#100 - Long COVID, Chronic Pain and the Next Big Breakthrough in Rehab with Keith Cronin, DPT, Part 2

Hi guys, it's time for another episode of The Factor Podcast. I'm your host, Jessica Riddle. Welcome and thanks for listening. Today is a special episode, and not only are we diving into part 2 of our fascinating look into the world of electrophysiological neuromodulation, but this also happens to be our 100th episode. That's right, 100 episodes of sharing cutting-edge research, real-world clinical strategies, and conversations with some of the brightest minds in healthcare and human performance. Whether this is your first time listening or you've been with us since the very beginning, we're so grateful to have you here. Now, if you tuned into part 1, you know we're exploring the future of patient care with Dr. Keith Cronin, discussing innovative technologies that could reshape treatment as we know it. In this episode, we continue that conversation, taking a closer look at how wearable neuromodulation is impacting chronic pain management, autonomic dysfunction, and even complex conditions like long COVID and traumatic brain injuries. Today, Dr. Cronin will share some groundbreaking insights on how these advancements can not only improve patient outcomes, but also create new possibilities for how we approach treatment in clinical practice. Let's dive in.

All of these possibilities are incredible. And knowing that, if we can get targeted, when drugs and over-the-counter solutions, the less expensive things, they aren't enough, and our next step is saying, hey, let's go just make them the Million Dollar Man and do surgery and stick a whole bunch inside of them. What if we instead can just go, let's go look at something in between? What's the thing that we can use for these chronic difficult patients? Even your orthopedic ones. I want everyone here, if you're dealing with just people with chronic back pain, Other pains and issues, this thing works phenomenal because if it's helping them with that autonomic level, the physical end is piece of cake. So if we have non-invasive, drug-free wearable electrophysiologic neuromodulation, what can the future be? And the reason I'm so excited, even at the conclusion of this presentation, is like, y'all, I want to go make some more beautiful mind boards here. I know everyone in this audience, there are those here who go like, yeah, yeah, I want that. Well, come talk to me. Talk to me, talk to us, talk to us, because the only way we're going to get this information out there to break through the bias of why we didn't know it in the first place is we're going to have to push and share. And by sharing information, it's going to go help those individuals who came to start at this and said, I will give you all this information, just do right by other people. And I really am excited to show this, not just for the purposes of, man, this is new tech, Because with it, we potentially have the ability to give hope to those who don't have any options. And that, as a clinical end, is probably the most exciting thing of all. So I appreciate y'all being part of this. And Jessica, I'll kind of turn it over for questions and everything else now, but yeah, let's go. Fire away.

Absolutely. Thank you so much. I think to begin with, wow, I know I'm a little bit blown away by some of the applications here, and I know the possibilities are monumental. For practitioners that have used e-stim in the past, those that are using that again for chronic pain, for possibly patients that come in with acute injuries, this is a huge jump and a huge leap forward. So if they're thinking now of their Long COVID patients, for example, like where are you seeing this fitting in really well with that specific population? And are there any type of symptoms that this has had a surprising impact on that you didn't expect?

