Electrical Stimulation Therapy Increases Rate of Healing of Pressure Ulcers in Community-Dwelling People With Spinal Cord Injury


      Houghton PE, Campbell KE, Fraser CH, Harris C, Keast DH, Potter PJ, Hayes KC, Woodbury MG. Electrical stimulation therapy increases rate of healing of pressure ulcers in community-dwelling people with spinal cord injury.


      To investigate whether electric stimulation therapy (EST) administered as part of a community-based, interdisciplinary wound care program accelerates healing of pressure ulcers in people with spinal cord injury (SCI).


      Single-blind, parallel-group, randomized, controlled, clinical trial.


      Community-based home care setting, Ontario, Canada.


      Adults (N=34; mean age ± SD, 51±14y) with SCI and stage II to IV pressure ulcers.


      Subjects were stratified based on wound severity and duration and randomly assigned to receive either a customized, community-based standard wound care (SWC) program that included pressure management or the wound care program plus high-voltage pulsed current applied to the wound bed (EST+SWC).

      Main Outcome Measures

      Wound healing measured by reduction in wound size and improvement in wound appearance at 3 months of treatment with EST+SWC or SWC.


      The percentage decrease in wound surface area (WSA) at the end of the intervention period was significantly greater in the EST+SWC group (mean ± SD, 70±25%) than in the SWC group (36±61%; P=.048). The proportion of stage III, IV, or X pressure ulcers improving by at least 50% WSA was significantly greater in the EST+SWC group than in the SWC group (P=.02). Wound appearance assessed using the photographic wound assessment tool was improved in wounds treated with EST+SWC but not SWC alone.


      These results demonstrate that EST can stimulate healing of pressure ulcers of people with SCI. EST can be incorporated successfully into an interdisciplinary wound care program in the community.

      Key Words

      List of Abbreviations:

