Microcurrent Therapy in Wound Healing: March 2012

Thursday, 29 March 2012

Silver Nylon Info & Contraindications

Hey everyone, would just like to add some small elobaration to what was posted earlier mentioning Silver nylon use, as well as provide some contraindications for MET:

The application of Silver nylon used in conjunction with MET can be very beneficial for wound healing. The main benefit is the constant availability of free silver ions in the microbial environment (Huckfeldt, Flick, Mikkelson, Lowe, & Finley, 2007). These silver ions have strong germicidal effects through the blocking of cell respiration pathways, which helps add to the antimicrobial affect of microcurrent therapy (The facts about silver, 2000).

Huckfeldt, R., Flick, A. B., Mikkelson, D., Lowe, C., & Finley, P. J. (2007). Wound closure after split-thickness skin grafting is accelerated with the use of continuous direct anodal microcurrent applied to silver nylon wound contact dressings. J Burn Care Res, 28(5), 703-707. doi: 10.1097/BCR.0B013E318148C94501253092-200709000-00010

The Facts about Silver. (2000). Retrieved from http://www.burnsurgery.org/Modules/silver/section2.htm

Contraindications

ANY RISKS to the practitioner / patients?

Practitioners will have to consider the patients’ conditions to apply an appropriate regime and target population. Although MET has shown it is beneficial in many tissue healing applications, there is little research showing whether there are negative effects of MET application.

Here are some examples for microcurrent treatment contraindications from commercial device companies:

Electrode should not apply across the carotid sinus (neck region).
MET should not be used on cardiac pacemaker and metal implant patients.
Electrode should not place through the head for therapy.
Electrode should not be placed on abdomen and uterus area.
MET should not be used until etiology is established.
MET should not use during pregnancy, delivery and lactation as it has not been established.
MET should not be used during other electronic monitoring equipment (such as ECG).
MET device should be kept out of the reach of children.
MET should be stopped or type of electrode changed if patients experience skin irritation or hypersensitivity.
MET might increase bleeding, dislodge clots and local infection due to increased blood flow and circulation.
Cancer patients and lower motor neuron damage individuals should not use MET as there is no well established studies.

There is no research suggesting that there are negative effects of MET on wound healing. However Kaslow (2011) suggested that there were side effects 90 minutes after treatment that lasts for 4-24 hours, including nausea, fatigue, drowsiness, and a temporary flu like feeling. As mentioned previously, there is no standardised value for dosage, frequency, duration, gender, age, type of skin, moisture of skin (conductivity), electrical field related to wound type, and polarity (cathode/anode); it is therefore necessary to have further research conducted in these areas in order to avoid any risk of injury or further damage and allow MET to be widely used in hospital settings for reducing wound healing time.

References:

Dynatron 850 and Dynatron 550 plus Service Manual (2004). Retrieved from http://www.ersbiomedical.com/Manuals/Dynatron/D850D550plusService%206-04%20with%20schematics.pdf

Functional Electrical Stimulation (FES) Indications and Contraindications. (2006). Retrieved from http://www.equinew.com/indicationscontraindication.htm

Kaslow, J.E.,(2011). Frequency Specific Micro-current. Retrieved from http:// http://www.drkaslow.com/html/frequency_specific_microcurren.html

Monday, 26 March 2012

Procedure

As mentioned in the previous blog, the standard therapeutic application, dosage and procedure is still not fully established. This blog is aiming to provide with the procedures and equipment used in current research that has shown successful application of microcurrent therapy in wound healing.

In terms of the application of microcurrent stimulation to wounds, the easiest application technique was using two metal electrodes with a spherical tip (10mm) positioned on the wound (de et al., 2011). Some would apply two layers of electrodes with tap water as the conducting medium (Lee, Wendell, Al-Waili, & Butler, 2007). Most were applied by using moistened silver nylon fabric shown in figure 1, as the surface of these fabrics can be tested with a voltmeter to check for an even spread of current to the wound site (Becker & Spadaro, 1978; Huckfeldt, Flick, Mikkelson, Lowe, & Finley, 2007; Webster, Spadaro, Becker, & Kramer, 1981). Furthermore, alternative techniques such as electroacupunture also use low-frequency microcurrent, with stimulation conducted through acupuncture needles shown in figure 2, which also shows suppressed myostatin expression, and proliferative retention of skin tissues and repaired skeletal muscle (Takaoka et al., 2007).

