Testing a Feedback‐controlled Heated Vest to Treat Thermoregulatory Dysfunction in Persons with Spinal Cord Injury

Abstract

Study ObjectiveAfter spinal cord injury (SCI), The ability to maintain a constant core body temperature (Tcore) is compromised. Persons with higher levels of SCI (Hi‐SCI: above the first thoracic vertebrae) are far more vulnerable to hypothermia (Tcore <35°C) when exposed to cool ambient temperatures. A decrease in Tcore in persons with Hi‐SCI has been associated with impaired cognitive performance after limited exposure to cool environmental conditions (2 hours at 18°C). The objective of this pilot study is to determine the efficacy of a feedback‐controlled heated vest (HV) to minimize the decrease in Tcore and associated cognitive impairment in persons with Hi‐SCI when exposed to cool ambient conditions.MethodsThree participants with Hi‐SCI (C4‐C7, AIS A‐B) were recruited to study under two conditions [HV and non‐heated vest (NHV)] in random order on 2 separate visits when exposed to a cool challenge (CC). To obtain Tcore in a continuous manner, participants ingested a CorTempR capsule 1‐3 hours before initiation of the study. Abdominal (Tabd) and distal (Tdsk) skin temperatures were measured. Fifteen minutes of baseline (BL) data were collected while seated at thermoneutral (25°C). At the end of BL, a cognitive battery that consisted of the Montreal Cognitive Assessment (MoCA) and Stroop Color and Word Test (SCWT) was administered. Participants were then fitted with either HV or NHV and transferred into an 18°C room for 2 hours, after which the cognitive battery was once again administered.Results: During Cool Challenge (values are expressed as BL‐ CC): The decrease in Tcore was less when wearing the HV (‐0.22°C) than when wearing the NHV (‐0.54°C). The increase in Tabd was greater when wearing the HV (4.34°C) than when wearing the NHV (0.90°C). When wearing the HV, Tdsk of the fingers was higher (6.48°C HV vs. 4.20°C NHV), but not of the toes (6.46°C HV vs. 7.92°C NHV). The decrease in performance for the MoCA was less when wearing the HV (‐8.33%) than when wearing the NHV (‐43.33%). The decrease in score for the Stroop word test was less when wearing the HV (‐0.17%) than when wearing the NHV (‐3.32%). Of note, the Stroop Color and Color‐Word score increased when wearing the HV (10.12% and 5.73%, respectively) but decreased when wearing the NHV (‐0.97% and ‐4.9%, respectively).ConclusionIn persons with Hi‐SCI, our preliminary findings demonstrate the ability of the HV to minimize the expected decline in Tcore when exposed to the CC and decreased the decline in cognitive performance. While our results are quite encouraging, they require confirmation in a larger number of participants. However, once confirmed, our HV may offer persons with Hi‐SCI protection against adverse declines in Tcore when exposed to cool environmental conditions.