Table Of Contents

What is the Adaptive Electrotherapy?
What is ENF?
THE FEEDBACK is THE SECRET
THE HEALTH OF THE CELL DEPENDS ON ITS BIOELECTRIC BALANCE
THE EFFICIENCY and THE VERSATILITY
CLINICAL EVIDENCE
SCIENTIFIC EVIDENCE
ENF MEDICAL DEVICES

What is the Adaptive Electrotherapy?

Adaptive Electrotherapy is the new innovative generation of electroceutical technology for advanced effective treatment and accelerated healing used by Electro Neuro Feedback therapy system (ENF)

What is ENF?

It is an advanced treatment technology that uses innovative adaptive electrotherapy to diagnose the medical problem and treat it. The ENF technology can guide the physician during the treatment method by the various types of medical protocols, and it increases the communication between the patient and the physician during the treatment session due to the advanced 3D Anatomy system used in ENF technology too.

THE FEEDBACK is THE SECRET

ENF; The Rehabilitative Technology and Tissues Regeneration

The Electro Neuro Feedback (ENF) Technology by adaptive electrotherapy generates waveforms that are automatically modified by the feedback of the change of skin impedance, according to a compensation algorithm. This continuous adjustment process of the waveform leads to a bio-electric rebalancing of the membrane of the cells that form the tissue underlying to the point of treatment.

Typical ENF waveform, The figure illustrates how the adaptive electrotherapy works. The blue line represents the dynamic reaction of the body, whereas the black line represents the dynamics emission of ENF, as compensation for the body’s response. Adaptation is eliminated and the field of rehabilitative action is significantly expanded.

In return, the achieved balance facilitates the regeneration processes that the tissues involved can express given the severity of the injury and the patient’s potential. With ENF technology, the AC-FVW pulses (Alternate Current-Feedback Variable Waveform) automatically vary according to the change in the body’s reaction to treatment. The wide range of protocols and versatility of ENF therapy, lead to obtaining high-quality results. For that, ENF devices have great application possibilities and high therapeutic potential that ENF can definitely be considered a regenerative electrotherapy proper.

ENF; The Evolution of the Traditional Electrotherapy

The traditional electro-medical devices (both Direct current and Alternate current) emit an invariable waveform throughout the time of application on the patient during the treatment session. The constant emission is not just a feature of popular electrotherapies such as Tens, Tecar, and Radio-Frequencies, but also of very different technologies such as Hyperthermia, Cryotherapy, Ultrasounds, Magnetic Fields, Shock Waves, and Lasers. All these inducing adaptabilities, often have little therapeutic value or a limited scope of application and treatment.

Typical waveforms of conventional electrotherapy. The figure shows the waveforms implemented in the most known electrotherapy used in rehabilitation. Each of them has unique therapeutic specificity but is limited by two factors: the constant supply and adaptation of the organism.

ENF; Searches, Finds … and Rapidly Treats

ENF Technology used adaptive electrotherapy in a very significant and innovative way. The procedure to be performed under the ENF Technology consists of the following two phases:

● Search and Find the Point of Treatment

As the skin is a projection surface of the bioelectric reactions of the inner tissues that in case of pathology, can affect its impedance, it is possible to use the ENF in every area of the body which enables the physicians to easily identify such abnormal points or areas and map them in a complete diagnostic arrangement. Its extreme usefulness can be surprising, especially when the patient’s condition is complex and requires an approach of differential diagnosis.

● Treatment of Bioelectric Balance

After searching for the Point of Treatment, the second phase involves the choice of the therapeutic effect from the ENF menu. The Physician will be able to select the correct treatment protocol according to the analysis of the pathological conditions of the anatomical structures, that showed anomalies in reaction. The wide range of therapeutic effects and versatility of ENF Technology leads to obtaining quickly high-quality results in many diseases.

