This document discusses high volt pulsed galvanic stimulation (HVPGS), a type of neuromuscular electrical stimulation. It delivers a monophasic twin peak waveform with a high voltage up to 500 volts and short pulse duration to stimulate nerves and tissues. HVPGS can be used to promote wound healing, reduce edema, manage pain, and stimulate muscle. It provides physiological effects like increasing range of motion and blood flow. Treatment duration is typically 15-30 minutes per session and can be repeated daily.
Rebox electrotherapeutic method is based on non-invasive transcutaneous application of specific electric currents to a living tissue. Main indications for using the Rebox include treatment of acute and chronic pain, immobility, musculoskeletal and neurological disorders and oedema.
Diadynamic currents are also called Bernard's currents based on a sine wave with a frequency of 50Hz. Due to the ease of generation of this current shape, they have been known almost from the beginning of electrotherapy, and their influence on the human body has been thoroughly studied.
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Rebox electrotherapeutic method is based on non-invasive transcutaneous application of specific electric currents to a living tissue. Main indications for using the Rebox include treatment of acute and chronic pain, immobility, musculoskeletal and neurological disorders and oedema.
Diadynamic currents are also called Bernard's currents based on a sine wave with a frequency of 50Hz. Due to the ease of generation of this current shape, they have been known almost from the beginning of electrotherapy, and their influence on the human body has been thoroughly studied.
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IFT which stands for Interferential Therapy is one of the types of electrotherapy used for the management of pain. The principle of interferential therapy is to cause two medium frequency currents of slightly different frequencies to interfere with one another. For example, if circuit A carries a current with the frequency of 4000Hz and Circuit B carry a current with a frequency of 3980 Hz, then the low frequency produced will be 20 Hz and this frequency is very useful in pain modulation. A new low-frequency current known as the beat frequency is equal to the difference in frequencies between the two medium frequency currents produced in the tissues at the point where the two currents cross.
It is basically used for the treatment of Chronic, Post Traumatic, and Post-surgical pains. The basic principle involves the utilization of effects of low frequencies (<250pps) without painful or unpleasant side effects. The major advantage of IFT is that it produces effects in the tissue, exactly where required without unnecessary and uncomfortable skin stimulation. This technique is widely used to elicit muscle contraction, promote healing and reduce edema.
Vector effect: The interference field is rotated to an angle of 450 in each direction, the field thus covers a wider area. This is useful in diffuse pathology or if the site of the lesion cannot be accurately localized.
Frequency swing: Some equipment allows a variation in the speed of the frequency swing. A rhythmic mode may be a continuous swing from 0 to 100 Hz in 5-10s and back in similar time or it may hold for 1-6s at one frequency followed by 1-6s at another frequency with a variable time to swing between the two.
Constant frequency: Some treatments may be carried out with the interference fixed at a certain frequency. Rhythmic frequency is useful if several types of tissues are to be treated at once. A variation in the frequency also overcomes the problem of tissue accommodation where the response of a particular tissue decreases with time.
WORKING PRINCIPLE: Interferential current therapy works by sending small amounts of electrical stimulation to damaged tissues in the body. The therapy is meant to boost the body's natural process of responding to pain, by increasing circulation thus produces hormones that promote healing. IFT delivers intermittent pulses to stimulate surface nerves and block the pain signal, by delivering continuous deep stimulation into the affected tissue. IFT relieves pain, increases circulation, decreases edema, and stimulates the muscles. A frequency of 100Hz may stimulate the large diameter A-beta fibers, which have an effect on the pain gate, and inhibit the transmission of small-diameter nociceptive traffic ( C and A-delta fiber), which effectively closes the gait to painful impulses. Interferential current Increases the circulation of blood thus reduces swelling.
It is a direct current named after inventor Dr.L. Galvani. 2. Its direction of polarity is constant and passing continuously in one direction only, so termed as constant direct current. 3. Because of its unidirectional property, when applied to a muscle tend to contract and remain in that position till it is brought to zero, which seems to be very painful. GALVANIC CURRENT
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5. Introduction
HVPC used in therapy for many years in many
countries.
It is highly popular in other countries
HVPC delivers monophasic current so the polarity of
each electrode is known.
It is a versatile form of electrical stimulation
It has wide variety of uses (Muscle reeducation, nerve
stimulation, Edema reduction, pain control)
6. HVPC generator produces:
twin peaked waveform (pulses in duplets)
OR
a train of two single pulses having a short phase duration and
long interpulse interval.