Yeah, I was going through most of my— it almost like I'd have to go check all boxes. So the ones that— let's just go, those individuals that are coming in, the challenge that you run into is if you've worked with chronic fatigue patients, fibromyalgia, or even chronic pain patients, we know we got to get them moving to feel better, but there's this like weird balance to do it. The science is unfolding that's showing us like at a central level, they're already downregulated. So we're kind of like running uphill. And so with this, if you can balance out their sympathetics and parasympathetics by putting them more in a rest and digest state by electrophysiologically modulating them, then what you can do is once you get them more stable, you can start to slowly increase them. And from this, it was putting this into place where before you'll see out there, it's like, hey, let's just— this like the Peloton of whole body electrical stimulation, right? That's not this. This is much more refined. It's much more thought out. And that's why we never looked at it that way. Our goal was to say, hey, let's do 20 minutes of exercise and I don't have to work out for a week, right? 'Cause I can just make muscles sore. You can electrically stimulate anything and, and eventually wear it out. But here, by spreading out the energy, here's the most surprising things that I started seeing was that improvement in bowel, bladder, and sexual function. I just went, What? Because patients sheepishly— I didn't ever ask, they just started saying, I want to let you know something's improved in my life. I go, really? And they get into details and I'm like, oh, let's go check the box for that one. Okay. The other one was actually a decrease in blood pressure. And so when I saw a decrease in blood pressure, I went— for people who are standardly high, I went, hold on, how did you— only can do that with drugs. That's, that's not possible. And then they would always ask like, oh, well, you have to have the suit on all the time. Well, We were only having on people 2 to 3 times a week for 30 minutes. Why was it regulating after that? That one also broke my brain. And then finally, the ones who were having chronic pain, it was going away almost immediately. And you start to then realize, in my head I go, man, what if you could combine this with either adjustments or combine it with decompression or things like that that are mechanical, and you could clear up a CNS and then all of a sudden use this at the same time. I'm like, wait, this like takes treatment to a whole new level. And so through this, we've been able to like see so many amazing things, and it keeps happening every day that I go, there's a new one that's popping up, and we're just excited. The most recent one was someone's A1C starting to stabilize, but they aren't hardcore exercising with it. I thought you'd have to like really exercise. No, they're— that's improving. And so we all know these are anecdotal, but now we have enough information to say, y'all, This is where the issue is, and we gotta look at it.

So let's talk a little bit about clinical practice and how this looks on a daily basis, because we've had a lot of questions here about, is this suit something that they wear constantly or for sessions? If you're a doctor and you are considering implementing this with your patients, what does that look like on a visit basis? Can you use suits for multiple patients? How does that work?

Yeah, so first the technology, the suit itself can actually be washed. So you can put it on cold in the wash with our instructions that are in there, and you can actually utilize that to be able to clean it in between. It'll still take, you have to air dry it. So we can say, you know, like, look, it's gonna be used and you can probably only use that one once on a day unless you had a fan and tried to dry it off. But in practice, what we're recommending is that practices get the system, get suits, and then if they want to do for more focused treatment in their facility, what they're gonna be able to do is they come in and people would try it for the first time. And if they get benefit from it, then what you would do is just have 'em buy their own suit. And so the suits are far— the system is the more expensive part. The suits are far less expensive, which we'll be happy to go send out afterwards. But then that allows the individual to, I call suit up. They are coming ready. They're wearing a uniform. We wear uniforms in the Olympics. We wear uniforms to play in any professional sport. We wear uniforms when we're public servants. You wear a uniform when you're going to therapy. When you're going to help yourself. And by doing that, it also puts them in a better mindset. And so you're asking, does it have to be worn all day? No, we're finding the benefits kick in for the most part around 20 minutes, but we're not seeing anything what I call majorly better after 40 minutes. So it means using this 2 to 3 times a week, all the stuff that I'm talking about is happening without having to have it on all day. There are other technologies that you wear for walking that actually help lift your foot. Well, the challenge is if you electrically push all day, you can actually start causing some skin damage and irritation. That's a possibility. This is one that's not. You don't have to have it on all the time. And I think that's the part that why in a medical practice you bring this in, you're able to incorporate it in knowing that the person's not going to be there for 10 hours. They're going to be there for 30 minutes.

And then in terms of the research that's been done, are there protocols that have been developed so that if you're dealing with a specific condition or a specific symptom, you would do this for 2 to 3 days a week? 30 minutes apiece, or are there kind of protocols that have been developed for specific types of conditions that you're treating?

