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What is TM Flow Test and What does it shows

Updated: Jul 15



One of the Biggest Challenges in Medicine is Helping the Patient to Understand the True Lifestyle Challenges of Long-Term Complications of Metabolic Disorders


The TM FLOW is a non-invasive, 12-minute in-clinic test that focuses on the early detection of complications of the autonomic and vascular symptoms.

Many clinicians agree that the identification of glucose mismanagement and the detection of metabolic disorders is not difficult.  Identification is a matter of ordering and reviewing a few lab reports.


The bigger and often uncommunicated challenge is helping the patient understand just how life-altering the long-term complications can be.  The evolution of metabolic disorders is, for the most part, asymptomatic.  The patient does not FEEL anything.  To them, everything is fine.  But the clinician is all too aware of the long-term challenges – end-organ damage, diabetic peripheral neuropathy, wound healing issues, cardiovascular disease that leads to cardiac events, etc.


The TM FLOW allows a clinician an easy-to-read overview with the patient's name on the report.  The output can be classified with different colours, similar to traffic signal which turns green, yellow, and red to indicate different actions. The clinician can use this as an effective way to communicate and SHOW the patient's areas of concern.  If the patient SEES the information on THEIR report, they often understand that there could very well be a challenge on the horizon that needs a plan.  For the practitioner, this can help create urgency for a better pathway toward health and wellness.

Here is an example report.  It is an easy-to-review, at-a-glance report:



What Does a TM Flow Test Show


  • User Friendly diagnostic test

  • Medical Assistant Can Perform the Test

  • 12-minute, nearly fully automated test

  • Supported by Most Major Insurance Carriers

  • Average Medicare Reimbursement - $ 290.00

  • Allows Clinician to reimburse for 3 CPT codes


The TM FLOW System in summary


  • Ankle Brachial Test (ABI)

  • Cardiac Autonomic Reflex Test or EWING Test including the Valsalva Maneuver.

  • Sudomotor Function Test

  • Photo-plethysmography using an oximeter. 


This demonstrates the variations in heart rate along with the spectral analysis of the oximeter waveform.


The TM FLOW System is comprised of 3 assessments – the sudomotor, the autonomic nervous system, and the ankle-brachial index (ABI).    The Ankle-Brachial index helps medics evaluate if the patient is suffering from peripheral artery disease (PAD).


Diving Deeper -  Ankle-Brachial Index (ABI)


Peripheral artery disease (PAD) is a disorder of the cardiovascular system where there is a decrease in the flow of blood through the peripheral arteries and in particular the arteries supplying the lower extremities.  Caudication can result from a decrease in blood flow.  A patient will typically describe the symptoms of pain or discomfort in the leg, often in the thigh or calf muscles when they exert themselves in a physical activity like walking. Peripheral Artery Disease can impact the patient’s quality of life and overall health outcome.


According to the Centers for Disease Control and Prevention (CDC), almost 6.5 million adults aged 40 and older in the USA are impacted by PAD influences. African Americans are more likely to have PAD.  There are other risk factors, such as diabetes, hypertension, high blood pressure, and smoking linked with PAD.  When anyone is diagnosed with PAD, there is a greater chance of coronary artery disease and cerebrovascular disease. A patient with PAD often is at risk of having additional cardiac and cerebrovascular events including heart attack and stroke.


Early diagnosis of PAD is very important as individuals with PAD should receive treatment and appropriate risk factor management and treatment.  Treatment will help reduce the likelihood of life-threatening events.  The Ankle-Brachial Index (ABI), a part of the TM FLOW test, is a widely used diagnostic tool for PAD.


Medications are often used initially in the management of peripheral artery disease (PAD).   These can include pentoxifylline, cilostazol, and aspirin.  These medications are used to increase blood flow and diminish the formation of clots.  Other cholesterol-regulating agents such as statins help diminish the risk of cardiac arrests.


For individuals with more severe cases of PAD, interventional therapy is often considered.  Procedures like angioplasty can be used to open blocked arteries or the utilization of stents where small tubes are utilized to keep the artery open.   Bypass surgery is also considered in the case of PAD is more severe.


