Enjoy your
movements
again

Neostim-5 consists of five independent stimulation channels and is designed to stimulate the structures of the spinal cord to restore voluntary movements in patients with movement disorders.
The presence of five stimulation channels allows simultaneously stimulate segments and dorsal roots of the spinal cord. For example, we can stimulate either 5 segments of the spinal cord, or 3 segments of the spinal cord and 2 dorsal roots of the spinal cord, or 1 segment of the spinal cord and 4 dorsal roots of the spinal cord, etc.

Neostim-5 allows generating rectangular pulses with or without a carrier frequency.
There are four possible pulse shapes:

1. bipolar with carrier frequency,
2. bipolar without carrier frequency
3. monopolar with carrier frequency 
4. monopolar without carrier frequency.

In all cases, we start selecting the current strength for the patient using bipolar pulse configuration  with a carrier frequency. This is the most gentle and efficient stimulation mode. If we do not achieve the desired effect, we switch to other forms of current: bipolar pulse without a carrier frequency, then to monopolar pulse with a carrier frequency. And if we do not get an effect here either, we switch to monopolar without a carrier frequency. The last  one is the most painful, so we use it only on patients with greatly reduced sensitivity to pain and in whom we have not received any motor response when using other, more gentle forms of current.  
The program allows to select the start modes and other stimulation parameters independently for each channel. In particular, two start modes can be used, continuous and periodic. But for treatment, we recommend using only the continuous mode, when the channel continuously generates impulses with the specified parameters.   
To simplify the work of doctors, the following stimulation programs are already pre-installed in the new version of Neostim-5:
There are 6 menu items in total:

1. Rehabilitation of motor disorders after spinal cord injury
2. Rehabilitation of motor disorders after stroke (CVA)
3. Rehabilitation of pulmonary dysfunction
4. Rehabilitation of urinary function
5. Rehabilitation of motor disorders in cerebral palsy
6. Customized neurostimulation

No, Neostim-5 is not designed to stimulate nerves or muscles. It stimulates the spinal cord areas where step generators are located, excites the neural networks of the spinal cord, activating afferent and efferent neurons, and triggers involuntary  movements. To stimulate nerves or muscles, we use the Neostim-16 FES device, which we often use together with Neostim-5.

Neostim-5 can work for 8 hours without recharging. It cannot work while recharging, when it is charging, the device cannot be turned on.

Yes, of course. Each patient has their own sensitivity and skin resistance. When you start stimulation and gradually increase the current strength, you need to make sure that the patient does not experience any unpleasant sensations from the stimulation.

Not only can, but must. Transcutaneous Spinal Cord Stimulation, just like Functional Electrical Stimulation, is effective only in motion. When a patient cannot independently move his arms or legs, it is necessary to involve robotic rehabilitation systems and move paralyzed limbs in active-passive modes. In the case of small children with cerebral palsy, the movement of limbs during stimulation is carried out by the hands of doctors.

Yes, it can. As a rule, one set of electrodes is enough for a patient for one course of ten stimulation sessions. The package with electrodes should be labeled and used only by this patient. For hygiene reasons, we do not recommend using these electrodes for other patients. We order good quality electrodes from Electrode’s production factory in China. You can buy it directly from the factory.

No, we do not have such a practice. Renting will require the involvement of an insurance company that will insure the rented devices. With small volumes, this will lead to a significant increase in the cost of devices.

When purchasing several devices, this option is possible.

When purchasing two or more devices.

We restore motor and visceral functions by stimulating different structures of the spinal cord that are responsible for functions lost as a result of injury. In the last ten years, neurophysiologists from Russia and the USA have proven that the spinal cord is not just a transmission mechanism from the brain to the nerves and muscles, but is an independent, «Smart» structure, by stimulating which it is possible to control not only motor but also visceral functions.

Neostim-5 has received approval (license) from the Thai FDA for use in clinics for the purpose of rehabilitation after spinal cord injury, cerebral palsy and stroke.

The warranty period for Neostim-5 is one year.
Methodological support for using the device – without time limits.

Experience with Neostim-5 on the US market has shown the reliability of the device over several years of regular use.

Non-invasive spinal cord stimulation as well as functional muscles stimulation is effective only in combination with physical exercises in active or passive mode.  
As a result of single stimulation session, we can only test the patient and see if he has a motor response to stimulation. For example, when training a sitting position using spinal cord stimulation, the patient should straighten his back, when training a standing position, he should stand more confidently. After he has learned to sit and stand independently, we can move on to the next stage of rehabilitation, walking training. We can talk about the long-term effect of rehabilitation only after several rehabilitation sessions, lasting from two to three weeks.

Please see sections 1 and 2 of this document.

When we stimulate the T11-T12 vertebrae with single pulses (1 ms duration), we can trigger the contraction of the leg muscles at certain current intensities. This response is a spinal monosynaptic reflex, and it takes about 15 milliseconds. This reflex is caused by the activation of dorsal roots, which results in one synaptic transmission to spinal motoneurons.  Making the stimulus stronger activates the motor axons and causes muscle contraction. This happens 3 milliseconds faster than the monosynaptic spinal reflex. This fast muscle reaction is called an M-response.  The M-response is basically a reflect of the activation of spinal motoneurons. The H-response demonstrates the activation of sensory neurons in the superficial layers of the dorsal horns of the spinal cord. 
The spinal monosynaptic response shows that sensory neurons (dorsal roots) get activated, which excites spinal motor neurons.
When you stimulate the T11-T12 vertebrae at 30 to 40 Hz, the spinal neuronal network known as central pattern generation (CPG) gets activated. This CPG produces a stepping pattern that causes stepping movements. There's a lot of evidence that transcutaneous electrical stimulation activates the spinal locomotor network. This is based on a bunch of experiments on animals and humans, including pharmacological blocking of different afferent fibers.

All the characteristics of bladder stimulation you can find in pre-installed programs of Neostim-5 device.

We use the stimulation of L5-S1 segment to reduce spasticity in the lower limbs using a frequency of 30 Hz.

The maximum technically possible current for the Neostim-5 stimulator is 250 mA
 When you gradually increase the current strength, please be sure that the patient does not experience any unpleasant sensations from the stimulation.

The pulse repetition frequency depends on the level of impact and the type of training; it was identified and selected during clinical trials, that is, these parameters are recommended in accordance with our experience gained as a result of numerous clinical studies and trials.
The current strength is selected individually. We increase the current strength during training to hold the torso while sitting or standing until the patient can hold the pose. During rhythmic stimulation - until contractions occur in the lower extremities. During exercise bikes and walking - until the patient tolerates the procedure painlessly, but not less than 20 mA.

The frequency does not change; it depends on the level of impact and type of training. It was revealed during multiple  clinical trials. The current strength can change depending on the patient's sensations, the main criterion is the absence of pain.

Each patient is individual. It depends on the severity of the condition.

If complete (anatomical) spinal cord injury is clinically proven, then we are powerless and no one can help such a patient. This happens rarely, as was proved during a pathological examination in the US on a large sample of corps of patients diagnosed during their life with complete SCI: 90% of them did not have a complete anatomical injury and could have been rehabilitated.

No, it can't, for that we developed Neostim-6 which can stimulate spinal cord roots using signals from sensors, placed on the hip of the patient. So, it can safely manage flexor/extensor pattern. It's possible but risky to do it using Neostim-5, because it doesn't have sensors, so stimulation of flexor/extensor can't be as precise as needed.

We place electrodes on the patient's skin, a cathode (2-3 cm diameter) at the Th11-Th12 level, a couple of anodes (~5*10 cm2) on the iliac crests or to the right and left of the umbilicus. When we start stimulation, we create an electric field that transits a body from the cathode to the anodes and stimulates the spinal cord as well as the dorsal roots. Stimulation of the afferents of dorsal roots excites the neural networks of the spinal cord and triggers muscle activity in the limbs. Current lines pass through the entire body, from the cathode to the anode. The maximum current density is under the cathode, that is, in the spinal cord.

A 2-3 cm cathode is placed above the spine (spinal cord), two anodes (approximately 5*10 cm2) are placed on the front side of the body, above the iliac crests or to the right and left of the navel. During stimulation, the current lines are directed from the anodes to the cathode where depolarization of the neurons is occur , passing from the back surface of the body to the front; the maximum density of current lines is in the spinal cord, in those segments of the spinal cord over which the cathode is placed.
NMES stimulates a nerve and causes a muscle to contract. Transcutaneous spinal cord stimulation stimulates the spinal cord and causes activation of neural networks that regulate movement (or some others, depending on where the cathode is placed), which can cause muscle groups to contract.

Transcutaneous spinal cord stimulation stimulates the spinal cord and causes activation of neural networks that regulate movement (or some others, depending on where the cathode is placed), which can cause contraction of muscle groups.
When stimulating with single impulses (1 msec, 1 impulse every 3 sec or less), increasing the current strength can cause muscle contractions, which can be observed by electromyography or simply by the eyes. The Jendrassik maneuver will reduce the current strength at which motor responses are observed.
When stimulating with continuous pulses (20-30 Hz), as the current increases, tension can be seen in the muscles that correspond to the stimulated segment of the spinal cord. In people with normal sensitivity, it is not always possible to achieve such intensity.
Activation of neural networks of the spinal cord during stimulation with an intensity lower than that which causes a motor response can be observed by comparing the magnitude of the motor response without stimulation and with stimulation (for example, the strength of the hand grip during stimulation of the cervical spine, walking speed during stimulation of the lower thoracic and lumbar spine, etc.). The effects of transcutaneous spinal cord stimulation are also observed when this stimulation is combined with transcranial magnetic stimulation of the motor zones.

Compare the performance of a target action without stimulation and with stimulation.

Transcutaneous spinal cord stimulation activates neural networks in the spinal cord that regulate locomotor functions. If the desired effect is to facilitate or restore locomotion, then stimulation will achieve this effect. Stimulation imitates supraspinal signals. To achieve the desired effect, stimulation must be synchronized with motor activity.

• Stroke
• Reduced spasticity
Transcutaneous spinal cord stimulation activates neural networks of the spinal cord that regulate locomotor functions. Stimulation replaces supraspinal signals. To achieve the result, stimulation must be synchronized with motor activity.

The modified Ashworth scale is the main method for assessing changes in spasticity as a result of transcutaneous spinal cord stimulation (e.g. review by Alashram AR et al. Transcutaneous spinal cord stimulation effects on spasticity in patients with spinal cord injury: A systematic review // The Journal of Spinal Cord Medicine. 2023. Vol. 46, No. 4. P. 582–589).

When using transcutaneous spinal cord stimulation to restore motor functions, the stimulation intensity is selected at the level of stimulation tolerance (stimulation should be felt, but not cause pain or discomfort). The stimulation intensity is selected for each patient individually, adjusted at each procedure. This intensity can be both less and more than 30 mA.