Patent Publication Number: US-2022218992-A1

Title: Method of treating a patient and apparatus therefor

Description:
FIELD OF THE INVENTION 
     The present invention relates to a method of treating a patient and apparatus therefor, and more particularly to a method of introducing pulses to a patient through the use of an electrical muscle stimulation apparatus for treatment of the patient. 
     BACKGROUND OF THE INVENTION 
     It is well known that electrical energy, specifically pulses of electricity at various voltage levels and frequencies, can be used to heal and repair human tissue, and can even relieve undesirable and painful symptoms in a human, end even eliminate disease. 
     Under typical human movement, the brain sends impulses to the muscles, thereby causing them to voluntarily contract. With this in mind, prior art electrical stimulation units that are used to help heal patients in various manners. It has been found that stimulating the muscles using electrical pulses that are at least in some manner similar to the electrical impulses from the human&#39;s brain can have therapeutic effects. Accordingly, typical electrical muscle stimulation units tend to employ the use of pulses. The voltage level, frequency and duration of these pulses are based to at least some degree on the reaction and behaviour of human muscle tissue to electrical impulses received from the brain. 
     It has been found that the human body responds to such electrical pulses from such electrical stimulation units by sending extra blood and oxygen to the area being treated. This increased circulation is the same natural process used by the body when performing a healing function. Accordingly, such electrical stimulation units are used for pain relief, decrease of inflammation, improved circulation, recovery from injury, fighting disease, muscle conditioning, and assisting muscles to contract properly. 
     Various types of electrical muscle stimulation therapies are well known in the prior art. 
     Transcutaneous electrical nerve stimulation (TENS or TNS) involves the use of a complete range of transcutaneously applied currents used for nerve excitation, Generally, TENS is applied at high frequency (&gt;50 Hz) with an intensity below motor contraction (sensory intensity) or low frequency (&lt;10 Hz) with an intensity that produces motor contraction. 
     Neuromuscular electrical stimulation (NMES) is a non-invasive, non-addictive means of muscle rehabilitation used help return a patient to normal function quickly after an injury, surgery, or disease. NMES applies customized electrical stimulus to cause a muscle to contract. 
     Inferential current (IFC) electrical stimulation, also known as Interferential Therapy (IFT), helps decrease pain and improve circulation to injured tissues. The IFC/IFT works much like TENS, but the current can be easily moved and varied to target the most painful area of injury. The basic principle of IFC/IFT is to utilise the significant physiological effects of low frequency (&lt;250 pps) electrical stimulation of nerves without the associated painful and somewhat unpleasant side effects sometimes associated with low frequency stimulation. 
     Iontophoresis is a type of electrical stimulation used to transdermally administer medication to a patient. Typically, an electrical current applied from about 6 volts to about 24 volts at about 10% to 90% pulsed current. The use of Iontophoresis with appropriate medication can be used to help decrease inflammation, decrease swelling, and decrease muscle spasms, among other things. 
     Presently, the closest known prior art to the present invention is disclosed in U.S. Pat. No. 9,302,102, issued Apr. 5, 2016, to Thomas et al. The Thomas patent discloses an electro-therapeutic stimulator that provides an output signal having a first controllable main pulse periodic-exponential signal and a second background pulse periodic-exponential signal. The main pulse signal is controllable, preferably to a digital numerical value of 1 to 500 pulses per second, to a digital, numerical value of duty cycle, and to a digital numerical value of balance. The signal is produced using a class D amplifier and with a transformer optimized for the background pulse (such as at 10 kHz) rather than for the main pulse. 
     It has been found that this particular electrotherapeutic stimulator does not produce a desirable waveform throughout much of its range of frequency and duty cycle due to the fact that it has used an output transformer optimised for the background pulses. It has also been found that it can produce pulses that provide current greater than a desired threshold, especially upon initial application. 
