Article

OBJECTIVES: To investigate the efficacy of local cooling on reducing sacral skin
ischemia in a weight-bearing position, and to identify the underlying
physiological mechanisms using wavelet-based spectrum analysis of reactive
hyperemia in people with spinal cord injury (SCI). DESIGN: Repeated-measures and
before-after trial design. SETTING: University research laboratory. PARTICIPANTS:
Wheelchair users with SCI with injury level between C4 and T5 (n=10) and
able-bodied controls (n=10). INTERVENTIONS: Three protocols consisting of
pressure without temperature changes, pressure with local cooling (Deltat=-10
degrees C), and pressure with local heating (Deltat=+10 degrees C) were tested.
Each protocol consisted of a 10-minute baseline period, a 20-minute loading
period at 60 mmHg, and a 20-minute recovery period (reactive hyperemia). A
30-minute washout period was allowed between protocols. MAIN OUTCOME MEASURES: A
compound sensor head consisting of laser Doppler and heating and cooling probes
was used to measure sacral skin blood flow and control skin temperature. Reactive
hyperemic response to pressure and temperature stimuli was characterized in the
time and frequency (metabolic [.0095-.02 Hz], neurogenic [.02-.05 Hz], and
myogenic [.05-.15 Hz] components) domains. RESULTS: Pressure with local cooling
resulted in a smaller reactive hyperemic response in both people with SCI and
able-bodied controls as compared with pressure with local heating (P<.017) and
pressure without temperature changes (P<.017), and the smaller hyperemia was
attributed to reduced metabolic and neurogenic activities. People with SCI showed
an attenuated response in reactive hyperemia (P<.017). CONCLUSIONS: This study
supports the concept of using local cooling to reduce skin ischemia under surface
pressure in people with SCI.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
- Escarre

Langue : ANGLAIS