TY - JOUR
T1 - Effectiveness of local cooling for enhancing tissue ischemia tolerance in people with spinal cord injury
AU - Tzen, Yi Ting
AU - Brienza, David M.
AU - Karg, Patricia E.
AU - Loughlin, Patrick J.
PY - 2013/7
Y1 - 2013/7
N2 - Objective: To investigate the effects of localized cooling and cooling rate on pressure-induced ischemia for people with and without neurological deficits. Design: A 2× 3 mixed factorial design with two groups: (1) people with spinal cord injury (SCI) and (2) people without neurological deficits (control), and three test conditions: (1) pressure only, (2) pressure with fast cooling (-4°C/min), and (3) pressure with slow cooling (-0.33°C/min). Setting: University laboratory. Participants: Fourteen controls and 14 individuals with SCI. Interventions: Pressure on the sacrum was 0.4 kPa for 5 minutes, then 8 kPa for 20 minutes, and finally 0.4 kPa for 15 minutes. Fast and slow cooling to 25°C applied during 8 kPa of pressure. Outcome measures: Reactive hyperemia and its spectral densities in the metabolic, neurogenic, and myogenic frequency ranges. Results: In controls, reactive hyperemia was greater in pressure only as compared with both cooling conditions. No change was noted in all spectral densities in both cooling conditions, and only neurogenic spectral density increased without cooling. In subjects with SCI, no difference was noted in reactive hyperemia among conditions. However, metabolic and myogenic spectral densities increased without cooling and all spectral densities increased with slow cooling. No change was noted in all spectral densities with fast cooling. Conclusion: Local cooling reduced the severity of ischemia in controls. This protective effect may be masked in subjects with SCI due to chronic microvascular changes; however, spectral analysis suggested local cooling may reduce metabolic vasodilation. These findings provide evidence towards the development of support surfaces with temperature control for weight-bearing soft tissues.
AB - Objective: To investigate the effects of localized cooling and cooling rate on pressure-induced ischemia for people with and without neurological deficits. Design: A 2× 3 mixed factorial design with two groups: (1) people with spinal cord injury (SCI) and (2) people without neurological deficits (control), and three test conditions: (1) pressure only, (2) pressure with fast cooling (-4°C/min), and (3) pressure with slow cooling (-0.33°C/min). Setting: University laboratory. Participants: Fourteen controls and 14 individuals with SCI. Interventions: Pressure on the sacrum was 0.4 kPa for 5 minutes, then 8 kPa for 20 minutes, and finally 0.4 kPa for 15 minutes. Fast and slow cooling to 25°C applied during 8 kPa of pressure. Outcome measures: Reactive hyperemia and its spectral densities in the metabolic, neurogenic, and myogenic frequency ranges. Results: In controls, reactive hyperemia was greater in pressure only as compared with both cooling conditions. No change was noted in all spectral densities in both cooling conditions, and only neurogenic spectral density increased without cooling. In subjects with SCI, no difference was noted in reactive hyperemia among conditions. However, metabolic and myogenic spectral densities increased without cooling and all spectral densities increased with slow cooling. No change was noted in all spectral densities with fast cooling. Conclusion: Local cooling reduced the severity of ischemia in controls. This protective effect may be masked in subjects with SCI due to chronic microvascular changes; however, spectral analysis suggested local cooling may reduce metabolic vasodilation. These findings provide evidence towards the development of support surfaces with temperature control for weight-bearing soft tissues.
KW - Induced hypothermia
KW - Ischemia
KW - Laser-Doppler flowmetry
KW - Pressure ulcer
KW - Reactive hyperemia
KW - Skin temperature
KW - Spinal cord injuries
UR - http://www.scopus.com/inward/record.url?scp=84880830850&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84880830850&partnerID=8YFLogxK
U2 - 10.1179/2045772312Y.0000000085
DO - 10.1179/2045772312Y.0000000085
M3 - Article
C2 - 23820151
AN - SCOPUS:84880830850
SN - 1079-0268
VL - 36
SP - 357
EP - 364
JO - Journal of Spinal Cord Medicine
JF - Journal of Spinal Cord Medicine
IS - 4
ER -