The Science | NMES for Neuromuscular Reeducation | NeuFit®

The Science

The Neubie® is a breakthrough neuromuscular electrical stimulation (NMES) device.

It works by sending electrical impulses through the skin to nerves in tissue to elicit muscle contractions and sensory impulses(1,2). These impulses mimic action potentials from both the peripheral and central nervous systems, which is how they communicate with other parts of the body(3). The impulses then communicate with sensory and motor neurons to activate contractile and sensory muscle fibers, resulting in the stimulation of muscle, tissue, and nerve activation, and increasing blood flow(2-7).

Incorporating NMES into training and therapeutic rehabilitation programs can enhance long-term outcomes by supporting adaptation of cells in muscles, blood vessels, and nerves(8). NMES has been used clinically for a variety of conditions, including orthopedic issues(1,9-17) neurological conditions like stroke and spinal cord injury(18-23), and in training regimens to improve overall fitness and health at any age(24-30).

The NEUBIE is a unique NMES device for several reasons. It uses pulsed direct current (DC) as opposed to alternating current (AC); it has unique effects on the body's tissues to promote healing; and it has unique effects on the nervous system that, when combined with the NeuFit System, allows practitioners to provide a meaningful dose of neuromuscular re-education.

Using DC is important, because it has numerous, positive biological effects. DC fields have been shown to accelerate the body’s own physiological processes of healing, repair, and regeneration,(31-36) and to have unique effects on the nervous/neuromuscular system.(36-39) Although this has been known for a long time, most devices out there are alternating current (AC). These devices are cheaper and easier to engineer, and most people don’t know the difference. Unfortunately, they won’t have anywhere near the same effect at the cellular level.

The Neubie’s DC technology enables practitioners to use an “input-based” approach to rehab and training: sending inputs into tissue that can influence the body’s outputs and responses to stimuli. The unidirectional flow of DC fields is able to achieve more input stimulation to sensory afferent signaling compared to the bidirectional flow of AC, which can cause a co-contraction that suggests both input and output stimulation to the nervous system. Further, DC allows for more specific contractile movement at higher amplitudes, making it more useful and efficient for training and rehabilitation. DC has a longer phase duration than AC, requiring less intensity (amplitude) to evoke an action potential. Additionally, activation of denervated muscles requires a longer pulse length, achievable with DC(40) but not with AC. In the past, the power of DC devices has been limited, as DC fields can cause charge build up that leads to skin irritation. But the NEUBIE beats the build up by including an additional waveform that dissipates heat and charge buildup, allowing for higher intensity stimulation without irritation!

In addition to having positive effects on tissues, the NEUBIE is used along with the NeuFit System for neuromuscular re-education. The NeuFit system is based on new research showing that electrical stimulation can affect reflex patterns,(40-43) brain activity,(44-47) muscle output,(48-49) and pain(59-52).

Treatments with the NEUBIE and NeuFit System are active rather than passive. Traditional e-stim treatments have patients lying down, passively accepting the current and not moving. In contrast, the DC signal of the NEUBIE actually permits movement, even at therapeutic levels of stimulation. This allows for optimal, eccentric contractions, which research is proving to be a major factor in effective rehabilitation(53-55). The combo works so well because it generates neuromuscular adaptations while allowing adjustment of motor control in voluntary movement, which is more effective and efficient than either alone; The combo results in greater induction of muscular adaptations, improved performance of complex dynamic movements, and accelerated recovery of muscle contractility and functional abilities(56).

We are currently working on several formal scientific research projects, including several registered clinical trials. Here is an overview of our studies in progress, and we and are excited to share those results with you as they come available:

Clinical Outcomes: A Multi-Center Study Looking at how NeuFit Impacts Post-Surgical Outcomes

We are working with Orthopedic One, of Columbus, Ohio, and Arrowhead Orthopedics of Southern California, to compare the outcomes for patients using the standard-of-care physical therapy protocols to recover from orthopedic surgery and patients using NeuFit.

