Articles
| Open Access |
DOI: Effect of Physical Therapist Management using Pulsed Short-Wave Diathermy for a Stage III Sacral Pressure Ulcer in a patient with Alzheimer’s Dementia: A 4-Week Study in a Skilled Nursing Facility: Case Report.
Harpreet Singh , PT, DPT, MSHA , Sacramento, CA 95831, USAAbstract
Alzheimer's disease (AD) is the most common cause of dementia which results in progressive decline in memory, cognitive and functional abilities of patients. Pressure ulcers are a common complication in patients with AD in skilled nursing facilities (SNF) and contribute significantly to the mortality rate.1, 2 Pulsed short wave diathermy (PSWD) treatment has been shown to promote faster healing of pressure ulcers.12 The purpose of this case report was to examine the effect of PSWD treatment on Stage III sacral pressure ulcer healing and its impact on sitting balance in an 80 year old female with advanced AD residing in an SNF.
Case Description
The patient was an 80-year-old female with stage 6 AD and a Stage III sacral pressure ulcer.
Intervention
The patient underwent 16, hour long physical therapy sessions over 4 weeks focused on localized PSWD treatment for wound healing alongside interventions to improve muscle strength, sitting balance, posture, and positioning.
Outcomes
Patient's sacral ulcer improved to Stage III healed, evidenced by 100% eschar and no slough tissue. Pain was effectively managed, with a final Pain Assessment in Advanced Dementia (PAINAD) score of 0. The patient's Braden Scale for Predicting Pressure Sore Risk (BRADEN) score improved to 18, indicating reduced risk for skin breakdown. The patient’s Function in Sitting Test (FIST) score improved to 46/56, indicating improved sitting balance.
Discussion
This case report demonstrates that PSWD facilitates faster wound healing and improved pain management in patients with AD. This case report encourages future research to validate the efficacy and safety of PSWD in similar patient populations.
Keywords
Geriatrics, Physical Therapist management, Alzheimer's Disease (AD), Pressure Ulcer, Sacral Ulcer, Pulsed Short-Wave Diathermy (PSWD), Skilled Nursing Facility (SNF).
References
Reitz C, Mayeux R. Alzheimer disease: epidemiology, diagnostic criteria, risk factors and biomarkers. Biochem Pharmacol. 2014;88(4):640-651.
Gambassi G, Landi F, Lapane KL, et al. Predictors of mortality in patients with Alzheimer’s disease living in nursing homes. J Neurol Neurosurg Psychiatry. 1999;67:59-65.
Alzheimer’s Association. Seven Stages of Alzheimer’s. http://act.alz.org/site/DocServer/sevenstages.pdf?docID=16881. Published 2023. Accessed February 17, 2025.
Arvanitakis Z, Shah RC, Bennett DA. Diagnosis and management of dementia: a review. JAMA. 2019;322(16):1589-1599. Accessed February 17, 2025.
Porreca EG, Giordano-Jablon GM. Treatment of severe (Stage III and IV) chronic pressure ulcers using pulsed radio frequency energy in a quadriplegic patient. Eplasty. 2008;8:e49.
Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):370-379. doi:10.7326/M14-1568
National Pressure Injury Advisory Panel. Treatment of Pressure Injury: Technical Report. http://www.npiap.org/wp-content/uploads/2012/03/Final-2009-Treatment-Technical-Report1.pdf. Published 2009. Accessed February 25, 2025.
Bergstrom N, Horn SD, Rapp M, et al. Preventing pressure ulcers: a multisite randomized controlled trial in nursing homes. Ont Health Technol Assess Ser. 2014;14(11):1-32.
Scarborough P. Biophysical Agents in Wound Care. Cleveland Clinic. http://www.clevelandclinicmeded.com/live/courses/WOCN/pre-syllabus/100314_1330_Scarborough_Biophysical%20Agents%20in%20Wound%20Care.pdf. Accessed February 19, 2025.
McGaughey H, Dhamija S, Oliver L, et al. Pulsed electromagnetic energy in management of chronic wounds: a systematic review. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination; 2009. https://www.ncbi.nlm.nih.gov/books/NBK77958/
Lefevre MD, Cruz Azul Study on Magnetic Therapy. https://ozonoterapia.ozotec.pt/wp-content/uploads/2016/12/Estudo-cientifico-Cruz-Azul-sobre-terapia-de-magnetismo.pdf. Accessed February 17, 2025.
Shields N, Gormley J, O'Hare N. Short-wave diathermy: a review of existing clinical trials. Phys Ther Rev. 2001;6(2):101-118.
Brain R, Bannister R. Dementia and Higher Cerebral Function. In: Brain and Bannister's Clinical Neurology. 7th ed. New Delhi, India: Oxford University Press; 2004:284-294.
Low J, Reed A. Electromagnetic Fields: Short Wave Diathermy, Pulsed Electromagnetic Energy and Magnetic Therapies. In: Electrotherapy Explained: Principles and Practices. 3rd ed. New Delhi, India: Replica Press Pvt. Ltd.; 2001:276-314.
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc. 2003;4(1):9-15.
Cox J. Predictive power of the Braden Scale for Pressure Sore Risk in Adult Critical Care Patients: a comprehensive review. Crit Care Nurse. 2012;32(6):65-76. https://www.nursingcenter.com/cearticle?an=00152192-201211000-00006. Accessed March 10, 2025.
Samuel Merritt University. Function in Sitting Test (FIST). http://www.samuelmerritt.edu/fist. Published January 24, 2017. Accessed March 10, 2025.
Gorman SL, Harro C, Platko C, Greenwald C. Examining the Function In Sitting Test (FIST) for validity, responsiveness, and minimal clinically important difference. Arch Phys Med Rehabil. 2014;95(12):2304-2311.
Sung JH, Ousley CM, Shen S, Isaacs ZJK, Sosnoff JJ, Rice LA. Reliability and validity of the Function in Sitting Test in nonambulatory individuals with multiple sclerosis. Int J Rehabil Res. 2016;39(4):308-312.
Shaffer S, Harrison A, Brown K, Brennan K. Reliability and validity of Semmes-Weinstein monofilament testing in older community-dwelling adults. J Geriatr Phys Ther. 2005;28(3):112-118. https://journals.lww.com/jgpt/Fulltext/2005/12000/Reliability_and_Validity_of_Semmes_Weinstein.19.aspx. Accessed March 10, 2025.
White DJ. Musculoskeletal Assessment. In: O'Sullivan SB, Shmitz TJ. Physical Rehabilitation Assessment and Treatment. 4th ed. New Delhi, India: Jaypee Brothers Medical Publishers; 2001:118-121.
Article Statistics
Copyright License
Copyright (c) 2025 Harpreet Singh
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright of their manuscripts, and all Open Access articles are disseminated under the terms of the Creative Commons Attribution License 4.0 (CC-BY), which licenses unrestricted use, distribution, and reproduction in any medium, provided that the original work is appropriately cited. The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations.