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Cold water immersion for the oedematous hand in stroke patients

Department of Physical Medicine and Rehabilitation, Howard A Rusk Rehabilitation Center, University of Missouri-Colombia Hospital and Clinics, Columbia

John A Gragnani

Department of Physical Medicine and Rehabilitation, Howard A Rusk Rehabilitation Center, University of Missouri-Colombia Hospital and Clinics, Columbia

One of the therapeutic effects of cold application is to decrease oedema through local vasoconstriction. The oedematous hand of the hemiplegic side in the stroke patient is common and usually due to the dependency and the lack of motor function of the hand, or as a result of reflex sympathetic dystrophy. The objective of this study was to determine the effectiveness of cold water immersion therapy for the oedematous hand by measurement of hand volume before and after the therapy. To determine the experimental error in measurement of hand volume, 13 normal subjects were tested as the control study, 10 times each, by measurement of the overflow of water when the hand was immersed. A water tank with a temperature control was designed to maintain a constant temperature during each experiment. The water temperature was between 49°F (9.4°C) and 52°F (11.1 °C) depending on the patient's tolerance to the cold. Hand volume was measured before and after immersion. The hand was placed into the cold water intermittently, as the patient tolerated it, for 30 minutes. There were 14 experiments in nine stroke patients. It was found that experimental error in measurement of hand volume in the normal subjects varied from 3.2ml to 12.3ml, with the mean value of 6.4ml. One patient did not show any hand volume change. In eight stroke patients, the decrease in hand volume ranged from 1 0ml to 45ml after the cold water immersion. Since it is easy and readily available, cold water immersion should be taught to stroke patients for home treatment of the oedematous hemiplegic hands.

Clinical Rehabilitation, Vol. 3, No. 2, 97-101 (1989)
DOI: 10.1177/026921558900300202


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