Underlying Mechanisms: How the Neubie Impacts the Cellular Processes Related to Muscle Hypertrophy

We are working with the Muscle Physiology Laboratory at the University of South Florida (U.S.F.), led by Dr. Sam Buckner, Ph.D., to look at what happens at a biochemical and structural level as the body recovers from a NEUBIE session. One of the current hypotheses being evaluated is that the NEUBIE can be used to create muscle hypertrophy without external load.

Measuring the Autonomic Response to NeuFit Sessions

In partnership with BioStrap Labs, we are measuring the impact of the Neubie on various biomarkers, like heart rate variability (HRV), sleep quality, and blood flow. Early data is showing that the NEUBIE does increase HRV, which is a powerful indicator of parasympathetic nervous system function and has profound effects on overall health, recovery, and the ability to handle physical, psychological, and emotional stress.

Studying the Effect of NeuFit on Neurological Populations

In partnership with a couple of hospital systems, we are evaluating the ability of the Neubie to restore function in patients who have had a stroke or who have M.S. We are also working on a multi-center study to measure the impact of the Neubie on patients with neuropathy. 

  1. Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007 May;35(5):562-90. doi: 10.1002/mus.20758. PMID: 17299744.
  2. Kato T, Sasaki A, Yokoyama H, Milosevic M, Nakazawa K. Effects of neuromuscular electrical stimulation and voluntary commands on the spinal reflex excitability of remote limb muscles. Exp Brain Res. 2019 Dec;237(12):3195-3205. doi: 10.1007/s00221-019-05660-6. Epub 2019 Oct 10. PMID: 31602493; PMCID: PMC6882749.
  3. Carson RG, Buick AR. Neuromuscular electrical stimulation-promoted plasticity of the human brain. J Physiol. 2019 Sep 8. doi: 10.1113/JP278298. Epub ahead of print. PMID: 31495924.
  4. Cabric M, Appell HJ, Resic A. Stereological analysis of capillaries in electrostimulated human muscles. Int J Sports Med. 1987 Oct;8(5):327-30. doi: 10.1055/s-2008-1025678. PMID: 3679647.
  5. Pette, D. and Vrbová, G. (1999), What does chronic electrical stimulation teach us about muscle plasticity?. Muscle Nerve, 22: 666-677. https://doi.org/10.1002/(SICI)1097-4598(199906)22:6<666::AID-MUS3>3.0.CO;2-Z
  6. Salmons S, Vrbová G. The influence of activity on some contractile characteristics of mammalian fast and slow muscles. J Physiol. 1969 May;201(3):535-49. doi: 10.1113/jphysiol.1969.sp008771. PMID: 5767881; PMCID: PMC1351409.
  7. Bickel CS, Gregory CM, Dean JC. Motor unit recruitment during neuromuscular electrical stimulation: a critical appraisal. Eur J Appl Physiol. 2011 Oct;111(10):2399-407. doi: 10.1007/s00421-011-2128-4. Epub 2011 Aug 26. PMID: 21870119.
  8. Vanderthommen M, Duchateau J. Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev. 2007 Oct;35(4):180-5. doi: 10.1097/jes.0b013e318156e785. PMID: 17921786.
  9. Avramidis K, Karachalios T, Popotonasios K, Sacorafas D, Papathanasiades AA, Malizos KN. Does electric stimulation of the vastus medialis muscle influence rehabilitation after total knee replacement? Orthopedics. 2011 Mar 11;34(3):175. doi: 10.3928/01477447-20110124-06. PMID: 21410130.
  10. D.T. Demircioglu, N. Paker, E. Erbil, D. Bugdayci, T.Y. Emre, The effect of neuromuscular electrical stimulation on functional status and quality of life after knee arthroplasty: a randomized controlled study, Journal of physical therapy science, 27 (2015) 2501-2506.
