Helping to heal complications from spinal cord injury

Dec 8 2004

A London scientist has received a major grant to help improve the quality of life for individuals with spinal cord injuries.

A research team led by Pamela Houghton, Associate Professor in the School of Physical Therapy at The University of Western Ontario and Associate Scientist at Lawson Health Research Institute, has been awarded $150,000 from the Ontario Neurotrauma Foundation to study a new treatment model for pressure wounds – a common complication for people living with paralysis and one of the factors leading to the death of Christopher Reeve earlier this year.

With an additional $150,000 in matching donations from private companies, Houghton’s study will examine how care providers can use Electrical Stimulation Therapy (EST) to heal pressure wounds in individuals with spinal cord injury. The study aims to determine if implementation of a wound care program including EST will result in faster wound closure, improved quality of life and reduced cost of care.

Pressure sores, also called decubitus ulcers or pressure wounds, occur when the skin is compressed for a prolonged period of time between a person’s bone and an external surface like a wheelchair or bed mattress. A recent Canada-wide survey revealed approximately one in four patients treated in health care facilities or through home care agencies have a pressure wound, and over half of these wounds are severe, requiring daily nursing care. If these wounds are not managed properly they can remain open and become chronic wounds, sometimes lasting years.

“People with spinal cord injuries are particularly vulnerable to pressure sores because of a number of factors, with limited mobility being one of the largest contributors,” explains Houghton. “These wounds have a tremendous impact on the patient’s quality of life and can result in serious complications including infection, dangerous fluctuations in blood pressure, amputations, and even death.”

EST involves using specialized equipment and dressings to deliver an electrical current at low levels directly to the wound in order to facilitate healing. Normally an electrical current is produced in the body naturally after a wound occurs and this current acts to stimulate many processes important in wound healing. Chronic wounds like pressure sores lack this current. But research has shown replacement of these naturally occurring electrical currents using EST can speed healing in certain types of chronic wounds. EST is used clinically in the United States but has only limited use in Canada.

“It is likely that EST is not widely used in the Canadian health care system because the application techniques are too cumbersome and require careful monitoring and adjustment by health care professionals who have specialized training,” says Houghton. New technologies available from industrial partners have simplified the treatments. “By working with these private companies and with Community Care Access Centres (CCACs), we hope to change the way treatment is delivered so more people can access this unique therapy.”

The three-year study will follow 50 patients with pressure wounds for six months. After initial assessment at the Lawson Health Research Institute’s clinical research facilities, all subjects will receive a customized wound care program, and half will also receive EST. Treatments will be arranged in collaboration with the CCAC of London Middlesex and the CCAC of Waterloo Region so they can be provided to individuals with spinal cord injuries who are living in the community in Southwestern Ontario.

Dianne Lesperance knows first hand the benefit of EST. She received the therapy as part of a pilot study by Houghton and the CCAC two years ago to treat a serious pressure wound. “That ulcer literally laid me in bed longer than all my initial injuries,” says Lesperance, who has had paraplegia since 1967. “Once EST started, the healing escalated quickly and I was able to see improvement at each session. The impact of providing EST on a wider basis could be quite profound. It could save a lot of money, a lot of time, and probably a lot of lives.”

If proven successful, the EST treatment model could expand to others affected by pressure wounds. This could reduce health care costs significantly since the average cost to the Canadian health care system to manage a single chronic pressure wound is estimated to be between $5,000 and $60,000. Economic analyses performed in the United States and United Kingdom estimate $5 billion US and between 300 and 500 million; are spent each year to treat persons with chronic skin ulcers.

“Many people with spinal cord injuries and other disabilities are unaware of how serious a pressure wound can be,” says Houghton. “We hope the study will not only improve the treatment available for pressure wounds, reducing the risk of infection, but also raise awareness of the need to follow and manage pressure wounds more carefully. Ideally if skin breakdown is monitored more closely we will be able to prevent these wounds from ever occurring in the first place.”