Efficacy of High Voltage Pulsed Current for Healing of Pressure Ulcers in Patients with Spinal Cord Injury

Abstract

The purpose of this study was to assess the efficacy of high voltage pulsed direct current (HVPC) for healing of pressure ulcers in patients with spinal cord injury. Seventeen patients having pressure ulcers in the pelvic region were randomly assigned to either an HVPC group or a placebo HVPC group. Treatments were given for 1 hour a day for 20 consecutive days. The HVPC protocol consisted of an aluminum-foil electrode placed over the ulcer and set at negative polarity in reference to the dispersive electrode placed on the thigh. Stimulator frequency was set at 100 pps, and an intensity of 200 V was used. Measurements of ulcer surface area were conducted before treatment and after treatment days 5, 10, 15, and 20. To measure ulcer area (in square millimeters), slides taken at each measurement time were projected at actual size, traced, and digitized. Percentage of change compared with pretreatment ulcer size was calculated for each measurement time. Ulcers in the HVPC group demonstrated significantly greater percentage-of-change decreases from their pretreatment size than did ulcers in the placebo group at days 5, 15, and 20. The results suggest that HVPC, in conjunction with good nursing care, can significantly increase the healing rate of pelvic ulcers in patients with spinal cord injury.

Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions

“…Pulsed electrical stimulation has been shown to facilitate healing of stage II, III and IV pressure ulcers 134,135 and is recommended for that purpose by the Agency for Healthcare Research and Quality. 136 Electric muscle stimulation for prevention of pressure ulcers has been suggested based on research which showed that such stimulation of the gluteus maximus muscle produces increased muscle blood flow and undulation of the buttock tissues, that is muscle contraction and relaxation, with shape refiguration, 137,138 effects which are in addition to the well-documented and potentially protective increase in muscles bulk with such intervention.…”

Electrical stimulation therapy to promote healing of chronic wounds: a review of reviews

“…Table 2 is a summary of controlled clinical trials where E-Stim was used to treat three of the main types of chronic wounds (pressure injuries, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] venous ulcers and other wounds of the lower extremity, [45][46][47][48][49][50][51][52][53] and diabetic and/or ischemic ulcers [54][55][56][57][58][59][60] ). This chart of controlled clinical trials does not include three studies that were found to have the same data presented in another publication -referred to as …”

“…[29][30][31]33,34,37,39,[42][43][44][45][48][49][50][51][52][53][54][55][56][57]59 Although data from a control group that did not receive EST was included in the report and analyses, eleven studies had key methodological flaws and were labeled "controlled trial" (CT) since they did not use a random allocation method 36,38,40 or involved fewer than 10 subjects per group. 28,35,38,41,46,47,58,60 The majority of the controlled studies involved the use of relatively small number of subjects and seldom were the large-scale multicenter trials coordinated by industry. Most controlled clinical trials enrolled a total of 20-50 subjects, and only eight trials had 60 or more subjects in the study.…”

“…28,35,38,40,41,46,47,50,53,58,60 Research that focused on pressure ulcer treatment using EST is most common. A total of 27 clinical reports evaluated the effect of EST on people with pressure ulc ers, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]64,67,[69][70][71]74,75,77,79,82,[85][86][87] and 17 of these were controlled clinical trials. [28][29][30][31][32][33][34][35][36][37]…”

“…A total of 27 clinical reports evaluated the effect of EST on people with pressure ulc ers, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]64,67,[69][70][71]74,75,77,79,82,[85][86][87] and 17 of these were controlled clinical trials. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] This extensive search also identified eleven clinical reports (n=367) that have used EST for the treatment of VLUs. Three of these studies [46][47][48] included "ulcers of the lower leg" of which ...…”