  11. A.K. Klika, G. Yakubek, N. Piuzzi, G. Calabrese, W.K. Barsoum, C.A. Higuera, Neuromuscular Electrical Stimulation Use after Total Knee Arthroplasty Improves Early Return to Function: A Randomized Trial, The journal of knee surgery, DOI 10.1055/s-0040-1713420(2020).
  12. R. Delanois, N. Sodhi, A. Acuna, K. Doll, M.A. Mont, A. Bhave, Use of home neuromuscular electrical stimulation in the first 6 weeks improves function and reduces pain after primary total knee arthroplasty: a matched comparison, Annals of translational medicine, 7 (2019) S254.
  13. Lake DA. Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries. Sports Med. 1992 May;13(5):320-36. doi: 10.2165/00007256-199213050-00003. PMID: 1565927.
  14. Paillard T. Combined application of neuromuscular electrical stimulation and voluntary muscular contractions. Sports Med. 2008;38(2):161-77. doi: 10.2165/00007256-200838020-00005. PMID: 18201117.
  15. Nussbaum EL, Houghton P, Anthony J, Rennie S, Shay BL, Hoens AM. Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiother Can. 2017;69(5):1-76. doi: 10.3138/ptc.2015-88. PMID: 29162949; PMCID: PMC5683854.
  16. Hauger AV, Reiman MP, Bjordal JM, Sheets C, Ledbetter L, Goode AP. Neuromuscular electrical stimulation is effective in strengthening the quadriceps muscle after anterior cruciate ligament surgery. Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):399-410. doi: 10.1007/s00167-017-4669-5. Epub 2017 Aug 17. PMID: 28819679.
  17. Lepley LK, Wojtys EM, Palmieri-Smith RM. Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction. Knee. 2015 Jun;22(3):270-7. doi: 10.1016/j.knee.2014.11.013. Epub 2014 Dec 10. PMID: 25819154; PMCID: PMC4754794.
  18. Maffiuletti NA, Gondin J, Place N, Stevens-Lapsley J, Vivodtzev I, Minetto MA. Clinical Use of Neuromuscular Electrical Stimulation for Neuromuscular Rehabilitation: What Are We Overlooking? Arch Phys Med Rehabil. 2018 Apr;99(4):806-812. doi: 10.1016/j.apmr.2017.10.028. Epub 2017 Dec 9. PMID: 29233625
  19. Knutson JS, Fu MJ, Sheffler LR, Chae J. Neuromuscular Electrical Stimulation for Motor Restoration in Hemiplegia. Phys Med Rehabil Clin N Am. 2015 Nov;26(4):729-45. doi: 10.1016/j.pmr.2015.06.002. Epub 2015 Aug 14. PMID: 26522909; PMCID: PMC4630679.
  20. Chandrasekaran S, Davis J, Bersch I, Goldberg G, Gorgey AS. Electrical stimulation and denervated muscles after spinal cord injury. Neural Regen Res. 2020 Aug;15(8):1397-1407. doi: 10.4103/1673-5374.274326. PMID: 31997798; PMCID: PMC7059583.
  21. Carnaby GD, LaGorio L, Silliman S, Crary M. Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: A double-blind placebo-controlled trial. J Oral Rehabil. 2020 Apr;47(4):501-510. doi: 10.1111/joor.12928. Epub 2020 Jan 19. PMID: 31880338; PMCID: PMC7067660.
  22. Stein RB , Chong SL, James KB, et al. . Electrical stimulation for therapy and mobility after spinal cord injury. Prog Brain Res.2002 ;137:27–34.
  23. Belanger M , Stein RB, Wheeler GD, et al. . Electrical stimulation: can it increase muscle strength and reverse osteopenia in spinal cord injured individuals? Arch Phys Med Rehabil.2000 ;81:1090–1098.
  24. Wakahara T, Shiraogawa A. Effects of neuromuscular electrical stimulation training on muscle size in collegiate track and field athletes. PLoS One. 2019 Nov 13;14(11):e0224881. doi: 10.1371/journal.pone.0224881. PMID: 31721812; PMCID: PMC6853328.
