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    No bed rest for pressure sores!??!

    http://clinicaltrials.gov/ct2/show/N...+canada&rank=1

    I was shocked to see this tonight (can't sleep). What they are saying about bedrest is certainly true though, in my experience, as far as detrimental effects on other body systems as well as emotional effects.

    Purpose

    People with spinal cord injuries posses many factors that increase their risk of developing pressure ulcers. Not surprisingly, approximately 82% of persons with spinal cord injury (SCI) will experience a pressure ulcer at sometime during their life. Earlier guidelines for the assessment and treatment of pressure ulcers produced by RNAO in 2002 recommended that "a client who has a pressure ulcer on a seating surface should avoid sitting." Unfortunately, this recommendation has fueled the long standing view that people with pressure ulcers should stop using their wheelchairs and return to bed. The strength of evidence assigned for this recommendation was Level=C reflecting the paucity of research evidence to support this common practice. Not only do the benefits of bed rest on healing remain to be demonstrated, there is mounting evidence that bed rest can be harmful to a person's overall health and well being. Bed rest has been shown to be strongly associated with complications in most body systems including respiratory, cardiovascular, musculoskeletal, cerebrovascular, gastrointestinal, and genital-urinary. Psychosocial complications and cognitive impacts are also well documented. Without evidence to dispel the myth that "bed rest is best" it will be difficult to change practice and avoid many of the secondary complications.

    This study is a pilot study to

    1) determine whether pressure ulcers heal faster in individuals with SCI who receive an individualized community-based, pressure management and mobility program compared to a similar group assigned to usual care (bed rest)

    2) determine the strength of the association between the intervention (pressure/mobility or bedrest) and wound healing, motor performance/independence and quality of life while adjusting for motivation to regain independence, degree of caregiver burden, and compliance with the intervention

    3) determine whether individuals with SCI who participate in a pressure/mobility management program experience fewer secondary complications than those who do not participate

    4) determine the cost-effectiveness of providing a time-efficient, pressure management and mobility program compared to bed rest.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

    #2
    Originally posted by lynnifer
    http://clinicaltrials.gov/ct2/show/N...+canada&rank=1

    I was shocked to see this tonight (can't sleep). What they are saying about bedrest is certainly true though, in my experience, as far as detrimental effects on other body systems as well as emotional effects.

    Purpose

    People with spinal cord injuries posses many factors that increase their risk of developing pressure ulcers. Not surprisingly, approximately 82% of persons with spinal cord injury (SCI) will experience a pressure ulcer at sometime during their life. Earlier guidelines for the assessment and treatment of pressure ulcers produced by RNAO in 2002 recommended that "a client who has a pressure ulcer on a seating surface should avoid sitting." Unfortunately, this recommendation has fueled the long standing view that people with pressure ulcers should stop using their wheelchairs and return to bed. The strength of evidence assigned for this recommendation was Level=C reflecting the paucity of research evidence to support this common practice. Not only do the benefits of bed rest on healing remain to be demonstrated, there is mounting evidence that bed rest can be harmful to a person's overall health and well being. Bed rest has been shown to be strongly associated with complications in most body systems including respiratory, cardiovascular, musculoskeletal, cerebrovascular, gastrointestinal, and genital-urinary. Psychosocial complications and cognitive impacts are also well documented. Without evidence to dispel the myth that "bed rest is best" it will be difficult to change practice and avoid many of the secondary complications.

    This study is a pilot study to

    1) determine whether pressure ulcers heal faster in individuals with SCI who receive an individualized community-based, pressure management and mobility program compared to a similar group assigned to usual care (bed rest)

    2) determine the strength of the association between the intervention (pressure/mobility or bedrest) and wound healing, motor performance/independence and quality of life while adjusting for motivation to regain independence, degree of caregiver burden, and compliance with the intervention

    3) determine whether individuals with SCI who participate in a pressure/mobility management program experience fewer secondary complications than those who do not participate

    4) determine the cost-effectiveness of providing a time-efficient, pressure management and mobility program compared to bed rest.

