CSkills 2 - Electrical Currents for Soft Tissue Healing

What is galvanotaxis

Directional movement of cells in response to an electrical field

The activation of cells by altering cell membrane function can activate and upregulates

Fibroblast growth

What are the mechanisms of ES for tissue healing

1. Galvanotaxis to attract appropriate cell types

2. Activation of cells by altering cell membrane

3. Enhancement of antimicrobial effects

4. Enhanced circulation

What is HVPC

High volt pulsed current

During injury, charged ions leak out of the cells and cause

The center of the wound to be negatively charged compared to the skin

Galvanotaxis utilizes

Monophasic pulsed or DC

Galvanotaxis is most effective with

HVPC

What polarity should be used for inflamed or infected wounds

Negative

What polarity should be used for non-inflammed wounds

Positive

Chronic wounds that would warrant ES include

- Pressure ulcers

- Diabetic ulcers

- Venous ulcers

- Arterial ulcers

Two or more treatment electrodes placed around the wound should be of what polarity

The same polarity

For open wounds, you can place one treatment electrode

In the wound

When placing electrodes, one large dispersive electrode should be placed

On the skin away from the wound

What polarity should a dispersive electrode be

Opposite of the treatment electrode

HVPC is what kind of current

A monophasic pulsed current

Positive polarity electrodes facilitate

Epithelialization

What pulse duration should be used for a chronic wound

40-200 us, usually preset to ~100

What frequency should be used for chronic wounds

60-125 pps, usually set to ~100-105

What duty cycle should be used for chronic wounds

Continuous

What amplitude/intensity should be used for chronic wounds

To a comfortable sensory/tingling sensation

ES for chronic wounds should not produce any

Motor response

What is treatment time for chronic wounds

45-60 minutes, 3-7 days a week

When using ES for edema that is due to inflammation, what polarity would you want to use

Negative

Why would you want to use negative polarity for edema caused by inflammation

The negative charge repels negatively charged serum proteins

Negative polarity can slow the formation of

Acute edema

Using ES for inflammation caused edema can see up to how much reduction

50%

How would you differentiate between edema caused by inflammation and a lack of muscle contraction

If the cause is inflammation, the skin will be red, hot, and swollen. If it is caused by lack of muscle contraction, the skin will be cold, pale, and swollen

Edema caused by lack of muscle contraction should be treated with

Motor levels of ES and elevation

How would you apply electrodes for edema caused by inflammation

Over the area of edema with a dispersive electrode over a flat area distal to the edema

What polarity should be used for inflammation caused edema

Negative over the area of the edema, positive for the dispersive

What pulse duration should be used for edema caused by inflammation

Fixed 40-100 us

What frequency should be used for edema caused by inflammation

120 pps

What amplitude should be used for edema caused by inflammation

To a comfortable sensation, no motor contraction

What is the treatment time for edema caused by inflammation

30 minutes

What waveform should be used for edema caused by lack of muscle contraction

Pulsed biphasic or Russian protocol

Where should electrode placement be for edema caused by lack of muscle contraction

On muscles around main veins draining the area

What is the pulse duration for edema caused by lack of muscle contraction

150-350 us

What is the frequency for edema caused by lack of muscle contraction

35-50 pps

What is the on/off time for edema caused by lack of muscle contraction

1-2s on, 1-2s off

What is the amplitude for edema caused by lack of muscle contraction

To produce small, visible muscle contraction

What is the treatment time for edema caused by lack of muscle contraction

20-30 minutes

What is iontophoresis

The use of electrical current to promote transdermal drug delivery

Iontophoresis utilizes what kind of current

Low amplitude direct current

The most common application of iontophoresis is apply

Dexamethasone

Dexamethasone has a _ charge

Negative

When using iontophoresis, the treatment pad and dispersive pad should have what polarity

Treatment pad is same as drug and dispersive is opposite drug

How deep does iontophoresis penetrate the skin

3-20 mm

What waveform does iontophoresis use

Direct current

What amplitude should be used for iontophoresis

To patient tolerance but no more than 4 mA

What is the suggested dose of iontophoresis

40 mA-min

Treatment time for iontophoresis depends on

Time to produce 40 mA-min

What are the contraindications for ES for soft tissue healing (PASTA SAUCE + MA)

- Malignancy

- After treatment that may alter skin permeability

What are the precautions for ES for soft tissue healing (MBA CHIME + AI)

- Application of iontophoresis after another physical agent in the same area

- Infection control

What are the adverse effects of ES for soft tissue healing

- Excessive granulation tissue formation

- Skin irritation

- Burns