Inflamed and normalized Tissues — Figure 3

ENF Technology; the Regenerative Electrotherapy. Application on a skin lesion. As the left figure demonstrates, the ENF technology delivers a high dose of Adaptive Electrotherapy energy in the condition of pathological tissue treatment. Whereas in the right figure, the amount of energy delivered is significantly less due to tissue/body recovery

THE HEALTH OF THE CELL DEPENDS ON ITS BIOELECTRIC BALANCE

The Cell is a Bioelectric Circuit

The human cell works as a capacitor, which accumulates and consumes electric charges keeping to a voltage level of about 70 millivolts. If a body tissue is sick or injured, the voltage of those cells drops at least by 20 millivolts. As a result, not enough ATP is produced to feed the cells and their vital functions begin to be compromised.

Circuit diagram of the cell. Electrical stimuli applied to date, were addressed to electrically excitable tissues (muscle tissue and nervous tissue). This innovative ENF Technology allows physicians to work at the cellular level, reaching all types of tissue: epithelial, connective, muscular, and nervous. Through the proper functioning of the cell membrane, neurotransmitters are produced and conveyed into the cells of the damaged tissue, promoting the restoration of their natural balance.

The Movements of IONS affect the Sodium-Potassium pump

In 1955 Hodgkin and Keynes established that the cell membranes of muscles and nerves are alternatively crossed by ions Na⁺ outbound and K⁺ inbound and that these elements continually change the ionic concentration and therefore the electric gradient. The ionic potential balance is defined by the Nernst equation as the electrical potential that is necessary to balance a given ionic concentration. This balance is realized by the passage of ions through the cell membrane. A high concentration of ions tends to disperse in low-concentration areas. Their movements are therefore influenced by voltage levels resulting from the electrical voltage difference between the inside and the outside of a cell.

Na⁺/K⁺-ATPase Pump. The figure shows the output from the cell of Na⁺ exchanged with the incoming K⁺. Thanks to the energy provided by the hydrolysis of a molecule of ATP, the pump extrudes from the cell three ions Na⁺ exchanging them with two K⁺ ions that pass from the outer to the inner side of the membrane.

How can ENF Technology speed up the repair of cellular damage?

When a cell belonging to an electrically excitable tissue suffers damage, its membrane is subjected to stress. Damaged tissue has too low a level of electrical activity and its healing ability is therefore inhibited (Injury Current). ENF Technology through adaptive electrotherapy transfers a quantity of energy that is variable because self-regulated by the feedback, can act more quickly on the Injury Current, integrating the natural bioelectric activity and facilitating the repair process by stimulating the migration and the production of fibroblasts.

Cell regeneration. An appropriate adaptive electrotherapy stimulus recognizes the physiological bioelectric movement of ions that surround the cell membrane and allows the restoration of normal cell functions by accelerating the repair of the damage.

The Qualitative Advantages of the ENF Technology

The higher quality of the ENF Technology is to provide damaged tissues with energy, to the extent required by the conductivity detected on the skin. This variable dose of electric charges is more appropriate because corresponds to the real needs of the tissue. It is the real benefit of ENF therapy, compared to conventional forms that transmit constant energy such as electrical stimulation, heat, and percussion.

Process of repair of muscle fibers — Figure 7

The therapeutic process of repairing the muscle fibers. (A) The components of damaged cells are digested by inflammation. (B) The satellite cells proliferate and then, (C) merge in myotubes to form new myofibrils. (D) The proteins of the myofibrils are synthesized to occupy new fibers. (E) The muscle fibers are regenerated.

Normalizing the cell voltage levels, bioelectric communication processes accelerate accordingly. This means that ENF technology through adaptive electrotherapy can solve inflammation operating on the cells of a tissue and encourage encouraging regeneration that facilitates homeostasis, thus significantly reducing pain. ENF therapy does not just relieve the symptoms but helps the body heal faster.

The ENF Technology is effective for different types of treatment, including:

• Reduce inflammation.

• Promote the regeneration of soft tissues.

• Promote the regeneration of bone and tendon tissues.

• Promote the regeneration of nerve tissue.

• Reduce calcification.

• Improve lymphatic and cardiovascular circulation.

