Frequently Asked Questions

• It is a powered muscle stimulator, that effects the muscular skeletal and neurological systems.
• A small battery paired with computer programs that send out times (microseconds) sequenced bursts of electric current to the Smart Suits embedded electrodes covering the the motor points.
• Timing pattern can be quick like a sprinter or slow like a patient with injury or neurological condition.
• Creates a muscle contraction while the user voluntarily resists the contraction
• Activates 20-30% of the User’s MVC (maximum voluntary contraction).

Precise timing patterns that the nervous system applies to muscles

Normal Neurophysiology:

• Brain activates the spine electrically by sending a nerve signal to the muscle to tighten and then back to the spine after the tightening
• The spine circuit then shuts down opposing muscles to facilitate the movement.
• The movement back and forth with the timing of the muscles contracting and opposing muscles releasing is a spinal generator circuit. All movements are within this motor circuit.
• PEMS replicates these timing patterns through various programs (training modes)
• Prior to Neuro20 PEMS programs stimulated 2-4 muscles at a time in these patterns
• Neuro20 stimulates up to 44 muscles in a pattern artificially creating a motor chain, effecting the brain.
• Neuro20’s precision neurophysiology – the biomechanics combined with advanced materials, and computers algorithms replicate movement patterns unlike anything before it.

• Protocols are set by the medical professionals, however Neuro20 has captured guidelines based on field use and trains providers with suggested use.
• Protocols will continue to develop and we always keep an open line of communication flowing.

• Resistance exercises with weights or bands with greater than 30%MVC
• Typical protocol of ascending or descending reps to fatigue
• Add co-contraction of agonist/antagonist muscles to change the MVC to 10-20% and will result in more agonist work
• Stimulation of Deltoids increases recruitment for abduction exercises, added recruitment increases maximum motor output/number of reps tolerated
• Abdominals plus lumbar paraspinals increases time tolerance for core stabilization exercises
• Glutes, quads, and hamstring assist in eccentric and concentric extension exercises
• Increased free weight loading while standing and flexing / extending the hips and knees plus relatively high intensity stimulation of the glutes, quads/hamstrings as well as the lumbar paraspinals allows an increase in the number of reps.
• All are standard techniques for strengthening the thighs and buttocks while stabilizing the low back

• Improvements created by a combination of power + efficiency of movement
• Balance and precise muscle timing improves efficiency
• Cardiopulmonary improves by training to the anerobic threshold
• Metabolic activity of muscles (not heart and lungs) determines shift into anerobic or lactate generation phase
• Stimulation increases microcirculation blood flow into the muscles which increases glucose consumption and metabolic enzymes in the muscles
• Coupled with exercise EMS increases the mitochondria size and numbers
• Combining stimulation with endurance exercise increases O2 utilization approx. 30%
• Improved sensory nerve feedback increases position sense thereby improving balance and muscle sequence timing
• NET RESULT is increased muscle performance

• Muscle stimulation increases local blood flow which leads to increased joint lubrication in synovial joints. (Knees, hips, shoulders)
• This happens without active exercise and can be passive in approx. 5 minutes
• At the same time the Neuro20 PRO reduces muscle guarding and inhibition
• The result is reduced joint pain and improved coordination
• Although Neuro20 is not indicated for pain, Neuro20 is indicated for many of the underlying causes of pain.

• Lower extremity stimulation (quadricep) assists with standing and walking
• Reciprocal stim (quads/hams) used to walk assist patients with incomplete spinal cord injuries
• Electrical stimulation shown effective in some Parkinson’s patients helping balance and walking (gait and arm swing).
• Whole-body EMS has been utilized successfully with hundreds of patients with a wide range of conditions and have benefitted to include: Multiple Sclerosis, Parkinson’s, Stroke, Spinal Cord Injury, TBI, Long-Covid, Diabetes, Neuropathy, Amputation, Functional Neurological Disorder, Chronic Fatigue Syndrome, POTS, Pain Management and a wide variety of orthopedic and sports medicine conditions.

• Frequencies run between 7-100 Hz for functional and full body contraction programs. Frequencies specific to each training mode and can be found in the Operational Manual.
• Amplitudes in milliamps and can be increased, with a constant current controlled output. 40mA applied at 50Hz of 250uSec square wave pulses is strong enough to produce 20% MVC in the quads.

Biphasic rectangular waves, net zero charge. Pulse width 75-200 microseconds, however this varies based on the training mode. Refer to the Operation Manual for each mode’s parameters.

• Lactate is a fuel and is a potent signal irrespective of oxygen tension.
• VO2 increases dramatically with stimulation and movement.
• Doctors have reported positive changes in pulmonary effeciency in multiple patients.

• Cardiovascular endurance comes from an increase in muscle to extract and utilization of oxygen and glucose
• Capillary dilation, a change in transport enzymes in the muscle fibers, and an increase in size and number of mitochondria is critical
• The average improvement in the active group was 36% with no change in the control group receiving sham stim. (G. Bourjeily, 2003) on a device with minimal technological advancements compared to Neuro20. Neuro20 is interested in working with Researchers in this field.

