High Voltage Galvanic Current (HVGC) High-voltage galvanic stimulation (HVGS) produces a highvoltage current with a high-peak intensity of a maximum of 300 to 400 ma but with a low-frequency current and a very short duration, ranging between 50 and 100 msec. Characteristics: * The high-peak intensity produced is of a twin-pulsed shape. * It is safer and more comfortable (less painful) to the patient than faradic current because of its short duration. * It penetrates deeper than that of low-voltage currents. * Direct stimulation of deep nerves and muscles can be effective. * It can stimulate either an isolated muscle or muscle group according to the appropriate technique. * High-voltage galvanic current does not produce contraction in the denervated muscle as the pulse duration is too short to depolarize the muscle membrane. * Partially innervated or totally innervated muscle will respond well to high-voltage galvanic current. Physiological effects of HVGC: * Pain reduction: It is accomplished either through decreasing pain by using two small electrodes closely-spaced in a narrow area or minimizing pain fiber stimulation by using two widely-spaced large electrodes. Both of these methods can stimulate the release of opiate substance; ß-endorphins in the central nervous system in order to suppress pain. 1 * Increase of joint mobility: This occurs due to reduction of pain through the direct effect of the current on blood vessels, which leads to improvement of circulation. So, HVGC is effective after fractures, menisectomy, osteoarthritis and frozen shoulder. Reduction of post-traumatic edema is evident immediately after treatment. * Improvement of peripheral circulation: This is due to the stimulation of muscle pumping effect on the venous circulation and stimulation of sympathetic neurons, which subsequently cause vasodilatation. * Healing of ulcers: It is accomplished through electrical stimulation with the positive electrode, which increases the repair process. Furthermore, electrical stimulation with the negative pole destroys bacteria. * Relief of muscle spasm: It is accomplished due to reduction of pain through strong muscle contraction, which produces relaxation. Indications: As a low-frequency current, with the exception of treating the denervated muscles, it may be used for: - Facilitation of muscle contraction inhibited by pain. - Re-education of weak muscles. - Reduction of post-traumatic edema. - Mobilization of joint stiffness. - Reduction of pain and muscle spasm (arthritis, sprain and strain). - Improvement of peripheral circulation. - Healing of ulcers. 2 Contraindications: They are similar to those of the other low frequency currents, including: * Skin lesions. * Acute infections and inflammations. * Thrombosis. * Loss of sensation. * Cardiac pacemakers. * Superficial metal. Dosage: It is adjusted according to the patient’s tolerances. In cases of edema, muscle spasm and stiff joint, the dose must be high enough to produce muscle contraction: - Pulse rate: 80 pulses / sec. - Treatment duration: 20 - 30 minutes. 3