INTRODUCTION

Pressure ulcers are regions of localized damage to the skin and

underlying tissues that usually develop over bony prominences such as
the sacrum or heels. These lesions are an important source of suffering for
patients and their caregivers. Pressure ulcer prevalence varies widely
depending on patient factors (eg, age, physical impairments) and
treatment setting.

Treatment strategies for pressure ulcers can be both costly and complex.
Hundreds of different mattresses and local wound care products are
currently promoted, and few have been evaluated in randomized
controlled trials (RCTs). It remains unclear which of the many available
treatments promote the most effective healing of pressure ulcers.

While several effective strategies to prevent pressure ulcers exist, many

patients continue to develop them. This is especially true in high-risk
settings such as acute care hospitals, in which patients have reduced
mobility. Thus, clinicians require an understanding of effective treatment
options. We examined the evidence supporting interventions for the
treatment of pressure ulcers.

Eighteen per cent of patients in hospital have a pressure ulcer. These are
often difficult to manage and are associated with significant morbidity
and mortality.

Pressure ulcers are localised areas of tissue damage caused by excess

pressure, shearing or friction forces. They occur in people who cannot
reposition themselves to relieve pressure on their bony prominences. This
ability is often diminished in people who are very old, malnourished or
suffering from acute illness.
Scope of the Problem
Pressure ulcers, or PRUs, have affected humans for ages, and addressing
the overall management of pressure ulcers is now a prominent national
healthcare issue. Despite current interest and advances in medicine,
surgery, nursing care, and self-care education, pressure ulcers remain a
major cause of morbidity and mortality. This is particularly true for
persons with impaired sensation, prolonged immobility, or advanced age.
See the image below.

Advanced sacral pressure ulcer shows the effects of pressure,

shearing, and moisture.

Research in the area of pressure ulcers, specifically in characterization,

prevention, and treatment of pressure ulcers, is important in preventing
secondary complications in persons with disabilities. As the standards of
acute, posttraumatic, and rehabilitation care improve, the population of
persons with lifelong functional impairments continues to grow.
Consequently, the prevention of secondary complications has become an
increasingly prominent concern.

Definitions
"an inflammatory, often suppurating lesion on the skin or an internal
mucosal surface of the body, as in the duodenum, resulting in necrosis of
the tissue."
"a local defect or excavation on the surface of an organ or tissue which is
produced by sloughing of inflammatory necrotic tissue."
"an area of unrelieved pressure over a defined area, usually over a bony
prominence, resulting in ischemia, cell death, and tissue necrosis."
Description
The ulcers are often referred to as pressure sores, bedsores, or decubitus
ulcers (from the Latin word decumbere, which means "to lie on one's
side"). Because persons at risk can develop lesions in various positions
(eg, sitting).

Measurement
Standardized measuring techniques are necessary to provide quantitative
information on wound healing and to validate research.
The most common method of monitoring the healing of pressure ulcers
utilizes photography and diagrams.The Vista MED wound measurement
system, uses color-balanced and light-balanced computerized
photographic images to help clinicians obtain precise objective
information about the size, shape, outline, area, and color of the wound. It
also provides objective information regarding the changes of surrounding
tissue.
In addition, digital subpixel techniques are available to measure clinician-
defined image areas, such as wound edges, eschar, necrotic tissue, or
granulation formation. Concise documented measurement contributes to
efficient wound treatment, management, and progress review.
Numerous other devices have been used to measure the volume
(volumetrics) and the dimensions of the pressure ulcer wound. One
simple method is to use a measured amount of saline to infer the volume
of the wound. More sophisticated radiographic techniques, such as sinus
radiographs, CT scans, and MRIs, are available but too expensive for
routine use.4

Common sites of involvement

Several studies reveal varying sites of occurrence with different
diagnoses. These sites of occurrence include the ischium (28%), the
sacrum (17-27%), the trochanter (12-19%), and the heel (9-18%). See the
image below.

Heel pressure ulcer.

Pressure ulcers commonly develop on the occiput of geriatric and
pediatric patients who spend extended amounts of time lying supine.
Patients with the secondary manifestations of osteoporosis and associated
thoracic kyphosis can develop pressure ulcers over the spinous processes.
Elderly patients and patients with diabetes often have pressure ulcers on
the heel.

Summary of Contributing Factors

Factors contributing to pressure ulcers are summarized below.