    I've been saying this for years. With all due respect to KLD,her protocol for recovery is disclaimed by studies done by Plastic Surgeons.New cushions allow people to be up with less pressure than the best low pressure bed. This is a good site but too many experts post personal opinions rather than facts. Accepted protocol after flap surgery is 2 weeks immobilization followed by 2 weeks of limited movement and sitting.Some drs have patients sitting within several days of surgery.
    Can you imagine the walking population laying around 2 mos or so after surgery. We cripples are not considered productive thus we can lie around forever.Hell,most HO develops after prolonged periods of immobility.
    i've askd the nurses here several times about the SCIs they treat. I bet very few of them are employed. Take subtance abusers out of the VA hospitals in my area and the census would drop 50%. Most are not service connected.Most working Vets go to private hospitals.
    Lynn,we need to demand more accountability from our drs rather than let them warehouse us in hospitals.
    These drs who immobilize you for six weeks are covering their lazy asses at your expense. They don't have confidence in their work. Lawsuits frighten them and they'd rather be working on your eyelids,tummy,or breasts.
    Lynn,watch this flap surgery recovery protocol change in the coming years. My buddy went home 4 days after quadrupal bypass surgery. His skin did not rip open. TForty yrs ago,the experts were saying rest.
    The Medical Model of disability is archaic and views people as unemployable and less valuable than their able bodied counterparts.

    Comment


      #3
      LOL. SusanM is right again! I used to see those guys at the VA, face-down on those wheeler-gurneys for months. What a shame if that was unnecessary...
      Blog:
      Does This Wheelchair Make My Ass Look Fat?

      Comment


        #4
        The many sores, craters, I've had on my upper legs and butt have all been closed using muscle flaps. Treatment after surgery is always six weeks of bed rest and slowly returning to the chair. However, with my mattress, I can sit up in bed and do work.

        Before surgery, my sores don't always care, but often do better in my chair than in bed. So I agree that the chair is usually better, but not sure that that's always the case.
        C2/3 quad since February 20, 1985.

        Comment


          #5
          Truth in the study

          I see truth in this study.

          I myself have not had a pressure sore post 21 years. I check myself twice everyday, after my shower and before I go to sleep. I also eat right everyday. All my life I have eaten plain yogurt everyday too. It makes me wonder if that yogurt has properties that help strengthen the skin from getting pressure sores?

          Reading posts here about pressure sores many people do get up in their 'chairs to do something or other. Lying in bed for any length of time, one week, two weeks or six weeks has detrimental effects on the mind and body. I agree that there can be a balance between healing a pressure sore, bed rest, psychological and physiological effects on the mind and body.

          titanium4motion
          "We must overcome difficulties rather than being overcome by difficulties."

          Comment


            #6


            Okay ... now I just don't know anymore ...... !!

            Obieone
            ~ Be the change you wish to see in the world ~ Mahatma Gandi


            " calling all Angels ...... calling all Angels ....walk me through this one .. don't leave me alone .... calling all Angels .... calling all Angels .... we're tryin' and we're hopin' cause we're not sure how ....... this .... goes ..."
            Jane Siberry

            Comment


              #7
              I think each situation is different and you must monitor what works for you. Keep a close eye on your sore as well as other potential pressure areas. Being in bed all the time is not healthy overall, but depending on WHERE the sore is and WHAT is causing it is the biggest issue. And, if you can keep pressure completely off the sore and at minimum in other areas. healing sores is like a game. these studies, I think some of these phd type people need something to do to look important to us lowly sci lolol.

              With a sore you need high protien diet, correct wound cleansing practices, good debreeding and skin growth medications, no pressure, and a practical, patient positive type mindset.

              Comment


                #8
                I would feel the exact LOCATION of the sore would make a big difference here.
                T7-8 since Feb 2005

                Comment


                  #9
                  From my experience mine healed A LOT faster once I was back up & doing things...Now, I DID have a wound vac on it, but even the down time w/vac healed slower than the up time w/vac....
                  'Chelle
                  L-1 inc 11/24/03

                  "My Give-a-Damn's Busted"......

                  Comment


                    #10
                    I have one on my left ischium right now that I've tried to stay up on but it still gets worse, no matter how many weight shifts I do. I can't even put my head up in bed too far for too long without it making a difference. I'm just now waiting for my surgeon to go ahead with the flap to get it healed since it is all the way to the bone.
                    C-5/6, 7-9-2000
                    Scottsdale, AZ

                    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

                    Comment


                      #11
                      Hey rybread, dont u do a thing w/o getting an MRI first to see if u have an infection in your bone. If u have an infection nothing will take and u wont heal.We are in the middle of it right now.
                      My son had 9 months of this sore and no one diagnosed the osteo mylitus until I came here and talked to the SCI nurse.Now hes on bedrest with IV antibiotics to clean up infection. In 2 weeks we'll see a plastic surgeon and see where we go.

