High voltage galvanic stimulation/Twin Peak Monophasic Dr. Amal Abd El Baky, Loganathan chandrasekar 353 RHPT – 1435 – 1436 – 1st Semester

Lecture outline Introduction and important facts about HVGS/ HVPC current Parameter of HVGS/ HVPC Current Indications & Contra indication & precaution of HVGS/ HVPC current Parameters &technique of application of HVGS/ HVPC 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Lecture objectives At the end of lecture the student is able to Define and outline the principle of HVGS current. Memorize the effects & uses & waveform parameters. List the indication & contraindication of HVGS current Compare the main concepts related to the application of HVPC to other electrical, electromagnetic & thermal (EPAs) agents. Select the appropriate HVGS current dose Demonstrate & apply HVGS current on her/ his colleague 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Equipment / Machine Ultra-G Digital Galvanic, High Voltage Pulsed Stimulation PGS-123 Galvanic Analog, High Voltage Pulsed Stimulation 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

High Volt Pulsed Galvanic Current (HVPGC) High voltage galvanic stimulation (HVG) is recognized by many different names, including high volt pulsed galvanic (HVPG), high voltage stimulation (HVS),and twin peak monophasic. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Definition HVPGS is the use of a high driving voltage current (up to 500V) to produce analgesia, muscle contractions and to facilitate wound healing. It is a monophasic, twin-peak wave form with almost instantaneous rises and exponential falls. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Parameters Current: Monophasic, twin pulse waveform Intensity: 150 -500 V Duration: short , last only a few microseconds (μs) typically less than 200 μs. The interpulse interval: 9800 μs Frequency: 2-100 Hz Polarity: it is altered as required. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Parameters Mode : 1- Continuous as the train of the twin pulses are delivered continuously 2- Reciprocate mode: refers to the alternate application of trains of twin pulses to one or other two active pads and does not mean that the current direction is reversed. 3- Surge mode: gives a train of pulses whose the intensity is gradually increased. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Important points It allows for deeper penetration. It does not burn (low amps). It flows between each pad and dispersive pad (usually placed on large muscle group). It can be used in water. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Important points It has the ability to move fluids. It is used for open wounds, burns and over scar tissue. Can be used on metal implants. This current can easily passed through the tissues as it is comfortable due to their wide discrimination between sensory, motor and nociceptor nerve fibers 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Uses / Indications of HVGS Wound healing Pain modulation Muscle stimulation Edema reduction Reduction of muscle spasm Post-Operative 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Wound healing HVGS increase DNA and protein synthesis, improve micro-vascular circulation, electrode polarity kills or repels different microbes and inhibits bacteria growth. If the wound is infected, the negative electrode (cathode) is applied first for about 3 days or more because of its bactericidal effect. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Wound healing - Application Procedures: Cleaning and debridement of the wound. Placing the active electrode over the gauge and the dispersive proximal to it. After recovery of wound from infection, change the polarity (use anode as active electrode). If the wound is clear from the start, begin treatment with anode as active electrode. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Wound healing - Application The current applied might be in the range of 10- 50μA/cm2. The current frequency is around 30 to 100Hz. Treatment time should be for 30 to 45min daily or three times/week. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Pain modulation High frequency- low intensity current will stimulate mechanoreceptors Aᵝ and inhibit Aδ and C fibers by pre-synaptic inhibition. High intensity- low frequency to stimulate inter-neurons and release of endorphin and encephalin to inhibit C fibers. HVPGS has been recommended to inhibit all kinds of pain. Acute pain: Positive electrode over painful site Chronic pain: Negative electrode over site 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Muscle stimulation As the pulse is very short duration it is used to stimulated innervated muscles. Short pulses with high intensity are more selective in stimulating motor nerve rather than pain nerves. HVGS used for both strengthening as well as reduction of atrophy. 30 Hz is the recommended frequency. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Edema reduction HVGS help in edema reduction due to: Pumping effects that increase venous return Increase blood flow Direct effect on the autonomic nervous system lead to local vasodilatation, increase fluid exchange. Negative electrode may prevent the formation of edema as it causes the gaps between endothelial cells to close, preventing leakage 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Reduction of muscle spasm HVGS is effective in the treatment of muscle spasm and enhance joint mobility. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Post-Operative Complete protocols available on the application of sterile electrodes for post-surgical pain control, edema reduction and accelerated wound closure. This early therapeutic intervention facilitates the patients recovery and return of function. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Other Indications For Clinical Use Sports Injuries: -Acute (sprains, muscle pulls, spasms) -Chronic Pain and Injuries -Post surgical for ligament or tendon repair -Joint Impingement Post Operative: -Edema -Post Amputation -Open Wounds -Arthroscopy -Total Knees, Total Hips Laminectomies – Rotator Cuff Repairs Post - Menscetomy 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Other Indications For Clinical Use Injuries: -Arthritis-Rhuematoid -Arthritis-Degenerative -Tendonitis, Epicondylitis -Chondromalacia -Carpal Tunnel Open Wounds: - Diabetic Ulcers-Stages I, II, III, IV -Trauma -Burns -Wound Granulation -Skin Flaps 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Other Indications For Clinical Use Fractures: -To reduce edema before x-ray. -To reduce edema before casting. -To stimulate fibro-synthesis, Chrondro-synthesis -Closed reduction (pain control) Vascular Pathologies: -Diabetic Polyneuropathies -Vascular insufficiency -Chronic Inflammatory Response -Pre-Amputation vascular flow enhancement 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Other Indications For Clinical Use Sprains & Strains: -Cervical (Neck) -Back -Knee -Elbow -Shoulder -Ankle/Hand/Wrist 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Contraindications/Precautions: Should not be used on patients with cardiac pacemakers. Should not be used on cancer patients. Should not be used on persons with epilepsy (suspected or diagnosed). Should not be used by women pregnant. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Contraindications/Precautions: Should not be used over a menstruating uterus. Should not be used over the carotid artery. Thrombophlebitis Superficial skin lesions or infections. Pain of unknown origin; over suspected fracture sites 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Dosage Intensity: It should be governed by the patient's tolerance. In cases of edema, muscle spasm and reduced joint mobility the intensity should be high enough to produce a muscle contraction. Pulse rate setting: 80 pulses /seconds. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Dosage Electrodes: The electrode should be selected as follows: Active electrode: (usually the anode) large enough to cover the entire painful or edematous area or affected joint. In the case of muscle spasm two active electrode are used , one on the muscle belly and the other on the musculo-tendinous junction. The dispersive electrode: (usually the cathode):is positioned in the lumber region. 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018

Dosage Treatment time: It is usually applied 20 minutes, enough in cases of edema 30 min may be effective. It is recommended that HVGS be preceded by the use of hot packs in cases of pain, reduced joint mobilization and mild stretching techniques in cases of pain, reduced joint mobility and muscle spasm 353 RHPT - 1435-1436H - 1st Semester HVGS/HVPC 9/18/2018