Pathomechanical factors (extrinsic or primary) include the following:

• Compression
• Maceration
• Immobility
• Pressure
• Friction
• Shear

Pathophysiologic factors (intrinsic or secondary) include the following:

• Fever
• Anemia
• Infection
• Ischemia
• Hypoxemia
• Malnutrition
• Spinal cord injury
• Neurologic disease
• Decreased lean body mass

Increased metabolic demands Risk assessment includes the following:

• Complete medical history taking

• Determination of Norton (or Braden) score (see Table 1,
below).
• Skin examination
• Identification of previous pressure ulcer sites
Prime candidates for pressure ulcers includes the following:

• Elderly persons
• Persons who are chronically ill (eg, those with cancer,
stroke, or diabetes)
• Persons who are immobile (eg, due to fracture, arthritis, or
pain)
• Persons who are weak or debilitated
• Patients with altered mental status (ie, under the effects of
narcotics, anesthesia, or coma)
• Persons with decreased sensation and/or paralysis

Secondary factors include the following:

• Illness or debilitation increases pressure ulcer formation

• Fever increases metabolic demands
• Predisposing ischemia
• Diaphoresis promotes skin maceration
• Incontinence causes skin irritation and contamination
• Other factors, such as edema, jaundice, pruritus, and xerosis
(dry skin)

Rationale for strategies to prevent pressure ulcers

Skin care is paramount and must be carried out in conjunction with the
following principles:
Pressure relief is important. Patients should be shifted or turned in
position every 2 hours. Support surfaces and specialty beds require
criteria for use.
Patients can benefit from lying prone.
Minimize shearing forces by keeping the head of the bed lower than 45°.
Use an air-fluidized bed.
Persons who use a wheelchair should be taught to perform pushup
exercises and to lean side to side for pressure relief.
Use of pressure-relieving cushions of air, foam, gel, or a combination can
help relieve pressure.
Frictional relief is also important.
Nutritional support involves several steps, as follows:

• Obtain the patient's nutritional history.

• Perform physical examination.
• Obtain anthropometric measurements.
• Order laboratory studies (eg, albumin, total lymphocyte
count, transferrin level).
• Provide enteral or parenteral support.
• Provide vitamin therapy.

Muscle spasms should be controlled. Involuntary muscle contractions can

lead to abrasions. The use of oral antispasticity agents is the simplest
method of controlling spasticity. Pressure ulcers occur more frequently in
patients with flaccid paralysis than in those with spasticity.
Prevention of contractures is another strategy. Uncontrolled spasticity or
lack of movement causes shortening of the muscles, usually the hip, knee,
elbow, and ankle plantar flexors. Contractures can limit the patient to
only a few positions. Contractures can be prevented in patients who have
some mobility by encouraging ambulation and range-of-motion exercises
twice daily.

Debridement and debriding agents

The purpose of wound debridement is to remove all materials that
promote infection, delay granulation, and impede healing, including
necrotic tissue, eschar, and slough (ie, the stringy yellow, green, or gray
nonviable debris in an ulcer). Accurate ulcer staging cannot be made until
necrotic tissue is removed. Three debridement procedures are commonly
used: enzymatic debridement, mechanical nonselective debridement, and
sharp debridement.
Enzymatic debridement uses various chemical agents (proteolytic
enzymes) that act by attacking collagen and liquefying necrotic wound
debris without damaging granulation tissue. Proteolytic enzymes are used
to chemically debride wounds. The action of these enzymes is aimed
specifically at necrotic tissue.

Mechanical nonselective debridement, in which necrotic tissue is

loosened and removed, is generally accomplished by whirlpool
treatments, forceful irrigation, or use of wet-to-dry dressings. Wet-to-dry
dressings involve placing wet gauze into the lesion and allowing it to dry.
A few hours later, when the dressing is removed, the necrotic debris that
has adhered to the dressing is also removed. Solutions commonly used
for wet-to-dry dressings include normal saline and 0.25% acetic acid
solution.
Povidone-iodine solution can be used to debride infected ulcers.
Although the effervescent action of hydrogen peroxide results in wound
debridement, it is not recommended for frequent use in pressure ulcers,
because it indiscriminately removes necrotic material and fragile
granulation tissue.
The widespread practice of using hydrogen peroxide continues, but it is
not recommended for long-term use because it and other cleansing agents
have been found to be toxic to fibroblasts.
Once debridement has been completed and clean granulation tissue has
been established, the use of debridement agents should be discontinued
and the site should be kept clean and moist.