                      Comment


                        #12
                        i've always healed in the chair..can't do the bed route

                        Comment


                          #13
                          Originally posted by lynnifer
                          I was shocked to see this tonight (can't sleep). What they are saying about bedrest is certainly true though
                          Wait a minute. They aren't saying anything (in connection to wound healing and SCI) yet. This study hasn't even been started, so no conclusions should be jumped to. I will be interested in seeing the results, but that won't be for a year.

                          C.

                          Comment


                            #14
                            Sounds like an interesting study.
                            I don't think anyone with a pressure ulcer needs to be on "bedrest"; however for the ulcer to heal there has to be no pressure. And Unfortunately the area where the ulcer is usually where increased pressure is when up in the chair i.e ischium. But if there is a way t keep the pressure off the ulcer by repositioning or some device that is okay but most of the time this is impossible.

                            CWO
                            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                            Comment


                              #15
                              The problem is that everybody is speaking without evidence. Those who claim that bedrest is necessary have not compared bedrest against any other kind of therapy. Those who claim that there should be no pressure at all on the sore likewise have little data to support their claim because nobody has done a double-blind comparison between no pressure and intermittent pressure.

                              Many companies sell pressure reduction devices both for sitting and lying positions. Some of the sitting devices do reduce pressure almost as much as the lying down devices. However, one can lie prone (on one's stomach) with complete relief of pressure on the butt or back. A lot of claims have unfortunately been made for such devices without rigorous clinical trial evidence. Industry revenues for such devices exceed $8 billion (Source). The goal of all the devices is to minimize pressure.

                              Pressure on tissue reduces blood flow. Normally, blood flows from artery to vein. Tissue pressure opposes blood flow by increasing venous pressure. That is why most doctors and nurses prefer protocols that minimize pressure of any kind. However, it is not clear that any (no matter how small or transient) pressure is bad or that lying prone maximizes the blood flow to the decubitus. Standing up, walking, exercise, movement, or swimming may be better for blood flow than just lying down or sitting down.

                              There are reports that pulsed (non-thermal) electromagnetic fields may increase vascularization and reduce healing time for debubiti. While several reviews of the work suggest that none of the studies are yet convincing, there is enough suggestive data to justify a careful randomized controlled study to determine whether there is an effect or not. I list some abstracts below.

