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The objective of this blog is to create a locale for discussions and a repository of evidence about the use of physical therapy modalities. We have also created a YouTube channel where students have demonstrated the use of several physical therapy modalities. Please feel free to post links to current articles, reflections about modality usage, or feedback about the site. The YouTube link is: http://www.youtube.com/user/PTModalities?feature=mhee

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Monday, March 5, 2012

High Voltage Pulsed Current

High Voltage Pulsed Current (HVPC) can be used for treatment of dermal wounds, edema managment, muscle weakness, and pain management depending on the parameters the machine is set to. HVPC is a twin-peaked, pulsed, direct current. We found it difficult to stick to one specific injury and the effects HVPC has. Therefore, a summary of articles that both support and refute the use of HVPC for some of the reasons listed are presented below.

Articles that Support

Among the uses of HVPC can be edema management. Mendel et al. demonstrates this in Influence of High Voltage Pulsed Current on Edema Formation following Impact Injury in Rats.
This study used four 30-minute treatment sessions of HVPC at 120 pps on rats in order to determine the effect on reducing edema. HVPC was performed on one leg of each rat after both legs were put under trauma. After two treatments, leg measurement was significantly decreased in the treated leg as compared to the untreated leg (p=0.0057). Thus, this article shows that HVPC can be used to decrease edema.  

HVPC is the "gold standard" stimulation modality for wound healing.  A study in Cairo, Egypt by Ahmed studied the effect of HVPC on chronic pressure ulcers and the optimal duration for enhancing healing.  This study included sixty participants suffering from chronic pressure ulcers, monitored for a treatment period of five weeks.  Participants were divided into four equal groups.  Each group received HVPC seven days a week for a different amount of time, and one group served as the control, receiving sham HVPC.  The wound surface area was measured at initial treatment, three weeks, and five weeks, and served as the dependent variable.  The independent variable was varied HVPC treatment times.  Wound surface area decreased in the 60 minute and 120 minute groups, seven days a week.  These two groups proved to be the optimal duration for enhancing healing of chronic pressure ulcers.

Again, HVPC is recognized as a "gold standard" stimulation modality for wound healing.  A study published in the Journal of the American Physical Therapy Association looked at the effectiveness and efficiency of HVPC for treating and healing pressure ulcers in patients with spinal cord injury.  Seventeen patients were included in the study.  They were divided into a placebo HVPC group or a group that received HVPC.  The treatment lasted 20 days for one hour each day.  This study as well as the one above, measured wound surface area to see if the treatment of HVPC was helping with pressure ulcers.  Pressure ulcers on the spinal cord patients were measured at initial treatment, 5, 10, 15, and 20 days after the start of treatment.  There was a reduction in the size of the pressure ulcers after treatment from the HVPC group compared to the placebo, meaning HVPC is a good choice as a modality treatment among patients with pressure ulcers that suffer from spinal cord injury.  


Articles that Refute

High voltage pulsed current can be used for several purposes, but Butterfield et al. found that it does not provide a significant effect for helping delayed-onset muscle soreness (DOMS). This article examined the effects HVPC has on pain, ROM loss, and strength loss due to the DOMS. The randomized control trial tested 28 college students in which there was a control group that received sham treatments where they believed they were being given a nonsensory treatment and an experimental group that received 3 30-minute treatments of HVPC at 125 pps over 48 hours. The DOMS was induced by having the subjects perform concentric and eccentric knee extension exercises with their right leg. Subjects were not allowed to use any other form of treatment such as ice, massage, or pain medications. Pain was less during the HVPC treatment but did not have a significant affect 24 to 72 hours post-exercise (p=0.67). There was also no significant decrease in loss of ROM as compared to the control group (p=0.38) or decrease in loss of strength (p=0.25).