That's a great question. So I built the protocols for this based upon autonomic risk. So individuals who are higher autonomic risk and they exhibit symptoms associated with autonomic dysfunction, which would include the things, and I listed them earlier, blood pressure, heart rate, abnormal sweating, you know, respiratory rate, SpO2. And weird dilation and movement of eyes. That's the things we can measure. But then there's the other ones which are subjective, which is sometimes why we don't get into it as much because you have to ask 'em, are they able to socialize? Do you have enough energy? How are you sleeping? What's your sex life like? Are you actually able to urinate and go to the bathroom at your own control? When we started to go dive into those, that's when we started to realize, ah, individuals who start with those issues, we need to start 'em on more of a parasympathetic protocol, which is gonna be a 40 to 7 hertz cycle on active and, and off time. And those individuals are gonna be on that for 20, 30 minutes a day for about 3 times a week. And then what we find is then you start tracking all of those measures here with outcomes forms, and then you start measuring those objectives that you have in clinic. We even recommend when you start using this in clinic, those patients come in, you need to, if you really want to dive in and do this right, you need to do a blood pressure and heart rate at the start of treatment and then look at it at the end. What was crazy is we started seeing individuals who started exercising with it, but then their heart rate went down. Now, you'd expect someone in a chronic state for their heart rate to start jumping up, but that's not the case. And so, we find that neuromodulation starts to really kick in around 10, but we really find that 20 seems to be able to be across the board creating effect. 5 minutes, 10 minutes doesn't seem to be enough. So, from a protocol perspective, we start them there. Then, what we do is we move them into pattern movements as we go along, which is going to be things like sit-to-stand, walking. Yes, you can actually use pattern movements with this. to create spikes within their own muscles and actually then be able to control it, see how they react, and then keep moving into more strength modes where at that point, hopefully, if things are stabilized, then you're just exercising them. You're actually being able to push them better. You're going to be able to do things to help calm them down because oftentimes with this product, it's actually cleared for localized increase in blood flow. Well, when you cover the whole body except below the elbow and below the knee, localized blood flow is like everywhere. So you're able to actually Get them up and moving and circulating, and then that gets more into the functional electrical stimulation component of it where we can drive past just thinking about autonomics and what can we do to actually stimulate muscles. Because as I mentioned before, the more we can actually get someone to push and reach fatigue but stay controlled, that is going to go create all the myokines that are going to be able to help stabilize them and create anti-inflammatory effects, increase your dopamine, increase your hippocampal activity. Decrease the hypothalamic-pituitary axis, which is oftentimes driving cortisol. All those fun things you can do with fancy words by just having someone put on a suit and use the protocols we have set forth. And at the end of it, they just feel like, I look like Iron Man. So that's pretty cool as well.

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So with HRV, those are ones that— great, y'all bring that up cuz obviously it's a hot topic right now cuz that's a true autonomic test. That's where we're, we're looking and working with groups like Brooks Rehabilitation are gonna start looking into this. And even some of the tests that we are gonna start running for pilot studies, we're gonna look at it for ourselves. We are 100% open to anyone who wants to look at this as well. From a mitochondrial standpoint, we haven't been able to dive in that far. This is new technology. We know something is going on, we just don't know how it's getting there. And what I wanted to do is, even coming to this today, is, is we can talk mechanisms, and those are things I'm excited about. The outcomes are happening, and so since they are, let's backtrack and work towards why it's coming through. And I personally am open to every conversation who wants to look at this, because with these patients, it is a balance of mechanical, nutrition, a good mental state, quality care from a quality practitioner, and then being able to test and move these things. We're just giving another tool in the toolbox to be able to really get at the core of this. And if we can start to calm down some of these issues, it is my belief that then we're going to be able to see What's going to really fix and help these people long-term. We have a system right here that is improving quality of life. It is making changes for them for the better, but some of the issues obviously still at hand are still there. If we can clear away a lot of the stuff that's in the way, we might be able to see it better. And in doing so, the individuals who are bringing up stuff like heart rate variability, looking at the mitochondria, looking at things that are happening deeper, I think they're going to come to light. And that's the part I'm most excited about is we got, I think we got the bridge to get people to where we're gonna be able to actually fix these things.

That's amazing. And that's certainly something I know that will give hope to, to many, many people. One person was asking about if this could possibly help those that have autonomic disorders that were caused by traumatic brain injury. Is there any difference in the protocols that you utilize For those that have these autonomic dysfunction issues because of TBI?

