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Physical Agent > Electrical Stimulation for Tissue Healing > Flashcards

Electrical Stimulation for Tissue Healing Flashcards

1
Q

What percentage of individuals with previous healed diabetic foot ulcer will have:
Reoccurrence within 1 year?
Recurrence within 3 yr?
Reccurence within 5 yrs?

A

40%
60%
65%

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2
Q

Of those who suffer an amputation as a result of chronic wounds, what percent will undergo a second procedure? And what percent will die within 1 month? What percent will die within 1 year?

A

25%
22%
44%

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3
Q

What causes mortality to be 2x higher in diabetics?

A

Foot Ulcer

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4
Q

Who is more likely to undergo an amputation? Diabetic or Not one?

A

Diabetic (8x more)

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5
Q

How do chronic wounds form? (Etiology)

A

Decreased Sensation
Decreased Blood Supply
Decreased ROM
Decreased Mobility

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6
Q

How can you facilitate tissue healing with electricity?

A

Directly or indircetly

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7
Q

What is indirectly applying electricity do?

A

Control edema
Transdermal delivery of medication

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8
Q

What are some mechanism of electrical stimulation & tissue healing?

A

Galvanotaxis
Cell Activation
Antimicrobial Effects
Enhanced Circulation

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9
Q

What is Galvanotaxis?

A

Directional movement of cells in response to electrical field

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10
Q

How does Galvanotaxis cause tissue healing?

A

Alter cell membrane function
Enhance Antimicrobial Activity
Promote Circulation
Reduce Edema
Improve Tissue Oxygenation

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11
Q

Biologically what happens following the wound at the skin?

A
  1. Trans epithelial potential becomes 0 at wound & the intact skin has higher trans epithelial potential
  2. This generates a weak electrical field that pushes current to center of wound
  3. Electrical field keeps going until there is new epithelial on the wound
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12
Q

Why when there is a wound does epithelial cells get driven toward the center of the wound?

A

The electrical field provides a directional signal to guide migrating epithelial cells toward wound center

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13
Q

What charge do you apply to a wound to stimulate healing?

A

Cathode (Negative)

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14
Q

What will using a cathode bring to the wound?

A

Lymphocytes
Platelets
Mast Cells
Keratinocytes
Neural progenitor cells
Fibroblasts
Activate neutrophils

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15
Q

What charge do you apply to aid in sealing the wound up?

A

Anode (pos)

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16
Q

What does using an anode bring to the wound?

A

Macrophages
Epidermal Cells
Inactive Neutrophils

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17
Q

What two things can cellular activation do to stimulate tissue healing?

A
  • Electrical Stimulation activates fibroblasts
  • Promote epidermal & lymphocyte migration, proliferation & function
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18
Q

How does activating fibroblast help promote tissue healing?

A

Enhance replication & synthesis of DNA & collagen
Upregulating growth factor pathways
Induces conversion to myofibroblasts

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19
Q

What does the promotion of epidermal & lymphocyte migration, proliferation & function cause? And how does that help tissue healing?

A

Increases Vascular Endothelial Growth Factor production

This stimulated development of microcirculation which increases delivery of O2 & nutrients

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20
Q

When discussing the antimicrobial effects of electrical stimulation & tissue healing what does Monophonic Currents do?

A

Kill bacteria
May be effective against antibiotic resistant bacteria in biofilms by enhancing other agents (Silver Dressing)

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21
Q

Is electrical stimulation the best way to get enhanced circulation?

A

No–> therapeutic exercise is better

22
Q

What are some clinical applications of electrical stimulation?

A

Chronic Wounds
Edema Control
Iontophoresis

23
Q

What criteria must a patient meet for medicare & medicaid to approve payment for electrical stimulation to be used in wound care?

A

Treat stage III & IV Ulcers not healed or responding to standard treatment in 30 days

24
Q

True or False: Electrical stimulation significantly accelerates the rate of wound healing

A

True

25
Q

When compared to standard wound care or sham stimulation does electrical stimulation reduce pressure size more or less?

