episodes of severe pain, typically concentrated around one eye or on one side of the head, lasting from 15 minutes to 3 hours. These episodes often occur in clusters or series, which can persist for weeks or months. This case report details a patient experiencing cluster headaches localized on the right side of the head, triggered by a traumatic event, and accompanied by anxiety.

Case description:

Patient: Male with a history of cluster headaches during spring and summer each year, with episodes of severe pain affecting his daily activity.

Symptoms: Severe right-sided pain, anxiety-triggered episodes, lasting up to one hour and pain peaks of 8 out of 10.

NESA® Microcurrent Treatment:

Treatment approach: A NESA® Microcurrent treatment was chosen with the aim of improving anxiety and better control of headache episodes.

Frequency of sessions: 10 sessions spread over a month, using specific programmes to address both headache and anxiety.

Developments and Results:

Improvements observed: The patient reported a significant improvement in anxiety control and no new episodes of headache during treatment.

Treatment adjustments: Adjustments were made to treatment programmes based on patient response, focusing on anxiety and pain management.

Key Findings:

Importance of personalisation: This case highlights the need to personalise treatment to the specific needs of the patient, adjusting treatment programmes according to evolution.

Long-term benefits: NESA® Microcurrent treatment was shown to be effective in significantly improving the patient's cluster headaches, allowing them to resume their daily activities without interruption from pain.

Comprehensive approach: The integration of anxiety treatment into the management of cluster headaches is crucial for therapeutic success, underlining the importance of addressing all aspects of the patient's problem.

This case study illustrates how NESA® Microcurrent therapy can provide an effective solution for cluster headaches, addressing both pain and emotional triggers, such as anxiety, through a personalized approach and the utilization of advanced technology.

(EN) WATCH VIDEO Clinical case: Cluster headaches. Dr. Santiago Garfias, neurosurgeon, NESA® Expert

What is ankylosing spondylitis, and how does it manifest in this case?

Ankylosing spondylitis is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, leading to pain and stiffness. This case report, presented by physiotherapist Fabiola Molina, focuses on a 32-year-old female patient diagnosed with ankylosing spondylitis. Her primary symptoms include generalized joint pain, particularly in the lumbar and sacral regions.

Case description:

Patient: 32-year-old woman with ankylosing spondylitis.

Symptoms: Generalized joint pain, particularly in the lower back and sacrum, mood disturbance, anxiety, and sleep problems.

NESA® Microcurrent Treatment:

Treatment approach: A general treatment with NESA® Microcurrents was chosen to improve mood, anxiety, sleep quality, and pain relief.

Frequency of sessions: Initially four sessions in the first week, followed by three sessions in the second week, then adjustments according to patient response.

Developments and Results:

Observed Improvements: The patient initially experienced exacerbation of symptoms, followed by significant improvement in joint pain, mood, and sleep quality. Additionally, an improvement in gait and a reduction in fatigue were observed.

Treatment adjustments: Adjustments were made to treatment programs, with a focus on modulating the autonomic nervous system, particularly through the vagus nerve, to regulate systemic inflammation.

Key Findings:

Importance of personalisation: This case highlights the need to personalise treatment to the specific needs of the patient, informing about possible initial effects and adjusting treatment according to evolution.

Long-term benefits: Although ankylosing spondylitis is a chronic disease, treatment with NESA® Microcurrents was shown to be effective in improving the patient's quality of life, allowing a more bearable management of the disease.

Integrative approach: Modulating the autonomic nervous system, particularly via the vagus nerve, plays a crucial role in the management of inflammatory diseases such as ankylosing spondylitis, highlighting the significance of an integrative therapeutic approach.

This case study illustrates how NESA® Microcurrent therapy can offer significant improvement in patients with ankylosing spondylitis, addressing both pain, emotional and sleep issues, through a personalised approach and the use of advanced technology.

(EN) WATCH VIDEO: Clinical case on ankylosing spondylitis. Physiotherapist Fabiola Molina, NESA® Ft Meden Inmed

What is spondylolisthesis, and how does it manifest in this case?

Spondylolisthesis is a condition characterized by the displacement of one vertebra forward over the vertebra below it. This displacement can lead to low back pain, and, in some instances, radicular pain caused by compression of nerve roots. In this clinical case, presented by neurosurgeon Santiago Garfias, a 45-year-old patient with grade one spondylolisthesis and cervical disc herniation is described. This condition results in the involvement of the left L5 root, primarily manifesting as radicular pain in the left L5 territory.

Case description:

Patient: 45-year-old male, fishing worker, experiencing recurrent episodes of low back pain and left L5 radicular pain.

Symptoms: Low back pain partially controlled with physiotherapy, but with radicular pain rated 7 out of 10, limiting his daily activities.

NESA® Microcurrent Treatment:

Treatment approach: A neuromodulation treatment with NESA® Microcurrents was chosen to alleviate radiated pain, considering the limitations due to the organic nature of the pain.

Frequency of Sessions: 10 sessions in total, with six sessions in the first two weeks and two sessions per week thereafter.

Developments and Results:

Improvements observed: : The patient experienced significant relief from radicular pain, enabling him to carry out his daily activities more normally.

Treatment adjustments: Adjustments were made to treatment programs, focusing on managing root pain through strategic placement of electrodes and selection of specific programs.