Yeah, that's— that one's great. The answer is no, because when you get a traumatic brain injury, you're going to have central nervous system inflammation no matter what, and they are going to present exactly the same. This is where we— this is where I call the leap of faith, where we've got to give the body a little credit to be able to say, if we can just modulate and help How can you help fix yourself? We do this every single day, our cells and macrophages, and we have immune system, whether it's innate or adaptive, it keeps us protected. We are putting it in a better position. So, for example, if traumatic brain injury, if it was, say, a stroke, right, this would be able to help with actually getting muscles more stimulated to simply help to create that connection because there's no afferent going up. So, why would there be any efferent action going down? We are creatures that feel and sense our world. It goes into our head, then we think about what that's going to do, and then we move. Well, if we can do things to, at the, at the periphery, come in, provide a bolus of information, then basically have the brain go, man, I gotta audit and gotta start thinking about this stuff, and then change the way that we actually act, you're gonna see whether it's traumatic brain injury, concussion, stroke, all those things we've already seen benefit with. Parkinson's, same deal, because it's still a central issue, Why are their tremors decreasing? Spinal cord patients are probably the more complicated one because that one is actually, the difficulty is not neuromodulating at the head, it's actually at the delivery point. And we do know our spinal cords are able to even store gait. They even shown recently they can even store memories. When you have a modulation issue here, it varies tremendously from person to person. So we know we're going to be able to help a lot of individuals. They're not going to get up one day and just start walking perfectly fine immediately. They have been deconditioned for a long time, but from what we've seen at the autonomic level, it's putting this into a lot of hope to make a lot of change for people.

No, that, that's incredible for sure. Of the patient presentations that we've talked about, you talked about those that have chronic pain, long COVID, autonomic dysfunction. Have we seen complete remission of symptoms, or is this a protocol that requires kind of ongoing sessions For an extended period of time. What does that look like when it comes to the lifespan of that patient treatment and kind of what that treatment plan looks like long-term?

So these are going to be long-term no matter what. Anyone who has autoimmune, spinal cord injury, traumatic brain injury, and even though I'm going to put those, I mean, it seems so like common, but chronic back pain falls into the same category. They actually become complicated. And what we're seeing is I'm not, we've not seen what I call full remission. Someone who has a stroke and has difficulty walking, we've gotten individuals who haven't been able to walk for 2 years and they get up and they're able to actually start standing and walking a little bit on their own. And that's after a couple months. We know if we keep pushing 'em, they're gonna keep getting better. So we need to go treat this instead of we're trying to fix a disease state. We need to be able to manage it to be able to get the individual in a state where they can start taking care of themselves. I mentioned before, this technology does have the ability to go home as well. And that is why a lot of the rehab centers have been interested in what we do. And the reason they're interested in what we do is because of the fact that we have something that can go home with. I had one group comment to me, they said, look, I have millions of dollars of equipment in here, but nothing can go home with the patient. And now we have that ability. And with telehealth and the ability to actually store data and remotely monitor and check and track everything that's going on, We, even the device itself, we can actually see if it's been used on time, it's been used. We can actually then start to backtrack this to actually create a remote means of being able to help people. And sure, they're 100%, y'all gonna start out in the clinic and they need to be monitored, but it gets to a point where they're just gonna need to do more over a long period. And we need to be open to the fact that this may need to go home with them. And if it does need to go home with them, why does it need to go home with them and how long are they gonna use it for? Anybody who's a spinal cord patient would still, just like all the other conditions they have, need it. Need it for life. Chronic pain patients we've seen so far are able to actually eventually get off, not needing this anymore. But those in the autoimmune are likely going to need it for a very long extended period because the issues that are having— they're having are complex in nature. And even after hundreds of billions of dollars of money being thrown in, they can't— still can't figure it out. Well, today is the first one where we can bring an electrophysiologic approach as opposed to just a drug, a chemical, and/or mechanical.

That's actually kind of a great segue to the next question. When it comes to the suit itself, and I know it's something that they can take home with them, or obviously you can do treatments in office, what type of tracking mechanisms are in place within the technology? What type of metrics and data can providers gain from these treatments? You mentioned that there were some components of the suit that you can actually track how it's being used and the—

Mm-hmm.