For patients with PAD, ABI can be used regularly to assess the response to treatments.  A baseline measure is taken before any treatment protocol is utilized.  Then, post-intervention, another ABI is taken and compared to the initial measurement.  If the ABI value increases, the blood flow has improved.  However, if the ABI value drops, it shows the ineffectiveness of the treatment.  Continuing to capture an ABI value, can help to assess the potential of a patient to be at risk of cardiovascular events.  Such patients might require an aggressive treatment procedure.


The TM FLOW’s involvement in the detection of PAD


The TM FLOW allows for a more complete evaluation of PAD than a traditional ABI test.  The 3 areas monitored by a TM FLOW are sudomotor testing, autonomic nervous system (ANS) and the ABI.  The sympathetic and parasympathetic system is evaluated by the ANS test.  These two parts of the ANS system play a key role in controlling the human circulatory system.  The health of the small nerve fibres that control the sweat glands is reviewed by the sudo motor test.


The TM Flow test provides a more comprehensive evaluation of PAD as, unlike the ABI, the TM Flow addresses factors beyond the blood flow in the lower extremities.  The ABI is not always accurate in individuals with severe PAD or in those individuals with calcified arteries. 


The TM Flow measures the blood flow at the capillary level, which allows the test to allow a more accurate assessment of the microvascular perfusion in the extremities.  This helps the clinician to more accurately identify patients with more severe PAD and who may be at risk of additional complications. 


Being able to measure flow in real-time, the TM Flow can measure the velocity of blood flow and fluctuation in blood pressure in real time.  This can allow the TM Flow to assess the impact of exercise and body posture on the flow of blood.  This can be helpful to the clinician to identify early stages of PAD and to monitor how well treatment protocols are working with the patient.


A Review of Sudomotor Tests


Sudomotor tests are diagnostic procedures aimed at evaluating the sweat glands’ functionality and sweat production in response to various stimuli.   This test provides insights into the Autonomic Nervous system and automatic functions in the body like blood pressure, heart rate and sweating.


Sudomotor tests are often helpful for clinicians to create a medical diagnosis.  These tests are useful in diagnosing various medical conditions such as diabetic peripheral neuropathy, diabetes, Parkinson’s disease, multiple scleroses, and others.  In addition, sudomotor tests can provide information about the severity and progression of these conditions and can be used to monitor the efficacy of treatments.  Furthermore, these tests are noninvasive and don’t involve radiation, making them a safe and effective diagnostic tool for physicians to consider in their patient evaluations.


Comprehensive ANS testing with the TM Flow


TM Flow testing is a comprehensive assessment that evaluates several aspects of ANS function, including blood pressure variability, skin perfusion, and sweat secretion.  The test includes three components: Ankle-Brachial index (ABI) testing, ANS assessment, and sudomotor testing.  The integration of these three methods allows for a more precise assessment of ANS activity compared to single-modality tests.


The foremost advantage of the TM Flow over other ANS tests is its ability to identify specific patterns of ANS dysfunction.  This info can then be used to develop bespoke treatment plans for the patients.  The result of the test can also be used to changes in ANS function over time and determine the effectiveness of treatments.


As a clinician, a top priority is to always strive to provide excellent care for your patients. If your goal is to maximize your assessment of ANS dysfunction, consider incorporating TM Flow into your diagnostic arsenal.  TM Flow provides a cutting-edge diagnostic tool that offers an advantage over traditional methods by combining the measurement of three diagnostic tests into one seamless process.

Enhance your patient outcomes and give yourself a competitive edge by utilizing the TM Flow test.  Don’t delay.  Take the next step in elevating your patient care by visiting bowman hewitt and reaching out!  We’d love to answer your questions!


Legal Disclaimer: The info in this article is illustrated for informational purposes only and should not be interpreted as medical or legal advice on any subject matter.  You should not act or abstain from anything based on the content published on this site without pursuing medical, legal, or other professional advice. The contents of this site comprise general information and might not reflect present legal developments or address your condition. We deny all liability for actions you take or fail to take based on this article's content.


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