Sharp debridement is surgical removal of the eschar and any devitalized

tissue within it. Although sharp debridement is the most effective method
of removing necrotic tissue, it is contraindicated in certain patients,
particularly those who cannot withstand the loss of blood that may occur
during the procedure. Moist devitalized tissue supports the proliferation
and growth of pathogens. The removal of this devitalized tissue is a
prerequisite to new tissue growth.
Sharp debridement is indiscriminate in the removal of vital and
devitalized tissue. A great deal of clinical skill and judgment are needed
in surgically debriding a wound.
Elderly patients and those with diabetes often have pressure ulcers of the
heel that look black and have eschar. Conventional wisdom encourages
physicians to debride the eschar, but it is usually protective and should be
left to autodebride unless an active infection dictates more aggressive
measures.
Surgical debridement is well established as an approach to pressure ulcer
care, but more research is needed.
Dressings for pressure ulcers

Transparent adhesive dressings are semipermeable and occlusive. They

allow gaseous exchange and transfer of water vapor from the skin, and
they prevent maceration of the healthy skin around the wound. In
addition, these dressings are not absorptive, they reduce the incidence of
secondary infection, and they eliminate the risk of traumatic removal.
However, transparent adhesive dressings do not function well on patients
who are diaphoretic or on patients with wounds that have significant
exudate.

Hydrocolloid wafer dressings contain hydroactive particles that interact

with wound exudate to form a gel. These dressings provide absorption of
minimal to moderate amounts of exudate and keep the wound surface
moist. This gel can have fibrillolytic properties that enhance wound
healing, protect against secondary infection, and insulate the wound from
contaminants.

Gel dressings are available in sheet form, in granules, and as liquid gel.
All forms of gel dressings keep the wound surface moist as long as they
are not allowed to dehydrate. Some gel dressings provide limited to
moderate absorption, some provide insulation, and some provide
protection against bacterial invasion. All gel dressings provide atraumatic
removal(see Table 2, below).

Calcium alginate dressings (eg, Sorbsan) are semiocclusive, highly

absorbent, and easy to use.They are natural, sterile, nonwoven dressings
derived from brown seaweed. Calcium alginate dressings are extremely
effective in treating wet (exudative) wounds and can be used on wounds
that are contaminated or infected.
 Phototherapy

Definition
Phototherapy, or light therapy, is the administration of doses of bright
light in order to normalize the body's internal clock and/or relieve
.depression

Precautions
Patients with eye problems should see an ophthalmologist regularly, both
before and during phototherapy. Because some ultraviolet rays are
emitted by the light boxes used in phototherapy, patients taking
photosensitizing medications (medications making the skin more
sensitive to light) and those who have sun-sensitive skin should consult
with their physician before beginning treatment. Patients with medical
conditions that make them sensitive to ultraviolet rays should also be seen
.by a physician before starting phototherapy

Pressure Ulcer (Decubitus) Treatment

The Episcan® dermal ultrasound scanner is used for early detection of

pressure sores before they are visible and to guide treatment including the
.detection of wound undermining

For treatment of pressure ulcers low power laser therapy has been
available for some time but the take up has been slow, since it requires a
trained therapist, special eye protection and closed treatment rooms. The
coverage is quite small, so laser phototherapy treatments are too slow,
expensive and impractical in many long term care environments, which is
.where pressure ulcers most often occur
Phototherapy for decubitus

The Q.Light® PRO non-laser phototherapy device from Switzerland

now treats larger areas more quickly and it has a built in timer, aperture
control and display for accurate treatments. It gives up to 40cm diameter
coverage and does not require special training or eye protection, making
it eminently practical and convenient to use in open ward situations,
.including over a patient's bed
Just a few minutes per day when the wound is clean and exposed is all
that is required and the results can be remarkable in terms of accelerated
healing, including stimulating even very stubborn wounds to heal. The
treatment is painless, drug-free and non-invasive so it can be used in
.conjunction with existing therapies
Some non-laser phototherapy devices offer a fixed frequency range
including infra-red, but infra-red can be uncomfortable for infected
.wounds or burns

Q.Light® PRO overcomes this objection as it is a flexible, modular

system. It uses a range of optional filter modules to provide specific light
frequencies from the visible and near-infra red range for different medical
conditions and there is no ultra-violet component. Filter modules are
simply slotted in and out according to need and are clearly labelled,
making

