Thermoregulation during intermittent exercise in athletes with a spinal-cord injury

Purpose: Individuals with a spinal-cord injury have impaired thermoregulatory control due to a loss of sudomotor and vasomotor effectors below the lesion level. Thus, individuals with high-level lesions (tetraplegia) possess greater thermoregulatory impairment than individuals with lower-level lesions (paraplegia). Previous research has not reflected the intermittent nature and modality of wheelchair court sports or replicated typical environmental temperatures. Hence, the purpose of this study was to investigate the thermoregulatory responses of athletes with tetraplegia and paraplegia during an intermittent-sprint protocol (ISP) and recovery in cool conditions. Methods: Sixteen wheelchair athletes, 8 with tetraplegia (TP, body mass 65.2 ± 4.4 kg) and 8 with paraplegia (body mass 68.1 ± 12.3 kg), completed a 60-min ISP in 20.6°C ± 0.1°C, 39.6% ± 0.8% relative humidity on a wheelchair ergometer, followed by 15 min of passive recovery. Core temperature (Tcore) and mean (Tsk) and individual skin temperatures were measured throughout. Results: Similar external work (P = .70, ES = 0.20) yet a greater Tcore (P < .05, ES = 2.27) and Tsk (P < .05, ES = 1.50) response was demonstrated by TP during the ISP. Conclusions: Despite similar external work, a marked increase in Tcore in TP during exercise and recovery signifies that thermoregulatory differences between the groups were predominantly due to differences in heat loss. Further increases in thermal strain were not prevented by the active and passive recovery between maximal-effort bouts of the ISP, as Tcore continually increased throughout the protocol in TP

Integrated fan cooling of the lower back for wheelchair users

Introduction: A large proportion of a wheelchair user's body is in contact with their wheelchair. Integrated fan cooling systems fitted to a wheelchair's backrest aim to alleviate the build-up of heat at the skin-chair interface. The aim of this pilot study was to evaluate the effectiveness of an integrated fan cooling system at cooling the user during daily pushing activity. Methods: Eight male able-bodied participants completed two conditions, with (FAN) and without (CON) fan cooling, pushing for four 15 min blocks. The fan was turned on (highest setting) at the end of block 1 (FAN), whilst in CON the fan remained off. Skin temperature was measured over the back and chest throughout alongside heart rate and perceptual responses (rating of perceived exertion, thermal sensation, thermal comfort, wetness sensation) at the end of each 15 min block. Results: Wetness sensation and lower back skin temperature were lower in FAN (both p < 0.02), with the difference in lower back skin temperature between the two conditions being 2.20°C at the end of block 4. Conclusion: The integrated fan cooling system provided significant cooling to the lower back without affecting any other physiological or perceptual response, besides wetness sensation

Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study

Study design: Retrospective chart audit. Objectives: The National Early Warning Score (NEWS) is based on seven physiological parameters which can be altered in some individuals with spinal cord injuries (SCI). The aim was to start the development of adapted NEWS suitable for SCI population. The objective was to determine the SBP NEWS specificity based on neurological level of injury (NLI) and completeness of injury. Setting: Tertiary centre in the UK. Methods: Adult patients admitted for the first time to the National Spinal Injuries Centre between 1st January 2015 and 31st December 2016 were included if they were > 6 months post-injury. Data were extracted retrospectively including the last ten consecutive BP and heart rate readings before discharge. Data were analysed based on different AIS grades, completeness of injury and NLI. Results: 191 patients were admitted in 2015 and 2016 and 142 patients were included in the primary analysis. The mean SBP ranged between 92 and 151 mmHg. Patients with the NLI of T6 and above (≥ T6) motor complete lesions had a significantly lower SBP than motor incomplete lesions. The specificity of the SBP NEWS was 35.3% in ≥ T6 motor complete individuals versus 80.3 % in ≥ T6 motor incomplete individuals. Conclusion: The baseline BP is significantly lower in the ≥ T6 motor complete SCI individuals (> 6 months post-injury) resulting in a very low specificity of 35.3 % to SBP NEWS which could lead to mismatch between clinical deterioration and NEWS resulting in lack of timely clinical response

Effects of cooling before and during simulated match play on thermoregulatory responses of athletes with tetraplegia

Objectives: Athletes with high level spinal cord injuries (tetraplegia) are under greater thermal strain during exercise than the able-bodied. The purpose of this study was to investigate the effectiveness of pre-cooling using an ice vest and the combination of pre-cooling and cooling during play using water sprays in athletes with tetraplegia. Design: Counter-balanced, cross-over design. Methods: Eight wheelchair rugby players with tetraplegia completed a 60 min intermittent sprint protocol (ISP) on a wheelchair ergometer in 20.2 °C ± 0.2 °C and 33.0% ± 3.1% relative humidity. The ISP was conducted on three occasions; no cooling (NC), pre-cooling with an ice vest (P) and pre-cooling with an ice vest and water sprays between quarters (PW). Gastrointestinal (Tgi) temperature, mean skin temperature (Tsk) and perceptual responses were measured throughout. Results: At the end of pre-cooling, the change in Tgi was not significantly different between conditions (P > 0.05) but the change in Tsk was significantly greater in P and PW compared to NC (P 0.05). Conclusions: Water spraying between quarters combined with pre-cooling using an ice vest lowers thermal strain to a greater degree than pre-cooling only in athletes with tetraplegia, but has no effect on simulated wheelchair rugby performance or perceptual responses