  25. Gondin J, Cozzone PJ, Bendahan D. Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes? Eur J Appl Physiol. 2011 Oct;111(10):2473-87. doi: 10.1007/s00421-011-2101-2. Epub 2011 Sep 10. PMID: 21909714.
  26. Gondin J, Brocca L, Bellinzona E, D'Antona G, Maffiuletti NA, Miotti D, Pellegrino MA, Bottinelli R. Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis. J Appl Physiol (1985). 2011 Feb;110(2):433-50. doi: 10.1152/japplphysiol.00914.2010. Epub 2010 Dec 2. PMID: 21127206.
  27. Jandova T, Narici MV, Steffl M, Bondi D, D'Amico M, Pavlu D, Verratti V, Fulle S, Pietrangelo T. Muscle Hypertrophy and Architectural Changes in Response to Eight-Week Neuromuscular Electrical Stimulation Training in Healthy Older People. Life (Basel). 2020 Sep 8;10(9):184. doi: 10.3390/life10090184. PMID: 32911678; PMCID: PMC7554879.
  28. Mancinelli R, Toniolo L, Di Filippo ES, Doria C, Marrone M, Maroni CR, Verratti V, Bondi D, Maccatrozzo L, Pietrangelo T, Fulle S. Neuromuscular Electrical Stimulation Induces Skeletal Muscle Fiber Remodeling and Specific Gene Expression Profile in Healthy Elderly. Front Physiol. 2019 Nov 27;10:1459. doi: 10.3389/fphys.2019.01459. PMID: 31827446; PMCID: PMC6890722.
  29. Di Filippo ES, Mancinelli R, Marrone M, Doria C, Verratti V, Toniolo L, Dantas JL, Fulle S, Pietrangelo T. Neuromuscular electrical stimulation improves skeletal muscle regeneration through satellite cell fusion with myofibers in healthy elderly subjects. J Appl Physiol (1985). 2017 Sep 1;123(3):501-512. doi: 10.1152/japplphysiol.00855.2016. Epub 2017 Jun 1. PMID: 28572500.
  30. Pigarev IN, Pigareva ML. Therapeutic Effects of Electrical Stimulation: Interpretations and Predictions Based on the Visceral Theory of Sleep. Front Neurosci. 2018 Feb 12;12:65. doi: 10.3389/fnins.2018.00065. PMID: 29483861; PMCID: PMC5816067.
  31. Chen, Y., Ye, L., Guan, L., Fan, P., Liu, R., Liu, H., Chen, J., Zhu, Y., Wei, X., Liu, Y., Bai, H., Physiological electric field works via the VEGF receptor to stimulate neovessel formation of vascular endothelial cells in a 3D environment. Biol Open, 7(9), 2018. 
  32. Hu, W.W., Chen, T.C., Tsao, C.W., Cheng, Y.C., The effects of substrate-mediated electrical stimulation on the promotion of osteogenic differentiation and its optimization. J Biomed Mater Res B Appl Biomater, 2018. 
  33. Rouabhia, M., Park, H., Meng, S., Derbali, H., Zhang, Z. Electrical stimulation promotes wound healing by enhancing dermal fibroblast activity and promoting myofibroblast transdifferentiation. PLoS One. 8(8), 2013.
  34. Borgens R.B., Vanable J.W., Jaffe L.F., Bioelectricity and regeneration. I. Initiation of frog limb regeneration by minute currents. J Exp Zool. 200(3), 1977. 
  35. Leppik L.P., Froemel D., Slavici A., Ovadia Z.N., Hudak L., Henrich D., Marzi I., Barker J.H., Effects of electrical stimulation on rat limb regeneration, a new look at an old model. Sci Rep. 5, 2015.
  36. McCaig C.D., Rajnicek A.M., Song B., Zhao M., Controlling cell behavior electrically: current views and future potential. Physiol Rev 85(3), 2005. 
  37. Latchoumane, C.V.,, Jackson, L.,, Sendi, M.S.E., Tehrani, K.F., Mortensen, L.J., Stice, S.L., Ghovanloo, M., Karumbaiah, L. Chronic Electrical Stimulation Promotes the Excitability and Plasticity of ESC-derived Neurons following Glutamate-induced Inhibition In vitro. Sci Rep, 8(1), 2018
  38. Petersen EA, Slavin KV. Peripheral nerve/field stimulation for chronic pain. Neurosurg Clin N Am. 25(4), 2014.