Key Findings:

Alternative to surgical treatment: This case highlights how NESA® Microcurrents can provide an effective alternative treatment for patients who decline surgery or where surgery is not a feasible option.

Importance of customization: Personalization of treatment, including program selection and electrode placement, is crucial to effectively address radicular pain associated with spondylolisthesis.

Powerful tool in pain management: NESA® Microcurrents are presented as a potent tool to provide relief for chronic pain and conditions that restrict conventional treatment options.

This clinical case illustrates the effectiveness of NESA® Microcurrents in managing spondylolisthesis and associated radicular pain, offering significant improvements in the patient's quality of life, and emphasizing the importance of a comprehensive and personalized therapeutic approach.

(EN) WATCH VIDEO Clinical case on ankylosing spondylitis. Physiotherapist Fabiola Molina, NESA® Ft Meden Inmed

The clinical effects observed through scientific evidence in contributing to the optimisation of the rehabilitation of musculoskeletal structures are as follows:

Inhibition of muscle tone

NESA® Non-Invasive Neuromodulation, through the precise application of microcurrents, plays a key role in inhibiting muscle tone. This therapeutic approach is aimed at decreasing muscle tension and stiffness, thereby facilitating a more relaxed and flexible state of the muscles. By reducing excessive muscle tone, NESA® Non-Invasive Neuromodulation significantly contributes to pain relief, improved mobility, and increased flexibility, which are crucial elements in the process of rehabilitation and overall wellness.

Relationship of microcurrents and inhibition of muscle tone:

"Muscle Tone Physiology and Abnormalities"

DOI: 10.3390/toxins13040282

"Effects of Acute Microcurrent Electrical Stimulation on Muscle Function and Subsequent Recovery Strategy"

DOI: 10.3390/ijerph18094597

"Effectiveness of combining microcurrent with resistance training in trained males"

DOI: 10.1007/s00421-019-04243-1

Activation of neurodynamics

The application of microcurrents in NESA® Non-Invasive Neuromodulation aims to facilitate nerve mobility and functionality. Through targeted stimulation, the gliding and elasticity of the nerves is promoted, contributing to optimal neuromuscular health. This allows free mobility of the nerves in accordance with body movements, minimising pain, and restrictions.

Relationship between Microcurrents and Neurodynamics:

"Effects of Acute Microcurrent Electrical Stimulation on Muscle Function and Subsequent Recovery Strategy”

DOI: 10.3390/ijerph18094597

"Investigating the effectiveness of adding microcurrent therapy to a traditional treatment program in myofascial pain syndrome in terms of neck pain and function"

DOI: 10.5114/PQ.2020.96421

Optimisation of tissue tensegrity

NESA® Non-Invasive Neuromodulation, through microcurrents, can influence the balance and distribution of tension within the connective and muscular tissue. This process aims to enhance the coordination between compressive and tensile stresses, promoting proper posture, increased mobility, and reduced risk of injury, thereby maintaining the structural integrity of the body.

Relationship between microcurrents and tissue tensegrity:

"Electrical stimulation as a novel tool for regulating cell behavior in tissue engineering"

DOI: 10.1186/s40824-019-0176-8

"Effects of Electrical Stimulation on the Signal Transduction-Related Proteins, c-Src and Focal Adhesion Kinase, in Fibroblasts"

DOI: 10.3390/life12040531

Trophic improvement

Microcurrent stimulation can enhance trophism, which involves proper nutrition and maintenance of tissues. This is achieved by promoting efficient blood circulation, facilitating the delivery of nutrients and oxygen to the tissues, and aiding in the elimination of metabolic waste. These actions are essential for tissue repair, regeneration, and maintenance of tissue health.

Relationship of microcurrents and trophism:

"Microcurrent therapy in the treatment of knee osteoarthritis. Could it be more than a placebo-effect? A randomized controlled trial"

DOI: 10.23736/S1973-9087.20.05921-3

Improvement of proprioception

NESA® Non-Invasive Neuromodulation can contribute to enhancing proprioception, which is crucial for the brain's perception of body position, movement, and balance. By increasing the body's ability to detect changes in position and movement, it facilitates the safe and efficient performance of everyday activities, as well as aiding in injury prevention.

Relationship between microcurrents and proprioception:

"Effects of Acute Microcurrent Electrical Stimulation on Muscle Function and Subsequent Recovery Strategy"

DOI: 10.3390/ijerph18094597

"Bioactive polymeric materials and electrical stimulation strategies for musculoskeletal tissue repair and regeneration"

DOI: 10.1016/j.bioactmat.2020.03.010

Enhancement of mechanotransduction

Finally, the application of microcurrents aims to enhance the process of mechanotransduction, which refers to the ability of cells to convert mechanical stimuli into biochemical responses. Enhancing this process is crucial for tissue growth, repair, and regeneration, and can be achieved by applying controlled forces through specific exercises, manual therapies, and other techniques.

Relationship of microcurrents and mechanotransduction:

"Effectiveness of combining microcurrent with resistance training in trained males"

DOI: 10.1007/s00421-019-04243-1

"Electrical stimulation increases hypertrophy and metabolic flux in tissue-engineered human skeletal muscle"

DOI: 10.1016/j.biomaterials.2018.08.058

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