title: Head pre-cooling improves symptoms of heat-sensitive multiple sclerosis patients.
abstract: BACKGROUND
  Damage to the central nervous system by Multiple Sclerosis (MS) leads to multiple symptoms, including weakness, ambulatory dysfunction, visual disturbances and fatigue. Heat can exacerbate the symptoms of MS whereas cooling can provide symptomatic relief. Since the head and neck areas are particularly sensitive to cold and cooling interventions, we investigated the effects of cooling the head and neck for 60 minutes on the symptoms of MS.
  
  
  METHODS
  We used a double blinded, placebo controlled, cross-over study design to evaluate the effects of head and neck cooling on six heat-sensitive, stable, ambulatory females with MS (Extended Disability Status Scale 2.5-6.5). To isolate the effects of perceived versus physiological cooling, a sham cooling condition was incorporated, where subjects perceived the sensation of being cooled without any actual physiological cooling. Participants visited the clinic three times for 60 minutes of true, sham, or no cooling using a custom head and neck cooling hood, followed by evaluation of ambulation, visual acuity, and muscle strength. Rectal and skin temperature, heart rate, and thermal sensation were measured throughout cooling and testing.
  
  
  RESULTS
  Both the true and sham cooling elicited significant sensations of thermal cooling, but only the true cooling condition decreased core temperature by 0.37 °C (36.97 ± 0.21 to 36.60 ± 0.23 °C). True cooling improved performance in the six minute walk test and the timed up-and-go test but not visual acuity or hand grip strength.
  
  
  CONCLUSIONS
  Head and neck cooling may be an effective tool in increasing ambulatory capacity in individuals with MS and heat sensitivity.
authors.affiliation: School of Health and Human Performance, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia.
authors.forename: Luke F
authors.initials: LF
authors.lastname: Reynolds
authors.forename: Christine A
authors.initials: CA
authors.lastname: Short
authors.forename: David A
authors.initials: DA
authors.lastname: Westwood
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cheung
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001831:Body Temperature / Q000502:physiology; D017679:Cryotherapy / Q000379:methods*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D006257:Head / Q000502:physiology*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D010292:Paresthesia / Q000209:etiology* / Q000628:therapy*; D013997:Time Factors; D016138:Walking