In the article by Michlovitz, Smith, and Watkins, the researchers wanted to compare ice versus ice and high voltage pulsed stimulation (HVPS) for the treatment of ankle sprains (Michlovitz, Smith, & Watkins, 1988).  There were 30 subjects used in this study all of which had either grade I or grade II ankle sprains.  All 30 subjects were given treatment within 30 hours of their injury and were treated once daily for 3 days.  The subjects were randomly assigned and separated into 3 groups of 10, group 1’s treatment only consisted of 30 minutes of ice, group 2’s treatment consisted of ice and HVPS (28 pps, negative polarity, current to comfort without contraction,) and group 3’s treatment consisted of ice and HVPS (80 pps, negative polarity, 30 minutes.)  The results of this experiment found that there was no significant difference between the duration of injury between the groups and that there were no significant differences between the groups in volumetric or ROM measures.  Overall this study concluded that there were no significant differences between treatment effects among groups sprains (Michlovitz, Smith, & Watkins, 1988).


In the study by Mendel, Dolan, Fish, Marzo, and Wilding, the researchers investigated whether the use of subsensory High-Voltage Pulsed Current (HVPC) applied almost continuously for 3 days immediately after a lateral ankle sprain decreased the time lost to the injury (Mendel, Dolan, Fish, Marzo, & Wilding, 2010).  This study was a multicenter, randomized, double-blind, placebo-controlled trial that collected data from 9 colleges and 1 professional training site.  There were 50 subjects in this study and they were randomly given HVPC or the placebo in addition to traditional acute/subacute care.  This study found that there was no difference between the 2 groups in regards to the time lost to injury and it was actually found that in the subjects that had grade I ankle sprains the treatment group that was being administered the live HVPC actually lost more time to injury than did the placebo group.  The conclusion of the study was that the use of subsensory HVPC does not decrease the time lost to injury in regards to lateral ankle sprain injuries (Mendel, Dolan, Fish, Marzo, & Wilding, 2010).

Sources

Ahmad, E.T., "High Voltage Pulsed Galvanic Stimulation: Effect of Treatment Duration on Healing of Chronic Pressure."  Faculty of Physical Therapy, Cairo University, Cairo, Egypt. (2008): Vol. XXI-n.3. <http://www.ncbi.nlm.gov/pmc/articles/PMC3188162/pdf/Ann-Burns-and-Fire-Disasters-21-124.pdf> 

Butterfield, David L., David O. Draper, Mark D. Ricard, J. W. Myrer, Earlene Durrant, and Shane S. Schulthies. "The Effects of High-Volt Pulsed Current Electrical Stimulation on Delayed-Onset Muscle Soreness." Journal of Athletic Training 32.1 (1997): 15-20. PubMed. NCBI. Web. 04 Mar. 2012. <http://www.ncbi.nlm.nih.gov.proxy.kumc.edu:2048/pubmed/16558426>.

Griffin, Judy W., Tooms, R., Mendius, R., Clifft, J., Zwaag, V., El-Zeky, F.  "Efficacy of High Voltage Pulsed Current for Healing of Pressure Ulcers in Patients with Spinal Cord Injury."  Journal of the American Physical Therapy Association (1991): 71:433-422.   <http://ptjournal.apta.org/content/71/6/433.long>   

Mendel, Frank C., Juli A. Wylegala, and Dale R. Fish. "Influence of High Voltage Pulsed Current on Edema Formation following Impact Injury in Rats." Physical Therapy 72 (1992): 668-73. PubMed. Web. 4 Mar. 2012. <http://www.ncbi.nlm.nih.gov.proxy.kumc.edu:2048/pubmed/1508974>.

Mendel, F. C., Dolan, M. G., Fish, D. R., Marzo, J., & Wilding, G. E. (2010). Effect of high-voltage pulsed current on recovery after grades I and II lateral ankle sprains. Journal of sport rehabilitation, 19(4), 399-410. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21116009

Michlovitz, S. L., Smith, W., & Watkins, M. (1988). Ice and high voltage pulsed stimulation in treatment of acute lateral ankle sprains*. The Journal of orthopaedic and sports physical therapy, 9(9), 301-4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18796993

-Brittany Brown, Lauren Mulsow, Zac Snow, Andrew Towell

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