• Improve neurological response.

• Reduce pain.

• Strengthen regenerative medicine interventions.

THE EFFICIENCY and THE VERSATILITY

CLINICAL EVIDENCE

The medical results and evidence for different types of ENF therapies are available for the physicians, Click Here to get the required information.

SCIENTIFIC EVIDENCE

• Evaluative and therapeutic applications of Electro Neuro Feedback (ENF) technology: a pilot study – Bellomo R.G., Barassi G., Di Felice P. A., Giannuzzo G., Pecoraro I., Saggini R.–Neuroscienze Department of Gabriele D’Annunzio University – Chieti, IT, 2015 – Published in the Scientific Journal “Arch Fisioter Glob Res” – Lublin University (PL) 2016

Abstract: The study was conducted on 40 subjects, aged from 20 to 50 years (22 males and 18 females) suffering from pain in the neck, with the myofascial syndrome of the trapezius muscle, diagnosed after clinical evaluation. The patients were assessed before and immediately after a single treatment under the ENF therapy, with the Myoton measurement system. The results indicate a significant improvement both in pain and muscle rheological parameters. In the treatment of myofascial dysfunction of the trapezius muscle, ENF therapy is an effective method with a decrease in pain already from the first session.

• The ENF therapy in Spasticity: a new rehabilitation treatment for the upper Motor Neuron Syndrome, evaluation and correlation between quantitative phase analysis and botulinum toxin – D’Ascoli F., Furfari P., Balestrieri AM, Praticò L., Sgro D. – University Lu.de.s. – Lugano, CH, 2014

SCIENTIFIC EVIDENCE Figure 2 — Figure 10

Abstract: The study was conducted on 20 subjects, aged from 6 to 72 years (10 males and 10 females) suffering from “Upper Motor Neuron Syndrome” with Focal Spasticity due to P.C.I. or Stroke. Patients underwent an initial visit (T0) with an assessment of basic conditions and subsequently were randomly assigned to group A (Botulinum Toxin) or group B (ENF therapy), then beginning the corresponding therapy. For the evaluation, the following were used: the measurement in degrees of popliteal angle, the ROM passive Tibiotarsal extended and flexed, and electromyography G-walk. The results testify to the great utility of ENF therapy in the treatment of spasticity in patients with MNS syndrome adults and children alike, as an important aid in the period of physiological decrease of the effectiveness of the toxin.

• IlPain at the Heel Bone in football players: a retrospective study with proposed guidelines for treatment – Saggini R., M. Migliorini, Di Stefano A., Bellomo RG. -Department of Neuroscience, University Gabriele D’Annunzio – Chieti, IT 2015

Abstract: A study was conducted on 19 football players, including professionals, semi-professional, and amateurs ranging in age from 19 to 43 years (15 males and 4 females), suffering from pain in the Heel Bone due to compression of the Sural Nerve. Patients underwent an initial visit with assessments based on the VAS scale and FADI score (Foot Ankle Disability Index). The results show a statistically significant difference between T0 and T6. Besides, following the first treatment with ENF therapy, players resumed training and returned to practice sports after only 10 days. ENF therapy seems to be a very effective method to reduce the pressure of the Sural Nerve without limiting sports activities.

• Electro Neuro Feedback (ENF) technology: clinical evaluation of a new form of electrotherapy in the painful shoulder – A. Coati – the University of Verona, IT 2012

Abstract: Single-blind study in 34 subjects, 10 placebo and 24 treated with ENF therapy, for the duration of 5 sessions a month. Subjects ranging in age from 18 to 45 years (16 males and 18 females), practicing sports at a competitive level and heavy work in daily jobs. Were taken into account shoulder pathologies Shoulder pathologies were taken into account, in particular Impingement, Tendinitis of the Rotator Cuff, and the Long Head of the Biceps. For the evaluation tests of Evidence-Based Medicine used: Yocum, Jobe, Palm-up, and Lift-off. The results show excellent rapid processing capabilities thanks mainly to the numerous and versatile therapeutic effects inside the device, that allows you to speed up the healing process. From the survey results, ENF therapy is a very effective method in the treatment of acute diseases, carried out immediately after the physical injury.

