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Iontophoresis & High Volt Galvanic/Pulse Stim

Becca, Brittney, Clayton, Kaitlyn, Mary Catherine

Iontophoresis

Parameters:

What do you know/need to know??

High Volt Galvanic/Pulse Stim (HVGS/HVPS)

  • Dexamethasone is the primary medication administered by iontophoresis, but other medications include acetate, hydrocortisone, & lidocaine (1)
  • dosage is measured in milliAmps/minute (mA-mins) = multiplication of mins of treatment *current intensity (amplitude) (1)
  • max recommended is 4mA (1)
  • a recommended treatment cycle consists of 4-6 treatment sessions over 2-3 weeks (1)
  • can be used, and is most commonly used for pts over 40 yrs. (1)
  • an electrical field is produced between 2 electrodes that have opposite polarities, which either repel or attract ions within a medication (1)
  • involves the transmission of ionized medication & non-medicated substances in to the skin (1)
  • dexamethasone is the primary medication administered by iontophoresis treatments to a depth of 30mL (1)
  • it is an energy source of electronic current, which usually consists of a battery and controlled electronics (2)
  • an active electrode which contains the ionic therapeutic agent & an indifferent or return reservoir system which contains an electrolyte & serves to complete the electric circuit (2)

Parameters

What you need to know:

  • HVPC consists of twin peak, monophasic pulses of very short duration (>200ms) driven at 150-500 volts (5)
  • the expected capability of the unit is in the range to provide 300-500 volts (6)
  • High peak current generation provides better penetration in to the tissues (6)
  • Clinitians choose either positive or negative polarity for this type of electrical therapy depending on the desired outcome (7)
  • A “galvanotaxis effect” induces the migration of polarized cells toward either the cathode or anode (5)
  • The pulse duration is appx 5-7 microseconds per peak, with the combined duration of the 2 peaks lasting up to 200 microseconds (6)
  • The pulse frequency can be varied, ranging from 1-120 pps (6)
  • HVPC treatment should be administered as soon as possible after injury occurrence, & it should be maintained the period that edema formation occurs (5)
  • most commonly investigated HVPS treatment protocol was 4, 30 min treatments (30 min treatment, 30 min rest cycles, for 4 hours) w/ a negative polarity over the injured site at a frequency at 120 pulses (pps) & an intensity of 90% visual motor contraction (8)
  • by decreasing the pulse duration & increasing the voltage, stimulation of deeper tissues occurs without tissue damage (6)

Indications

  • Idiopathic palmar, plantar & axillary hyperhidrosis (for tap water) (3)
  • Often used to treat arthritis, bursitis, & tendinopathy, it can also be used to treat edema, hyperhidrosis, & certain dermatophytoses (2)
  • Calcific tendinopathy, inflammatory conditions & subacute (3-14 days) musculoskeletal injuries (4)

Contraindications

Physiological Effects:

  • HVPS minimizes the leakage of plasma proteins, & thus, edema formation by limiting macrovascular permeability & repelling large, negatively charged plasma proteins for interstitial spaces through the placement of a negatively charged electrode over the injured site (8)
  • Edema control – HVPC – negative polarity – 120 pps – underwater or larger surface electrodes – 90% of visible motor threshold output (7)
  • Wound management – HVPC – positive polarity to attract macrophages; negative polarity to attract fibroblasts – 100 pps – electrodes in the wound or adjacent to wound edges - tingle output (7)
  • The pain relieving effect of HVGS can be attributed to the Gate Control Theory: the stimulation of large-diameter myelinated fibers blocks the C afferent fiber input at the level of the medulla spinalis (6)

Contraindicaions

Indications:

  • Pts under the age of 5: Child cannot understand the treatment or follow therapy instructions (3)
  • Pts w/ implanted electronic devices (e.g. pacemaker) should not receive tap water iontophoresis (3)
  • Pregnancy, an intrauterine pessary (IUD) containing metal, large skin defects that cannot be covered by petrolatum or insulating bandages/foils (3)
  • Pt w/ allergy or sensitivity to the substance applied, open wounds, decreased sensations, or within the immediate vicinity of metallic implants, wires, or staples (4)
  • cardiac pacemakers, pregnancy, infections, neoplasms, & peripheral vascular disease (7)

Physiological Effects

  • Condition of the skin effects the penetrating properties of the permeant: Abdomen>forearm>instep>heel>plantar (2)
  • Major drawback of transdermal delivery system is the potential for localized irritant & allergic cutaneous reactions (2)
  • Setting the treatment dosage above 80mA-mins can cause skin burns (1)
  • Acute pain, postoperative pain, & reduction of muscle spasms, muscle strengthening, due to its analgesic effects, HVGS may be helpful as an adjunctive modality myofascial pain treatment (6)
  • Primary purpose is to accelerate the healing process for cutaneous wounds (5)
  • Also used for prevention of edema formation muscle reeducation, muscle spasm reduction, & pain modulation (5)

Pt Outcomes:

Pt Outcomes

  • Dexamethasone iontophoresis is effective in decreasing symptom severity & improving functional status in pts with carpal tunnel (1)
  • There was study that compared dexamethasone iontophoresis with a placebo treatment in terms of reduction of carpal tunnel syndromes and nerve conduction, findings concluded there was no significant difference b/t the treatment group and the placebo group – suggesting dexamethasone treatment was no better than placebo (1)
  • Another study found that dexamethasone iontophoresis significantly reduced short term pain & inflammation in 99 pts suffering from acute epicondylitis, when compared to a control group of 100 pts (1)
  • Another study found that management of Achilles tendon pain w/ dexamethasone iontophoresis was effective in reducing pain at 6 months compared to a control group (1)
  • Tenderness index was decreased significantly in the treatment group (P<0.05) (6)
  • Results remained the same 15 days after the treatment (6)
  • Promoted wound healing and managed swelling and muscle spasms associated with musculoskeletal injuries (5)
  • Can shorten recovery periods and, subsequently, return patients back to play faster (8)

References:

(1)Brown C, Lauber C. Evidience-Based Guidelines for Utilization of Dexamethasone Iontophoresis. IJATT. Fall 2011; 16(4): 33-36

(2)Dhote V, Bhatnagar P, Mishra P, Mahajan S, Mishra D. Iontophoresis: a potential emergence of a transdermal drug delivery system. Sci Pharm. 2012; 80: 1-28

(3)Hölzle E, Hund M, Lommel K, Melnik B. Recommendations for tap water iontophoresis. Journal Der Deutschen Dermatologischen Gesellschaft = Journal Of The German Society Of Dermatology: JDDG. May 2010;8(5):379-383.

(4)Rand S, Goerlich C, Marchand K, Jablecki N. The physical therapy prescription. American Family Physician. December 1, 2007;76(11):1661-1666.

(5)Draper D, Knight K, Rigby J. High-volt pulsed current: treatment of skin wounds and musculoskeletal injuries. IJATT. July 2012;17(4): 32-34.

(6)Tanrikut A, Özaras N, Ali Kaptan H, Güven Z, Kayhan Ö. High voltage galvanic stimulation in myofascial pain syndrome. Journal Of Musculoskeletal Pain. June 2003;11(2):11-15.

(7)Dolan M, Meldel F. Clinical application of electrotherapy. Athletic Therapy Today. September 2004;9(5):11.

(8)Snyder AR, Perotti AL, Lam KC, Bay RC. The influence of high-voltage electrical stimulation on edema formation after acute injury: a systemic review. Journal of Sport Rehabilitation. 2010;19: 436-451.

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