Using reactive hyperemia to assess the efficacy of local cooling on reducing sacral skin ischemia under surface pressure in people with spinal cord injury

A preliminary report

Research output: Contribution to journalArticle

Abstract

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 (Δt=-10 C), and pressure with local heating (Δt=+10 C) were tested. Each protocol consisted of a 10-minute baseline period, a 20-minute loading period at 60mmHg, 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-.02Hz], neurogenic [.02-.05Hz], and myogenic [.05-.15Hz] 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.

Original languageEnglish (US)
Pages (from-to)1982-1989
Number of pages8
JournalArchives of Physical Medicine and Rehabilitation
Volume94
Issue number10
DOIs
StatePublished - Oct 1 2013

Fingerprint

Hyperemia
Spinal Cord Injuries
Ischemia
Pressure
Skin
Heating
Temperature
Wheelchairs
Skin Temperature
Weight-Bearing
Spectrum Analysis
Lasers
Head
Outcome Assessment (Health Care)
Wounds and Injuries
Research

Keywords

  • Laser-Doppler flowmetry
  • Microcirculation
  • Pressure ulcer
  • Rehabilitation
  • Skin temperature
  • Spinal cord injuries
  • Wavelet analysis

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

@article{830db680002840639b0f00b1adb1a2ce,
title = "Using reactive hyperemia to assess the efficacy of local cooling on reducing sacral skin ischemia under surface pressure in people with spinal cord injury: A preliminary report",
abstract = "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 (Δt=-10 C), and pressure with local heating (Δt=+10 C) were tested. Each protocol consisted of a 10-minute baseline period, a 20-minute loading period at 60mmHg, 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-.02Hz], neurogenic [.02-.05Hz], and myogenic [.05-.15Hz] 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.",
keywords = "Laser-Doppler flowmetry, Microcirculation, Pressure ulcer, Rehabilitation, Skin temperature, Spinal cord injuries, Wavelet analysis",
author = "Jan, {Yih Kuen} and Fuyuan Liao and Rice, {Laura A.} and Woods, {Jeffrey A.}",
year = "2013",
month = "10",
day = "1",
doi = "10.1016/j.apmr.2013.03.022",
language = "English (US)",
volume = "94",
pages = "1982--1989",
journal = "Archives of Physical Medicine and Rehabilitation",
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T1 - Using reactive hyperemia to assess the efficacy of local cooling on reducing sacral skin ischemia under surface pressure in people with spinal cord injury

T2 - A preliminary report

AU - Jan, Yih Kuen

AU - Liao, Fuyuan

AU - Rice, Laura A.

AU - Woods, Jeffrey A.

PY - 2013/10/1

Y1 - 2013/10/1

N2 - 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 (Δt=-10 C), and pressure with local heating (Δt=+10 C) were tested. Each protocol consisted of a 10-minute baseline period, a 20-minute loading period at 60mmHg, 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-.02Hz], neurogenic [.02-.05Hz], and myogenic [.05-.15Hz] 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.

AB - 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 (Δt=-10 C), and pressure with local heating (Δt=+10 C) were tested. Each protocol consisted of a 10-minute baseline period, a 20-minute loading period at 60mmHg, 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-.02Hz], neurogenic [.02-.05Hz], and myogenic [.05-.15Hz] 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.

KW - Laser-Doppler flowmetry

KW - Microcirculation

KW - Pressure ulcer

KW - Rehabilitation

KW - Skin temperature

KW - Spinal cord injuries

KW - Wavelet analysis

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U2 - 10.1016/j.apmr.2013.03.022

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SP - 1982

EP - 1989

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

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ER -