Figure 1: Silver nylon favbric dressing. (Wound contact dressings, retrieved March 27, 2012)

Figure 2: Electroacupuncture, microcurrents stimulates through acupuncrure needles. (Electroacupuncture, rertrieved March 27, 2012)

Dosage can be separated into applied current, frequency and duration. As for current (microcurrent precisely), most of electrical stimulation employs current intensities between 1 and 999uA (Lee, et al., 2007). The voltage and current levels were significantly below the threshold of sensation of the patient (Huckfeldt, et al., 2007). The earliest application of electrical stimulation used 50-300uA direct current applied to silver nylon in 1983 keratome-induced wounds on pigs. This study found a significant increase in wound epithelialization. The lowest microcurrent used that has shown an effect on wound healing was at 20uA which induces the flow of electrons into the skin and subcutaneous injury (Fleischli & Laughlin, 1997). However, recent research in 2011 used 10uA/ 2min, and showed a positive effect on the number of fibroblasts, vascularization and epithelialization (de, et al., 2011). Microcurrent treatment, at an output of 100uA, the result shows effective reduced post exercise creatine kinase levels after induction of muscle damage (Fleischli & Laughlin, 1997). In addition, the results showed enhanced soft tissue healing and treatment of fracture nonunion (Bach, Bilgrav, Gottrup, & Jorgensen, 1991; Carley & Wainapel, 1985). However, the most commonly used microcurrent intensity was 40uA, and has proven to accelerate the wound healing process in 1988, 1990, 1991, 1993, 1994 and 1996 (Chu, Matylevich, McManus, Mason, & Pruitt, 1996; Chu, McManus, Mason, Okerberg, & Pruitt, 1990; Chu, McManus, Okerberg, Mason, & Pruitt, 1991). But a recent study indicates that the current should vary between 40 to 100uA dependent upon the resistance of the wounded skin site (Huckfeldt, et al., 2007).

Most frequencies applied to wound healing were all very low, normally ranging from sub1 to 150Hz, with the lowest one using ultra-low microcurrent at 0.000732Hz (Lee, et al., 2007). Most of the other applications use around 0.5Hz (Santos et al., 2004).

The frequency and duration of microcurrent therapy application on wounds varies greatly. Early human clinical trials using microcurrent was reported in the early 80's using a standardized clinical technique in open wounds. Initial treatments were limited to 4 hour periods twice a day, but later expanded to all durations and frequency, even 24hrs continuous treatment (Webster, et al., 1981).

In one technique tested on chronic resistant wounds, the patients were treated with a direct current of 1 polarity for 12min and then the opposite polarity for another 12min. These patients were treated approximately 3.5hr/day, 5 days a week (Lee, et al., 2007). Another study applied microcurrent stimulation 48 hours after the trichloracetic acid peeling in rats. Each treatment was applied for 20 minutes and every two days up to day 21 for comparison, with the results showing significant increase in number of fibroblasts, with compact eosinophitic collagen fibers (Santos et al., 2004). In the research of the effect of microcurrent on the surgically induced wound healing in rats, the treatments started 24 hours after surgical intervention and were continued daily for 10 days (de, et al., 2011).

All of the above applied methods, current, frequency and duration of microcurrent stimulation therapy were shown to be successful and provided a significant decrease in the time of wound healing. Although there is no gold standard for the procedure and dosage, most research that has shown successful results used moistened silver nylon fabric in direct contact over the wound surface, with microcurrent ranging from 20-100uA with low frequency below 1Hz, over at least 20minutes a day until a wound heals.

The following are examples of the devices used in the research articles mentioned earlier. Two portable microcurrent devices used in Frick & McCauley’s (2005) research, called Alpha-Stim 100 Microcurrent & Cranial Electrotherapy Stimulator (shown in figure 3) costing US $995.00 and Alpha-Stim PPM Microcurrent Stimulator costing US $595.00 (Electromedical Products International, Inc; Mineral Wells, TX; https://store.alpha-stim.com/SearchResults.asp?Cat=1) The company described these devices as “extremely comfortable, usually no sensation at all.” Another device used in Lee's (2007; 2010) research (figure 4) is called BondiHealth TENS System (EPRT Technologies-USA, Simi Valley, CA; http://www.eprttechnologies.com/content/view/35/52/) although no prices were displayed on their website. However, it is expected to cost over $1000 as the entrance level portable devices advised for sport recovery already cost AU $995 (EPRT Technologies-USA, Simi Valley, CA; http://www.bodicharger.com/). All of the above devices are available directly to the public, with tutorial classes teaching the users. The company’s brochure described the feeling of the device as “Most patients feel nothing, but sometimes a slight tingling sensation may be experienced”. Although the prices for these devices might be acceptable for hospital settings, it is quite expensive for individual patients to purchase and most likely will only used for around one month until the wound heals.