                              References
                              1. Johnston L (2005). Alternative, complementary, energy-based medicine for spinal cord injury. Acta Neurochir Suppl. 93: 155-8. laurancejohnsto@aol.com. This paper provides an overview on various alternative, complementary, or energy-based therapies that expand the healing spectrum of individuals with spinal cord injury (SCI). Not only do they have the capability to help a variety of secondary conditions, they have the ability in some people, for certain injuries, to restore function, sometimes dramatically. After providing an overall contextual rationale for the use of alternative medicine, this paper briefly summarizes various Eastern-medicine healing modalities, laser-based therapies, nutritional and homeopathic approaches, and pulsed electromagnetic therapies.
                              2. Olyaee Manesh A, Flemming K, Cullum NA and Ravaghi H (2006). Electromagnetic therapy for treating pressure ulcers. Cochrane Database Syst Rev. CD002930. University of York, Department of Health Sciences, Postgraduate Area, HYMS Building, Heslington, York, North Yorkshire, UK, YO10 5DD. ao115@york.ac.uk. BACKGROUND: Pressure ulcers are defined as areas "of localized damage to the skin and underlying tissue caused by pressure, shear, friction and/or the combination of these". In the UK, pressure ulcers occur in 5 to 32% of District General Hospitals people and in 4 to 7% of people in community settings. Electromagnetic therapy, in which electrodes produce an electromagnetic field across the wound, may improve healing of chronic wounds such as pressure ulcers. OBJECTIVES: To assess the effects of electromagnetic therapy on the healing of pressure ulcers. SEARCH STRATEGY: For this first update, we searched the Cochrane Wounds Group Specialised Register (last searched October 2005); CENTRAL (The Cochrane Library 2005, Issue 4); MEDLINE (1966 to October 2005); EMBASE (1980 to October 2005); and CINAHL (1982 to October 2005). SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy, or other (standard) treatment. DATA COLLECTION AND ANALYSIS: For this first update, two authors independently scrutinized the results of the search to identify relevant RCTs and obtained full reports of potentially eligible studies. For the original review, details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. Data extraction was checked by a second author. Meta-analysis was applied to combine the results of trials when the interventions and outcome measures were sufficiently similar. MAIN RESULTS: This update identified no new trials. Two RCTs were identified for inclusion in the original review (total of 60 participants). One was a three-armed study comparing electromagnetic therapy with electromagnetic therapy in combination with standard therapy, and with standard therapy alone, on 17 female and 13 male with grade II and III pressure ulcers. The other study compared electromagnetic therapy with sham therapy in 30 male participants with a spinal cord injury and a grade II or grade III pressure ulcer.Neither study found a statistically significant difference between the healing rates of pressure ulcers in people treated with electromagnetic therapy compared with those in the control group. AUTHORS' CONCLUSIONS: The results provide no evidence of benefit in using electromagnetic therapy to treat pressure ulcers. However, the possibility of a beneficial or harmful effect cannot be ruled out, due to the fact that there were only two included trials both with methodological limitations and small numbers of participants. Further research is recommended.
                              3. Pullen R (2004). [Treatment of pressure sores in elderly patients]. Z Gerontol Geriatr. 37: 92-9. Medizinisch-geriatrische Klinik, Diakonissen-Krankenhaus Frankfurter Diakonie-Kliniken, Holzhausenstrasse 72-92, 60322 Frankfurt/Main, Germany. rupert.puellen@fdk.info. The treatment of pressure sores in elderly patients requires careful documentation and a comprehensive treatment plan, which takes into account the patient's overall situation. The treatment has to be evidence based. At the moment only three recommendations can be based on two or more prospective, randomized clinical studies: to use a dressing to maintain a moist environment at the wound/dressing interface, to reduce the risk of infection and enhance wound healing by hand washing, wound cleansing and debridement and to institute a systemic antibiotic treatment for patients with advancing cellulitis, sepsis and osteomyelitis. For other treatment options such as topical negative pressure, maggot therapy, electromagnetic therapy, therapeutic ultrasound or growth factors, the data at present are not sufficient to support general use in pressure sore treatment.
                              4. Cullum N, Nelson EA, Flemming K and Sheldon T (2001). Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 5: 1-221. Department of Health Studies, University of York, UK. BACKGROUND: Chronic wounds such as leg ulcers, diabetic foot ulcers and pressure sores are common in both acute and community healthcare settings. The prevention and treatment of these wounds involves many strategies: pressure-relieving beds, mattresses and cushions are universally used as measures for the prevention and treatment of pressure sores; compression therapy in a variety of forms is widely used for venous leg ulcer prevention and treatment; and a whole range of therapies involving laser, ultrasound and electricity is also applied to chronic wounds. This report covers the final three reviews from a series of seven. AIMS: To assess the clinical effectiveness and cost- effectiveness of: (1) pressure-relieving beds, mattresses and cushions for pressure sore prevention and treatment; (2) compression therapy for the prevention and treatment of leg ulcers; (3) low-level laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy for the treatment of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases, including MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register (CENTRAL), were searched. Relevant journals, conference proceedings and bibliographies of retrieved papers were handsearched. An expert panel was also consulted. METHODS - STUDY SELECTION: Randomised controlled trials (RCTs) which evaluated these interventions were eligible for inclusion in this review if they used objective measures of outcome such as wound incidence or healing rates. RESULTS - BEDS, MATTRESSES AND CUSHIONS FOR PRESSURE SORE PREVENTION AND TREATMENT: A total of 45 RCTs were identified, of which 40 compared different mattresses, mattress overlays and beds. Only two trials evaluated cushions, one evaluated the use of sheepskins, and two looked at turning beds/kinetic therapy. RESULTS - COMPRESSION FOR LEG ULCERS: A total of 24 trials reporting 26 comparisons were included (two of prevention and 24 of treatment strategies). RESULTS - LOW-LEVEL LASER THERAPY, THERAPEUTIC ULTRASOUND, ELECTROTHERAPY AND ELECTROMAGNETIC THERAPY: Four RCTs of laser (for venous leg ulcers), 10 of therapeutic ultrasound (for pressure sores and venous leg ulcers), 12 of electrotherapy (for ischaemic and diabetic ulcers, and chronic wounds generally) and five of electromagnetic therapy (for venous leg ulcers and pressure sores) were included. Studies were generally small, and of poor methodological quality. CONCLUSIONS (1) Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure sores in people at risk, as can pressure-relieving overlays on the operating table. One study suggests that air-fluidised therapy may increase pressure sore healing rates. (2) Compression is more effective in healing venous leg ulcers than is no compression, and multi-layered high compression is more effective than single-layer compression. High-compression hosiery was more effective than moderate compression in preventing ulcer recurrence. (3) There is generally insufficient reliable evidence to draw conclusions about the contribution of laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy to chronic wound healing.
                              5. Flemming K and Cullum N (2001). Electromagnetic therapy for the treatment of pressure sores. Cochrane Database Syst Rev. CD002930. Centre for Evidence Based Nursing, University of York, Genesis 6, York Science Park, York, UK, YO10 5DQ. kaf1@york.ac.uk. BACKGROUND: Electromagnetic therapy is used with the aim of improving the healing of chronic wounds such as pressure sores and venous leg ulcers OBJECTIVES: To assess the effectiveness of electromagnetic therapy in the treatment of pressure sores SEARCH STRATEGY: The Cochrane Wounds Group search strategy was used (see Scope) to search for randomised controlled trials (RCTs) of electromagnetic therapy for the treatment of pressure sores SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy, or other (standard) treatment DATA COLLECTION AND ANALYSIS: Results of searches were scrutinised by one reviewer (and checked by a second) to identify possible RCTs and full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. Data extraction was checked by a second reviewer. MAIN RESULTS: A total of two eligible RCTs were identified for inclusion in this review. The first of these studies (Comorosan 1993) was a three armed study comparing electromagnetic therapy, electromagnetic therapy in combination with standard therapy, and standard therapy alone. The second study (Salzburg 1995) was a comparison between electromagnetic therapy and sham therapy on 30 male patients with a spinal cord injury and a grade two or grade three pressure sore. Neither study found a statistically significant difference between the healing rates of electromagnetic therapy treated and control group patients. REVIEWER'S CONCLUSIONS: The results suggest no evidence of a benefit in using electromagnetic therapy to treat pressure sores. However the possibility of a beneficial or harmful effect cannot be ruled out due to the fact there were only two trials with methodological limitations and small numbers of patients.
                              6. Franek A, Franek E and Grzesik J (1999). [Electrically enhanced damaged tissues healing. Part II: direct and pulse current in soft tissue healing]. Pol Merkur Lekarski. 7: 198-201. Katedry i Zakladu Biofizyki Lekarskiej Slaskiej, Akademii medycznej. Methodology of soft tissues wounds, ulcers and pressure sores healing with direct current is described by the authors. Results of clinical trials and animal experiments are represented, as well as technical and using data. Electrical properties of damaged tissues (e. i. skin battery, vascular-interstitial closed circuits etc.) and probable electrical healing mechanisms are discussed. Effects of electrical current on batteries are described. Inductive and capacitive coupling of electric and magnetic fields, and high voltage electrostimulation for enhance tissue healing are also described in the article.
                              7. Sheffet A, Cytryn AS and Louria DB (2000). Applying electric and electromagnetic energy as adjuvant treatment for pressure ulcers: a critical review. Ostomy Wound Manage. 46: 28-33, 36-40, 42-4. Department of Preventive Medicine and Community Health, Bronx VA Medical Center, NY, USA. Chronic pressure ulcers are a significant health problem especially in the aging population. National estimated annual treatment costs are in the billions of dollars. Only two treatment-related recommendations receive high ratings for reported experimental evidence of validity: Use of moist wound dressings and adjunctive electrotherapy for unresponsive Stage III and IV and recalcitrant Stage II ulcers. A critical literature review pertaining to electrotherapy reveals a myriad of electrical treatment modalities varying greatly in electric current type, strength, direction, frequency, waveform, and underlying voltage. However, few clinical trials pertaining to electrotherapy exist with almost all of them characterized by a small sample size leading to a biased group assignment with no possibility for stratification by ulcer stage, site, and other important factors. Power analysis shows that a sample size of at least 164 subjects is needed to permit cost-effectiveness evaluation with attention to critical variables. "Time to healing" is recommended as the treatment outcome measure to permit proper efficiency comparisons between the various treatment modalities and controls. These comparisons are crucial in a cost-conscious environment.
