Article

Cooling of the lower limb in people with Hereditary and Spontaneous
Spastic Paraparesis (pwHSSP) has been shown to affect walking speed and
neuromuscular impairments.
The investigation of practical strategies, which may
help to alleviate these problems is important. The potential of superficial heat
to improve walking speed has not been explored in pwHSSP. Primary objective was
to explore whether the application of superficial heat (hot packs) to lower limbs
in pwHSSP improves walking speed. Secondary objective was to explore whether
wearing insulation after heating would prolong any benefits. METHODS: A
randomised crossover study design with 21 pwHSSP. On two separate occasions two
hot packs and an insulating wrap (Neo-G) were applied for 30minutes to the lower
limbs of pwHSSP. On one occasion the insulating wrap was maintained for a further
30minutes and on the other occasion it was removed. Measures of temperature
(skin, room and core), walking speed (10 metre timed walk) and co-ordination
(foot tap time) were taken at baseline (T1), after 30 mins (T2) and at one hour
(T3). RESULTS: All 21 pwHSSP reported increased lower limb stiffness and
decreased walking ability when their legs were cold. After thirty minutes of
heating, improvements were seen in walking speed (12.2%, P<0.0001, effect size
0.18) and foot tap time (21.5%, P<0.0001, effect size 0.59). Continuing to wear
insulation for a further 30minutes gave no additional benefit; with significant
improvements in walking speed maintained at one hour (9.9%, P>0.001) in both
conditions. CONCLUSIONS: Application of 30minutes superficial heating moderately
improved walking speed in pwHSSP with effects maintained at 1hour. The use of hot
packs applied to lower limbs should be the focus of further research for the
clinical management of pwHSSP who report increased stiffness of limbs in cold
weather and do not have sensory deficits.
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