  39. Aplin, F.P., Singh, D., Delia Santina, C.C., Fridman, G.Y., Ionic direct current modulation for combined inhibition/excitation of the vestibular system. IEEE Trans Biomed Eng, 2018.
  40. Zehr, E.P., Collins, D.F., Chua, R., Human interlimb reflexes evoked by electrical stimulation of cutaneous nerves innervating the hand and foot. Exp Brain Res 140:495-504, 2001
  41. Clair, J.M., Anderson-Reid, J.M., Graham, C.M., Collins, D.F., Postactivation depression and recovery of reflex transmission during repetitive electrical stimulation of the human tibial nerve. J Neurophysiol 106: 184-192, 2011 
  42. Clair, J.M., Okuma, Y., Misiaszek, J.E., Collins, D.F., Reflex pathways connect receptors in the human lower leg to the erector spinae muscles of the lower back. Exp Brain Res 196:217-227, 2009
  43. Kitago, T., Mazzocchio, R., Liuzzi, G., Cohen, L.G., Modulation of H-reflex excitability by tetanic stimulation. Clin Neurophysiol 115: 858-861, 2004
  44. Hamdy, S., Rothwell, J.C., Aziz, Q., Singh, K.D., Thompson, D.G., Long-term reorganization of human motor cortex driven by short-term sensory stimulation. Nature Neurosci 1: 64-68, 1998
  45. Ridding, M.C., Brouwer, B., Miles, T.S., Pitcher, J.B., Thompson, P.D., Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects. Exp Brain Res 131(1): 135-43, 2000
  46. Kalisch, T., Tegenthoff, M., Dinse, H.R., Repetitive electric stimulation elicits enduring improvement of sensorimotor performance in seniors. Neural Plast 2010:690351, 2010
  47. Charlton, C.S., Ridding, M.C., Thompson, P.D., Miles, T.S., Prolonged peripheral nerve stimulation induces persistent changes in excitability of human motor cortex. J Neurol Sci 208: 79-85, 2003
  48. Collins, D.F., Burke, D., Gandevia, S.C., Sustained contractions produced by plateau-like behaviour in human motoneurones. J Physiol 538.1: 289-301, 2002
  49. Dean, J.C., Yates, L.M., Collins, D.F., Turning on the central contribution to contractions evoked by neuromuscular stimulation. J Appl Physiol 103: 170-176, 2007
  50. Stackhouse S.K., Taylor C.M., Eckenrode B.J., Stuck E., Davey H., Effects of Noxious Electrical Stimulation and Eccentric Exercise on Pain Sensitivity in Asymptomatic Individuals. PM R, 8(5), 2016.
  51. Fujii-Abe K, Umino M, Fukayama H, Kawahara H., Enhancement of Analgesic Effect by Combination of Non-Noxious Stimulation and Noxious Stimulation in Humans. Pain Pract, 16(2), 2016. 
  52. Eckenrode BJ, Stackhouse SK., Improved Pressure Pain Thresholds and Function Following Noxious Electrical Stimulation on a Runner with Chronic Achilles Tendinopathy: a Case Report. Int J Sports Phys Ther, 10(3), 2015. 
  53. Galloway, M.T., Lalley, A.L., Shearn, J.T., The role of mechanical loading in tendon development, maintenance, injury, and repair. J Bone Joint Surg Am, 95(17), 2013. 
  54. Kaux J.F., Libertiaux V., Leprince P., Fillet M., Denoel V., Wyss C., Lecut C., Gothot A., Le Goff C., Croisier J.L., Crielaard J.M., Drion P., Eccentric Training for Tendon Healing After Acute Lesion: A Rat Model. Am J Sports Med, 45(6), 2017. 
  55. Geremia, J.M., Baroni, B.M., Bobbert, M.F., Bini, R.R., Lanferdini, F.J., Vaz, M.A., Effects of high loading by eccentric triceps surae training on Achilles tendon properties in humans. Eur J Appl Physiol, 118(8), 2018.  
  56. Paillard T. Combined application of neuromuscular electrical stimulation and voluntary muscular contractions. Sports Med. 2008;38(2):161-77. doi: 10.2165/00007256-200838020-00005. PMID: 18201117

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