Q.Light® PRO simple to use in practical, daily situations in hospitals,

.care homes and clinics

Light Therapy

Light Therapy already has a long history going back thousands of years.
The first source of light used for medical treatment was the sunlight
which is known as heliotherapy and dates from about 1400 BC In 1903
The Danish Physician Niels Ryberg Finsen was awarded one of the
earliest noble prizes for his 'Finsen light Therapy' for infectious diseases.
.Dr Finsen hence is considered to be the founder of modern light therapy

The important therapeutic effects prompted many researchers and

scientists to develop and use filtered solar and artificial light source and
the phototherapy techniques became an alternative to heliotherapy.
Further studies by other researchers and scientists resulted in the creation
of the Bioptron® polarized light that works with almost the whole range
of the visible and part of the infrared light, and the Bioptron® devices
.were launched
This was a huge development, and the Bioptron® Light Therapy became
an effective and viable additional treatment for various conditions and
.illnesses, affecting both adults and children

Studies and researches into the effect of phototherapy using Polarized,

Incoherent, low energy light therapy show that polarized light help speed
up the healing process in cases such as venous leg ulcers, pressure sores
and burns. "In conclusion, the results of this clinical study demonstrate
that polarized-light therapy reduces the need for surgery in the treatment
of deep dermal burns. In this group of patients, the use of polarized light
accelerated wound healing and allowed very early pressure therapy, thus
reducing hypertrophic scarring and contracture. No extension of the
hospital stay was required. Because of the better aesthetic and functional
results (especially in burns of hands), polarized-light therapy has become
"the therapy of choice for deep dermal burns in University Hospital

The term 'light' refers to the visible part of the electromagnetic radiation
spectrum. The light used in the submitted clinical trials consists of the
visible and part of the infrared light measuring between 480 nanometres
and up to 3000 nanometres. This Bioptron® range ensures the exclusion
of any UV light thus avoiding any UV radiation and posing no risk to the
.patient

Today it is known that the human organism transforms light into

electrochemical energy, which activates a chain of biochemical reactions
within cells, stimulating metabolism and reinforcing the immune
.response of the entire human body
Bioptron® Light Therapy can be used as mono-therapy and/or as
complementary therapy for pain treatment in the following indications:
Rheumatology (osteoarthritis, rheumatoid , chronic arthritis),
Physiotherapy (low back pain, shoulder and neck pain, carpal tunnel
syndrome, scar tissue, musculoskeletal injuries) and Soft Tissue Injuries
(soft tissue injuries of muscles, tendons and ligaments, muscle spasm,
.(sprains, strains, tendonitis, tennis elbow

General Benefits

Bioptron® Light Therapy can be used both as a complementary treatment

to support conventional medical methods and as monotherapy for certain
.indications

:Bioptron® Light Therapy can

• Improve microcirculation;
• Harmonize metabolic processes;
• Reinforce the human defence system;
• Stimulate regenerative and reparative processes of the entire
organism;
• Promote wound healing;
• Relieve pain or decrease its intensity.

The outstanding characteristics of Bioptron® Light enable the light to

penetrate not only the skin but also the underlying tissues. Thus the
positive effect of Bioptron® Light is not limited to the treated skin area
.but also has a beneficial effect on the entire organism

• Bioptron® Light has biostimulative effects: when applied to

the skin; it stimulates light-sensitive intracellular structures and
molecules. This initiates cellular chain reactions and triggers so-
called secondary responses, which are not only limited to the
treated skin area, but can involve the whole body;
• Bioptron® Light Therapy stimulates and modulates
reparative and regenerative processes as well as the processes of
the human defence-system;
 • Bioptron® Light Therapy acts in a natural way by
supporting the regenerative capacity of the body and therefore
helps the body to release its own healing potential.

Wound Healing

Bioptron® Light Therapy can be used as monotherapy and/or as

:complementary therapy for wound healing in the following indications

• Wounds after a trauma (injuries)

• Burns
• Wounds after operations
• Leg ulcers
• Decubitus (pressure sores)

We recommend consulting a physician before using Bioptron® Light

Therapy in order to receive professional advice as to whether this
treatment is recommendable or whether other medical treatment is
.necessary

Pain Treatment

Bioptron® Light Therapy can be used as monotherapy and/or as

:complementary therapy for pain treatment in the following indications

Rheumatology

• Osteoarthritis
• Rheumatoid arthritis (chronic)
• Arthroses

Physiotherapy

• Low back pain

• Shoulder and neck pain
• Carpal tunnel syndrome
• Scar tissue
• Musculoskeletal injuries