I'm imagining the response that's Coming from that?

Yeah, so the things that we can go look at right now, let's go look at what the system itself is, a little box that goes on the hip that connects to an iPad. And that's what we start with, what I call clinically, that's what you use in your clinic. When a system goes home, you actually have to start getting more boxes because that box is actually a fit software for your clinic. You couldn't go and just give yours because they would actually be able to see all your patient data in there 'cause it's a HIPAA-compliant cloud that's in there. So we actually, you have to start tracking it, but you can get access to be able to look at your own patients. Now, the things that we're able to currently look at are going to be for the time use. We're actually going to be able to see the modes and everything else that's being used on there. The technology is finalized for what it is now, but just note, this is becoming medical wear. This is the future of treating patients because eventually we're going to have anything from your heart rate monitors to being able to measure cortisol to things that you would be able to actually have and track and treat on your tablet and be able to get to know much more about your patient without them having to say a lot. And so we, with the technology as it sits now, is already far advanced of what others can currently do, but it's only the beginning because now that we know the effects that it's having, now imagine the practice where you now can not only treat people in your office, but you can treat out of it, be able to monitor them, say, change up these different protocols on here, be able to change the amount of hertz frequency and be able to do that based upon real data, which would be your blood pressure, which would be your heart rate, which would be your respiratory rate, and be able to make adjustments. There are individuals using this right now. Why it's important is because they're— the amount of drugs that they need for what they are currently doing go down or they go away. Now, it doesn't mean we're going in here and saying, hey, we're going to get rid of the drug needs for everybody, but the fact that it's even happening just says, gosh, guys, Medical providers need to be the one doing this because you need someone skilled. And so as we build out over time, it's only going to get better and better, but it comes from getting more adoption into the medical community. And until then, there's not enough feedback. And the more feedback we get and the more things that we can make changes for— it's a SaaS solution, it's a software, it is something that we can now use to use a Zoom call and looking at an iPad. And now being able to make a tremendous impact in someone's life. And you eventually, you just won't even have to be in the same room.

That's absolutely incredible. And I think it's really cool to be on the cutting edge and to see what's coming in the future. And I think wearable medical care is going to be huge in the future, as well as customized care, things like DNA-specific medications and things like that. I know a lot of you have been asking about where to get more information, and we're certainly going to go over that here shortly. I don't know if you wanna kind of give a little bit of information about what was shared in this white paper and, and how that can be useful for them.

Yeah. So in the white paper, I was looking at it from, we had about, it's interesting. I wrote the, you guys are gonna see it. I wrote it and this is, I believe Dr. Proctor's still on here. So he actually helped me edit it. And it was actually his providing patient information that actually helped me put this together. Without it, I would not have been able to do this. So I'd say thank you so much. With it. I did it in like 2 weeks. I remember doing this before I reviewed research for the National Journal of Sports Physical Therapy. I did my doctorate and I did all that stuff. That took like a year. You make your paper. I did it in 2 weeks because I woke up 4:00 AM on Memorial Day weekend and I just said, I'm going to go write it. And I talked to texted 30 pages in 2 days. It was, and I was excited. I was just actually just elated because I went, I know what this is doing now and other people need to know it. And this was with 7 patients who all had long COVID, all had benefit. And we all started seeing this with POTS patients as well. And when you go 7 for 7 and then actually improving some outcomes, whether it's social, whether it's blood pressure, and then most recently a $30 million, 156-person study completely fails and shows no one got better with anything. I know it's only 7. I mean, it's a case series at best, but it's certainly enough to go tell people, hey, we might want to check this out because to date we haven't had anyone had adverse reactions.

Yeah.