     Another prior art patent that is in the same area as the present invention is U.S. Pat. No. 7,499,746 issued Apr. 5, 2016, to Buhlmann et al. The Buhlmann patent discloses an automated adaptive muscle stimulation system and method that includes at least one electrode assembly adapted to deliver a muscle stimulation signal to the tissue of a user, a sensor system adapted to detect a muscle response, and an electrical stimulation device operably coupled to the at least on electrode assembly and the sensor system. The electrical stimulation device includes a control system operable to automatically diagnose at least one characteristic of a muscle from the detected muscle response and adjust at least one parameter of the muscle stimulation signal in response thereto. The device delivers an adjusted muscle stimulation signal as per the at least one parameter. The electrical stimulation device also includes a dual mode muscle stimulation system adapted to accept first and second data sets and provide first and second levels of treatment data. 
     It is an object of the present invention to provide a method of treating a patient and apparatus therefor. 
     It is an object of the present invention to provide a method of treating a patient and apparatus therefor that uses electrical pulses delivered to a patient. 
     It is an object of the present invention to provide a method of treating a patient and apparatus therefor that uses electrical pulses delivered to a patient, which electrical pulses comprise a first series of pulses and a second series of pulses. 
     It is an object of the present invention to provide a method of treating a patient and apparatus therefor that uses electrical pulses delivered to a patient, which electrical pulses comprise a first series of pulses having a frequency in a range from about 1 Hz to about 5 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90% and a second series of pulses having a frequency in a range from about 5 kHz to about 50 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1 to about 90%. 
     It is an object of the present invention to provide a method of treating a patient and apparatus therefor that uses electrical pulses delivered to a patient, which electrical pulses comprise a first series of pulses and a second series of pulses, and adjusting the voltage of at least one of the first series of pulses and the second series of pulses based on said voltage adjustment to thereby control the output current level below a maximum threshold. 
     It is an object of the present invention to provide a method of treating a patient and apparatus therefor that uses electrical pulses delivered to a patient, wherein various impedance values, comparison values, and actions to be taken are displayed. 
     It is an object of the present invention to provide a method of treating a patient and apparatus therefor that uses electrical pulses delivered to a patient, wherein the first series of pulses and said second series of pulses are automatically adjusted based on measured impedance values. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy apparatus. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy apparatus, wherein the electrical muscle stimulation therapy apparatus produces a first series of pulses and a second series of pulses. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy apparatus, wherein the electrical muscle stimulation therapy apparatus produces a first series of pulses having a frequency in a range from about 1 Hz to about 5 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90% and a second series of pulses having a frequency in a range from about 5 kHz to about 50 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90%. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy apparatus, wherein the electrical muscle stimulation therapy apparatus produces a first series of pulses and a second series of pulses, and adjusting the voltage of at least one of the first series of pulses and the second series of pulses based on said voltage adjustment to thereby control the output current level below a maximum threshold. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy apparatus, wherein various impedance values, comparison values, and actions to be taken are displayed. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy apparatus, wherein the electrical muscle stimulation therapy apparatus produces a first series of pulses and said second series of pulses that are automatically adjusted based on measured impedance values. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy method. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy method, wherein the electrical muscle stimulation therapy method produces a first series of pulses and a second series of pulses. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy method, wherein the electrical muscle stimulation therapy method produces a first series of pulses having a frequency in a range from about 1 Hz to about 5 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90% and a second series of pulses having a frequency in a range from about 5 kHz to about 50 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90%. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy method, wherein the electrical muscle stimulation therapy method produces a first series of pulses and a second series of pulses, and adjusting the voltage of at least one of the first series of pulses and the second series of pulses based on said voltage adjustment to thereby control the output current level below a maximum threshold. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy method, wherein various impedance values, comparison values, and actions to be taken are displayed. 
     It is an object of the present invention to provide an electrical muscle stimulation therapy method, wherein the electrical muscle stimulation therapy apparatus produces a first series of pulses and said second series of pulses that are automatically adjusted based on measured impedance values. 
