Hi-Volt or High-Volt Galvanic Flashcards

1
Q

What is Direct Current (DC)?

A

the continuous, unidirectional flow of charged particles that lasts longer than one second. The result is a net flow of electrons

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2
Q

What are the parameters for very low intensity direct current?

A

Amplitude: 200-800 miliamps
Tx time: 1-2 hours
Tx per day: 1-3
Freq/wk: 5-7x/wk

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3
Q

Direct current can be used in high volt and low volt for what dx?

A

wound healing

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4
Q

What is the wave form of high volt pulsed current (HVPC)?

A

paired monophasic with instantaneous rise and exponential fall of current; twin-peak monophasic pulse

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5
Q

What is the phase duration of HVPC?

A

25 micro seconds, sometimes adjustable; this is a comfortable but weak current, net DC, does not usually exceed 1hr

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6
Q

What is the modulation options of HVPC?

A

continuous, surged, or interrupted

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7
Q

What is Hi-Volt usually used for?

A

edema control & wound healing

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8
Q

What are the goals and indications for Hi-Volt?

A

edema
inflammation phase: free from necrosis and exudates, promote granulation
proliferation phase: reduce wound size including, depth, diameter, and tunneling.
epitheliazation phase: stimulate epidermal proliferation and capillary growth

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9
Q

What are the contraindications for Hi-Volt?

A
  • osteomyelitis
  • malignancies/neoplasms
  • carotid sinus/laryngeal m.
  • through the thorax
  • demand-type pacemakers
  • over topical agents containing metal ions (iodine, mercury, zinc, silver; e.g. betadine mercurochrome, silvadene)
  • others as previously learned; except for open tissue
  • decreased sensation
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10
Q

Is the goal for NMES stimulation of the peripheral nerve or some other tissue?

A

PN stim is the goal; best for mild to moderate contractions and areas not covered with excess adipose

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11
Q

Is the goal for TENS for stimulation of the peripheral nerve or some of other tissue?

A

PN stim is the goal

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12
Q

Is the goal for wound healing for stimulation of the peripheral nerve or some other tissue?

A

CHRONIC, slow healing wounds; PN still happens

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13
Q

Is the goal for acute edema formation for stimulation of the peripheral nerve or some other tissue?

A

based in animal research; PN still happens

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14
Q

Is the goal for iontophoresis for stimulation of the peripheral nerve or some other tissue?

A

not widely supported; PN still happens

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15
Q

When Hi-Volt is used for muscle stimulation what is the basic set-up?

A
  • slowly increase intensity until a m. response is observed

- 10-25 m. contractions may be sufficient to obtain tx. goal

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16
Q

What is the duty cycle for Hi-Volt used for m. stimulation (on/off ratio)?

A
  • interrupted/ramped modulation of currents allows the m. to recovery between stimulation periods
  • it has been shown that stimulation on:off ratios of 1:3 minimizes the fatigue effects of ES
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17
Q

What are the factors using HVPC for NMES or TENS?

A
  • amplitude (based on desired excitatory response)
  • pulse rate (related to pain control theory or motor response needed)
  • mode: continuous, ramp-surge, alternate
  • placement of electrodes: as with Russian or FES
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18
Q

What are the 6 effects of electrical stimulation said to enhance the rate of healing in chronic wounds?

A
  • Galvanotaxis: the attraction of body cells to an electrical conductor of the opposite polarity (+ or -)
  • Augmentation of collagen synthesis and proliferation of fibroblasts
  • Angiogenesis stimulation of wound microperfusion
  • Bactericide killing or impeding the growth of bacteria in the wound
  • epithelization electrical stimulation may enhance the rate of epithelium growth
  • electrical stimulation may enhance flood flow to the wound area
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19
Q

What are the 4 concepts of healing?

A
  1. intact skin surface negative with respect to deeper epidermal layers
  2. injury to skin develops positive potentials initially and negative potentials during healing process
  3. absent or insufficient positive potentials retard tissue regeneration.
  4. addition of positive potentials, initially through anode, may promote or accelerate healing
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20
Q

What are the charges of skin, deeper tissues, neuraxis (unpaired part of CNS: cord & brain stem), periphery, & wound tissue?

A

skin (-), deeper tissues (+), neuraxis (+), periphery (-), wound tissue (+)

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21
Q

What is the idea behind using Hi-Volt for wound healing?

A

the wound system is disturbed & creates a “current of injury” that initiates tissue healing

22
Q

The use of E-stim ______ the “current of injury” to initiate, maintain, or speed the process.

A

magnifies

23
Q

The difference between wound tissue & skin around is called the “skin battery” or “________” and must exist for proper healing; if it fails or is disrupted, then slow/no healing can occur. E-stim can help restore the “skin battery.”

A

current of injury

24
Q

For epithelization, autolysis & active inflammatory process what Hi-volt type would you use and what waveform?

A

type: sensory with anode at wound
waveform: monophasic twin peaked

25
Q

For the promotion of granulation with Hi-Volt what type would you use and what waveform?

A

type: sensory with cathode at wound
waveform: monophasic twin peaked

26
Q

For treating the bactericidal effect for an infected wound with Hi-Volt what type would you use and what waveform?