Interpulse interval is much longer than pulse duration
7. Low pulse charge requires an output voltage of
approx. 150 V or more to stimulate motor or sensory
nerves i.e. high peaked voltage up to 500 V typically
between 150-500 V
Short phase duration allow activation of sensory and
motor nerve at a low intensity without stimulating pain
fibers.
8. Definition
The high volt pulsed galvanic stimulator (HVPGS), a
type of neuromuscular stimulator is a short duration
(microsecond), microamperage current driven by a
high voltage current (up to 300 volts) that is delivered
as a twin-peak monophasic waveform of fixed
duration (100 microseconds).
This direct current can produce both a mechanical
contraction and a chemical change within the body.
9. HVPGS is the use of a high driving voltage (up to
500V) to produce analgesia, muscle contractions, and
to facilitate wound healing.
Galvanic stimulation combines very short pulse
duration (of constant intensity) and high peak voltage,
yet low total current per second, to give relative
comfort and avoid tissue damage while stimulating
deep tissues.
It is also an efficient means of exciting nerve fibers
10. Parameters
Current type:
(A) Direct current
(B) Monophasic pulsed DC
(C) Symmetric biphasic pulsed
(D)Twin peak monophasic
Amplitude: 0-500 ma
Voltage: 150-500 Volts
Pulse Frequency : 1-120 Pulse/sec
Pulse Duration: 13-100 ms
Phase Duration: 13-100 ms
11. (A) direct current (B) monophasic pulsed DC (C) symmetric biphasic
pulsed (D)twin peak monophasic
13. Treatment duration
Typical duration of HVPC is 15-30 min and the
treatment may repeated as many time as day needed
14. MODES:
A MODE SWITCH CAN CHANGE THE PATTERNS OF
CURRENT:
1. In continuous mode: The train of twin pulses are
delivered continuously.
2. Reciprocate mode: Refers to the alternate
application of train of pulses to one or other of two
active pads and does not mean that current
direction is reversed
3. Surge mode: Gives a train of pulses whose
intensity is gradually increased
15. Physiological effects
Maintaining or increasing range of motion.
Re-educating muscles.
Edema/swelling/inflammation reduction.
Reducing motor spasticity.
Increasing local blood circulation to injured area and
promoting fluid movement to and from treatment area.
16. Preventing or retarding muscle disuse atrophy.
Managing chronic/post-traumatic/post- surgical pain
conditions allowing patient to participate in their pain
management program.
Stimulation and acceleration of wound healing by
promoting blood circulation to wound.
18. 1. Wound healing
This current is formed to cause healing of the wound
and ulcer.
Induce human fibroblast
Increase rate of DNA and
protein synthesis
Hence healing occurs
19. Positive electrode is used as active electrode if wound
healing is free from infection.
This is because of the biophysical effects on wound
healing are polarity specific.
Blood clots /infection
pH acidic (+)
Hence cathode is used
20. To account for the effects of polarity during the
treatment of cutaneous wounds the application of 20
min of negative polarity by 14 min of positive polarity
stimulation has been recommended .
21. • NOTE: depending upon the polarity of electrode
leucocytes, epidermal cells, fibroblast are attracted to
the area and level of collagenase increases.
• HVPS inhibits the growth of bacteria in infected
wounds.
• No changes in Ph and temperature that could effect
wound healing are not seen.
22. Negative polarity helps in dissolving blood clots and
increases inflammatory byproducts, promoting healing
of the tissues.
23. 2. Muscle stimulation
The current is used for stimulation of innervated
muscle as the pulses are very short(short pulses at
high intensity are more selective in stimulating motor
rather than pain nerves).
HVPS is used both for strengthening as well as
reduction of disuse atrophy.
Frequency of 30 Hz has been used.
24. 3. Edema reduction
Rhythmical muscle contraction and release
due to the HVPS on motor nerve produces a
pumping effect and increased blood flow in
muscle and tissues and helps in draining in
edema and direct effect on the ANS leads to
local vasodilation, increase fluid exchange
thereby reduces edema .
25. 4. Reduction of spasm
Ability of HVPS to stimulate innervated muscle has
leads to recommendation of this current in the
treatment of muscle spasm and enhance joint
mobility.
26. 5. Pain modulation
Mechanism of pain relief brought about by this current
is the same as involved in the gate control theory of
pain.
Since both the frequencies and intensities of HVPS
can be controlled. It is possible to apply both the high
frequency and low intensity stimulation for pain gate
control and low frequency or high intensity stimulation
for opiate release in descending pain suppression