Sports Medicine
:Soft tissue injuries of muscles, tendons and ligaments including

• Muscle spasm
• Sprains
 • Strains
• Tendonitis
• Ligament and muscle tears
• Dislocations
• Contusions
• Tennis elbow

We recommend consulting a physician before using Bioptron® Light

Therapy in order to receive professional advice as to whether this
treatment is recommendable or whether other medical treatment is
.necessary

Colour Therapy

Health is contingent upon balancing not only our physical needs, but
our emotional, mental and spiritual needs as well. The colour
chakra therapy principle is based on the assumption that
colours are associated with seven main chakras, which are
spiritual centres in our bodies located along the spine. These
chakras are like spirals of energy, each one relating to the
specific area.

Chakra is the Sanskrit word for 'wheel'. It is assumed that

chakras store and distribute energy. There are seven of these
chakras and each is associated with a particular organ or
system in the body. Each chakra has a dominant colour, which
may become imbalanced. If this happens, it can cause a
disorder and physical ramifications. By introducing the
appropriate colour, the disorder is considered to be improved.

Light and Colour are essential for our body and soul, however,
colour therapy works purely as an alternative, non medical,
holistic level, unlike the polarized, low energy Incoherent light
therapy described above.
What is LLLT?

LLLT (Low Level Laser Therapy) is the application of red and near infra-red light over
injuries or lesions to improve wound / soft tissue healing and give relief for both acute and
chronic pain.

LLLT is used to: increase the speed, quality and tensile strength of tissue repair; give pain
relief; resolve inflammation; improve function of damaged neurological tissue and often used
as an alternative to needles for acupuncture.

The red and near infrared light (600nm-1000nm) commonly used in LLLT can be produced by
laser or high intensity LED. The intensity of LLLT lasers and LED's is not high like a surgical
laser. There is no heating effect.

The effects of LLLT are photochemical (like photosynthesis in plants). Red and near infrared
light can affect cell membrane permeability and aid the production of ATP thereby providing
the cell with more energy which in turn means the cell is in optimum condition to play its part
in a natural healing process.

LLLT devices are typically delivering 10mW - 500mW (0.2 -> 0.01 Watts). The power density
typically ranges from 0.05W/Cm2 -> 5 W/Cm2.

LLLT is popularly used for soft tissue injuries, joint conditions, chronic pain, non-healing
wounds and ulcers, post-op pain and acupuncture.
How
does
LLLT
work?

Like photosynthesis - the correct wavelengths and power of light at certain intensities for an
appropriate period of time can increase ATP production and cell membrane perturbation
could lead to permeability changes and second messenger activity resulting in functional
changes such as increased syntheses, increased secretion and motility changes. Red and near
infrared light seem to be the most ideal wavelengths.Red light acts on the mitochondria and
near infrared light on the mitochondria and at the cell membrane. In in-vitro and animal
LLLT wound healing studies comparing wavelengths, red consistently is more effective.
Shorter wavelengths are not so good, expensive to produce and with poor penetration they
are a poor choice.

Clinical Effects of LLLT

An appropriate dose of light can improve speed and quality of acute and chronic wound
healing, soft tissue healing, pain relief, improve the immune system and nerve regeneration.
Applications with good RCT evidence include Venous Ulcers, Diabetic Ulcers,
Osteoarthritis, tendonitis, Post Herpetic Neuralgia (PHN, shingles) & postoperative pain.

To paraphrase NASA research:

“Low-energy photon irradiation by light in the far-red to near-IR spectral range with low-
energy (LLLT) lasers or LED arrays has been found to modulate various biological
processes in cell culture and animal models. This phenomenon of photobiomodulation has
been applied clinically in the treatment of soft tissue injuries and the acceleration of wound
healing. The mechanism of photobiomodulation by red to near-IR light at the cellular level
has been ascribed to the activation of mitochondrial respiratory chain components, resulting
in initiation of a signaling cascade that promotes cellular proliferation and cytoprotection.”

“A growing body of evidence suggests that cytochrome oxidase is a key photoacceptor of

light in the far-red to near-IR spectral range. Cytochrome oxidase is an integral membrane
protein that contains four redox active metal centers and has a strong absorbance in the far-
red to near-IR spectral range detectable in vivo by near-IR spectroscopy.”

