high voltage therapy physiotherapy (high voltage therapy physiotherapy) is a non-invasive method of applying high voltage, low amperage and direct current to a specific region of the body. high voltage therapy physiotherapy has evolved as an electrotherapeutic agent being adopted to alleviate pain, stimulate blood flow, and promote wound healing(1). Some people refer to high voltage stimulators as ‘high voltage pulsed galvanic stimulators’ (HVPGS), however the more accurate term is high voltage therapy physiotherapy, as galvanic falsely implies that a constant current is used. Characteristics of high voltage therapy physiotherapy include: a very short pulse duration between 20-200µs, voltage greater than 100 volts in a therapeutic manner, stimulation range between 0-150Hz, and its unique twin peak monophasic waveform(2). Despite a low total current per second (microcurrent), a relatively comfortable stimulation is achieved via the combination of a very short pulse duration and high peak voltage. high voltage therapy physiotherapy’s clinical versatility is gained through this combination allowing provision of an efficient excitation of sensory, motor and pain-conducting nerve fibers.
How does this high voltage therapy physiotherapy differ from the others?
high voltage therapy physiotherapy utilises a high voltage and direct current (DC), thus differentiating this device from transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES), which uses a low voltage and alternating current (AC)(3). This allows high voltage therapy physiotherapy to penetrate tissue in a more effective manner due to the reduction in pulse duration that reduces the skin’s impedance. high voltage therapy physiotherapy devices deliver more than 100V at microsecond pulse durations, and have features such as an adjustable pulse rate, positive or negative polarity switch, and alternating or synchronous stimulation. When using a high voltage therapy physiotherapy device a large ‘dispersive’ pad is needed to ground the current, and smaller ‘active’ pads are placed over the treatment site(4). With its constant unidirectional current flow high voltage therapy physiotherapy’s oppositely charged electrode pads are set up allowing the operator to switch the polarity of the output to generate a hot and cold sensation for the patient. The positive pad emits a cooling sensation, which tends to reduce circulation and decrease swelling in the region beneath teh pad. In contrast, the negative pad emits warmth, promoting increased circulation and improves the overall rate of healing. There are methods available to objectively measure changes in temperature due to high voltage therapy physiotherapy. At the cutaneous level you can use an infrared thermometer or a cutaneous thermistor. Both forms of bioinstrumentation allow for temperature changes to be recorded in degrees Celsius. Despite this, a study conducted by Hecker, Caron & Schwartz (1985) found that there was no significant temperature variations from baseline with any frequencies(5). In high voltage therapy physiotherapy, voltage can be kept constant so there is no increase in current intensity when only part of an electrode is in contact with the skin, therefore electrodes can be moved whilst the machine is on unlike other modalities.
What beneficial effects does high voltage therapy physiotherapy have on wound healing?
Electrical stimulation using high voltage therapy physiotherapy exerts the following beneficial effects on the phases of wound healing(6):
Inflammation Phase
Proliferation Phase
Remodelling Phase
• Initiates wound repair processes
• Improves blood flow
• Promotes phagocytosis
• Enhances tissue oxygenation
• Reduces edema
• Attracts and stimulates fibroblasts and epithelial cells to the site of injury
• Stimulates DNA synthesis
• Controls infection
• Solubilises blood products (including necrotic tissue)
• Stimulates fibroblasts and epithelial cells
• Stimulates protein synthesis
• Improves membrane transport
• Stimulates wound contraction
· Stimulates epidermal cell reproduction and migration
· Reduces scar tissue
References
1. Cukjati, D., Sarvin, R. 2004. Electric current wound healing.
2. Gardner, S. E., Frantz, R. A. and Schmidt, F. L. 1999. Effect of electrical stimulation on chronic wound healing: a meta-analysis. Wound Repair and Regeneration, 7: 495–503. doi: 10.1046/j.1524-475X.1999.00495.
3. Gordin Medical Centre. 2010. Physical therapy. http://www.gordinmedical.com/eng/electrotherapy.php.
4. Watson, T. 1996. Electrical stimulation for wound healing. Physical Therapy Reviews, 1:2, 89-103.
5. Hecker, B. Carron, H. & Schwartz, D.P. 1985. Pulsed galvanic stimulation:effects of current frequencyand polarity in healthy subjects. Arch Phys Med Rehabil Vol: 66(6):369-71.
6. Sussman, C. 1995. Electrical stimulation in wound care. http://medicaledu.com/estim.htm.
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