Just think of it, we're doing electrically, physiologically. We, we know things could potentially happen. We haven't had 'em. We haven't had any rashes. We haven't had any outside of muscle soreness from maybe someone pushing it too much. I had my spinal cord patient, she pushed too hard and had back pain for like 3 days cuz she, I told her not to, but she's like, I'm gonna go be faster and better than everyone. Well, this thing's a McLaren. This thing is not an Acura here. This thing has got a lot of power, but with it, when it's controlled and used correctly, you would see in the long COVID paper, the whole goal of it was to spark A thought. Because this be the possibility. You'll even see the research and everything that I used to support it. Everything's in like the past 2 years. The thing I just showed you was what, 3 weeks ago?

I—

it's all new. And because it's new, healthcare moves slow. And I can say on the call here today, the patients aren't going to wait for slow. Like, it can be done now. Like, we don't need to wait. We've gone through all the things to make sure it's FDA cleared, to make sure it can go home with people, to make sure it's safe. To make sure it's effective. And if we sit around and we go, let's wait until everyone else does something— that's why I got up and put it, because no one else put anything together. And so I wanted to go, it's like, you know what, I'll do it. I'll be the first one. And I can be slammed and told I'm wrong, or I can be told it's a problem, but those patients, it's much bigger for. And that's the most important part. It's them are the important part. And now that we see this, now that we know this is going on, and we can't look the other way. And so I put that paper together not to say I'm right or to say this is the only answer. It is to say, can we just for one second, for myself included, remove your bias towards the things you had always learned? But the challenge is you didn't have the right delivery mechanism. Like, that's it. Like, I loathe e-stim on my body. I taught against it in like 8 CEU courses. I'm sitting here talking to you all, answering questions, And I'm eating my own words and I couldn't be happier. I just couldn't, because now we can sit here and look over the paper and understand that we're at like the cusp of something that is going to change the way practice works moving forward. We did this years ago in orthopedics. If you do remember, we used to cast ACLs, right? And then we realized, you know what, movement makes people better. It's because students are cutting their casts off and they started moving it on their own. Even years before that, we figured out, man, if you put a deadened, like, virus in someone, you can actually create a vaccine. How many millions of people, billions of people were saved by that? We even created something that's so simple as like, what if we could just change the chemicals in someone's head and give them an antidepressant? And how much better it's made life for hundreds of millions of people. Well, I want everybody to know here, this, this This event today is our first chance to talk about what this can do like that. Like, this is today. And look at the paper. We're gonna put out more information. We're even gonna put out systems where you can potentially go trial this, guys. That's how confident we are that this is working. And I never thought I would be here talking to you all doing this. I haven't done this in like 4 years. It's like, it's almost like a homecoming here and I'm here by accident. So because I'm here, it doesn't matter. People need help.

So. I think that's, that's huge. And that's a key point too. Like we have to constantly challenge our own biases, especially when it comes to medicine, especially when it comes to healthcare and come together for what's best for the patients. There were a few questions here regarding insurance reimbursement and where you see that going in the future. Do we ever think now that there's FDA FDA clearance, that obviously is a huge step forward, but how far out do you think it is for the possibility of insurance companies covering this type of treatment?

Right now you can still have— use your standard CPT codes, your neuromuscular, all those things. They don't get kicked back. I mean, those are, those are fine because it fits within the model. But if you're saying like a specific one, like reimburse for the device or reimburse specifically for the treatment, it's going to move as fast as everyone adopts it. So the more people that adopt it, the more studies that are done, the more people get up there and start seeing it and posting it and showing it and doing that, that's going to go speed this up. We are in a state right now where long COVID in and of itself is costing— because it is considered a disability, it's costing between lost wages and insurance just for the fact you gotta pay people because they can't work, function, or live. And I just went to a long COVID study, uh, long COVID group 2 months ago, and I gotta tell you guys, I was shaken when I walked out of there of what I saw of of how horrible this is for people. It's going to move that fast. That's $230 billion right now and growing. Like, these are individuals in their 20s, guys. 20s. This isn't like a 70, 80-year-old issue. They're in their 20s and 30s and 40s, and they're going to spend the next 50, 60 years miserable. Like, just— there's quantity of life and there's quality. And that is after I saw that where people said, I can't remember ever feeling good because my brain just can't even compute it. I just broke down. Facilitated me to go finish this thing and make more protocols and everything else. It's going to be a while. The faster we get it adopted, the faster people start looking at it, the faster they talk about it, faster we get this in front of individuals who are in government positions, who are legislators, everybody else. I will fly, drive, show up, and say anything to make sure this gets through because we have to get it to that point to help the most people.