A

More

26
Q

If using electrical stimulation for edema are you looking to produce a muscle contraction?

A

No just 90% (right before seeing a muscle contraction)

27
Q

Is the evidence good for using electrical stimulation for edema control?

A

No

28
Q

Should you use electrical stimulation on edema if caused by systemic disorder?

A

No

29
Q

What is the science behind using electrical stimulation for edema control?

A

-Negative charge can repel negatively charged serum proteins, which blocks movement out of a blood vessel

  • Reduce microvascular diameter
30
Q

What is iontophoresis?

A

Use of electrical current to promote transdermal drug delivery

31
Q

What level of amplitude should you use to facilitate transdermal drug delivery?

A

low

32
Q

How does medication get pushed through the skin when using iontophoresis?

A

like charge repel (so whatever the charge of the medication is you use the same charge current to push it)

33
Q

When is iontophoresis preferred?

A

If patient is nauseated or vomiting w/ oral
If nasal is too uncomfortable, bad taste in mouth, & low bioavailability
If injections cause bleeding, infection or traumatic injuruy

34
Q

What medication is most commonly used with iontophoresis?

A

Anti-Inflammatory corticosteroid dexamethasone

35
Q

What are the advantages of iontophoresis?

A
  • Safe
    -non invasive
  • Painless (no tissue distortion)
  • Avoids GI tract (no first pass or GI irritation)
  • Can be applied to specific area
36
Q

What is the polarity & indication for Dexamethasone?

A

Negative
Anti-inflammatory

37
Q

What is the polarity & indication for lidocaine?

A

Pos
Local anesthetic

38
Q

What is the polarity & indication for Acetic Acid?

A

Neg
calcification

39
Q

What is the polarity & indication for zinc oxide?

A

pos
bacterial

40
Q

What is the polarity & indication for iodine?

A

Neg
Scar tissue

41
Q

What is the polarity & indication for salicylates?

A

Neg
Analgesic/ Anti-inflammatory

42
Q

What is the polarity & indication for Hyaluronidase?

A

Pos
Edema reduction

43
Q

What are the drawbacks to ionphoresis?

A

Expensive
Storage of meds
Disposal of meds
Limited effectiveness/ research
State practice act dependent

44
Q

What are some contraindication to electrical stimulation?

A
  • Malignant tumors
  • Demand pacemaker or unstable arrhythmias
  • Over carotid sinus
  • Venous or arterial thrombosis or thrombophlebitis
  • Pregnancy
  • Over eyes
  • Urinary Bladder Stimulator
  • Spinal Cord Stimulator
  • Transcerebrally
  • Superficial Metal Implants
  • Presence of active bleeding or infection
  • Pharyngeal or laryngeal muscles
  • Motor level stimulation in condition that prohibit movement
45
Q

What are some precautions to electrical stimulation?

A
  • Cardiac disease
  • impaired mentation or impaired sensation
  • skin irritation or Open wounds
46
Q

What are some precautions to the actual application of electrical stimulation?

A

Infection control
If electrode are placed in wounds, a new electrode & gauze should be used
Self adhesive electrodes should be single use only
Chronic open wounds should be kept clean & covered

47
Q

What are some adverse effects of electrical stimulation?

A

Excessive Granulation Formation
Skin irritation
Burns

48
Q

How should patient be positioned when applying the electrical stimulation?

A

Wounds readily available & positioned w/ minimal pressure on wounds

49
Q

What are the two electrodes use when applying electrical stimulation for wound healing?

A

Treatment electrode on or near wound
Dispersive electrode near wound

50
Q

When applying electrical stimulation for edema control how should the patient be positioned and where should the electrodes go?

A

Limb should be elevated
Negative electrode : over area of edema
Dispersive: Proximal to area of edema

51
Q

In general how should the electrodes be placed?

A

Delivery electrode should be placed over area of pathology
Dispersive pad is placed a few inches away over a large muscle

Physical Agent (10 decks)

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