     SUMMARY OF THE INVENTION 
     In accordance with one aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses having a frequency in a range from about 1 Hz to about 5 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90%; generating a second series of pulses having a frequency in a range from about 5 kHz to about 50 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90%; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; determining a voltage adjustment for at least one of the first series of pulses and the second series of pulses based on the impedance; adjusting the voltage of at least one of the first series of pulses and the second series of pulses based on the voltage adjustment to thereby control the output current level below a maximum threshold. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; displaying the calculated impedance. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; converting the calculated impedance to an impedance factor; and displaying the impedance factor. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; calculating an impedance value related to the calculated impedance; and displaying the impedance value and a benchmark impedance value for comparison purposes. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; calculating an impedance value related to the calculated impedance; calculating a comparison value based on the impedance value and a benchmark impedance value; and displaying the comparison value. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; calculating an impedance value related to the calculated impedance; determining an action to be taken based on the impedance value and a benchmark impedance value; and displaying the action to be taken. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; calculating an impedance value related to the calculated impedance; automatically adjusting the first series of pulses and the second series of pulses based on the impedance value. 
     In accordance with another aspect of the present invention there is disclosed a novel method of treating a patient, the method comprising the steps of generating a first series of pulses; generating a second series of pulses; modulating the first series of pulses and the second series of pulses into a combined waveform of pulses; and delivering the combined waveform of pulses to the skin of the patient via an electrical circuit to thereby treat the patient; monitoring the voltage and the current produced by the electrical circuit to attain a voltage value and a current value; calculating the impedance of the tissue of the patient using the voltage value and the current value; calculating an impedance value related to the calculated impedance; determining an action to be taken based on the impedance value and a benchmark impedance value; and automatically adjusting the first series of pulses and the second series of pulses based on the action to be taken. 
     Other advantages, features and characteristics of the present invention, as well as methods of operation and functions of the related elements of the structure, and the combination of parts and economies of production, will become more apparent upon consideration of the following detailed description and the appended claims with reference to the accompanying drawings, the latter of which is briefly described herein below. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The novel features which are believed to be characteristic of the method of treating a patient and apparatus therefor, together with further objectives and advantages thereof, will be better understood from the following drawings in which a presently preferred embodiment of the invention will now be illustrated by way of example. It is expressly understood, however, that the drawings are for the purpose of illustration and description only, and are not intended as a definition of the limits of the invention. In the accompanying drawings: 
         FIG. 1  is a side elevational view of the apparatus according to the present invention; 
         FIG. 2  is a cut-away perspective view of the apparatus of  FIG. 1 ; 
         FIG. 3  is an electrical schematic that is representative of the apparatus and method according to the present invention of  FIG. 1 , and showing a representation of a combined waveform of pulses used to treat a patient; 
         FIG. 4  is a scan on an oscilloscope showing the first series of pulses and the second series of pulses; 
         FIG. 5  is a front plan view of a cellular telephone connected in data transfer relation to the apparatus of  FIG. 1 , and displaying a calculated impedance, an impedance factor, an impedance value, a benchmark impedance value, a comparison value and an action to be taken; 
         FIG. 6  is a perspective view from the side of the apparatus according to the present invention connected to a patient for providing treatment, and with the patient holding the horizontal stability post; and, 
         FIG. 7  is an enlarged top plan view of a portion of the rotary dial mounted on the horizontal stability post, and showing the patient using one hand to adjust the rotary dial. 
     
    
    
     DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENT 
     Reference will now be made to  FIGS. 1 through 7 , which show an illustrated embodiment of the method of treating a patient and apparatus therefor according to the present invention. 