“Moreover, 660–680 nm of irradiation has been shown to increase electron transfer in

Physiotherapy for Wound Healing

Services Include:

• assessment of wound status and consultation regarding factors impairing wound

healing
• selection and design of a safe and comfortable wound treatment using a
therapeutic modality
• creation of a program of exercises/ positioning to help circulation and aid in
wound closure
• wherever possible, provision of training to the patient or the patient’s delegate
on how to continue treatments at home
• facilitation of any necessary equipment rental or purchase through a local
supplier
• ongoing evaluation of the wound healing and progression of the programme of
treatment as appropriate

Exercises/Positioning

Many chronic leg wounds are in part due to poor blood circulation and swelling of the leg.
Leg exercises help improve circulation and reduce swelling.

Prolonged or inappropriate positioning/seating surfaces for immobile individuals can lead to

pressure ulcers. Treatment of these ulcers requires offloading or more appropriate seating
surfaces. These factors will be evaluated and addressed.

Therapeutic Modalities

Physiotherapy involves the use of many different modalities that

are shown through research to aid in the healing of soft tissues.
Treatments such as electrotherapy, ultrasound, laser therapy and
ultraviolet light are all safe, comfortable, non-invasive means of
delivering electrical, sonic, light or thermal energy to a wound.

Electrical stimulation in particular has very strong evidence

supporting its use in healing of chronic wounds including those
that are infected. Electrical stimulation for this purpose is
recommended in several respected guidelines on the management
of ulcers including the RNAO Pressure Ulcer Guideline and the Canadian Association of
Wound Care Ulcer Guidelines.
Laser Treatment for Pressure Ulcer Healing Post SCI

Lasers have been used in the treatment of wounds since the 1970s.
Lasers are believed to exert their effects on the proliferative phase of
wound healing, prompting fibroblast activity and granulation tissue
formation in non-healing, chronic wounds. Currently the use of laser
to promote wound closure in chronic wounds is not supported by
evidence, The two studies presented in this document support this
conclusion.

EFFECT OF VISIBLE LIGHT ON SOME CELLULAR AND

IMMUNE PARAMETERS

“ …. visible light provokes the release of some biological mediators

(cytokines) from the immune competent cells and in this way stimulates
the natural resistance of an organism. Similar to UV radiation and
without the negative effect of suppressed natural killer cell activity, the
application of visible light, preferably linearly polarised light (LPL), for
the extracorporeal exposure of human blood is suggested”.

Mortality and pressure ulcers

Pressure ulcers contribute to increased mortality ,One study
identified that older patients with a pressure ulcer were three
times more likely to die sooner than those without .In the
 community, older people with pressure ulcers were more likely
to die sooner than those without

Conclusion

Bioptron® Light Therapy can be used both as a complementary treatment

to support conventional medical methods and as monotherapy for certain
.indications

Pressure ulcers, or PRUs, have affected humans for ages, and addressing
the overall management of pressure ulcers is now a prominent national
healthcare issue.
Standardized measuring techniques are necessary to provide quantitative
information on wound healing and to validate research.

The purpose of wound debridement is to remove all materials that

promote infection, delay granulation, and impede healing, including
necrotic tissue, eschar, and slough (ie, the stringy yellow, green, or gray
nonviable debris in an ulcer).
Phototherapy, or light therapy, is the administration of doses of bright
light in order to normalize the body's internal clock and/or relieve
.depression

The Episcan® dermal ultrasound scanner is used for early detection of

pressure sores before they are visible and to guide treatment including the
.detection of wound undermining

LLLT is used to: increase the speed, quality and tensile strength of tissue
repair; give pain relief; resolve inflammation; improve function of
damaged neurological tissue and often used as an alternative to needles
for acupuncture.
US/UVC should be considered as an added treatment when pressure
ulcers are not healing with standard wound care post SCI.

Pulsed electromagnetic energy improves wound healing in Stage II

and Stage III pressure ulcers post SCI.

REFERENCE

my.clevelandclinic.org

profreg.medscape.com

peainthepodfitness.com

publicinfo.com
 CONTENTS

INTRODUCTION

SCOPE OF THE PROBLEM

Summary of Contributing Factors

Debridement and debriding agents
Dressings for pressure ulcers
Phototherapy
Pressure Ulcer (Decubitus) Treatment
General Benefits

What is LLLT?

How does LLLT work?

Physiotherapy for Wound Healing