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J Appl Physiol 102: 1992-2001, 2007. First published February 1, 2007; doi:10.1152/japplphysiol.01092.2006
8750-7587/07 $8.00
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Prevention of pressure-induced deep tissue injury using intermittent electrical stimulation

Leandro R. Solis,1 Daniel P. Hallihan,1 Richard R. E. Uwiera,2 Richard B. Thompson,1 Enid D. Pehowich,1 and Vivian K. Mushahwar1

1Department of Biomedical Engineering, Faculty of Medicine and Dentistry, and 2Health Sciences Laboratory Animal Services, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

Submitted 27 September 2006 ; accepted in final form 30 January 2007

Pressure ulcers develop due to morphological and biochemical changes triggered by the combined effects of mechanical deformation, ischemia, and reperfusion that occur during extended periods of immobility. The goal of this study was to test the effectiveness of a novel electrical stimulation technique in the prevention of deep tissue injury (DTI). We propose that contractions elicited by intermittent electrical stimulation (IES) in muscles subjected to constant pressure would induce periodic relief in internal pressure; additionally, each contraction would also restore blood flow to the tissue. The application of constant pressure to the quadriceps muscles of rats generated a DTI that affected 60 ± 15% of the compressed muscle as assessed by magnetic resonance imaging. In contrast, in the groups of rats that received IES at 10- and 5-min intervals, DTI of the muscle was limited to 16 ± 16 and 25 ± 13%, respectively. Injury to the muscle was corroborated by histology. In an experiment with a human volunteer, compression of the buttocks reduced the oxygenation level of the muscles by ~4%; after IES, oxygenation levels increased by ~6% beyond baseline. Concurrently, the surface pressure profiles of the loaded muscles were redistributed and the high-pressure points were reduced during each IES-induced contraction. The results of this study indicate that IES significantly reduces the amount of DTI by increasing the oxygen available to the tissue and by modifying the pressure profiles of the loaded muscles. This presents a promising technique for the prevention of pressure ulcers in immobilized and/or insensate individuals.

spinal cord injury; muscle stimulation; pressure sores


Address for reprint requests and other correspondence: V. K. Mushahwar, 513 Heritage Medical Research Centre, Dept. of Biomedical Engineering, and Centre for Neuroscience, Faculty of Medicine and Dentistry, Univ. of Alberta, Edmonton, Alberta, Canada T6G 2S2 (e-mail: vivian.mushahwar{at}ualberta.ca)






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