                              8. Salzberg CA, Cooper-Vastola SA, Perez F, Viehbeck MG and Byrne DW (1995). The effects of non-thermal pulsed electromagnetic energy on wound healing of pressure ulcers in spinal cord-injured patients: a randomized, double-blind study. Ostomy Wound Manage. 41: 42-4, 46, 48 passim. The objective of this randomized, double-blind study was to determine if non-thermal pulsed electromagnetic energy treatment significantly increases the healing rate of pressure ulcers in patients with spinal cord injuries. Subjects included volunteers admitted to a Veteran's Administration Hospital in New York over a 2 year period and consisted of 30 male spinal cord-injured patients, 20 with Stage II and 10 with Stage III pressure ulcers. Subjects were given non-thermal pulsed high-frequency electromagnetic energy treatment for 30 minutes twice daily for 12 weeks or until healed. The percentage of pressure ulcers healed was measured at one week. Of the 20 patients with Stage II pressure ulcers, the active group had a significantly increased rate of healing with a greater percentage of the ulcer healed at one week than the control group. After controlling for the baseline status of the pressure ulcer, active treatment was independently associated with a significantly shorter median time to complete healing of the ulcer. Stage III pressure ulcers healed faster in the treatment group but the sample size was limited. For spinal cord-injured men with Stage II pressure ulcers, active non-thermal pulsed electromagnetic energy treatment significantly improved healing.
                              9. Stefanovska A, Vodovnik L, Benko H and Turk R (1993). Treatment of chronic wounds by means of electric and electromagnetic fields. Part 2. Value of FES parameters for pressure sore treatment. Med Biol Eng Comput. 31: 213-20. Faculty of Electrical & Computer Engineering, University of Ljubljana, Slovenia. Subjects with spinal cord injury are often distressed by pressure sores, which usually appear after prolonged pressure (wheelchair, bed) across the soft tissue which has already lost sensibility and has diminished microcirculation. The healing ability and its dynamics depend on the state of the subject's overall health. Consequently, evaluation of a particular treatment requires careful consideration of as many as possible of the parameters relevant to healing and an adequate criterion for assessing the state of the pressure sore. Bearing in mind these two circumstances, the results of a multicentre clinical study are analysed. The aim of the study was to test two hypotheses: first that healing is faster when sores are also treated by electric currents (ECs) (in addition to conventional treatment); and secondly that there exist differences in the efficiency of the treatment if direct or low-frequency pulsed currents (FES parameters) are applied. The data analysed show that pressure sores are likely to heal twice as fast when treated with low-frequency pulsed currents. EC seems to improve the healing rate in cases where the natural healing mechanisms of the body are not sufficient (chronic wounds, older subjects).
                              10. Comorosan S, Vasilco R, Arghiropol M, Paslaru L, Jieanu V and Stelea S (1993). The effect of diapulse therapy on the healing of decubitus ulcer. Rom J Physiol. 30: 41-5. Interdisciplinary Research Group, Fundeni Hospital, Bucharest, Romania. The effect of pulsed high peak power electromagnetic field (Diapulse) on treatment of pressure ulcers is under investigation. 20 elderly patients, aged from 60 to 84, hospitalized with chronic conditions and bearing long-standing pressure ulcers, are subjected to Diapulse sessions (1-2 daily), parallel to conventional treatment. 5 patients undergo conventional therapy, serving as control and 5 others follow conventional+placebo Diapulse treatment. All patients were daily monitored, concerning their clinical status and ulcers' healing. After a maximum 2-weeks treatment, bulge healing rate was, as follows: 85% excellent and 15% very good healing under Diapulse therapy; in the placebo group, 80% patients show no improvement and 20% poor improvement; in the control group, 60% patients show no improvement and 40% poor improvement of ulcers. This investigation strongly advises for Diapulse treatment as a modern, uninvasive therapy of great efficiency and low social costs in resolving a serious, widespread medical problem.
                              11. Itoh M, Montemayor JS, Jr., Matsumoto E, Eason A, Lee MH and Folk FS (1991). Accelerated wound healing of pressure ulcers by pulsed high peak power electromagnetic energy (Diapulse). Decubitus. 4: 24-5, 29-34. The purpose of this study was to evaluate the effect of pulsed high-frequency, high peak power electromagnetic energy (Diapulse) in the healing of pressure ulcers. Patients with Stage II ulcers unhealed within three to 12 weeks and those with Stage III ulcers unhealed within eight to 168 weeks by conventional methods were included in the study. When Diapulse was added to conventional therapy during the nine-month study, all 22 patients healed as evidenced by photographs and measurements of the ulcers. Stage II ulcers healed in one to six weeks (mean 2.33) and all Stage III ulcers healed in one to 22 weeks (mean 8.85). The increased healing time can provide significant cost savings and improved patient care.
                              Last edited by Wise Young; 10 Feb 2008, 12:38 PM.

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