Description of Intervention
Therapists teach patients to manage symptoms of cold hypersensitivity and intolerance in order to decrease discomfort and optimize hand function and activity performance.1 An essential part of treatment, therapists support patients to develop and maintain effective self-management strategies. Self-management strategies can be defined as strategies individuals use to manage the symptoms, treatments, physical and psychological consequences and lifestyle changes inherent in living with a chronic condition.2
Indications for Intervention
Cold hypersensitivity implies an abnormally low threshold to elicit cold-associated symptoms and signs. It affects the majority of patients sustaining upper-extremity nerve injuries.3 Typical symptoms include pain, aching, numbness, weakness, and stiffness and/or the feeling of coldness in the injured hand. These result from exposure to mildly cold temperatures and a relatively short period of cooling.4,5,6 Because the body does not adjust normally to cold temperatures, patients may experience peripheral vasoconstriction, that in turn leads to cold skin and a concomitant long time to re-warm fingers after cooling.7,8 The condition may arise after any tissue injury in the hand, but severe injuries are associated with more severe cold hypersensitivity.9 Symptoms often adversely affect hand function and/or restrict participation in ADL, work and leisure activities. The affects can become severe enough for patients to remain indoors during cooler weather and to use hand wear indoors even in warmer times of years.
Evaluation to Determine Need for Intervention
The therapist’s assessment consists of patient interview, recording patient reports and the use of rating scales and established questionnaires. Patients may grade their experience of the severity of symptoms such as discomfort, pain, numbness, reduced finger-sensibility, stiffness, or color changes in the hand upon cold exposure. Vaksvik et al used a five- point scale with the following categories: "none", "mild", "moderate", "severe" and "extreme". These researchers also employed the Blond McIndoe Cold Intolerance Symptom Severity questionnaire (CISS)3 and then expanded this questionnaire with some additional questions. Vaksvik et al measured cold exposure at work with the Potential Work Exposure Scale (PWES)11,12
If the patient experiences Raynaud’s, it may be possible to note the distribution of skin color change as exhibited with an avascular status. A photo of the color change will help to document this phenomenon.
Thermistors or infrared thermometers (reliability varies) also document hand temperature.
Intervention Options
According to Jarrell, management involves primarily prevention. She states that without proper management, the condition can have greater impact on overall quality of life. Management involves body core warmth maintenance, extremity warmth maintenance, lifestyle changes, and skin care.
As Jarrell10 states, the body prioritizes keeping the head and chest (core) warm. If heat escapes through these areas, the body will redirect blood away from the hands and feet to warm the core. She recommends thermo-protective clothing with high tech fabrics such as Outlast, Polarfleece, Polypropylene and Kaproline. She encourages socks, glove inserts, hats, earmuffs and long underwear. She notes that dressing in multiple layers also improves body insulation.
Patients will prefer to warm the environment before entering it. Use of electric blankets or mattress pads can not only warm the body, but also clothing when placed in the bed prior to dressing. Chemical and battery operated hand warmers can provide relief. Therapists should instruct patients to warm the car prior to getting in. Using a steering wheel cover can minimize hand cold exposure.
Changes to diet and changes in consumption of certain substances can promote comfort. High blood pressure can make cold intolerance more difficult to manage. Avoiding the vasoconstriction effects of some decongestants, nicotine and caffeine helps maintain extremity warmth.
In Vaksvik et al’s survey of cold hypersensitivity patients, they used several strategies, including clothing (100%), use of own body (movement/use of muscles to produce heat or massage of the fingers) (94%), and heating aids (48%), but were still limited in valued cold-associated activities two years after surgery.
Providing the names of the following organizations for additional patient information expands the services that therapists offer.
Raynaud’s Syndrome and Scleroderma Association
112 Crewe Road.
Alsager, Cheshire ST7 2JA
United Kingdom
Tel: 01270 872776
Fax: 01270 883556
Arthritis Foundation
1314 Spring Street, NW
Atlanta, GA 30309
Tel: (404) 872 – 7100
www.ArthritisFoundation.org
Precautions / Contraindications
Therapists should use care not to suggest interventions that interfere with patient’s current medication regimens.
Associated Diagnoses Where This Intervention May be Relevant
While some clinicians assume that patients with nerve or vascular injuries will have a higher incidence, one must be aware that any injury or surgery can precipitate cold hypersensitivity.
