HIGH VOLTAGE GALVANIC
STIMULATION/TWIN PEAK MONOPHASIC
Dr. Amal Abd El Baky,
Loganathan chandrasekar
353 RHPT – 1435 – 1436 – 1st Semester
Lecture outline
2

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
7/1/2016
Lecture objectives
3
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
7/1/2016
Equipment / Machine
4
Ultra-G Digital Galvanic, High
Voltage Pulsed Stimulation
PGS-123 Galvanic Analog,
High Voltage Pulsed Stimulation
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
High Volt Pulsed Galvanic Current
(HVPGC)
5

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
7/1/2016
6
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
Definition
7

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
7/1/2016
Parameters
8

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
7/1/2016
Parameters
9

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
7/1/2016
10
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
Important points
11

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
7/1/2016
Important points
12

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
7/1/2016
Uses / Indications of
HVGS
13
Wound
healing
Pain
modulation
Muscle
stimulation
Edema
reduction
Reduction of
muscle spasm
PostOperative
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
Wound healing
14

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
7/1/2016
15
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
16
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
Wound healing - Application
17
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
7/1/2016
Wound healing - Application
18

The current applied might be in the range of 1050μA/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
7/1/2016
Pain modulation
19


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
7/1/2016
Muscle stimulation
20

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
7/1/2016
Edema reduction
21
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
7/1/2016
Reduction of muscle spasm
22

HVGS is effective in the treatment of muscle spasm
and enhance joint mobility.
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
Post-Operative
23

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
7/1/2016
Other Indications For Clinical Use
24
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
7/1/2016
Other Indications For Clinical Use
25
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
7/1/2016
Other Indications For Clinical Use
26
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
7/1/2016
Other Indications For Clinical Use
27
Sprains & Strains:
-Cervical (Neck)
-Back
-Knee
-Elbow
-Shoulder
-Ankle/Hand/Wrist
353 RHPT - 1435-1436H - 1st Semester
HVGS/HVPC
7/1/2016
Contraindications/Precautions:
28

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
7/1/2016
Contraindications/Precautions:
29

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
7/1/2016
Dosage
30
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
7/1/2016
Dosage
31
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
7/1/2016
Dosage
32
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
7/1/2016