Figure 3: Alpha-Stim 100 Microcurrent & Cranial Electrotherapy Stimulator
(The Alpha-Stim 100, retrieved march 27, 2012)

Figure 4: BondiHealth TENS System
(BodiHealth TENS System, retrieved march 27, 2012)

Bach, S., Bilgrav, K., Gottrup, F., & Jorgensen, T. E. (1991). The effect of electrical current on healing skin incision. An experimental study. Eur J Surg, 157(3), 171-174.

Becker, R. O., & Spadaro, J. A. (1978). Treatment of orthopaedic infections with electrically generated silver ions. A preliminary report. J Bone Joint Surg Am, 60(7), 871-881.

Carley, P. J., & Wainapel, S. F. (1985). Electrotherapy for acceleration of wound healing: low intensity direct current. Arch Phys Med Rehabil, 66(7), 443-446.

Chu, C. S., Matylevich, N. P., McManus, A. T., Mason, A. D., Jr., & Pruitt, B. A., Jr. (1996). Direct current reduces wound edema after full-thickness burn injury in rats. J Trauma, 40(5), 738-742.

Chu, C. S., McManus, A. T., Mason, A. D., Jr., Okerberg, C. V., & Pruitt, B. A., Jr. (1990). Multiple graft harvestings from deep partial-thickness scald wounds healed under the influence of weak direct current. J Trauma, 30(8), 1044-1049; discussion 1049-1050.

Chu, C. S., McManus, A. T., Okerberg, C. V., Mason, A. D., Jr., & Pruitt, B. A., Jr. (1991). Weak direct current accelerates split-thickness graft healing on tangentially excised second-degree burns. J Burn Care Rehabil, 12(4), 285-293.

de, G. d. G. F. O., Foglio, M. A., de Carvalho, J. E., Santos, G. M., Testa, M., Passarini, J. R., Jr., . . . Mendonca, F. A. (2011). Effects of the Topical Application of Hydroalcoholic Leaf Extract of Oncidium flexuosum Sims. (Orchidaceae) and Microcurrent on the Healing of Wounds Surgically Induced in Wistar Rats. Evid Based Complement Alternat Med, 2011, 950347. doi: 10.1155/2011/950347
Electroacupuncture [Image] Retrieved March 27, 2012, from http://tweedacupuncture.com.au/electroacupuncture/

Fleischli, J. G., & Laughlin, T. J. (1997). Electrical stimulation in wound healing. J Foot Ankle Surg, 36(6), 457-461.

Frick, A. & McCauley, D. (2005), Microcurrent Electrical Therapy, Journal of Equine Veterinary Science 418 - 422

Lee, B. Y., Wendell, K., Al-Waili, N., & Butler, G. (2007). Ultra-low microcurrent therapy: a novel approach for treatment of chronic resistant wounds. Adv Ther, 24(6), 1202-1209. doi: 704 [pii]

Santos, V. N. S., Ferreira, L. M., Horibe, E. K., & Duarte, I. d. S. (2004). Electric microcurrent in the restoration of the skin undergon a trichloroacetic acid peeling in rats. Acta Cir Bra, 19 (5), 466-469.

Takaoka, Y., Ohta, M., Ito, A., Takamatsu, K., Sugano, A., Funakoshi, K., . . . Maeda, E. (2007). Electroacupuncture suppresses myostatin gene expression: cell proliferative reaction in mouse skeletal muscle. Physiol Genomics, 30(2), 102-110. doi: 00057.200610.1152/physiolgenomics.00057.2006

Webster, D. A., Spadaro, J. A., Becker, R. O., & Kramer, S. (1981). Silver anode treatment of chronic osteomyelitis. Clin Orthop Relat Res(161), 105-114.

