Electrical Stimulation for Tissue Repair and Edema

Lecture 7

F; 1 in 6 

T/F: 1 in 5 medicare beneficiaries suffer from chronic wounds

True

T/F: wound care costs billions of dollars each year with 53.1 million americans having DM

Electrical Stimulation

Indications for ______ for wounds include:

• pressure injuries

• diabetic ulcers

• venous statis ulcers

• arterial ulcers

• traumatic wounds

• surgical wounds

• burns

• donor sites

pressure injuries 

Research says there is the greatest effect of electrical stimulation for _____

reduction, closed

Research consistently found that ES stimulates faster wound size _____ and produces more _____ wounds

True

T/F: ES can produce organized granulation tissue in acute wound healing

chronic

ES can help prevent acute wounds from becoming ______ wounds

High Voltage Pulsed Current (HVPC)

_______ showed to be the best type of current for active electrodes placed over wounds 

pressure ulcers

With HVPC, _________ seemed to do better than venous or arterial ulcers

inversely

With HVPC, the efficacy is _______ related to wound size and wound duration

Galvanotaxis

_____ is cells associated with tissue healing that are charged and migrate toa specific pole of an electrical field 

Galvanotaxis

_________ includes:

• migration of neutrophils, macrophages, lymphocytes, keratinocytes

• endothelial cells elongating and reorienting 

• fibronectin increasing its binding 

• protein kinase activity increasing

• Electron transport chain 

angiogenesis, HEALING

The results of Galvanotaxis include:

• increased organized _______

• increased protein synthesis 

• decreased edema 

• _______

High Voltage Pulsed Current (HVPC) 

Parameters for _______ include:

• Pulse Frequency = 100 pps 

• Pulse Duration = 4-100 msec 

• Amplitude = comfortable sensory 

• Duration = 45-60’, 5-7x/week

True!! just make sure to “test” amplitude on uninvolved area first 

T/F: if a PT is trained in ES with wound care, you can OVERRIDE precautions of impaired sensation and impaired circulation 

FALSE; it’s monophasic!!!

T/F: HVPC is a biphasic current

monophasic, over, farther away from

Since HVPC is ______, there is one active electrode (beside/over) the wound and one dispersive electrode (beside/over/farther away from) the wound

cathode

For early stages of healing with HVPC, the _____ is used for wound inflammation and infection

anode

For later stages of wound healing with HVPC, the _______ is used for debridement and epithelization

45-90 degrees 

Electrode placement for HVPC can also have 2 electrodes on either side of wound, but PT MUST rotate electrodes ______ with each treatment session 

HVPC

To offset acute localized edema, use _____ ES

limit onset of acute swelling

Parameters for HVPC to ________:

• F = 100-125 pps

• PD = 2-100 msec 

• A = comfortably sensory (barely) 

• Active Electrode = cathode over edema 

• Duration = 20-45’ 

20-45 min

Duration for HVPC for acute swelling is 

cathode is over edema

Where is the active electrode for HVPC for acute swelling

barely comfortably sensory 

Amplitude for HVPC for acute swelling is 

2-100 msec

Pulse Duration for HVPC for acute swelling is

100-125 pps

Frequency for HVPC for acute swelling is

cathode, far from

When trying to limit acute swelling with HVPC, the ____ repels the serum proteins and the electrodes are (close to/far from) each other

False: 24-72 hours - early phases of wound healing

T/F: you should do HVPC within 48-72 hours to control acute localized edema

repetitive muscle action

For chronic localized edema, the mechanism of action is ________

HVPC chronic localized edema

Parameters for _______ :

• F = 20-80 pps 

• PD = 100-600 msec (biphasic) 

• A = tetanic contraction 

• On/Off Time = 1:1 ratio, 1-3” 

• Duration = 10-20 min.

10-20 min

Duration for HVPC for chronic edema is 

1:1 ratio, 1-3”

On/Off Time for HVPC for chronic edema is

tetanic contraction 

Amplitude for HVPC for chronic edema is 

100-600 msec (biphasic) 

Pulse Duration for HVPC for chronic edema is 

20-80 pps or bursts per sec

Frequency for HVPC for chronic edema is

Iontophoresis, polarity 

______ is a technique that utilizes direct/galvanic current to deliver a drug or other substance through the skin and application is _______ dependent 

high concentration

The purpose of Iontophoresis is to deliver the drug in ________ to the treatment site

Iontophoresis

The advantage of __________ is it minimizes the adverse local or systemic side effects

repel, bc same charge

Anodes (repel/attract) positive ions

repel, bc same charge

Cathodes (repel/attract) negative ions

active, dispersive

With Iontophoresis, the ____ electrode causes a direct current to flow to the _____ electrode, thus dispersing the treatment drug into the target tissue and surrounding blood vessels 

1. repulsion of like charges

2. electroporation 

3. electroosmosis 

What are the three mechanisms of ion movement?

