The Cooling-Suit In Multiple Sclerosis

Ten heat-sensitive patients with MS were randomly allocated in a cross-over study to wear a cooling garment for 60 minutes at 7 degrees C (active cooling) and 26 degrees C (sham cooling).

In contrast to sham cooling, active cooling improved fatigue and postural stability with eyes closed and muscle strength.

There was no decrease in Tympanic temperature, but active cooling was associated with a 41% decrease in mean Leukocyte Nitric Oxide (NO) production (p = 0.004).

This effect on NO could be relevant because it Blocks Conduction in DeMyelinated Axons.

The aim of the present study was to determine whether any significant alterations of Evoked Potentials could be detected after treatment of patients with Multiple Sclerosis with a cooling suit.

All patients had previously experienced a positive effect of this treatment.

Six patients were investigated with Visual, Sensory and Motor Evoked Potentials and six further patients with only Motor Evoked Potentials. All patients had relevant clinical lesions.

The mean values for the group of patients were similar before and after cooling, but a few individuals showed a substantial improvement of Motor Evoked Potentials after cooling, with increased amplitude and/or shortened Central Motor Conduction Time.

There was also a weak, but significant, correlation between temperature decrements and the reduction of Central Motor Conduction Time.

However, since the Central Motor Conduction Times of most patients were only slightly affected, this effect could explain only a small part of the beneficial effect of cooling.

Effects on Cognition and executive ability or improvement of Spasticity may be of greater importance.

Approximately 60%-80% of all Multiple Sclerosis (MS) patients are heat sensitive.

The aim of this study was to gain information on the effects of an assistive device, the cooling-suit, on MS-patients' self-care ability and also practical implications.

A single-case approach was adopted in a quasi- experimental before-and-after study.

The cooling-suit was used in their own homes by 10 individuals with diagnosed MS in different stages from Relapsing/Remitting to Chronic/Progressive.

Data collection procedures were self-assessment through a structured assessment-instrument, an open-ended interview before and after the intervention and a diary written during one week.

The selected instrument, the MS Self-Care ADL Scale, has been developed for persons with MS and was translated into Swedish.

The results showed increased self-care ability during and after use of the cooling-suit. However, different aspects of daily life activities were improved and to a varying extent.

It is concluded that the study participants were supported and empowered in different activities of daily life such as walking and transfer and reduced voiding problems by using the cooling-suit.

Some difficulties in handling the cooling-suit were also reported.

Aim Of The Study
To study if the use of a Cooling-Suit by individuals with Multiple Sclerosis (MS) influenced their experience of Fatigue and consequent restrictions in daily life.

Background
The majority of MS patients consider Fatigue as one of their most disabling symptoms and as having a significant impact on their daily lives.

Fatigue often increases in a warm environment. A Cooling-Suit has been reported as a practical method of cooling, but the effect on Fatigue has not yet been studied.

Research Methods
Eight individuals used a Cooling-Suit in their own homes during a test-period. In a single case-control design, their experience of Fatigue was studied before and after.

Quantitative and qualitative methods were used: self-assessments using the Fatigue Impact Scale (FIS), open-ended interviews and semi-structured diaries.

Results
All study participants reported a reduction in Fatigue during the test period.

On the FIS, they scored reductions in the physical, cognitive and psycho-social dimensions of daily life. They experienced Fatigue less often and for shorter periods.

In their diaries and interviews they described decreased muscular strain, less sense of Fatigue in relation to intake of food and positive effects on cognitive, social or affective problems related to Fatigue.

Discussion
The Cooling-Suit is a practical method for cooling. It gives freedom and flexibility and can be used regardless of setting.

Nurses who meet heat-sensitive individuals with MS have the opportunity to give information on cooling methods, including how to use a Cooling-Suit.

In this pilot study we found that individuals with MS who suffered from Fatigue reported a number of improvements in quality of daily life.