Wound contact dressings [Image] Retrieved March 27, 2012 from http://www.silverlon.com/consumer_otc_products.html

Saturday, 24 March 2012

Current research in the field of microcurrent therapy in wound healing

In the past most research in the area of wound healing with microcurrent electrical stimulation therapy are heavily attained in animal studies, such as the one applied on horses that Jerry introduced in the first blog. Similarly to most newly developed treatments, the information involving the background mechanism still remains speculative, and gaps still exists in the current understanding of specific cellular and functional targets, therapeutic dose, and the gold standards to achieve optimal wound healing. The following paragraphs will try to provide the most current research in the field of microcurrent therapy, to support this still evolving treatment technique.

In the research field of microcurrent therapy in wound healing, animals were widely used to study, which illustrates that this treatment is still in a development and evolving stage. In 2004, the effect of microcurrent was tested on rats whose skin had undergone trichloracetic acid peeling. 32 hairless male adult rats were randomly divided into groups, with a control group versus experimental group with microcurrent stimulation. The results show there was homogeneous epithelial regeneration, more evident healing scar and epidermis thickening seen in the experimental group compared to control. The amount of fibroblasts was greater than the control group, presenting more compact and eosinophitic collagen, with a statistically significant difference (p<0.01). Clear evidence was shown in the increased number of fibroblasts, and is illustrated in the photomicrograph figure 2: the experimental group’s skin in day 21 post skin peeling, compared to figure 1: the control group (Santos et al., 2004).

Figure 1: Photomicrograph of control group rat skin 21 days after skin peeling.

Figure 2: Photomicrograph of experimental group rat skin 21 days after skin peeling

In 2011, the effect of microcurrent was tested on surgically induced wounds on 36 male Wilstar rats. They were randomly divided into 4 groups; 1) control, 2) topical application of the extract, 3) treatment with microcurrent, 4) and topical application for the extract plus microcurrent. The simultaneous application of topical application for the extract plus microcurrent was found to be highly effective and significant (p<0.05), with positive effects on the area of newly formed tissue, number of fibroblasts, number of newly formed blood vessels, and epithelial thickness (de et al., 2011).

Research on the application of microcurrent therapy only begun recently. In 2007, the use of continuous direct anodal microcurrent was tested on wound closure after split-thickness skin grafting on burn wounds. As for thermal injury the processes that speed up time to stable wound closure could improve the outcome strongly, by decreasing complications such as infection, scarring and graft failure. This is a randomized clinical trial tested on 30 patients with full-thickness thermal burns, randomized into two groups. The control group recieved postoperative dressing care using moistened silver nylon fabric covered with gauze; the experimental group was similar with the addition of continuous direct microcurrent application. The results show that the experimental group experienced a 36% reduction in time to wound closure, and was statistically significant (P<0.05) (Huckfeldt, Flick, Mikkelson, Lowe, & Finley, 2007).

In 2007, the efficacy of ultra-low microcurrent was tested on treating chronic resistant wounds. All 23 patients were presented with chronic skin ulcers for an average of 17months, who were all not responsive to standard conservative treatment. The result showed that 34.8% of patients were able to achieve complete wound healing, and 39.1% achieved more than half of healing, with several patients obtaining significant results after 1-2 treatments. In 2010, the same research group published another article, this time focusing on patients with diabetes mellitus, hypertension and chronic wounds. The results showed that the wounds on the patient were markedly healed (30-100% closure) (Lee, Wendell, Al-Waili, & Butler, 2007; Lee et al., 2010).

However, these last two research articles leaned towards more promotional type of research, both using an Electro Pressure Regeneration Therapy (EPRT) device (EPRT Technologies-USA, Simi Valley, CA), therefore putting the validation in doubt. Moreover, both tests did not go through any statically significant tests and protocols used to measure the wound changes alone with treatment, and did not explain how the theory behind the device works.

The evidence from cellular and animal studies shows strong association between microcurrent stimulation and improved wound healing. However, the field of reliable and valid human research, and development of understanding in the mechanism, standard therapeutic procedure and dose still require further research in the future.

References:

Lee, B. Y., AL-Waili, N., Stubbs, D., Wendell, K., Butler, G., AL-Waili, T., & AL-Waili, A. (2010). Ultra-low microcurrent in the management of diabetes mellitus, hypertension and chronic wounds: Report of twelve cases and discussion of mechanism of action. Int. J. Med. Sci, 7 (1), 29-35.