     In one aspect, the present invention comprises a novel method of treating a patient  109 . The method comprises the steps of generating a first series of pulses  110  and generating a second series of pulses  120 . In the present invention, a signal generating apparatus  100  is used. In the disclosed embodiment, the first series of pulses  110  has a frequency in a range from about 1 Hz to about 5 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1 to about 90%. The second series of pulses  120  has a frequency in a range from about 5 kHz to about 50 kHz, a voltage range from about 0 (zero) volts to about 100 (one hundred) volts, and a duty cycle of about 1% to about 90%. The method also includes the step of modulating the first series of pulses  110  and the second series of pulses  120  into a combined waveform of pulses  130 , as shown in  FIG. 4 . Subsequently to modulating the first series of pulses  110  and the second series of pulses  120 , the combined waveform of pulses  130  is delivered to the skin of the patient  109  via an electronic circuit to thereby treat the patient  109 . In the disclosed embodiment, the electronic circuit may comprise a first pair of electrodes (first electrode pad  141  and second electrode pad  142 ) and a second pair of electrodes (third electrode pad  143  and fourth electrode pad  144 ). The first pair of electrodes is attached in electrically conductive relation to a patient&#39;s skin at a first area. Similarly, the second pair of electrodes is attached in electrically conductive relation to a patient&#39;s skin at a second area. The output, or in other words the combined waveform of pulses  130 , from the first pair of electrodes is the same as the output from the second pair of electrodes. Further, the output, or in other words the combined waveform of pulses  130 , from the first electrode pad  141  is typically the same waveform as the output from the third electrode pad  143 , and the output, or in other words the combined waveform of pulses  130 , from the second electrode pad  142  is typically the same waveform as the output from the fourth electrode pad  144 ; however, it is common to have the amplitude different one pair of electrodes from the other. 
     It has been found that in order to properly combine the first series of pulses  110  and the second series of pulses  120  into a steady combined waveform of pulses  130  that does not shift significantly, the frequency of the first series of pulses  110  should be an integer multiple of the frequency of the second series of pulses  120 . 
     The present invention also includes step of monitoring the voltage and the current produced by the electronic circuit to attain a voltage value and a current value. The voltage and current values that are produced by the electronic circuit  102  of the apparatus  100  according to the present invention are measured and used by the electronic circuit  102  itself via feedback loop current circuit  170 . Further, the voltage and current values are measured at a point in time, and may be measured as frequently as desired. Also, the voltage and current values are measured with respect to first electrode pad  141  and the second electrode pad  142 , and also are measured between the third electrode pad  143  and the fourth electrode pad  144 , to thereby produce the measured voltage and current values. 
     Subsequent to measuring the voltage values and current values, the step of calculating the impedance of the tissue of the patient  109  using the voltage value and the current value is performed. The calculated impedance is indicative of the impedance, or other words resistance, to electrical flow of the tissue of the patient  109  between the electrodes. 
     The next step is that of determining a voltage adjustment for at least one of the first series of pulses  110  and the second series of pulses  120  based on the impedance. Since the first series of pulses  110  and the second series of pulses  120  have been modulated together to form a combined waveform of pulses  130 , the measurement of is the maximum voltage of the combined waveform. It has been found that the frequency may be adjusted within a range from about 1 Hz to about 5 kHz, the voltage may be adjusted within a range from about 0 (zero) volts to about 100 (one hundred) volts, and the duty cycle may be adjusted within a range of about 1% to about 90%. The voltage is measured peak-to-peak and therefore ranges from +50 volts to −50 volts). 
     If desired, the next step may be that of automatically adjusting the voltage of at least one of the first series of pulses  110  and the second series of pulses  120  based on the voltage adjustment that has been determined. Such automatic adjustment of the voltage of at least one of the first series of pulses  110  and the second series of pulses  120  is performed to thereby control the output current level below a maximum threshold. In the present invention, the step of monitoring the voltage across the pair of electrodes and the current through the pair of electrodes is performed at a time interval of about between about 10 ms and 100 ms, and even more specifically is performed at a time interval of about 50 ms. 
     Further, the step of adjusting the voltage of at least one of the first series of pulses  110  and the second series of pulses  120  according to the calculated impedance to thereby control the output current level below a maximum threshold may comprise adjusting the voltage of the first series of pulses  110  according to the calculated impedance to thereby control the output current level below a maximum threshold. Alternatively or additionally, the step of adjusting the voltage of at least one of the first series of pulses  110  and the second series of pulses  120  according to the calculated impedance to thereby control the output current level below a maximum threshold may comprise adjusting the voltage of the second series of pulses  120  according to the calculated impedance to thereby control the output current level below a maximum threshold. Also, the step of adjusting the voltage of at least one of the first series of pulses  110  and the second series of pulses  120  according to the calculated impedance to thereby control the output current level below a maximum threshold may comprise adjusting the voltage of both the first series of pulses  110  and the second series of pulses  120  according to the calculated impedance to thereby control the output current level below a maximum threshold. 
