Electrical Stimulation for Tissue Healing

Question 1

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

Answer 1

40%
60%
65%

Question 2

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?

Answer 2

25%
22%
44%

Question 3

What causes mortality to be 2x higher in diabetics?

Answer 3

Foot Ulcer

Question 4

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

Answer 4

Diabetic (8x more)

Question 5

How do chronic wounds form? (Etiology)

Answer 5

Decreased Sensation
Decreased Blood Supply
Decreased ROM
Decreased Mobility

Question 6

How can you facilitate tissue healing with electricity?

Answer 6

Directly or indircetly

Question 7

What is indirectly applying electricity do?

Answer 7

Control edema
Transdermal delivery of medication

Question 8

What are some mechanism of electrical stimulation & tissue healing?

Answer 8

Galvanotaxis
Cell Activation
Antimicrobial Effects
Enhanced Circulation

Question 9

What is Galvanotaxis?

Answer 9

Directional movement of cells in response to electrical field

Question 10

How does Galvanotaxis cause tissue healing?

Answer 10

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

Question 11

Biologically what happens following the wound at the skin?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

Cathode (Negative)

Question 14

What will using a cathode bring to the wound?

Answer 14

Lymphocytes
Platelets
Mast Cells
Keratinocytes
Neural progenitor cells
Fibroblasts
Activate neutrophils

Question 15

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

Answer 15

Anode (pos)

Question 16

What does using an anode bring to the wound?

Answer 16

Macrophages
Epidermal Cells
Inactive Neutrophils

Question 17

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

Answer 17

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

Question 18

How does activating fibroblast help promote tissue healing?

Answer 18

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

Question 19

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

Answer 19

Increases Vascular Endothelial Growth Factor production

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

Question 20

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

Answer 20

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

Question 21

Is electrical stimulation the best way to get enhanced circulation?

Answer 21

No–> therapeutic exercise is better

Question 22

What are some clinical applications of electrical stimulation?

Answer 22

Chronic Wounds
Edema Control
Iontophoresis

Question 23

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

Answer 23

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

Question 24

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

Answer 24

True

Question 25

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

Answer 25

More

Question 26

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

Answer 26

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

Question 27

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

Answer 27

No

Question 28

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

Answer 28

No

Question 29

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

Answer 29

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

Question 30

What is iontophoresis?

Answer 30

Use of electrical current to promote transdermal drug delivery

Question 31

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

Answer 31

low

Question 32

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

Answer 32

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

Question 33

When is iontophoresis preferred?

Answer 33

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

Question 34

What medication is most commonly used with iontophoresis?

Answer 34

Anti-Inflammatory corticosteroid dexamethasone

Question 35

What are the advantages of iontophoresis?

Answer 35

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

Question 36

What is the polarity & indication for Dexamethasone?

Answer 36

Negative Anti-inflammatory

Question 37

What is the polarity & indication for lidocaine?

Answer 37

Pos Local anesthetic

Question 38

What is the polarity & indication for Acetic Acid?

Answer 38

Neg calcification

Question 39

What is the polarity & indication for zinc oxide?

Answer 39

pos bacterial

Question 40

What is the polarity & indication for iodine?

Answer 40

Neg Scar tissue

Question 41

What is the polarity & indication for salicylates?

Answer 41

Neg Analgesic/ Anti-inflammatory

Question 42

What is the polarity & indication for Hyaluronidase?

Answer 42

Pos Edema reduction

Question 43

What are the drawbacks to ionphoresis?

Answer 43

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

Question 44

What are some contraindication to electrical stimulation?

Answer 44

- 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

Question 45

What are some precautions to electrical stimulation?

Answer 45

- Cardiac disease - impaired mentation or impaired sensation - skin irritation or Open wounds

Question 46

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

Answer 46

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

Question 47

What are some adverse effects of electrical stimulation?

Answer 47

Excessive Granulation Formation Skin irritation Burns

Question 48

How should patient be positioned when applying the electrical stimulation?

Answer 48

Wounds readily available & positioned w/ minimal pressure on wounds

Question 49

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

Answer 49

Treatment electrode on or near wound Dispersive electrode near wound

Question 50

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

Answer 50

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

Question 51

In general how should the electrodes be placed?

Answer 51

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