• The treatment of musculoskeletal diseases – Ganzit G.P., Albano M., Cavaletto L., Astegiano P., Gribaudo C.G. – Institute of Sports Medicine FMSI – Torino, IT – 2007 – 2010

Abstract: The study was conducted on 253 subjects ranging in age from 18 to 88 years (151 males and 102 females), practicing and non-practicing sports. The VAS scale from 0 to 10 has been used for evaluation. The results indicate an anti-inflammatory and analgesic effect that is effective even in cases of progressive overload. The therapy was therefore an effective method for decreasing inflammations and persistent pains. It can be a coadjuvant of drug treatments, or it can also be used when these have not proved to be effective. This aspect is particularly interesting for all sports.

• The use of Adaptive Neuro-Stimulation to rebalance posture and muscle tone on football team players – Barassi G, et al. J Sports Med Phys Fitness – Gabriele D’Annunzio University – Chieti, IT 2019

Abstract: A study was conducted on 20 players aged 10 to 25. Patients were divided using a single-blind criterion into two groups. The experimental group was treated 4 times a week with ENF therapy, and the placebo-controlled group received treatment with the device turned off. Patients performed a myometric assessment with MyotonPRO® and a postural assessment with Rarog® at T0 before and at T1 after 4 weeks. An improvement in muscle tone was identified, particularly in the hamstrings, and a rebalancing of the main bony points in the postural system. In conclusion, Adaptive Neuro-Stimulation is useful not only for the treatment of injuries but also for strengthening and improving sports activity.

• Manual Therapy and Electro Neuro Feedback (ENF) in the treatment of Spasticity: evaluation of immediate effects. – Barassi G., Bellomo R.G. , Melle G., Giannuzzo G., Saggini R. – Gabriele D’Annunzio University – Chieti, IT 2019

Abstract: The study evaluates the immediate effects on the spasticity of the lower limbs in a single session ( T0 before – T1 after), on 30 patients (aged 10-20 years) with cerebral palsy, spastic para/tetra paresis, results in the scale Ashworth’s between 1 and 3. Patients were divided into 3 groups: group A treated with manual neuromuscular therapy in an aquatic environment, group B was treated with ENF therapy, and group C was treated with the device off. The analysis shows that both ENF therapy and Manual Therapy are effective in reducing muscle hypertonus, while in Group C no results were shown. We can therefore state that ENF therapy is a valid alternative for the treatment of spasticity, in terms of times, costs, and benefits.

• Manual pressure release and electrical stimulation of peripheral low-grade receptors in nonspecific low back pain: a randomized controlled trial – Barassi G., Pokorski M., Di Matteo C., Supplizi M., Prosperi L., Guglielmi V., Younes A ., Della Rovere F., Di Iorio A. – Gabriele D’Annunzio University – Chieti, IT 2021

Abstract: Chronic nonspecific low back pain is a common painful clinical condition that affects the level of disability and quality of life. The study was performed in a single-blind, randomized manner on 20 patients. In the first group, myofascial trigger points (MTrP) were treated with manual pressure release (MPR), and in the second group with adaptive electrotherapy (ENF). The study highlights the ENF as a reliable tool for the identification and deactivation of MTrPs, reducing disability in patients with chronic low back pain.

ENF MEDICAL DEVICES

ENF Studio

Configurable with SW Modules:
• Urology
• Neurology
• Pelvic Floor
• Gynecology
• Dental Care
• Physiotherapy
• Physio-aesthetics
• Sport Physiotherapy
• Post Surgery Orthopedics

ENF Pro

Configurable with SW Modules:
• Osteopathy
• Pelvic Floor
• Dental Care
• Physiotherapy
• Physio-aesthetics
• Massaggio Estetico
• Sport Physiotherapy

Adaptive Electrotherapy in Electro Neuro Feedback (ENF)