Prevention and treatment of pressure ulcers using electrical stimulation

Skin-related secondary disabilities, especially pressure ulcers, are a common problem for wheelchair users such as individuals with spinal cord injury (SCI), resulting in great discomfort and significant medical care costs. Pressure ulcers typically arise in areas of the body where prolonged pressure and shear forces are being exerted on soft tissue over bony prominences, such as the sacrum and the ischial tuberosities, inhibiting blood and oxygen supply and ultimately causing tissue ischaemia and necrosis. Individuals with SCI are at increased risk for pressure ulcers due to factors such as reduced mobility, reduced microcirculation, impaired sympathetic function, atrophy of the paralysed muscles, and a disturbed muscle pump function (also see Chap. 6). In addition, due to impaired sensation, individuals are often not aware of the necessity to relieve pressure. Although it has been shown that special cushioning systems can provide an improved redistribution of pressure, as has been reviewed in Chaps. 5 and 6, pressure ulcers still are prevalent in the SCI population. The predisposition of SCI patients with flaccid paralysis to ulcer development has been outlined in Chap. 5. It is theoretically possible that electrical stimulation (ES) and ES- induced exercise can help to reduce the risk of pressure ulcers, since they have been shown to increase muscle mass, capillary density and skin and muscle blood flow (BF). The first purpose of this chapter, therefore, is to discuss how ES can contribute to reduction of pressure ulcer risk and pressure ulcer incidence. The second purpose is to evaluate how ES can be helpful in pressure ulcer healing once preventative measures have failed.