     It has been determined through experimentation that the step of adjusting the voltage of at least one of the first series of pulses  110  and the second series of pulses  120  according to the calculated impedance to thereby control the output current level below a maximum threshold may advantageously comprise reducing the voltage by about 5% of at least one of the first series of pulses  110  and the second series of pulses  120  according to the calculated impedance to thereby control the output current level below a maximum threshold. 
     It is further contemplated that the step of adjusting the frequency of the first series of pulses  110  may comprise adjusting the frequency of one or both of the first series of pulses  110  and the second series of pulses  120  according to the calculated impedance. 
     It has also been found that in the present invention, communicating the results of the impedance values that are determined by the measurements of the voltage and current at the output of the electronic circuit according to the present invention is of significance. Accordingly, an important step in the method of the present invention comprises displaying the calculated impedance  151   a , such as on a digital display  104  on the apparatus  100 . The calculated impedance is expressed in ohms and is derived by dividing the voltage by the current. A person knowledgeable in this art, or generally knowledgeable in the art of electronics, may be comfortable with dealing with a displayed impedance value expressed in ohms; however, in the present invention, the method according to the present invention may further comprise the step of converting the calculated impedance to an impedance factor  151   b . Further, there may be the step of displaying the impedance factor  151   b . The impedance factor  151   b  may be expressed on a scale such as a cardinal scale of 1 (one) to 10 (ten), or similar, or any other convenient scale or the like that would be meaningful to a technician or a patient  109 . 
     Further, a maximum impedance factor and/or a minimum impedance factor may be displayed. The maximum impedance factor might represent the maximum desired impedance of the muscle tissue and the minimum impedance factor might represent the minimum desired impedance of the muscle tissue. Encountering measured impedance factors outside of the range of the maximum impedance factor and the minimum impedance factor can indicate potential problems with the cells of the muscle tissue. 
     A desired impedance factor might also be displayed. The desired impedance factor could be a guide to perhaps an ideal physiological condition of the cells of the muscle tissue being treated, and could be used as a guide as to whether the treatment is helping the cells with the muscle tissue. 
     A target impedance factor might also be displayed. The target impedance factor could be a temporary target value or a final targeted value that is trying to be reached given the type of muscle tissue being treated and information about the possible injuring or illness. 
     A standardized impedance factor might also be displayed. The standardized impedance factor could be an impedance factor that is accepted in the physiological treatment profession as being a value that my general would be expected for the particular treatment in that particular area of the human body, possibly also considering given the conditions that are being encountered. 
     Further, the present invention might include the steps of calculating an impedance value  151   c  related to the calculated impedance, and also displaying the impedance value  151   c  and a benchmark impedance value for comparison purposes. The impedance value and a benchmark impedance value  151   d  might be expressed in physiologically related terms, such as oxygen saturation in cells, protein levels in cells, and so on. A benchmark impedance value  151   d  is may be defined as a standard of excellence, achievement, and so on, against which similar things may be measured or judged. 
     Additionally, the steps of calculating a comparison value  151   e  based on the impedance value and the benchmark impedance value  151   d , and displaying the comparison value could be performed in order to qualitatively and/or quantitatively relate the impedance value and the benchmark impedance value in a manner that is meaningful and can be readily understood by a technician, a patient  109 , or the like. 
