Cryotherapy Effect Clinical Trial
Official title:
The Effect of Cryotherapy on Cerebral Hemodynamics Within Healthy Subjects
Upon suffering a concussion, a neurometabolic cascade including an increase in glucose and oxygen demand occurs for up to 48 hours post-insult.5 This period of increased glucose and oxygen demand is coupled with a period of hyperperfusion and decreased cerebral blood flow. 6-9 Cryotherapy in the musculoskeletal system has been shown to decrease tissue temperature, blood flow, oxygen and metabolic demands.10-17 Cryotherapy following moderate or severe traumatic brain injury has been demonstrated to decrease intracranial metabolic processes and oxygenation consumption.18-23 Although the benefits of cryotherapy have been established in moderate-severe TBI, the effects of superficial cranial cooling in individuals with and without concussion are unknown. The purpose of this randomized control trial is to evaluate the effects of superficial cryotherapy on cerebral blood flow and cognitive function in healthy, recreationally active young adults.
The prevalence of concussion has been estimated to be between 4,380 and 10,403 concussions
per day in the United States annually with over an estimated 3 million visits to emergency
departments each year.1 Symptoms following a concussion last up to 10 days for 90% of cases2;
however, the reduction of symptoms in this time frame does not indicate full neurometabolic
recovery.
Following concussion, a neurometabolic cascade of events immediately occurs following initial
impact with return to normative values around 30 days post-injury. In an attempt to maintain
homeostasis in the brain following impact, glucose and oxygen demand increases temporarily
and are coupled with periods of increased hyperperfusion and decreased cerebral blood flow
(CBF). Although the neurometabolic timeline immediately following impact is only generally
understood, there is consensus upon acute increases in CBF and metabolic activity followed by
decreased CBF until return to normative values.
Cryotherapy has been studied extensively for its' effects throughout the musculoskeletal
system. Cryotherapy in the musculoskeletal system has been shown to decrease tissue
temperature and blood flow, as well as decrease oxygen and energy demands.12-19 Cryotherapy
has also been applied in cases of moderate or severe traumatic brain injury and has
demonstrated to decrease intracranial metabolic processes and oxygenation consumption.
Although the potential benefits of cryotherapy have been established in cases of moderate to
severe traumatic brain injury (TBI), there is no current research examining cryotherapy in
the treatment of concussion.
A convenience sample of 34 healthy, recreationally active individuals between the ages of
18-25 years will be recruited for participation in this study. The independent variable in
this study will be group (cryotherapy, control). The primary outcome measures of interest are
cognitive functioning measured using the Stroop Test and cerebral blood hemodynamics and
hemoglobin saturation measured using near infrared spectroscopy. The pain visual analog scale
(VAS) will be used to quantify tolerance to the intervention.
The following study will address the following objectives and related hypotheses:
Objective 1: To determine if the application of cryotherapy influences intracranial
hemodynamics within healthy recreationally active young adults.
Hypothesis 1: Cryotherapy will cause a decrease in intracranial hemodynamics; specifically,
the CO2 saturation and deoxygenated hemoglobin causing a decrease in intracranial metabolic
activity.
Objective 2: To determine if the application of cryotherapy decreases cerebral blood flow
within healthy recreationally active individuals.
Hypothesis 2: The application of cryotherapy will not cause a change in cerebral blood flow
due to the highly regulated central nervous system.
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