Electrical Stimulation for Tissue Healing Flashcards
What percentage of individuals with previous healed diabetic foot ulcer will have:
Reoccurrence within 1 year?
Recurrence within 3 yr?
Reccurence within 5 yrs?
40%
60%
65%
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?
25%
22%
44%
What causes mortality to be 2x higher in diabetics?
Foot Ulcer
Who is more likely to undergo an amputation? Diabetic or Not one?
Diabetic (8x more)
How do chronic wounds form? (Etiology)
Decreased Sensation
Decreased Blood Supply
Decreased ROM
Decreased Mobility
How can you facilitate tissue healing with electricity?
Directly or indircetly
What is indirectly applying electricity do?
Control edema
Transdermal delivery of medication
What are some mechanism of electrical stimulation & tissue healing?
Galvanotaxis
Cell Activation
Antimicrobial Effects
Enhanced Circulation
What is Galvanotaxis?
Directional movement of cells in response to electrical field
How does Galvanotaxis cause tissue healing?
Alter cell membrane function
Enhance Antimicrobial Activity
Promote Circulation
Reduce Edema
Improve Tissue Oxygenation
Biologically what happens following the wound at the skin?
- Trans epithelial potential becomes 0 at wound & the intact skin has higher trans epithelial potential
- This generates a weak electrical field that pushes current to center of wound
- Electrical field keeps going until there is new epithelial on the wound
Why when there is a wound does epithelial cells get driven toward the center of the wound?
The electrical field provides a directional signal to guide migrating epithelial cells toward wound center
What charge do you apply to a wound to stimulate healing?
Cathode (Negative)
What will using a cathode bring to the wound?
Lymphocytes
Platelets
Mast Cells
Keratinocytes
Neural progenitor cells
Fibroblasts
Activate neutrophils
What charge do you apply to aid in sealing the wound up?
Anode (pos)
What does using an anode bring to the wound?
Macrophages
Epidermal Cells
Inactive Neutrophils
What two things can cellular activation do to stimulate tissue healing?
- Electrical Stimulation activates fibroblasts
- Promote epidermal & lymphocyte migration, proliferation & function
How does activating fibroblast help promote tissue healing?
Enhance replication & synthesis of DNA & collagen
Upregulating growth factor pathways
Induces conversion to myofibroblasts
What does the promotion of epidermal & lymphocyte migration, proliferation & function cause? And how does that help tissue healing?
Increases Vascular Endothelial Growth Factor production
This stimulated development of microcirculation which increases delivery of O2 & nutrients
When discussing the antimicrobial effects of electrical stimulation & tissue healing what does Monophonic Currents do?
Kill bacteria
May be effective against antibiotic resistant bacteria in biofilms by enhancing other agents (Silver Dressing)
Is electrical stimulation the best way to get enhanced circulation?
No–> therapeutic exercise is better
What are some clinical applications of electrical stimulation?
Chronic Wounds
Edema Control
Iontophoresis
What criteria must a patient meet for medicare & medicaid to approve payment for electrical stimulation to be used in wound care?
Treat stage III & IV Ulcers not healed or responding to standard treatment in 30 days
True or False: Electrical stimulation significantly accelerates the rate of wound healing
True
When compared to standard wound care or sham stimulation does electrical stimulation reduce pressure size more or less?
More
If using electrical stimulation for edema are you looking to produce a muscle contraction?
No just 90% (right before seeing a muscle contraction)
Is the evidence good for using electrical stimulation for edema control?
No
Should you use electrical stimulation on edema if caused by systemic disorder?
No
What is the science behind using electrical stimulation for edema control?
-Negative charge can repel negatively charged serum proteins, which blocks movement out of a blood vessel
- Reduce microvascular diameter
What is iontophoresis?
Use of electrical current to promote transdermal drug delivery
What level of amplitude should you use to facilitate transdermal drug delivery?
low
How does medication get pushed through the skin when using iontophoresis?
like charge repel (so whatever the charge of the medication is you use the same charge current to push it)
When is iontophoresis preferred?
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
What medication is most commonly used with iontophoresis?
Anti-Inflammatory corticosteroid dexamethasone
What are the advantages of iontophoresis?
- Safe
-non invasive - Painless (no tissue distortion)
- Avoids GI tract (no first pass or GI irritation)
- Can be applied to specific area
What is the polarity & indication for Dexamethasone?
Negative
Anti-inflammatory
What is the polarity & indication for lidocaine?
Pos
Local anesthetic
What is the polarity & indication for Acetic Acid?
Neg
calcification
What is the polarity & indication for zinc oxide?
pos
bacterial
What is the polarity & indication for iodine?
Neg
Scar tissue
What is the polarity & indication for salicylates?
Neg
Analgesic/ Anti-inflammatory
What is the polarity & indication for Hyaluronidase?
Pos
Edema reduction
What are the drawbacks to ionphoresis?
Expensive
Storage of meds
Disposal of meds
Limited effectiveness/ research
State practice act dependent
What are some contraindication to electrical stimulation?
- 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
What are some precautions to electrical stimulation?
- Cardiac disease
- impaired mentation or impaired sensation
- skin irritation or Open wounds
What are some precautions to the actual application of electrical stimulation?
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
What are some adverse effects of electrical stimulation?
Excessive Granulation Formation
Skin irritation
Burns
How should patient be positioned when applying the electrical stimulation?
Wounds readily available & positioned w/ minimal pressure on wounds
What are the two electrodes use when applying electrical stimulation for wound healing?
Treatment electrode on or near wound
Dispersive electrode near wound
When applying electrical stimulation for edema control how should the patient be positioned and where should the electrodes go?
Limb should be elevated
Negative electrode : over area of edema
Dispersive: Proximal to area of edema
In general how should the electrodes be placed?
Delivery electrode should be placed over area of pathology
Dispersive pad is placed a few inches away over a large muscle