     Also, the steps of determining an action to be taken  151   f  based on the impedance value and the benchmark impedance value, and displaying the action to be taken  151   f  can be performed. The displayed action may comprises reducing or increasing voltage of at least one of the first series of pulses  110  and the second series of pulses  120 . Alternatively or additionally, the steps of calculating an impedance value related to the calculated impedance and automatically adjusting the first series of pulses  110  and the second series of pulses  120  based on the impedance value Could be performed in order to provide automatic adjustment of the pulse is provided to the patient  109 , thereby helping to optimize the treatment. The step of automatically adjusting the first series of pulses  110  and the second series of pulses  120  based on the impedance value could comprise automatically adjusting at least one of the frequency, the duty cycle and the voltage of the first series of pulses  110  and the second series of pulses  120 . Further an electrical current value within a desired range or within a pre-determined range could be selected. 
     Also or additionally, the present invention could include the steps of calculating an impedance value related to the calculated impedance and determining an action to be taken based on the impedance value and a benchmark impedance value, and automatically adjusting the first series of pulses  110  and the second series of pulses  120  based on the action to be taken. For instance, the action to be taken could be to decrease the voltage by 10% and slowly increase the voltage incrementally to see what resulting impedance is produced. 
     Reference will now be made to  FIGS. 5 through 7 , which show the apparatus according to the present invention in use. The first electrode pad  141 , the second electrode pad  142 , the third electrode pad  143  and the fourth electrode pad  144  are secured in electrically conductive relation to the patient&#39;s skin. Also, a horizontal stability post  108  is gripped by the patient  109  in order to help the patient  109  have proper upright posture that is literally even, and also to indicate when the patient&#39;s posture might become improper or uneven. The apparatus can readily be used to properly treat the patient  109  according to the method of the present invention. 
     Reference will now be made to  FIG. 3 , which shows the electrical schematic that is representative of the circuit  150  that is the basis of the apparatus  100  and method according to the present invention. The microprocessor  152  that is used is a STM32 produced by ST Microelectronics, part number F303K8. Any suitable microprocessor  152  could alternatively be used. The microprocessor  152  is programmed to generate the first series of pulses  110  and the second series of pulses  120  that have the various voltage, frequency and duty cycle characteristics as set forth above. 
     The first series of pulses  110  and the second series of pulses  120  are modulated in the mixer circuitry  154  to thereby form the combined waveform of pulses  130 , which is fed into a signal gain adjust circuit  156 . The signal gain adjust circuit  156  is used to permit selective adjustment of the voltage level of the first series of pulses  110  and the second series of pulses  120 . This adjustment can be made by a technician or by the patient  109 . in the main illustrated embodiment, as can be seen in  FIGS. 1 and 2 , this adjustment can be made by turning the adjustment knob  107  on the main housing  106  of the apparatus  100  according to the present invention. Alternatively, as can be seen in  FIG. 7 , a rotary dial  108   r  of one end of the horizontal stability post  108  turns a variable resistor  108   vr , or the like. The variable resistor is connected in electrically conductive relation to the signal gain adjust circuit  156  to allow for adjustment of the voltage level of the first series of pulses  110  and the second series of pulses  120  of the combined waveform of pulses  130  via the rotary dial. 
     The microprocessor  152  also feeds a DC voltage through a doubling amplifier  157  into the signal gain adjust circuit  156  in order to control the amplitude of the output waveform. The output of the signal gain adjust circuit  156  is fed into a final amplifier  158  having four output channels. Each of the four output channels is fed through a separate resistor (R 1 ,R 2 ,R 3 ,R 4 ) to a corresponding electrode pad, namely first electrode pad  141 , a second electrode pad  142 , a third electrode pad  143 , and a fourth electrode pad  144 . The four electrode pads are each placed securely in electrically conductive relation to the skin of a patient  109  at the area to be treated. The combined waveform of pulses  130  created from the first series of pulses  110  and the second series of pulses  120  is fed through the four electrode pads. The combined waveform of pulses  130  is present across the first electrode pad  141  and second electrode pad  142 , and similarly is present across the third electrode pad  143  and fourth electrode pad  144 . 
     As is discussed above, the impedance of the tissue of the patient  109  between the first electrode pad  141  and the second electrode pad  142  and also between the third electrode pad  143  and fourth electrode pad  144  voltage by the current can be calculated by dividing the voltage by the current. The voltage output of the first electrode pad  141  and the second electrode pad  142  is determined. Similarly, the voltage output of the third electrode pad  143  in the fourth electrode pad  144  is determined. 