Are there any specific contraindications for using this technology, this wearable, such as combat veterans, veterans that may have shrapnel, children? Can this be used in pediatrics? Are there any specific groups that this is really contraindicated for?

The only one is just gonna be, is the main, we have some ones added too, but it's gonna be anyone who has a pacemaker or defibrillator. That just cuz it's electrical. There's warning ones where we talked about like if it's, you have centrally driven epileptic seizures, we just don't know enough. So we just say right now, unless there's really good guidance, stay away from that. Individuals who are actually pregnant, they said we could just turn off the abdominal pads, but we just don't know. I mean, you can use obviously post-pregnancy, but there aren't individuals that have a spinal stimulator. You just turn it off. Baclofen pump, same deal. You obviously have to have a doctor mediated, right? You're not just going to turn off pumps on people, but you can just have to turn it off. We have no issue with any equipment. Even shrapnel or anything else. Remember, this is a low energy throughout a lot of the body. I don't have any issue with that. We do have— there's no restrictions that we have from using this with kids. I'm actually starting it next week with pediatric autonomic neurogenic syndrome and working with one patient and being able to go see what this can do. If you go with the FDA, you can go look at the clearance on it. We'll be happy to go send it out. It's like a blank slate, everybody.

Yeah.

That says, you guys made something great. Figure it out, please.

When it comes to use for children, I know that there's obviously a suit. Does the suit come in a variety of different sizes? Is there a suit that is for a pediatric patient versus those that are for adults in different sizes? What are the options that docs have in terms of ordering the suits to fit our not-so-one-size-fits-all population?

We need to be able to have, even for what we're doing here, more funding, research, and be able to expand to be able to work our way down into those areas. For right now, anything that's going to be teenager and up, you're still perfectly fine just because of the sizing component. And there's always a concern that's saying it can cause like rhabdomyolysis or it can cause breakdown of too much tissue. Yeah, if you, if you put this on someone, they worked out for like 2 hours in a row, it's going to cause rhabdo with anybody. I— that's That's one of those, like, we, like, let's just move that part out. So this, from a sizing and everything else, we do have a fair bit of variability. It covers most. Okay. So it's gonna cover 90%. We don't have enough yet to cover 100%, but I would say for anyone on this call today, your sweet spot with this are going to be your autonomic patients, your autoimmune, your spinal cord patients, your chronic back pain, chronic pain patients, fibromyalgia, chronic fatigue syndrome, sexual dysfunction. Anyone who's actually having issues, urinary incontinence, bowel and bladder, even if you go look at our indications, 4 of our indications actually help with that, with reducing muscle spasms, being able to increase muscle strength, which could be considered in with the pelvic bowl. So you're going to increase localized blood flow. And when you add all those together with neuromuscular reeducation, increasing active range of motion, and decreasing disuse atrophy, just saying all those in a row, you're like, well, that's like Almost all my patients, I go, yep.

Any experience, or do you know of any healthcare providers that are using this with ALS patients?

No, not, not currently. If you think for ALS, just think of the condition though, that's going to be the death of motor neurons centrally. And could we use this to be able to help facilitate them? Yes. I don't see that stopping the disease process though. We have nowhere near enough information for that. Even when we use this with, with MS patients, they gained weight, they've improved mobility, but it doesn't change the fact that they still have viral nerve damage. And that's where we have to, I'm all for pushing like the boundaries on this, but sometimes we do have to come to the science of going like, well, a lot of those conditions are gonna be, we hope, changes in genetic drugs and tailored to be able to control those are probably going to be the answer to prevent the cascades from happening. There are things we can do to improve quality of life. 100% should not be dismissed. I just don't want to go set this up. They're like, oh, I got an MS or ALS patient. They're going to be cured. No, that's, that's too big of a leap for science here.