Lee, B. Y., Wendell, K., Al-Waili, N., & Butler, G. (2007). Ultra-low microcurrent therapy: a novel approach for treatment of chronic resistant wounds. Adv Ther, 24(6), 1202-1209. doi: 704 [pii]

Thursday, 15 March 2012

MET physiology

Hey everyone, Mitch here. Just thought I'd upload some interesting information that will complement what Jerry posted recently. I found a number of useful sources that illustrate just how MET achieves increased healing. Take a read:

Microcurrent Electrical Therapy is said to be capable of enhancing healing. However, now I shall explore further just how this is achieved physiologically at the level of the cell.

Researcher Robert. O. Becker made some important discoveries relevant to MET. In 1985 he inferred that there is a self repair system in the body for dealing with wounds. This system is now known to be a closed-loop self repair system, which involves a signal being generated within the body when an injury occurs, which signals repair (Kirsch, 2001). When MET is applied, the body’s own electrical signals are assisted by externally generated signals, increasing stimulus strength and therefore increasing levels of healing.

It can be basically said that MET stimulates cellular physiology and growth, with some evidence suggesting it can potentially increase ATP generation by approximately 500% (Lathrop, 2011). This increased energy production assists in wound healing due to a decrease in ATP production via sodium pump disruption caused by trauma. This results in injured tissue having a large increase in electrical resistance, and therefore a decrease in cellular capacitance. MET increases cellular healing by reversing these decreases in capacitance, via decreasing the electrical resistance (Microcurrent Electrical Therapy, 2009). This return to cellular homeostasis allows the ATP generation to return to normal and membrane active transport to be increased. These processes have an overall affect of increasing healing via increased protein synthesis in the injured tissue, which facilitates healing significantly.

MET is also shown be capable of decreasing oedema, increasing migration of epithelial cells and fibroblasts to the wound site, and inhibit the growth of some pathogens (Lathrop, 2011).

Resources:

Lathrop, P. (2011). Physiological Effects of Microcurrent on the Body. Retrieved from http://www.slideshare.net/drpeterlathrop/physiological-effects-of-microcurrent-on-the-body-peter-lathrop

Microcurrent Electrical Therapy (MET). (2009). Retrieved from http://www.youralphastim.com.au/main/page_side_nav_how_alphastim_works_met__microcurrent_electrical_therapy.html

Kirsch, L. (2001). A practical protocol for electromedical treatment of pain in pain management: A practical guide for clinicians. Mineral Wells, Texas.

Sunday, 11 March 2012

History of Electrical Stimulation for Wound Healing

About 300 years ago, electrically charged gold leaf was used to treat and enhance skin healing from smallpox lesions. Electrical stimulation therapy can be separated into 2 different types: High Voltage Pulsed Stimulation and Microcurrent Electrical Stimulation. In this blog, our main focus is on Microcurrent Electrical Stimulation.

Terminology

There are different names for microcurrent electrical stimulation, for example: low level direct electrical current therapy, microcurrent electrical therapy (MET), micro-amp therapy, microamperage electrical stimulation and Low-intensity Electrical Stimulation.

The first electrical therapy machine (Dermatron), a device using electrical stimulation to promote bone fracture healing, was developed in 1960 by the German Doctor Reinhold Voll (Barret, S 2011).

Figure 1: Dermatron

Previous studies suggested that microcurrent therapy could achieve the following:

History of tissue healing

1. Increase cell division (Bayat et al. 2006)
2. Stimulate secretion of growth factor (Chapman-Jones & Hill, 2002) (Cheng et al. 1982)
3. Stimulate ATP Synthesis (Lee et al. 2010) (Cheng et al. 1982)
4. Accelerate wound healing (Lee et al. 2007, 2010)
5. Improve fracture union (Kalamed Corporation)
6. Increase wound epithelialisation (Santos et al. 2004)

Animal studies :

Frick & McCauley (2005) reported that a very large wound (18 inches) on a 2- year-old horse’s right rear quarter leg had shown substantial healing after 10 days of MET. Initially, the large wound only showed slow progression of healing in one month post-surgery, flushing and treating with antibiotics. This was due to the area failing to develop healthy granulation of tissues and becoming infected before applying MET.

Figure 2 shows the original wound with infection and the electrode attachment site respectively. Figure 3 showed the healing and a clean wound without infection after 10 days of MET. Figure 4 was taken after 22 days MET treatment and finally after approximately 4 months when the horse had returned to training.