      CCAC (community care access center), EST (electrical stimulation therapy), PSST (pressure sore status tool), PWAT (photographic wound assessment tool), SCI (spinal cord injury), SWC (standard wound care), WSA (wound surface area), % ↓ WSA (percentage wound surface area reduction from baseline)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Vogel L.C.
        • Krajci K.A.
        • Anderson C.J.
        Adults with pediatric-onset spinal cord injury, part 1: prevalence of medical complications.
        J Spinal Cord Med. 2002; 25: 106-116
        • Krause J.S.
        • Broderick L.
        Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset.
        Arch Phys Med Rehabil. 2004; 85: 1257-1264
        • Chen Y.
        • DeVivo M.J.
        • Jackson A.B.
        Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects.
        Arch Phys Med Rehabil. 2005; 86: 1208-1213
        • New P.W.
        • Rawicki H.B.
        • Bailey M.J.
        Nontraumatic spinal cord injury rehabilitation: pressure ulcer patients, prediction, and impact.
        Arch Phys Med Rehabil. 2004; 85: 87-93
        • Garber S.L.
        • Rintala D.H.
        Pressure ulcers in veterans with spinal cord injury: a retrospective study.
        J Rehabil Res Dev. 2003; 40: 433-442
        • Bourguignon G.
        • Bourguignon L.
        Electric stimulation of protein and DNA synthesis in human fibroblasts in cell culture.
        FASEB. 1987; 1: 398-402
        • Bourguignon G.
        • Wenche J.
        • Bourguignon L.
        Electric stimulation of human fibroblasts causes and increase in Ca2+ influx and the exposure of additional insulin receptors.
        J Cell Physiol. 1989; 140: 385-397
        • Falanga V.
        • Bourguignon C.
        • Bourguignon L.
        Electrical stimulation increases the expression of fibroblast receptors for transforming growth factor beta.
        J Invest Dermatol. 1987; 88: 488-492
        • Orida N.
        • Feldman J.
        Directional protrusive pseudopodial activity and motility in macrophages induced by extra-cellular electric fields.
        Cell Motil. 1982; 2: 243-255
        • Sheridan D.
        • Isseroff R.
        • Nuccitelli R.
        Imposition of a physiologic DC electric field alters the migratory response of human keratinocytes on extracellular matrix molecules.
        J Invest Dermatol. 1996; 106: 642-646
        • Thawer H.A.
        • PE Houghton
        Effects of electrical stimulation on the histological properties of wounds in diabetic mice.
        Wound Repair Regen. 2001; 9: 107-115
        • Junger M.
        • Zuder D.
        • Steins A.
        • Hahn M.
        • Klyscz T.
        Treatment of venous ulcers with low frequency pulsed current (Dermapulse) effects on cutaneous microcirculation.
        Der Hautartz. 1997; 18: 879-903
        • Smith J.
        • Romansky N.
        • Vomero J.
        • Davis R.H.
        The effect of electrical stimulation on wound healing in diabetic mice.
        J Am Podiatr Assoc. 1984; 74: 71-75
        • Stromberg B.
        Effects of electrical currents on wound contraction.
        Ann Plast Surg. 1988; 21: 121-123
        • Mawson A.
        • Siddiqui F.
        • Connolly B.
        • Sharp C.
        • Summer W.
        • Binndo Jr, J.
        Effect of high voltage pulsed galvanic stimulation on sacral transcutaneous oxygen tension levels in the spinal cord injured.
        Paraplegia. 1993; 31: 311-319
        • Taylor K.
        • Fish M.R.
        • Mendel F.C.
        • Burton H.W.
        Effect of a single 30 minute treatment of high voltage pulsed current on edema formation in frog limbs.
        Phys Ther. 1992; 72: 63-68
        • Rowley B.
        • McKenna J.
        • Chase G.R.
        • Wolcott L.E.
        The influence of electrical current on infecting organisms in wounds.
        Ann N Y Acad Sci. 1974; 238: 543-551
        • Barranco S.D.
        • Spadero J.A.
        • Berger T.J.
        • Becker R.O.
        In vitro effect of weak direct current on Staphylococcus aureus.
        Clin Orthop. 1874; 100: 250-255
        • Kloth L.C.
        Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and clinical trials.
        Lower Extremity Wounds. 2005; 4: 23-44
        • Kaada B.
        Promoted healing of chronic ulceration by transcutaneous nerve stimulation (TNS).
        Vasa. 1983; 12: 262-269
        • Peters E.J.
        • Armstrong D.G.
        • Wunderlich R.P.
        • Bosma J.
        • Stacpoole-Shea S.
        • Lavery L.A.
        The benefit of electrical stimulation to enhance perfusion in persons with diabetes mellitus.
        J Foot Ankle Surg. 2001; 37: 396-400
        • Baker L.L.
        • Rubayi S.
        • Villar F.
        • Demuth S.K.
        Effect of electrical stimulation waveform on healing of ulcers in human beings with spinal cord injury.
        Wound Repair Regen. 1996; 4: 21-28
        • Griffins J.W.
        • Tooms R.E.
        • Mendius R.A.
        • Clifft J.K.
        • Vander Zwaag R.
        • El-Zeky F.
        Efficacy of high voltage pulsed current for healing of pressure ulcers in patients with spinal cord injury.
        Phys Ther. 1991; 71: 433-444
        • Houghton P.E.
        • Kincaid C.B.
        • Lovell M.
        • et al.
        Effect of electrical stimulation on chronic leg ulcer size and appearance.
        Phys Ther. 2003; 83: 17-28
