Neurological Wound Healing Approaches

Approaches to Facilitate Healing and Wound Neo-vascularization

• Hydrotherapeutic approaches
• Electrotherapeutic approaches:
  • Electrical stimulation: 45-60 minutes, 5-7 times a week
  • Iontophoresis: Zinc enhances re-epithelialization of partial thickness wound
  • Phototherapy (ultraviolet)
• LASER and optical stimulation:
  • Most commonly used in physiotherapeutic studies: helium neon (HeNe), gallium arsenide (GaAs), and infrared laser (IR)
  • Intensity: 20-65mW/cm2, duration: 4-8 minutes
• Ultrasound therapy:
  • Intensity: 0.1w/cm2, frequency: 3MHZ, daily for 7 days, 5 min/day
• Phonophoresis:
  • Intensities: 1-1.5 w/cm2, time: depends on the area to be treated, usually 1 min/1cm2 (average 15 min) for 3 weeks
  • Both continuous and pulsed energy can be used, but pulsed mode appeared to be more effective
• Electromagnetic therapy (EMT)
• Hyperbaric oxygen therapy (HBO):
  • Patient breathes 100% oxygen at 2-3 times atmospheric pressure for a session lasting 60-90 minutes
  • Average duration: 2-4 weeks
• Negative pressure wound therapy (NPWT):
  • Non-invasive mechanical technique using a vacuum dressing to promote healing in acute or chronic wound
  • Used in different stages
• Shock wave therapy
• Honey therapy

Rehabilitation of Spinal Cord Injury (SCI)

General Categories of Ambulation

• Community ambulation:
  • Ability to walk at home and in the community
  • Requires independence in performing transfers, ability to go from sit-to-stand positions, and ambulating unassisted in and outside the home for reasonable distances with or without braces and assistive devices
• Household ambulation:
  • Ability to walk within the home and use a wheelchair as the primary way to get around in the community
• Ambulation for Exercise:
  • Ability to use a wheelchair in the community and at home and patient walks with assistance once or twice a day for exercise
  • Appropriate for a person who requires significant assistance for ambulation
• Non-ambulatory:
  • Ability to only use a wheelchair for mobility
  • Patient may also walk while doing gait training with the therapist in the therapy gym only

Orthoses

• Ankle-foot-orthosis (AFO)
• Hip-knee-ankle-foot-orthosis (HKAFO)
• Knee-ankle-foot-orthosis (KAFO)

Functional Electrical Stimulation (FES)

• Also called neuroprosthesis
• Stimulates certain muscles in the legs to do the same job as a brace during walking
• For example, a cuff with electrodes may be placed around the lower leg that stimulates the muscle that picks up the foot as you take a step
• Electrodes for electrical stimulation may also be on separate small pads on the skin or be surgically implanted
• This treatment originated from work in patients with incomplete spinal cord injury
• The major mechanisms will be the facilitation of central pattern generators (CPGs) for locomotor behavior located at brain stem level in humans

Treadmill Training

• Different from conventional gait training in the sense that it induces locomotor activity biomechanically not requiring the patient to initiate locomotion voluntarily
• Treadmill training with partial body weight support has become a gold standard for gait training in patients with incomplete spinal injury
• Robotic technology has emerged to assist individuals during over ground gait and balance therapy following neurological injury and diseases
• These devices range in complexity depending on the type of assistance they provide
• For example, at the single joint level, exoskeletons are being used to supplement limb propulsion as a mean of compensating for weakness and poor coordination