Figure 2: Left: Initial state of wound before MET treatment , Right: Placement of electrode

Figure 3: State of wound after 10 days of MET treatment and showed clean wound

Figure 4: Left: State of wound after 3 weeks of MET treatment, Right: 4 months after returns to training

Another horse study from Marshall found that a normally 3 month long healing period for a suspensory ligament injury had been reduced greatly, with significant healing after 21 days of MET. Shortening the bone fracture healing period was also reported in another horse study by Kalamed, which introduced a bone growth stimulator based on magnetic stimulation.

Bayat et al. (2006) explained that the MET application significantly accelerated the wound healing of full-thickness incision in rabbits’ skin by increasing the fibroblasts after 7 days. Moreover the strength increased after 15 days. Similar studies have found that MET reduced the length of restoration of the area undergone TCA peeling in rats’ skin and increased amount and structure of fibroblasts and collagen (Santos et al. 2004).

Figure 5: Fibroblasts in ten zones of incisional wound bed in rabbits of sham-treated (Sham) (n = 15) and experimental (Ex) (n = 15) Ex groups showed significant difference at day 7 (Bayat et al. 2006).

Figure 6. Ex group showed significant difference at day 15 in tensile strength (Bayat et al. 2006)

Human studies:

MET has shown that chronic skin ulcers and abdominal wounds, present for an average of 16.5 months which did not respond to standard conservative treatment, experienced significantly accelerated healing (Lee et al., 2007). In a study on chronic achillies tendinopathy, it was shown that there was significant improvement in MET compared to the control group by observing four different indicators including clinical examination, ultrasound imaging, range of movement, and self - assessment (Chapman-Jones. & Hill 2002).

Figure 7. Difference in pain and stiffness between groups A (conversative treatment:control) and B (microcurrent regime) using mean score over four assessment intervals (Chapman-Jones. & Hill 2002).

MET has been also been used patients with diabetes mellitus, hypertension and chronic wounds. Evidence shows that the wounds were significantly healed by 30-100%. Some patients were able to reduce their medication or completely stop after MET treatment (Lee, 2010).

It is obvious that MET could increase the healing process in animal and human studies. Let’s look at how it works next!

Reference

Barret, S. (2011), Quack "Electrodiagnostic" Devices http://www.quackwatch.org/01QuackeryRelatedTopics/electro.html

Bayat, M., Asgari-Moghadam, Z., Maroufi, M., Sadat-Rezaie,F.,Bayat, M. & Rakhshan, M. (2006), Experimental Wound Healing using Microamperage Electrical Stimulation in Rabbit, Journal of Rehabilitation Research & Development,(43)2, 219-226

Chapman-Jones, D. & Hill, D. (2002), Novel Microcurrent Treatment is More Effective than Conventional Therapy for Chronic Achilles Tendiopathy -Randomised comparative trial, Physiotherapy, (88)8, 471-480

Cheng, N., Van Hoff, H., & Bockx, E. (1982) The effect of electriccurrents on ATP generation protein synthesis, and membrane transport in rat skin, Clinical Orthopedics 264 -272

Frick, A. & McCauley, D. (2005), Microcurrent Electrical Therapy, Journal of Equine Veterinary Science 418 - 422

Kalamed Corporation, Electrical Bone Growth Stimulator, Journal of Equine Veterinary Science

Lee, B.Y., Al-Waili, Stubbs, D., Wendell, K., Butler, G., Al-Waili, T.,& Al-Waili, A. (2010), Ultra-low Microcurrent in the Management of Diabetes Mellitus, Hypertension and Chronic Wounds: Report of Twelve Cases and Discussion of Mechanism of Action, Inernational Journal of Medical Sciences, (7)1, 29-35

Lee, B.Y., Wendell, K., Al-Waili, N. & Butler, G., (2007), Ultra-Low Microcurrent Therapy: A Novel Approach for Treatment of Chronic Resistant Wounds, Advances in Therapy, (24)6, 1202-1209

Marshall, D. Mircro-current TENS in Treating Ligament Injuries, Journal of Equine Veterinary Science

Primack, N. The History of Microcurrent Stimulation http://www.texas-medical.com/info/mchistory.htm

Santos, V.N.S., Ferreira, L.M., Horibe, E.K.,& Duarte, I.S.(2004) Electric microcurrent in the restoration of the skin undergone a trichloroacetic acid peeling in rats. Acta Cir Bras, (19),5, 466-470