        • Adunsky A.
        • Ohry A.
        Decubitus direct current treatment (DCCT) of pressure ulcers: results of a randomized double-blinded placebo controlled study.
        Arch Gerontol Geriatr. 2005; 41: 261-269
        • Wood J.
        • Evans P.
        • Schallreuter K.U.
        • et al.
        A multicenter study on the use of pulsed low-intensity direct current for healing chronic stage II and stage III decubitus ulcers.
        Arch Dermatol. 1993; 129: 999-1009
        • Adegoke B.O.
        • Badmos K.A.
        Acceleration of pressure ulcer healing in spinal cord injured patients using interrupted direct current.
        Afr J Med Sci. 2001; 30: 195-197
        • Jercinovic A.
        • Karba R.
        • Vodovnik L.
        • et al.
        Low frequency pulsed current and pressure ulcer healing.
        IEEE Trans Rehabil Eng. 1994; 2: 225-233
        • Karba R.
        • Semrov D.
        • Vodovnik L.
        • Benko H.
        • Savrin R.
        DC electrical stimulation for chronic wound healing enhancement, part 1: clinical study and determination of electric field distribution in the numerical wound model.
        Bioelectrochem Bioenergetics. 1997; 43: 265-270
        • Trontelj K.
        • Karba R.
        • Vodovnik L.
        • Savrin R.
        • Strukelj M.P.
        Treatment of chronic wounds by lower frequency pulsed electrical current.
        J Tissue Viability. 1994; 4: 105-109
        • Stefanoska A.
        • Vodovnik L.
        • Benko H.
        • Turk R.
        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. 1993; 31: 213-220
      1. Registered Nurses of Ontario (RNAO) Best Practice Guidelines for treatment of pressure ulcers.
        (Accessed July 20, 2009)
        • Keast D.H.
        • Parslow N.
        • Houghton P.E.
        • Norton L.
        • Fraser C.
        Best practice recommendations for the prevention and treatment of pressure ulcers: update 2006.
        Wound Care Can. 2006; 4: 31-43
        • Bergstrom N.
        • Bennett M.A.
        • Carlson C.E.
        • et al.
        Clinical practice guideline, number 15: treatment of pressure ulcers.
        U.S. Department of Health and Human Services, Agency for Health Care Policy and Research, Rockville1994
        • Consortium of Spinal Cord Medicine
        Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health care professionals. Sponsored by Paralyzed Veterans of America.
      2. National Pressure Ulcer Advisory Panel (NPUAP) updated staging system 2007.
        (Accessed July 20, 2009)
        • Sibbald R.G.
        • Williamson D.
        • Orsted H.L.
        • et al.
        Preparing the wound bed.
        Ostomy Wound Manage. 2000; 46: 14-35
        • Majeske C.
        Reliability of wound surface area measurements.
        Phys Ther. 1992; 72: 138-141
        • Haghpanah S.
        • Bogie K.
        • Wang X.
        • Banks P.G.
        • Ho C.H.
        Reliability of electronic versus manual wound measurement techniques.
        Arch Phys Med Rehabil. 2006; 87: 1396-1402
        • Houghton P.E.
        • Kincaid C.B.
        • Campbell K.E.
        • Woodbury M.G.
        Photographic assessment of the appearance of chronic pressure and leg ulcers.
        Ostomy Wound Manage. 2000; 46: 20-30
        • Bates Jensen B.M.
        • Vredevoe P.L.
        • Brecht M.L.
        Pressure ulcer status tool.
        Decubitus. 1992; 5: 20-28
        • Cardinal M.
        • Eisenbud D.E.
        • Phillips T.
        • Harding K.
        Early healing rates and wound area measurements are reliable predictors of later complete wound closure.
        Wound Repair Regen. 2008; 16: 19-22
        • Kantor J.
        • Margolis D.J.
        Efficacy and prognostic value of simple wound measurements.
        Arch Dermatol. 1998; 134: 1571-1574
        • Taly A.B.
        • Sivaraman Nair K.P.
        • Murali T.
        • John A.
        Efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with disorders of the spinal cord: a randomized double-blind controlled trial.
        Arch Phys Med Rehabil. 2004; 85: 1657-1661
        • Gardner S.E.
        • Frantz R.A.
        • Berqquist S.
        • Shin C.D.
        A prospective study of the pressure ulcer scale for healing (PUSH).
        J Gerontol A Biol Sci Med Sci. 2005; 60: 93-97
        • Sibbald R.G.
        • Contreras-Ruiz J.
        • Coutts P.
        • Fierheller M.
        • Rothman A.
        • Woo K.
        Bacteriology, inflammation, and healing: a study of nanocrystalline silver dressings in chronic venous leg ulcers.
        Adv Skin Wound Care. 2007; 20: 549-558
        • Lo S.F.
        • Chang C.J.
        • Hu W.Y.
        • Hayter M.
        • Chang Y.T.
        The effectiveness of silver-releasing dressings in the management of non-healing chronic wounds: a meta-analysis.
        J Clin Nurs. 2009; 18: 716-728
        • Deitch E.
        • Marino A.
        • Gillispie T.
        • et al.
        Silver nylon: a new antimicrobial agent.
        Antimicrobial Agents Chemother. 1983; 23: 356-359
        • Marino A.
        • Deitch E.
        • Albright J.
        Electric silver antisepsis.
        IEEE Trans Biomed Eng. 1985; 32: 336-337
        • Thibodeau E.
        • Handelmann S.
        • Marquis R.
        Inhibition and killing of oral bacteria by silver ions generated with low intensity direct current.
        J Dent Res. 1978; 57: 922-926