Wound Healing, Edema and Iontophoresis

Question 1

ESTIM is used for: Re-education/strengthening, muscle maintenance and analgesia. In order, name the types of ESTIM that are used for each.

Answer 1

NMES (innervated muscle), EMS (denervated muscle), TENS (motor, sensory, burst) or IFC (quadripolar, pre-modulated)

Question 2

Would ESTIM be your first choice for wound healing? Why or why not.

Answer 2

No, try convential methods first.
-Patient education (pressure relief, debridement, nutrition, skin hygene, dressings

Question 3

What type of wounds require special healing protocols when unresponsive to other treatments?

Answer 3

Pressure ulcers (stage III and IV), diabetic ulcers, venous ulcers, traumatic wounds, surgical wounds, burn wounds.

Question 4

An open wound has a ___ polarity, which is why when treating with ESTIM, you would place the ___ on the wound bed to attract fibroblasts to the area. The types of cells attracted to the area are determined by the phase of wound healing.

Answer 4

Positive, cathode (negative pole).

Question 5

What are the goals of tissue healing, specifically with HVPC (High Volt Pulsed Current)?

Answer 5

Enhances soft tissue healing
-Promotes protein synthesis
-Facilitates epithelial tissue migration/granulation
-Improves blood flow
-Improves tissue oxygenation
-Improves tensile strength
-Reduces edema
-Inhibits bacterial growth in vitro

Question 6

There are 10 contraindications to using HVPC. What are they?

Answer 6

1. Cardiac Pacemaker, Bladder stimulator
2. Pregnancy
3. Significant impaired sensation
4. Transthoracic/cervical region
5. Superficial metal implants
6. Along phrenic nerve
7. Malignancy
8. Carotid sinus, laryngeal musculature
9. Osteomyelitis
10. Over topical substances with metal ions

Question 7

When speaking about electric current, a cathode is ___ and an anode is ___. Galvanotaxis is related and describes ___?

Answer 7

Negative, positive. Galvanotaxis is the cellular movement stimulated by an electric current; “attraction”.

Question 8

What substances involved in the healing process are attracted by positive charge (anode)? What are attracted by a neagtive charge (cathode)? In what phase of healing are each used?

Answer 8

POSITIVE
-Inactive neutrophils, macrophages, epidermal cells.
-Used for necrotic tissue in the proliferative phase when no inflammation is present.

NEGATIVE
-Active neutrophils, lymphocytes, platelets, mast cells, keratinocytes, fibroblasts.
-Used for infected, inflammed tissue.

Question 9

What happens to collagen synthesis and DNA production at 60-90 volts?

Answer 9

Cellular membranes are altered by the electric current, enhancing synthesis.

Question 10

What is necessary to maintain current tissue charge and encourage healing?

Answer 10

0.9% saline solution on the wound (2.5ml applied in Iontophoresis)

Question 11

HVPC does not change the pH or temperature of the tissue significantly. Why is this?

Answer 11

Non-motor quality with short pulses and rapid reduction of current amplitude after its peak.

Question 12

Edema is the excessive fluid accumulation in interstitial space (which we want to avoid) and is different than inflammation. What are the indicatios for using ESTIM in edema management, and what types are used?

Answer 12

Reduce the formation of additional edema
-Acute Injury (Higher Frequency)
-No Motor Response
-High Volt Pulsed Current (HVPC: monophasic)

Estim for muscle pumping (similar to NMES)
-Lower Frequency to avoid visible contraction
-Biphasic
-Motor Response

Question 13

What specific mechanism behind ESTIM edema management is useful?

Answer 13

It repels negatively charged proteins involved in the inflammatory process. Also affects protein migration by decreases porous properties of blood vessels.

Question 14

What’s the main difference between muscle pump ESTIM and NMES?

Answer 14

In typical NMES, the surge time is 1:5 (on:off), in edema management (muscle pump), it’s 1:1.

Question 15

Name the 6 contraindications for iontophoresis.

Answer 15

1. Previous drug allergy/adverse drug reaction
2. Altered skin integrity
3. Impaired sensation
4. Cardiac pacemakers/arrhythmia
5. Carotid Sinus
6. Pregnancy

Question 16

Like HVPC, Iontophoresis isn’t used unless convential methods are working. How do you apply it within the scope of your plan of care?

Answer 16

Over several treatments, probably 4.

Question 17

Iontophoresis is the non-invasive transdermal delivery of medication. How does it work?

Answer 17

Using low amplitude DC, a charge repels ionized medication in the pad (charge polarity depends on medication) into the tissue beneath it. This process is efficient because the ion transfer increases the permiability of the skin.

Question 18

What are 2 benefits of iontophoresis?

Answer 18

1. Bipasses the GI and liver, keeping potency and maintaining therapeutic dose.
2. Not an injection. No related complications

Question 19

In galvanotaxis, the cathode is the negative pole, meaning ___ are attracted to it. Likewise, the anode is the positive pole, meaning ___ area attracted to it.

Answer 19

Cations (positively charged ions), anions (negatively charged ions).

Question 20

The therapeutic goal of iontophoresis is to reduce pain and inflammation. Which conditions is it most effective on?

Answer 20

Tendonitis, PF, bursitis
-Also effective in disovling calcium deposits, and reducing scar tissue and adhesions.

Question 21

When direct, continuous current is applied with too great an amplitude or turned up too quickly, adverse reactions can take place. What are the polarities of an alkaline or acidic reaction?

Answer 21

Negative, positive.

Question 22

What are the parameters for current density?

Answer 22

mA/cm2. With anode (+), <0.5 mA/cm2

Values can be calculated knowing the treatment area of the active electrode. These constants are multiplied by surface area of pad to get maximum amplitude.

Question 23

Name the polarities of drugs from table 8-6.

Answer 23

Dexamethasone (-)
Acetic Acid (-)
Lidocaine (+)