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Novel Therapies for Pressure Ulcer Prevention and Management 1. Prevention Smart-e-Pants www.scialberta.ca/study/smart-e-pants: For individuals with SCI who have lost the use of their legs, surface electrical stimulation of the buttocks can enable contractions in their gluteus muscles. These contractions provide mechanical and vascular stimulation which relieve pressure around bones, thereby reducing the risk of developing pressure ulcers. Sensimat www.toronto-fes.ca/sensimat: The Sensimat is a cushion that aims to prevent pressure development by monitoring the individual’s buttock-to-cushion interface pressures and posture. The intent is for the cushion to notify the individual regarding when and how best to do pressure relief. 2. Management Two sites (London and Toronto) report access to local research expertise in the management of non-healing pressure ulcers, with UV light therapy and electrical stimulation.7 Electrical stimulation therapy (EST) provides low-level current via surface electrodes to the pressure ulcer wound bed. Hypothesized mechanisms for improved wound healing by EST include protein synthesis, cell migration, and increased wound angiogenesis and tissue oxygenation (see photo of EST). In Toronto, the healing potential of low-intensity laser irradiation, for individuals with chronic pressure ulcers, has recently been evaluated. Electrical stimulation therapy (EST) provides low-level current via surface electrodes to the pressure ulcer wound bed. Hypothesized mechanisms for improved wound healing by EST include protein synthesis, cell migration, and increased wound angiogenesis and tissue oxygenation. Ultra Violet Light C (UVC) is a non-invasive treatment that promotes healing of chronic wounds by eradicating pathogens,8 and producing vasodilation in dermal blood vessels while stimulating epidermal cell proliferation. A randomized, double blind, placebo-controlled trial of UVC for pressure ulcers, in individuals with spinal cord injury, has demonstrated that UVC significantly improves healing of Stage 2 pelvic ulcers.9 Despite preliminary Level I evidence of their efficacy, further dissemination and uptake of EST and UV light therapy is urgently needed for those with non-healing wounds, living in the community. This will be possible with the acquisition of knowledge, skills and capacity for science of implementation. 88 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


H - Skin Integrity
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