TENS a Better Alternative to Winks Greene Transeva

The Winks Greene Transeva has allegedly shown the following effects upon application of the device. These have all been listed on the manufacturer’s website, with unknown sources of evidence (Winks Greene Transeva, 2002):

• Muscle tone returned to normal
• Increase in blood flow to the treated tissues
• Movement in lymph and waste products
• Increase in oxygen and nutrients
• Increase in absorption of fluid
• Dangers of adhesions are minimised
• Increase in elasticity of connective tissue
• Adhesions are gently and gradually torn apart by causing increasingly powerful contractions to the muscles
• Muscles are prevented from wasting
• Control of inflammation process (Winks Greene Transeva, 2002)

Transcutaneous electrical nerve stimulation (TENS) has been proven to have the following physiological effects upon application:

• Pain control

o   Gate Control Theory (Melzack & Wall, 1965)

o   Opiate-mediated control theory: promotion of endorphin release (McMahon & Koltzenburg, 2005)

o   Increase in local vasodilation in ischaemic tissue (Figure 4) (Leandri, Brunetti & Parodi, 1986)

o   Stimulation of acupuncture points causes a sensory analgesic effect (Melzack & Wall, 1965)

• Reduce nausea with the application of acupuncture TENS to PC06 (median nerve at the wrist level) (Dundee, Yang, & McMillan, 1991)
• Reduce spasticity by reducing or inhibiting excessive alpha-motor neuron activity (Goulet, Arsenault, Bourbonnais, Laramee & Lepage, 1996)
• Increase in local cutaneous blood flow (low frequency TENS above the motor threshold) (Sherry, Oehrlein, Hegge & Morgan, 2001)
  
  

  

  Figure 4: An example of TENS application

It can be seen from the above information that TENS and the Winks Greene Transeva have similar physiological effects. However, the information regarding the Winks Greene Transeva has no supporting research whereas TENS has a large evidence base to justify these effects. Currently the Winks Greene Transeva is not being used in Australia. Since TENS has evidence-based research available with the evidence becoming stronger as time continues and the transeva with currently no research base, there is reason behind why TENS is a popular choice in Australian physiotherapy practice.

A disadvantage of the transeva is the unknown contraindications and precautions. TENS, however, has an extensive list of contraindications ensuring those that can be harmed from the machine are prevented from using it (Belanger, 2010). Quite often, for physiotherapists to use a form of electrical stimulation, they want to be reassured that the patient is safe during and after its application.

In modern society Australia, there is an expectation of clinical research needed to be performed before clinicians and patients will use any technique or application of a machine. Without this research, the Winks Greene Transeva will not be TGA approved and therefore not implemented into clinical practice in Australia (Commonwealth Department of Health and Ageing, 2011). This is based on the lack of research supporting the transeva compared to the alternative in the TENS machine, performing similar tasks at a lower risk to the patient.

References

Belanger, A. (2010). Therapeutic Electrophysical Agents: Evidence Behind Practice (2nd ed.). Baltimore, USA: Lippincott Williams & Wilkins.

Commonwealth Department of Health and Ageing. (2011). Australian Regulatory Guidelines for Medical Devices (ARGMD). Canberra, Australian: Author. Retrieved from http://www.tga.gov.au/industry/devices-argmd.htm   

Dundee, J., Yang, J. & McMillan, C. (1991). Non-invasive Stimulation of the P6 (Neiguan) Antiemetic Acupuncture Point in Cancer Chemotherapy. The Journal of the Royal Society of Medicine, 84(4), 210-212.

Goulet C., Arsenault A., Bourbonnais D., Laramee M. & Lepage Y. (1996). Effects of Transcutaneous Electrical Nerve Stimulation on H-reflex and Spinal Spasticity. Scandinavian Journal of Rehabilitation Medicine, 28(3), 169-176.

Leandri, M., Brunetti, O. & Parodi, C. (1986). Telethermographic findings after Transcutaneous Electrical Nerve Stimulation. Physical Therapy, 66(2), 210-213.

McMahon S., & Koltzenburg M. (2005). Wall and Melzack’s Textbook of Pain. London, UK: Churchill Livingstone.

