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Development of Intermittent Electrical Stimulation for the Prevention of Deep Tissue Injury Open Access


Other title
Intermittent Electrical Stimulation
Deep Tissue Injury
Pressure Ulcers
Electrical Stimulation
Type of item
Degree grantor
University of Alberta
Author or creator
Solis Aguilar, Leandro R
Supervisor and department
Dr. Vivian Mushahwar (Department of Physical Medicine and Rehabilitation)
Dr. Martin Ferguson-Pell (Faculty of Rehabilitation Medicine)
Examining committee member and department
Dr. Yagesh Bhambhani (Department of Occupational Therapy)
Dr. Amit Gefen (Univeristy of Tel-Aviv)
Dr. Ted Tredget (Department of Surgery)
Dr. Ming Chan (Centre for Neuroscience)
Dr. Richard Thompson (Department of Biomedical Engineering)
Faculty of Rehabilitation Medicine
Rehabilitation Science
Date accepted
Graduation date
Doctor of Philosophy
Degree level
The main goal of this thesis was to develop a novel intervention named Intermittent Electrical Stimulation (IES) to prevent the formation of deep tissue injury (DTI) in immobilized individuals, in particular those with spinal cord injury. Deep tissue injury is a type of pressure ulcer that originates at the deep bone-muscle interface due to the prolonged entrapment of soft tissue between a bony prominence and an external surface. Intermittent electrical stimulation is applied to muscles at risk of developing DTI and works by eliciting periodic muscle contractions in cycles of 10 seconds “ON” followed by a period of 10 minutes “OFF”, replicating the subconscious repositioning performed by able bodied individuals in response to sitting discomfort. These periodic IES-elicited muscle contractions are able to counteract both the mechanical and vascular factors leading to DTI. Four studies were conducted to test the effects of IES within the muscle and its effectiveness to prevent DTI. In able-bodied volunteers the use of IES reduced and redistributed superficial pressure around the ischial tuberosities. In addition, it increased the level of muscle oxygenation immediately after the IES-induced muscle contraction, and kept it elevated throughout the entire duration of each IES “OFF” phase. In studies conducted in adult pigs both intact and with spinal cord injury, the results of this thesis showed that peak internal pressures due to external loading was localized within a 2cm area centered around the ischial tuberosities. Peak internal pressures were approximately 2 times higher than peak superficial pressures. The use of IES effectively reduced internal pressure levels around the ischial tuberosities and redistributed internal pressure levels away from the ischial tuberosities during each IES-induced contraction. The effectiveness of IES was demonstrated in a study in adult pigs with injured spinal cords and atrophied muscles. An external load equivalent to 25% of body weight was applied to the paralyzed limb of each animal every day for 4hrs a day for 1 month. In the group of pigs that received the application of IES the extent of DTI was significantly less (8%) compared to the extent of DTI in the control group (48%).
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Leandro R. Solis, Elizabeth Twist, Peter Seres, Richard B. Thompson, and Vivian K. Mushahwar. “Prevention of Deep Tissue Injury through Muscle Contractions induced by Intermittent Electrical Stimulation after Spinal Cord Injury in Pigs.” Journal of Applied Physiology. 2013; 114(2):286 - 296.Leandro R. Solis, Adrian B. Liggins, Peter Seres, Richard R. Uwiera, Niek R. Poppe, Enid Pehowich, Richard B. Thompson, and Vivian K. Mushahwar. “Distribution of internal strains around bony prominences in pigs” Annals of Biomedical Engineering, 2012; 40(8): 1721 – 1739.Leandro R. Solis, Adrian B. Liggins, Richard R. Uwiera, Niek R. Poppe, Enid Pehowich, Peter Seres, Richard B. Thompson, and Vivian K. Mushahwar. “Distribution of internal pressure around bony prominences: Implications to deep tissue injury and effectiveness of intermittent electrical stimulation.” Annals of Biomedical Engineering, 2012; 40(8): 1740 – 1759.Leandro R. Solis, Selina Gyawali, Peter Seres, Cara A. Curtis, Su Ling, Chong, Richard B. Thompson, and Vivian K Mushahwar. “Effects of intermittent electrical stimulation on superficial pressure, tissue oxygenation, and discomfort levels for the prevention of deep tissue injury.” Annals of Biomedical Engineering, 2011; 39(2): 649 - 663.Leandro R. Solis, Selina Gyawali and Vivian K. Mushahwar. “Mechanisms and Prevention of Deep Tissue Injury.” In: The Pathomechanics of Tissue Injury and Disease, and the Mechanophysiology of Healing. A. Gefen (ed), 2009.

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