Absolutely. And then finally, I think this is the last question here that I have had submitted. Someone was asking about if the home version is already on the market or only the Pro. So is this system ready now to where if I'm a provider, I want to implement this in my practice. I can already order a number of suits that I can begin sending home with patients so that they each kind of have their own.

Yeah. So right now in the clinic, a doctor can order a system, get suits, everything else, use it in there. Patient can come into their clinic and utilize it. Because doctors have their own practices, if they want to be able to purchase more systems and either rent and, and use as part of their practice to be able to give out to patients, they can absolutely monitor that. If we go to the next one, which is Can I just write an order and dispense it? We are just probably a few weeks away from that being now accomplished. We do have a partner with that. We have systems set up, and then that would allow it to be done through proper channels to make sure that everything— because each box has to be registered with the FDA as a Class II medical device. And we are right on the cusp. It's actually probably one of the most exciting parts is that February, we got this ability to like say, you can go home with it. We didn't have the mechanisms to actually deliver it, right?

Yeah.

And now it's, it's here. And now I'm talking with some doctors who work with long COVID patients and they said, well, I don't see them in my office. It's all done telehealth. And I was like, we're right there. We'll be able to dispense and they'll be able to utilize it and test it and be able to see if it works for 'em. And if it does, then they can move on to purchasing this thing so they can use it long-term and finance it. But we, we have remote technology and like, this is so cool. That you can, you can do this. So for all those on here, we're right on the cusp. So everyone here, this will be hopefully done in the next couple weeks, and once it is, we're gonna have a full-fledged ability to help millions of people even remotely.

Very, very cool. So finally, where can people find out more about this? Obviously, we're going to be sending out an email for those of you that have registered. What would be the next steps In terms of if someone wanted to contact you or a member of your team to just chat more about implementing this in their practice?

Just go to the contact form and that's what we're going to go send out. Go fill it in there. Said you attended the event. I even put words in there to say, and you want to hop on a call and I will open up my calendar as much as humanly possible to take as many calls as possible. Okay. It's that important. So it starts there. We don't even just getting trial systems out. We just, someone fills out a form and we just go send stuff. No, we wanna talk. I wanna know about your practice, what you're doing, how you're doing things. And if we can start it the right way, then it's gonna finish the right way, which is helping a crap ton of people, adding a technology to your practice that is not gonna help only the current people in it, but it's going to expand your ability to probably even treat more and help more people where before you may not have had the ability to, and now you will.

Absolutely. And whether you're here with us live or you're watching the recorded replay later, you'll be able to see the chat feature there. There are a number of healthcare providers that have been commenting in about the ways that they're using the Neuro20 Technology with their patients, whether it's neuro patients, some of the incredible results they're receiving. So I certainly suggest just take a little scroll there through the comment section and you can see what other providers are doing and how they're using them in practice. It sounds like this is really something that is very exciting, and I look forward to having you back on in about 6 months or so, so we can find out more about the leaps and bounds that have happened with not only the technology, but the way that it's being implemented in practices, not only here in the US, but around the world. So thank you so much again for your time today and for sharing all of this information. That's it for today's episode. Be sure to tune in next time where we kick off a new 2-part training with one of my absolute favorite subjects, the business side of healthcare. Our guest instructor will be Dr. Lisa Goodman, and we'll be talking about the true value of hiring or becoming an associate. Episode 101 drops in 2 weeks. Before we go, I just want to take a moment to say thank you to our listeners, our Factor community, and everyone who has supported this podcast from day one. This all began as a bit of a passion project, as a way to connect with our network of healthcare providers when COVID had offices shut down and in-person courses were at a standstill. We had absolutely no idea that 4 years later we would have tens of thousands of episodes downloaded every year, and we've grown a following of listeners in 25 countries around the world. To help us make sure that our next 100 episodes is even better than the last, I'd love for you to visit our website at factorpodcast.com and leave us a comment or message to tell us more about guest instructors or topics that you'd like to have us feature on future episodes. Here's to the next 100. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course. Scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.