Melzack, R. & Wall P. (1965). Pain Mechanisms: A New Theory. Science, 150(3699), 971-979.

Sherry, J., Oehrlein, K., Hegge, K. & Morgan, B. (2001). Effect of Burst-Mode Transcutaneous Electrical Nerve Stimulation on Peripheral Vascular Resistance. Journal of the American Physical Therapy Association, 81(6), 1183-1191.

Winks Greene Transeva. (2002). Retrieved March 28, 2012, from http://www.winksgreenetranseva.com

What are Faradic Principles?

The Winks Greene Transeva is based on Faradic principles, therefore an explanation is necessary. Founded by Michael Faraday, faradism is based on the application of percutaneous stimulation through interrupted direct current (DC) (Scott, 2002). Since the DC is interrupted it acts like an alternating current (AC) (Low & Reed, 2000). The properties of faradic pulses are:

·         Pulse duration of 0.1-1.0 ms

·         Frequency between 30 and 100 Hz

·         Can be uniphasic or biphasic (Low & Reed, 2000)

·         Usually asymmetrical in nature (Figure 3)

o   Positive portion has a short duration and a high amplitude

o   Negative portion has a long duration and low amplitude (Knight & Draper, 2008)

Figure 3: An example of a faradic waveform

Even though the Winks Greene Transeva is based on faradic principles, the information regarding the specifics of the machine is minimal (Products, 2002). On the maufacturer’s website it states that the Winks Greene Transeva has:

·         Pulse duration of 0.5-1.5 seconds

·         Intensity of 10 to 390 Volts (Products, 2002)

With the transeva able to reach 390 Volts and a skin resistance of as low as 1000 Ohms if the skin is moist or broken; according to Ohms law (V=IR), the current applied to the skin is 390 mA (U.S. Department of Health and Human Services, 1998). With the use of our calculations, there is potential to exceed the sensory current for humans (5mA) and may cause tissue damage and ventricular fibrillation (fibrillation threshold 300-500 mA) (Ferris, 2005). This suggests that the transeva may have safety concerns.

With a pulse duration more than 1000 times the duration of conventional faradism. Is the Winks Greene Transeva truly based on faradic principles?

No other specifications regarding the transeva have been acknowledged on the manufacturer’s website (Products, 2002). Without further information, the way in which the Winks Greene Transeva works is unable to be determined. Furthermore, there is no evidence showing Winks Greene Transeva has safety issues, despite having no information to prove otherwise. 

Today, faradism is not a major component of therapeutic electrical stimulation in clinical practice. There are other types of electrical stimulation, transcutaneous electrical nerve stimulation (TENS), which have been proven to be safe and TGA approved (Jones & Johnson, 2009).

References

Jones, I & Johnson, M. (2009). Transcutaneous Electrical Nerve Stimulation. Continuing

Education in Anaesthesia, Critical Care & Plan, 9(4), 130-135. doi:
10.1093/biaceaccp/mkp021

Ferris, C. (2005). Safety. In J. Whitaker (2nd ed.), The Electronics Handbook (pp. 2317

2342). Boca Raton, USA: CRC Press.

Knight, K. L., & Draper, D. O. (2008). Therapeutic Modalities: The Art & Science. Baltimore,
USA: Lippincott Williams & Wilkins.

Low, J., & Reed, A. (2000). Electrotherapy Explained: Principles & Practice (3rd ed.).

Oxford, UK: Butterworth Heinemann.

Scott, O. (2002). Sensory and Motor Nerve Activation. In S. Kitchen, Electrotherapy:

Evidence-Based Practice (pp. 57-73). Edinburgh, UK: Churchill Livingstone.

U.S. Department of Health and Human Services. (1998). Worker Deaths By Electrocution

(NIOSH Publication No. 98-131). Atlanta, USA: Casini, V.

Winks Greene Transeva: Products. (2002). Retrieved March 26, 2012, from

http://www.winksgreenetranseva.com/Products/products.html

A History of Winks Greene’s Transeva

The transeva was used before 1951 when Winks Greene arrived in London and studied under Charles Strong. Strong was a Harley Street specialist physiotherapist, who trained Greene in veterinary physiotherapy. The predecessor of the Winks Greene Transeva was known as the “Strongbox” developed by Strong, based on faradic principles (History of the Transeva, 2012).  