A

type: sensory with cathode or cathode followed by anode at wound
waveform: monophasic twin peaked

27
Q

For treating wound resurfacing with Hi-Volt what type and waveform would you use?

A

type: sensory with anode at wound
waveform: monophasic twin peaked

28
Q

ESTR is usually not used on ___________, it is done for __________.

A

well-healing wounds, chronic wounds

29
Q

What is the contemporary theory of Galvanotaxis?

A

a naturally occurring process whereby signaling/messenger systems work via bioelectrical mechanisms. (Does not contradict the chemical model of human physiology; “chemotaxis.”)

Process can be corrected and/or enhanced by attraction of cells to the wound thru use of anode (+) or cathode (-).

30
Q

What is the polarity of leukocytes, macrophages, fibroblasts, endothelial cells, and epithelial cells?

A
  • leukocytes (+)
  • macrophages (+)
  • fibroblasts (-)
  • endothelial cells (+)
  • epithelial cells (+)
31
Q

What are the 4 types of chronic wounds that physical therapists typically treat?

A

pressure sores, arterial insufficiency ulcers, venous insufficiency ulcers, diabetic ulcers

32
Q

What are pressure sores due to?

A

these are due to compression of the tissue which reduces blood perfusion and results in tissue necrosis

33
Q

What are arterial insufficiency ulcers due to?

A

these are due to arteriosclerosis or some sort of arterial occlusion (thrombosis), or arterial disruption (tourniquet).

34
Q

What are venous insufficiency ulcers due to?

A

these result from sustained venous hypertension or venous valve dysfunction

35
Q

What are diabetic ulcers due to?

A

these result from tissue trauma in areas of poor sensation or from peripheral vascular disease.

36
Q

What are the 2 primary procedures used prior to treatment with electrical stimulation for wound care using Hi-Volt?

A
  1. removal of all necrotic tissue

2. management of all infection in the wound

37
Q

Both HVPC and low-intensity continuous low-volt can be used for wound healing. Current intensity and treatment duration are ________. Hi-volt is often preferred due to penetration and ________.

A

similar, less chance of a burn

38
Q

Where do you place the electrodes for wound healing using Hi-Volt?

A

place active electrode over gauze

39
Q

For bactericidal effect using Hi-Volt, the active electrode should have ____ polarity.

A

negative

40
Q

For culture-free wounds using Hi-Volt, the active electrode should have ____ polarity.

A

positive

41
Q

What are the wound healing parameters for Hi-Volt (amplitude, pulse rate, pulse duration, duration of treatment, electrode placement options)?

A

amplitude: comfortable tingling sensation, paresthesia, no muscle response
pulse rate: 50-200pps
pulse duration: 20-100 micro seconds
duration of tx: 20-60min
electrode placement options: directly over the wound, directly in the wound, or straddling the wound

42
Q

What are the default settings for high-volt?

A
  • continuous on time
  • treatment time: 10 min
  • ramp up and down time: 0.5 sec
  • polarity: negative
  • high range: 80-120 Hz
  • low range: 1-10 Hz
  • available range: 1-200 Hz
43
Q

HVPC may have an effect upon acute edema FORMATION but the effect is short-lived. Therefore, treatment is recommended for ____ for the period of time that bleeding/swelling is expected to occur.

A

30 minutes every 4 hours; this treatment duration and frequency fits well with the RICE protocol, but may often be too frequent for an individual needling/trying to function (work or school).

44
Q

HVPC is used for acute edema CONTROL for what indications? What situation and tissue response must be present?

A

sprain, strain, contusion, or post-surgery. MUST BE AN ACUTE TRAUMATIC CONDITION where swelling & inflammation are actively developing.

45
Q

What are the treatment parameters using electrotherapy tx for edema control, ACUTE STAGE?

A
  • rx: control of formation
  • current: HVPC
  • polarity: negative
  • frequency: 120 pps
  • response: sensory (submotor)
  • time: 30min/4hrs
46
Q

What are the treatment parameters using electrotherapy tx for edema control, SUBACUTE/CHRONIC STAGE?

A
  • rx: reduction
  • current: HVPC biphasic Russian
  • polarity: N/A
  • freq: varies, need msec. pump
  • response: motor
  • time: 20min daily
47
Q

When can stages if healing and wounds can you bill for e-stim?

A
  • chronic stage III pressure ulcers
  • chronic stage IV pressure ulcers
  • arterial ulcers
  • diabetic ulcers
  • venous stasis ulcers
  • *chronic ulcers are defined as ulcers that have not healed within 30 days of occurrence
  • *e-stim is not billable for an initial tx
48
Q

E-stim will be covered ONLY AFTER appropriate standard wound therapy has been tried for at least ____ days and there are no measurable signs of healing; this period can begin while the wound is acute.

A

30

After 30 days of e-stim, if no measurable signs have been demonstrated reimbursement will not continue.

49
Q

What does standard wound care include?

A

optimization of nutritional status; debridement by any means to remove devitalized tissue; maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings; and necessary treatment to resolve any infection that may be present.

50
Q

What are measurable signs of improved healing?

A

decrease in wound size, either surface or volume, decrease in amount of exudates and decrease in amount of necrotic tissue.

51
Q

When is e-stim discontinued for wound healing?

A

when the wound demonstrates 100% epithelialized wound bed