     More specifically, at each of the four outputs of the final amplifier  158 , there is a resistor (R 1 ,R 2 ,R 3 ,R 4 ) that in the present circuit have a value of ten (10) ohms. The voltage across R 1  leading to the first electrode pad  141  is fed back into the inputs of a first operational amplifier  161 . Similarly, the voltage across R 2  leading to the second electrode pad  142  is fed back into the inputs of a second operational amplifier  162 , the voltage across R 3  leading to the third electrode pad  143  is fed back into the inputs of a third operational amplifier  163 , and the voltage across R 4  leading to the fourth electrode pad  144  is fed back into the inputs of a fourth operational amplifier  164 . The outputs of the four operational amplifiers are fed through diodes to a common input  171  of a feedback loop current circuit  170 , specifically through a resistor  172 , to act on the capacitor  174 . The voltage across capacitor  174  changes as the voltages from the operational amplifiers change. Basically, the resistor  172  and the capacitor  174  act to “smooth out” the peak voltages so that extreme variations of the voltage do not affect the feedback operation of the overall electronic circuit  102 . 
     The voltage across the capacitor  174  is applied as an absolute value into a first input  152   a  of the microprocessor  152 . If the voltage received by the first input  152   a  of the microprocessor  152  increases greater than a threshold amount, the microprocessor  152  decreases the voltage of the first series of pulses  110  and/or the second series of pulses  120  by about 5%. The variable resistor  176  is used to calibrate the feedback loop current circuit  170 . 
     The feedback loop current circuit  170  detects absolute value current peaks and absolute value peak voltage peaks of each of the first electrode pad  141 , the second electrode pad  142 ), the third electrode pad  143  and the fourth electrode pad  144 . The feedback loop current circuit  170  feeds the voltage values to the microprocessor  152  through pins ADC 1  and ADC 2 . The feedback values are read by the microprocessor  152  at intervals as programmed into the microprocessor  152 . The voltage is held by the feedback loop current circuit  170  until read by the microprocessor  152 . 
     As can be readily seen, the electronic circuit  102  according to the present invention employees DC coupled amplifiers to thereby faithfully produce an output that is a combined waveform of pulses. The DC coupled amplifiers accurately and faithfully produce all of the pulse frequencies including 1 Khz to 50 Khz. The known prior art cannot do this since it uses an output transformer that by its very nature can produce signals only in a somewhat narrow range. 
     The microprocessor  152  evaluates the input absolute values from the feedback loop current circuit  170 . If the peak current equals or surpasses the peak limit of 100 mA, the microprocessor  152  is instructed to reduce the DAC value output. 100 mA is the regulated maximum safety level current value. The DAC output pin  153  (12 bits) controls the mixed signal wave voltage amplitude level, from zero to a maximum signal. The DAC values are referenced by voltage levels, between 0 and 6 volts. 
     The microprocessor  152  may also send message to the APP controller  155  running on a cellular telephone  154  ( FIG. 5 ), or a portable tablet type computer, to limit the upper values being sent to the device, and prompt the user to scale back the sent values. 
     The microprocessor  152  can also disable the final amplifier  158  if there is a safety condition unmet, depending on the feedback conditions, including temperature sensing. 
     The microprocessor  152  can also monitor the calibration limits of the electronic circuit  102 . A message may also be sent to the APP controller  155  running on a cellular telephone  154 , if the electronic circuit  102  is out of calibration. The electronic circuit  102  as illustrated has the following calibration limit conditions: 
     25% of Amplitude=V25=X value+/−10%
 
50% of Amplitude=V50=Y value+/−10%
 
75% of Amplitude=V75=Z value+/−10%
 
     Other variations of the above principles will be apparent to those who are knowledgeable in the field of the invention, and such variations are considered to be within the scope of the present invention. Further, other modifications and alterations may be used in the present invention without departing from the spirit and scope of the accompanying claims.