Thermoregulatory responses during competitive wheelchair rugby match play

The purpose of this study was to determine whether a player’s physical impairment or activity profile was related to the amount of thermal strain experienced during wheelchair rugby match play. 17 elite wheelchair rugby players played a competitive match, whilst activity profiles, measures of core and skin temperature, heart rate and perceptual responses were taken. Players were divided into 2 groups depending on their physical impairment: players with a cervical spinal cord injury, (n=10) or non-spinal related physical impairment (n=7). Total distance was lower (4 842±324 vs. 5 541±316 m, p<0.01, ES=2.2) and mean speed slower (1.13±0.11 vs. 1.27±0.11 m∙s−1, p<0.03, ES=1.3) in players with a spinal cord injury. Yet, the change in core temperature (1.6±0.4 vs. 0.7±0.3°C, p<0.01, ES=2.5) was significantly greater in players with a spinal cord injury. In conclusion, players with a spinal cord injury were under greater thermal strain during wheelchair rugby match play, as a result of their reduced heat loss capacity, due to their physical impairment and not because of their activity profile

Evaporative heat loss insufficient to attain heat balance at rest in individuals with a spinal cord injury at high ambient temperature

The aim of the study was to determine whether climatic limits for achieving heat balance at rest are affected by spinal cord injury (SCI). Twenty-three males (8 able-bodied (AB), 8 with paraplegia (PP) and 7 with tetraplegia (TP)) rested in 37°C and 20% relative humidity (RH) for 20 mins. With the ambient temperature held constant, RH was increased by 5% every 7 mins, until gastrointestinal temperature (Tgi) showed a clear inflection or increased by >1°C. Tgi, skin temperatures, perceptual responses and metabolic energy expenditure were measured throughout. Metabolic heat production (AB: 123 (21) W, PP: 111 (15) W, TP: 103 (29) W) and required rate of evaporative cooling for heat balance (Ereq, AB: 113 (20) W, PP: 107 (17) W, TP: 106 (29) W) were similar between groups (p = 0.22 and p = 0.79). Compared to AB, greater increases in Tgi were observed in TP (p = 0.01), with notable increases in mean skin temperature (Tsk) for TP and PP (p = 0.01). A Tgi inflection point was demonstrated by 7 AB, only 3 out of 8 PP and none of TP. Despite metabolic heat production (and Ereq) being similar between groups evaporative heat loss was not large enough to obtain heat balance in TP, linked to a shortfall in evaporative cooling potential. Although PP possess a greater sweating capacity, the continual increase in Tgi and Tsk, in most PP, while lower than for TP, implies that latent heat loss for PP is also insufficient to attain heat balance

Infographic. Thermoregulatory impairment in athletes with a spinal cord injury

Presented in this infographic is a summary of studies investigating the thermoregulatory impairment of athletes with a spinal cord injury during real-world sporting scenarios. The infographic depicts the heightened thermal strain experienced by athletes with tetraplegia (high level lesions), both compared to athletes with paraplegia (low level lesions) and within the sport of wheelchair rugby. In addition to the cooling interventions presented, the infographic highlights the significant need for appropriate interventions to reduce the risk of overheating and potential performance decrements. This infographic was field tested with those who work within a wheelchair sports environment, ranging from practitioners, researchers, athletes with an SCI and sports clinicians. The experimental studies were also designed in consultation with the wheelchair rugby coaches and players

Vascular disrupting agent for neovascular age related macular degeneration: a pilot study of the safety and efficacy of intravenous combretastatin A-4 phosphate

BACKGROUND: This study was designed to assess the safety, tolerability, and efficacy of intravenous infusion of CA4P in patients with neovascular age-related macular degeneration (AMD). METHODS: Prospective, interventional, dose-escalation clinical trial. Eight patients with neovascular AMD refractory to at least 2 sessions of photodynamic therapy received CA4P at a dose of 27 or 36 mg/m2 as weekly intravenous infusion for 4 consecutive weeks. Safety was monitored by vital signs, ocular and physical examinations, electrocardiogram, routine laboratory tests, and collection of adverse events. Efficacy was assessed using retinal fluorescein angiography, optical coherence tomography, and best corrected visual acuity (BCVA). RESULTS: The most common adverse events were elevated blood pressure (46.7%), QTc prolongation (23.3%), elevated temperature (13.3%), and headache (10%), followed by nausea and eye injection (6.7%). There were no adverse events that were considered severe in intensity and none resulted in discontinuation of treatment. There was reduction of the excess foveal thickness by 24.15% at end of treatment period and by 43.75% at end of the two-month follow-up (p = 0.674 and 0.161, respectively). BCVA remained stable throughout the treatment and follow-up periods. CONCLUSIONS: The safety profile of intravenous CA4P was consistent with that reported in oncology trials of CA4P and with the class effects of vascular disruptive agents; however, the frequency of adverse events was different. There are evidences to suggest potential efficacy of CA4P in neovascular AMD. However, the level of systemic safety and efficacy indicates that systemic CA4P may not be suitable as an alternative monotherapy to current standard-of-care therapy

Practical aspects in the management of hypokalemic periodic paralysis

Management considerations in hypokalemic periodic paralysis include accurate diagnosis, potassium dosage for acute attacks, choice of diuretic for prophylaxis, identification of triggers, creating a safe physical environment, peri-operative measures, and issues in pregnancy. A positive genetic test in the context of symptoms is the gold standard for diagnosis. Potassium chloride is the favored potassium salt given at 0.5–1.0 mEq/kg for acute attacks. The oral route is favored, but if necessary, a mannitol solvent can be used for intravenous administration. Avoidance of or potassium prophylaxis for common triggers, such as rest after exercise, high carbohydrate meals, and sodium, can prevent attacks. Chronically, acetazolamide, dichlorphenamide, or potassium-sparing diuretics decrease attack frequency and severity but are of little value acutely. Potassium, water, and a telephone should always be at a patient's bedside, regardless of the presence of weakness. Perioperatively, the patient's clinical status should be checked frequently. Firm data on the management of periodic paralysis during pregnancy is lacking. Patient support can be found at