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Mental Health

Polyvagal theory explains what you see every day: patients in chronic hypervigilance or collapse. The autonomic nervous system (ANS) is the physiological substrate underlying these states, and acting directly on it opens an underutilized therapeutic dimension.

Non-invasive neuromodulation with NESA XSIGNAL® reorganizes the vagal and sympathetic circuits underlying mental health conditions. It does not replace your pharmacological or psychotherapeutic approach — it enhances it.

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Psychiatry and psychology

Protocols focused on autonomic regulation to support pain, sleep, microcirculation and recovery.
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Speech Therapy

Protocols focused on autonomic regulation to support pain, sleep, microcirculation and recovery.
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Geriatrics

Protocols focused on autonomic regulation to support pain, sleep, microcirculation and recovery.

Amygdala & limbic circuits →
threat/fear processing and
learning; modulate autonomic
output.

Anterior insula + anterior
cingulate cortex →
interoceptive network
integrating bodily signals and
autonomic control.

Hypothalamus (HPA
axis) → neuroendocrine
integration and stress
response.

Locus coeruleus →
noradrenergic arousal/stress
modulation; interacts with
autonomic networks.

Nucleus tractus
solitarius + dorsal vagal
complex → integration of
visceral afferents and
autonomic regulation.

Vagus nerve (CN X) → major
parasympathetic pathway
connecting brainstem and
thoraco-abdominal organs.

Common Indications
Anxiety, hyperactivation and difficulty switching off
Stress, irritability and mood dysregulation
Sleep disturbances
Cognitive fatigue and low energy
Autonomic dysregulation (sympathetic/parasympathetic imbalance)
Elevated physiological stress / hyperarousal
  • Support sessions before or after the main intervention to facilitate regulation and improve tolerance
  • Protocol adjustment based on dominant symptoms: pain, sleep, stress, microcirculation
  • Useful during high therapeutic load phases (intensive rehabilitation, return to activity, post-surgical recovery)
  • Monitoring through functional indicators: sleep, fatigue, load tolerance, perceived pain
  • Always within a multimodal and individualized approach

Introducing NESA XSIGNAL®

NESA XSIGNAL® is a non-invasive neuromodulation system that delivers very low-intensity microcurrents through electrodes, with protocols focused on autonomic nervous system regulation. It is designed to integrate into clinical practice as part of a multimodal approach.

In Mental Health, protocols specifically target the vagal and sympathetic circuits underlying hypervigilance, anxiety and autonomic shutdown.

The Impact of ANS Regulation in Mental Health
When specific work on the autonomic nervous system is incorporated, the effect is often systemic: reduced physiological “noise”, more consistent recovery and improved adaptive capacity. In Mental Health, this may translate into:
Supporting autonomic balance may expand the patient’s adaptive capacity, allowing local interventions such as manual therapy, exercise or procedures to be better tolerated and more consistent over time.

Key Evidence (3 papers):

  • Ramesh A, et al. (2023) Heart rate variability in psychiatric disorders: a review of literature. PMID: 37881808
  • Sgoifo A, et al. (2015) Autonomic dysfunction and heart rate variability in depression. PMID: 26004818
  • Goffi F, et al. (2025) Heart rate variability in major depressive disorder: a systematic review and meta-analysis. PMID: 40595479
Persistent pain is associated with both autonomic dysregulation and altered central processing. Supporting autonomic regulation may help reduce hypervigilance and complement pain management strategies.

Key Evidence (3 papers):

  • Rampazo ÉP, et al. (2023) Heart rate variability in adults with chronic musculoskeletal pain: a systematic review. PMID: 37661339
  • Adlan AM, et al. (2014) Autonomic function and rheumatoid arthritis: a systematic review. PMID: 25151910
  • Barkhudaryan A, et al. (2025) Autonomic dysfunction after stroke: an overview of recent advances. PMID: 40131648
Sleep is a key modulator of pain, inflammation and tissue repair. Supporting autonomic stability may help promote more restorative sleep patterns and more consistent recovery.

Key Evidence (3 papers):

  • Frandsen MN, et al. (2022) Preoperative heart rate variability as a predictor of perioperative outcomes: a systematic review without meta-analysis Journal of Clinical Monitoring and Computing. PMID: 35092527 DOI: 10.1007/s10877-022-00819-z
  • Cameron S, et al. (2024) Mind and skin: exploring the links between stress and dermatological disease. PMID: 37469218
  • Michalek-Zrabkowska M, et al. (2021) Cardiovascular implications of sleep bruxism: a systematic review. PMID: 34064229
The autonomic nervous system regulates vascular tone and perfusion. Improved regulation may support peripheral comfort, effort tolerance and recovery processes, particularly in patients with coldness, heaviness or reduced perfusion.

Key Evidence (3 papers):

  • Lee JY, et al. (2011) Heart rate variability in men with erectile dysfunction. PMID: 21811698
  • Goernig M, et al. (2008) Peripheral arterial disease alters heart rate variability. PMID: 18684283
  • Bachmann SB, et al. (2019) A distinct role of the autonomic nervous system in modulating the function of lymphatic vessels under physiological and tumor-draining conditions Cell Reports
Integrating non-invasive neuromodulation as a supportive approach may help address the regulatory component without replacing the primary treatment. The aim is additive: greater stability, improved recovery and better adherence.

Key Evidence (3 papers):

  • Yeom JW, et al. (2025) Transcutaneous auricular vagus nerve stimulation improves sleep quality in chronic insomnia disorder: a double-blind, randomized, sham-controlled trial Sleep Medicine. PMID: 40398066 DOI: 10.1016/j.sleep.2025.106579
  • Alomari MS, et al. (2022) Non-inferior and more feasible transcutaneous tibial nerve stimulation in treating overactive bladder: a systematic review and meta-analysis International Journal of Urology. PMID: 35711082 DOI: 10.1111/iju.14961
  • Ylikoski J, et al. (2020) Stress and tinnitus: transcutaneous auricular vagal nerve stimulation and neuroplasticity

Resources

Training courses

Our training work at NESA Academic is aimed at professionals who want to integrate non-invasive neuromodulation and autonomic nervous system regulation into rehabilitation, physiotherapy and reconditioning. The content combines physiology, application criteria by specialty, safety and session design, so that integration is practical and consistent in the clinical setting.

Testimonials

Real cases and experiences from clinics and teams that integrate NESA XSIGNAL® into rehabilitation, physiotherapy and reconditioning. What comes up repeatedly: better rest, reduced reactivity during high-load periods and more sustained treatments over time. We also share clinical meetings where protocols, learnings and case discussions are presented.

News

Articles, bibliography and downloadable materials to go deeper into non-invasive neuromodulation, autonomic nervous system, heart rate variability, vasomotor control and neurovascular health applied to rehabilitation, physiotherapy and reconditioning. A living library to keep clinical criteria up to date and provide context for each indication.