UncategorizedEffect of Electrical Stimulation on Wound Healing in Patients With Pressure Sore and Diabetic Ulcer: Ageless Physiotherapy Clinic Guide.

July 6, 20150

Effect of Electrical Stimulation on Wound Healing in Patients With Pressure Sore and Diabetic Ulcer: Ageless Physiotherapy Clinic Guide.

Pressure Sore Points

What are Pressure Sores and Decubitus Ulcers ?

Pressure ulcers, also known as decubitus ulcers or bedsores, are localized injuries to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction.   A sore, or ulcer, is caused by prolonged pressure against the skin and underlying tissue. The pressure cuts the blood flow to the affected area; the resulting ulcer can be extremely painful, and if left untreated may lead to such serious consequences as amputation or even life-threatening blood poisoning. Pressure sores are also known as “decubitus ulcers,” although in its strictest sense the latter term applies only in people who are “lying down” (the literal meaning of “decubitus”). A bedsore is a common example.

Pressure sores often develop in tissue around bony prominences, such as the elbows, tailbone, or greater trochanters (the two bones we sit on). They occur most commonly in people with diminished sensation and impaired blood flow who are bedridden or in wheelchairs, especially people in hospitals and nursing homes, who spend extended periods sitting or lying down. Diabetes increases the risk of pressure ulcers because of its association with nerve damage (neuropathy) and poor circulation.

Pressure Sores

Causes of pressure Ulcers

Pressure ulcers are caused by sustained pressure being placed on a particular part of the body.

This pressure interrupts the blood supply to the affected area of skin. Blood contains oxygen and other nutrients that are needed to help keep tissue healthy. Without a constant blood supply, tissue is damaged and will eventually die.

The lack of blood supply also means that the skin no longer receives infection-fighting white blood cells. Once an ulcer has developed, it can become infected by bacteria.

People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up on any part of their body.

Causes and Risk Factors

Common causes:

Long periods of uninterrupted pressure exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against an underlying surface is the primary risk factor
Shear forces and friction aggravate the effects of pressure and can contribute significantly
Age-related physiological alterations (eg, an increase in the fragility of blood vessels and connective tissue, and a loss of fat and muscle leading to a reduced capacity to dissipate pressure) can lower the threshold for pressure-induced injury in elderly patients.

Burns

Contributory or Predisposing Factors:

Any condition that is associated with prolonged, impaired wound healing, such as diabetes mellitus
A low tissue oxygen tension is a major risk factor. Associated conditions include heart failure, atrial fibrillation, myocardial infarction, peripheral vascular disease, and chronic obstructive pulmonary disease
Moisture due to fecal and/or urinary incontinence can lead to maceration, and the urine and feces act as skin irritants that can promote breakdown
Nutritional insufficiency significantly delays wound healing
Contractures and spasticity can increase pressure at the chronically flexed joint
Paralysis and insensibility may produce atrophy of the skin, increasing shear forces when a patient is being moved

Externally applied electrical stimulation is frequently used in the treatment of dermal wounds in cases where normal wound healing processes are delayed or absent, and has been used for over thirty years for the treatment of dermal ulcers and other open wounds, including septic abscesses1 and osteomyelitis. Such therapy involves the delivery of small amounts of electric current to the wound site via some type of electrode. Modes of stimulation, methods of delivery, and treatment protocols vary widely, however.

Ulcer

In a March 17, 1997 research work by Baker LL, Chambers R, DeMuth SK, Villar F. on the effects of Electrical Stimulation on Wound Healing in Patients With Diabetic Ulcers with an objective to evaluate the effects of two stimulation waveforms on healing rates in patients with diabetes and open ulcers.

The hypothesis was that stimulus waveforms with minimal polar characteristics would provide significant healing for this patient sample.

Electrical stimulation, given daily with a short pulsed, asymmetric biphasic waveform, was effective for enhancement of healing rates for patients with diabetes and open ulcers.

Electrical stimulation, given daily with a short pulsed, asymmetric biphasic waveform, was effective for enhancement of healing rates for patients with diabetes and open ulcers.

The most detailed study to date of skin wound healing, conducted by University of Manchester scientists with 40 volunteers, has provided new evidence that electrical stimulation accelerates wound healing.

In the new research, half-centimeter harmless wounds were created on each upper arm of the volunteers. One wound was left to heal normally, while the other was treated with electrical pulses* over a period of two weeks. The pulses stimulated angiogenesis — the process by which new blood vessels form — increasing blood flow to the damaged area and resulting in wounds healing significantly faster.

“This research has shown the effectiveness of electrical stimulation in wound healing,” said research leader Ardeshir Bayat of the University’s Institute of Inflammation and Repair. “We believe this technology has the potential to be applied to any situation where faster wound healing is particularly desirable, such as human or veterinary surgical wounds, accidents, military trauma, and sports injuries.”

Based on the findings, the researchers plan to work with Oxford BioElectronics Ltd. on a five-year project to develop and evaluate devices and dressings that use these experimental techniques to stimulate the body’s nervous system to generate nerve impulses directed to the site of skin repair.

Diabetic Sore

Types of Electrical Current Used

There are three types of electrical current that assist in wound closure and healing: direct current (DC), alternating current, and pulsed current (PC). The majority of clinical trials using ES currents for gwound healing have used PC delivered in either monophasic- or biphasic-pulsed waveforms, whereby current is delivered to the wound via a number of pulses per second (pps).G

gThere are three variations of PC that have been reported to augment chronic wound closure and healing. They are:
• high-voltage monophasic-pulsed current, frequently referred to as hi-volt pulsed current (HVPC);

• low-voltage monophasic-pulsed current; and

• low-voltage biphasic-pulsed current (LVBPC).

LVBPC is employed in transcutaneous electrical nerve stimulation (TENS) devices, primarily for pain control.

At present, HVPC is the current most supported by the evidence for wound healing and is most frequently used for this purpose in Ageless Physiotherapy Clinic. HVPC devices provide choices for polarity and pulsed frequency, which are known to affect cell behavior in and near the wound bed.

To this effect modern and current researches supported electrical stimulation as a promising alternative in the management of chronic wounds which could be pressure sores, decubitus ulcers, diabetic foot ulcers, and burns sores.

 

ImageCredit : Healthwise International, WebMD, Woman’s Health.

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