ES temporarily increases skin porosity

How does ES affect the skin through electroporation?

“volume flow”

Electroosmosis = ______

Na+, H2O, Cl-

During Electroosmosis, _____ and _____ are naturally attracted to the cathode (-) while _____ is attracted to the anode (+) 

FALSE!! Net Negative

T/F: Human skin is at a Net Positive

positive

Since human skin is net negative, the _____ ions from the drug being administered will be accepted more easily from the anode compared to the cathode

cathode 

Since the human skin is net negative, negative ions from the ______ will require a higher current to be used to deliver the drug throughout the skin 

6 months, sooner

For lateral epicondylitis, iontophoresis demonstrated short term benefits but there was no significant difference at _____ but subjects were able to return to work _____

MAY BE

For insertional achilles tendonitis, iontophoresis demonstrated that there ______ short term relief but there is no long term difference noted 

FALSE!!! Direct Current

T/F: iontophoresis unit produces Alternating current

Anode (red, +), Cathode (black, -)

With iontophoretic drug delivery system has 2 leads: _______ and _______

1. polarity of ion/drug being used

2. ensure good conductivity 

When setting up iontophoretic drug delivery, the PT must do/know these 2 things: 

active, over

the _____ electrode is typically placed (over/beside) the site to be treated during iontophoresis

over

Inactive electrode is placed (over/beside) the muscle belly at site distant to active electrode

True, farther apart = deeper penetration for current

T/F: if electrodes are placed closer to each other the current will penetrate tissue more superficially

1.7

Electrodes can reach up to ______ cm

maybe……it will vasoconstrict the tissue and thus the drug will stay in the same place for longer

Should you ice before performing iontophoresis?

current (mA) x duration (min) 

Dosage (mA) = 

20-80 mA-min, 40 mA

Typical clinical dosage is ______ at 0.1 to 4mA BUT _______ is a common target 

FALSE!! since dosage = current x duration, if current decreases then duration MUST increase

T/F: if you use a lower current, then the duration will decresae

24hrs (need to ask about this, not sure exactly what she means!)

For a home iontophoretic unit, there is a self contained patch with a <1 mA battery therefore you can use it up to ______

Current Density

________ is calculated by dividing the current amplitude by the conductive surface area of the electrode

mA / cm²

Current Density =

1.0 mA/cm², 0.5 mA/cm²

the maximum safe current density (mscd) for anode is ________ and cathode is _______

Sodium Hydroxide (NaOH)

When _______ forms under the cathode, there is a concern for skin damage

FALSE; will decrease current density

T/F: larger pads will increase current density

greater concern for skin damage due to chemical changes causing skin to soften

Why is the MSCD # for cathode lower/smaller?

Dexamethasone

_____ has a negative polarity and is used for inflammation — anti inflammatory effect

negative, calcific tendonitis

Acetic Acid has a ______ polarity and is used with ___________

• increase of solubility of calcium deposits for the body to absorb

Lidocaine

______ has a positive polarity, used for soft tissue pain and inflammation, for a local anestheic effect

adhesive capsulitis

Iodine has a negative polarity, used for ________ or soft tissue adhesions with a sclerolytic effect

muscle/joint pain

Salicylates have negative polarity, used for ____/________ for an analgesic and anti-inflammatory effect

Zinc Oxide 

____ has a positive polarity and is used for skin ulcers as a general antiseptic, might increase tissue healing 

inspect skin and clean with alcohol pad

First step of application of iontophoresis is

False; inactive electrode should be placed over muscle BELLY 

T/F: active electrode is placed over tx area while inactive/dispersive electrode is placed at muscle insertion location

burns

The amplitude of iontophoresis should be set to patient comfort but no higher than 4mA to avoid ______

dose

Tx time for iontophoresis is determined by total treatment _____

• 20-80 mA-min

• 40 mA-min is common target 

you as the PT must monitor the treatment

Compared to other ES methods, what is a key difference with iontophoresis treatment?

inspecting, skin 

Last step of iontophoresis treatment is closely _____ the _____ after treatment 

stinging, direct current

Some adverse effects of iontophoresis include sensation described as ________ or ant bites, skin irritation and redness due to the use of ______

False; it is from the use of direct current

T/F: redness and skin irritation from iontophoresis is from the drug itself

INTENSITY IS TOO HIGH

If the skin is blistering after/during iontophoresis, what could be the issue

active

Skin irritation is most common under the _____ electrode

Anode Attracts Acid — sclerotic process, skin hardens

Remember AAA

Cathode Attracts Base — sclerolytic process, skin softens 

Remember CAB

A, B, and C

If redness is lasting longer than you would expect, you should do which of the following?

• lower amplitude

• use a lager pad

• chose a different electrode location 

• quit your job and cry 

drug allergy 

Contraindications for iontophoresis are the same as before BUT __________ is an additional contraindication