The machine was an original concept that had been predicted to revolutionise the treatment of musculoskeletal injuries. The theoretical application of the machine, which set it apart from other machines, was the ability to pinpoint the location of the injury and then work around it (Stelling, 2002). Originally started on humans to cure polo sporting injuries, later Strong adapted his machine to treat both humans and their horses (Figure 2) (History of the Transeva, 2012). The transeva applies a low current electrical impulse through surface electrodes to the body to supposedly stimulate damaged muscle, increase blood circulation, reduce pain and spasm, break down old scar tissue and promote healing (History of the Transeva, 2012).      

Figure 2: Polo players and their horses

Greene, the daughter of a well-established breeder and owner of horses, later travelled back to South Africa. She continued the use of Strong’s transeva on her equine patients, the most famous being “Gondolier”. After the death of Strong, Greene prompted further advancements to the transeva and its applications (Stelling, 2002). Initially, Greene concentrated her work on sporting injuries, and later progressed to paraplegics, cardiovascular and orthopaedic trauma (History of the Transeva, 2012). Currently the Winks Greene Transeva is being used in Europe and South Africa. It has not yet been integrated into Australian clinical practice.      

However, as previously mentioned the Winks Greene Transeva has had little evidential support and therefore little publication has been written on the origins of the transeva itself. The only publications sourced, spoke more specifically about Winks Greene’s history rather than the development of the transeva. Further blogs will acknowledge the difference between faradic principles and the Winks Greene Transeva, the basis of Strong’s “Strongbox” and Greene’s transeva.

References

Winks Greene Transeva: History of the Transeva. (2002). Retrieved March 24, 2012, from
http://www.winksgreenetranseva.com/History/history.html

Stelling, K. (2002, August 4). Miracle worker: On a remote farm in South Africa, 71-year-old Winks Greene is achieving remarkable results healing crippled horses and injured athletes. The Observer. p.46

Have you heard about the Winks Greene Transeva?

Winks Greene Transeva is an electrotherapy device based on faradic principles. Originally used in horses, it later progressed to humans (Figure 1) (History of the Transeva, 2002). Currently there is little evidence behind the usage of Winks Greene Transeva, with the only notable sources being a newspaper article and the product manufacturer’s website (Stelling, 2002; Winks Greene Transeva, 2002).

Figure 1: Winks Greene treating a patient with her transeva

Figure 1: Winks Greene treating a patient with her transeva

Based in South Africa, the machine was very popular in Europe, however the Winks Greene Transeva has never been implemented into Australia (History of the Transeva, 2002). The Therapeutic Goods Administration (TGA) of Australia has rejected the use and importation of the Winks Greene Transeva into clinical practice. The reasons for refusal of this device include:

• Poor clinical evidence of the effects of the machine
• Long term safety breaches  
• Compromises of Workplace Health and Safety (Commonwealth Department of Health and Ageing, 2011). 

Currently safer machines such as TENS present similar results to that of the Winks Greene Transeva, without the negligible side effects and with more evidence based research. Side effects of this machine include:

• Electrical burns
• Reddening of skin 
• Peeling of skin
• Skin irritation beneath the electrodes (Jones & Johnson, 2009)

References

Commonwealth Department of Health and Ageing. (2011). Australian Regulatory Guidelines for Medical Devices (ARGMD). Canberra, Australian: Author. Retrieved from http://www.tga.gov.au/industry/devices-argmd.htm   

Jones, I & Johnson, M. (2009). Transcutaneous Electrical Nerve Stimulation. Continuing Education in Anaesthesia, Critical Care & Plan, 9(4), 130-135. doi: 10.1093/biaceaccp/mkp021

Stelling, K. (2002, August 4). Miracle worker: On a remote farm in South Africa, 71-year-old Winks Greene is achieving remarkable results healing crippled horses and injured athletes. The Observer. p.46.

Winks Greene Transeva: History of the Transeva. (2002). Retrieved March 13, 2012, from http://www.winksgreenetranseva.com/History/history.html

Winks Greene Transeva. (2002). Retrieved March 13, 2012, from http://www.winksgreenetranseva.com