• All exercise above 30% MVC eventually leads to hypertrophy
• Initially, strength improved from neurological timing and neuromuscular coupling and feedback reflex strengthening
• Blood flow increase, especially at the micro vascular level gives the appearance of increased muscle size
• Muscle density coupled with increased muscle fiber water gives the appearance of increased hardness as well as muscle size
• After 8 weeks of resistive exercise there is an increase in contractile protein production which is true of hypertrophy

• Bone density increases with linear compression loading. EMS helps with femur compression, but increased activity throughout the day adds significantly.
• Metabolic calcium loss through the kidneys due to gastrointestinal problems is equally significant as are hormones – PTH of course but also thyroid, insulin, testosterone.
• Pilot study at University of Tampa Human Performance Lab demonstrated a 9.68 Bone Density and 1.9 Bone Mineral Content Gain compared to the Control group.

Background info – Motor nerves from the spine to the muscles are categorized by size. Small fibers are called 1st order motor neurons. Then comes medium or 2nd order and finally 3rd order, the largest nerve fibers are recruited last.

• Without stimulation Motor Neurons are voluntarily activated in healthy humans in this order- 1st then 2nd, then 3rd order
• Electrical stimulation preferentially activates the larger fibers, the 3rd order motor axons first. Then 2nd and then 1st. This is Reverse Order Recruitment
• Muscles are also categorized by oxygen utilization as well as speed and strength of contraction. They do not follow the profiles of the motor neuron size
• The only thing that matters is the ability of the muscles and nerves to sustain contractions
• Once stimulation levels get to the higher intensities, all neurons are activated or depolarized. Then there is a delay period as the nerves recover and can fire again.
• At 50 Hz, most neurons and muscles fibers have recovered from pulse to pulse at least for the first few pulses
• Then fast twitch glycolytics drop out for about 150 to 200 mSec and fire again for a few pulses and drop out again. This continues for about 15 to 30 seconds. Then they need time for prolonged recovery.
• In the meantime, fast twitch oxidative muscles and all the slow twitch oxidative muscles continue to respond for about another few seconds up to about 2 – 8 sec.
• Then fast twitch oxidatives drop out and the only muscles continue to fire are the slow twitch muscles. The slow twitch oxidatives may continue for minutes.
• Research demonstrates that long term stimulation with EMS equipment, classical 10 sec “On” or such, produce an increase in slow twitch fibers. This includes numbers and size.
• It also seems to come at the expense of fast twitch glycolytics (Biopsy research Medicine & Science in Sports & Exercise 1986)
• Weightlifting produces an increase in fast twitch oxidative muscles.
• Only sprinting and very fast upper body exercises increase fast twitch glycolytics

– Paired with 10 – 30 seconds of very fast electrical stimulation, which is what the Neuro20 suit provides with our PEMS programs. This is a differentiator.

The following effects have occurred from Electrical Muscle Stimulation.

• Capillary blood flow to muscles and synovial joint lubrication
• Learned recruitment – “muscle memory” learns to recruit precisely
• Motor recruitment enhancement vs. AMI – output timing
• Post injury motor recruitment re-education
• Muscle fiber and neuron strengthening – TGF and BDNF, GDNF
• Synaptic facilitation – mitochondria strength and receptor density
• Improved sensory-motor feedback, position sense BG and cortex
• Proprioception enhancement – sensory strengthening
• Joint protection – decreased grinding during max contractions
• Bone strengthening – density and matrix from increased loading
• Lactate metabolism; it’s a fuel and a potent signal for angiogenesis

Muscle stim is nerve stim too

The Stim Parameters we utilize will increase:

• Nerve Growth Factor
• BDNF (Brain Derived Neurotropic Factor)
• This is an important factor in Brain healing, especially post- concussion/TBI (traumatic braininjury)
• Mitochondria Stress
• Receptor Density (facilitation)
• Motor Nerves transmit ACh

It is important to understand ACh and its effects from stimulation

• Norepinephrine constricts capillaries during the first 5 minutes in the suit
• After about 10 minutes ACh balances and then increases causing Vasodilation. This is critical for increased blood flow especially attention at the capillary and microcapillary level. All of which is critical for healing.

Nerves transmit in both direction and as discussed prior we do reverse order transmission of the electrical signal than from normal physiology

• Sensory to motor reflex
• Sensory position sense to basal ganglia
• Sensory continues to cortex
• Sensory neurons reflex to motor cortex is the return

Healing – soft tissue

• Blood flow, nutrients, O2, waste extraction

Joint injury recovery

• Synovial flow, O2, nutrients, waste removal

Pain reduction

• Reduced spasm and increased local blood flow
• Getting back to pre-injury – burst and endurance without pain

Motor re-education

• Full recruitment vs AMI
• Extremity activation plus core stabilization

Concussions and BDNF

• Serum BDNF was increased in the NMES (p = 0.003) and voluntary exercise interventions (p= 0.004) after each intervention.
• At the post-timepoint, serum BDNF in the NMES intervention was highest among allinterventions (p = 0.038) and significantly higher than in the voluntary exercise (p = 0.036).(K. Watanabe; T. Gordon) This study was conducted with EMS technology that predates the advancements of Neuro20.

Human Performance Benefits

• Speed and Power will increase for approximately 15-20 weeks between 3%-15% and then generally plateaus for a period of time
• Flexibility and ROM will significantly increase
• Case study- D1 athlete had 2” thigh circumference gains after 13 uses of the system
• Reaction time (reflex) will significantly decrease, nerve signal time becomes faster

Neuro20 is currently being tested in two Clinical Trials, two Pilot Studies and hundreds of Case Studies. We are rapidly expanding our use profile and want to work with Researchers to capture the mechanisms, results and healthcare cost savings of this impactful technology. Currently, we are working with 8 of the top 25 rehabilitation hospitals nationwide.