E-stim for edema reduction and wound care

Estim can reduce edema by?

polarity effect, improving blood flow, muscle pumping

What voltage and type of current has demonstrated effectiveness for reduction of edema?

High-voltage and Pulsed Current, Monophonic

Apply positive or negative charged electrode over edema area?

negative

What is cataphoresis?

movement of negatively charged cells through repulsion by the cathode

What is the suggest pps to get the polarity effect for edema reduction?

high pps (100-120)

What percentage of visible motor threshold for polarity effect?

90%

Treatment time for polarity effect?

30 mins or more, as often as 4 hours

When to begin tx with polarity effect?

ASAP, Acute phase

Improving blood flow with edema reduction does what?

• removal of inflammatory mediators

  • be cautious of facilitation of further edema

• local vasodilation

  • O2 perfusion increase

For improving blood flow for edema reduction, what 2 e-stim options are best?

IFC or Premod

What kind of electrodes to use with muscle pumping for edema reduction?

bipolar

• stimulating contraction and relaxation of agonist and antagonist

• proximal and distal

E-stim setup for muscle contraction edema reduction?

•phase:

•Duration

•Pulse rate

•Amplitude

•Duty cycle

•Treatment duration

•Monophasic high-voltage pulsed current or biphasic (symmetrical or asymmetrical)

•Duration 200-500 µseconds

•Pulse rate 40 - 60 pps

•Amplitude – to achieve maximum tolerable contraction

–Reciprocal or intermittent to achieve a pumping action

•Duty cycle 1:1

•Treatment duration 20-30 minutes (variable)

What is the current of injury?

The current with a positive polarity that gets exposed with an open wound.

What is the suggested trigger of wound healing?

the positive current

how long does the positive current of injury remain?

3-4 days, afterwards shifts to negative

What is glavanotaxis?

the process in which charged cells are attracted to an electrical field of opposite polarity

Neutrophils at pH of 8-6.8 attractsd to - or + pole?

+

Neutrophils at pH of 4.9 are attracted to - or + pole?

-

Macrophages attracted to what pole?

+

Fibroblasts attracted to what pole?

-

Epidermal cells attracted to what pole?

BOFA

Acute phase use what pole?

Positive

Past acute phase use what pole?

negative

Pseudamonas aerguinosa can be inhibited by cathode or anode?

cathode

Staphylococcus aureus inhibited by using?

both anode and Cathode

Positive field more useful for?

wound healing

Negative field more useful for?

bactericidal effect

Which polarity to facilitate autolytic debridement?

postive to attract negatively charged neutrophils and macrophages

To create a alkaline pH to soluble a necrotic wound use cathode or anode?

cathode

What kind of current and electrode setup for direct technique?

monopolar, low intensity, direct current

periwound technique electrode and type of current?

bipolar technique, asymmetric biphasic pulsed current

What type of tx for diabetic ulcers?

Dacron silver mesh sock and sleeve

Dacron silver mesh sock and sleeve is what type of voltage and type of current?

high voltage, monophasic, pulsed current

To use direct estim on a wound you must apply what?

sterile gauze moistened with saline (Dr. Owens said tap water)

Where do you place the dispersive electrode with direct estim on wound?

on intact skin, 15-20cm proximal

Potential advantages of periwound estim?

–Less potential for disturbance of the wound bed

–Reduced chance of cross-contamination

–Requires less specialized training than the direct technique

What is charge density?

amount of electrical charge per unit of cross sectional area of the electrode

larger electrode is smaller or larger current density?

smaller

What dosage range for charge density with wound care?

250 – 500 µC/sec

What absolute charge density may be effective for enhancement of wound healing?

0.1 – 2.0 C/cm²