Increasing hand efficiency at cold temperatures by training hand vasodilation with a classical conditioning-biofeedback overlap design

Evaluation of a home treatment program for cold hypersensitivity using a classical conditioning procedure in patients with hand and arm injuries

STUDY DESIGN

Case series.

INTRODUCTION

A home treatment program using a classical conditioning procedure to decrease cold hypersensitivity has potential to reduce symptoms.

PURPOSE

To evaluate a home treatment program for cold hypersensitivity using a classical conditioning procedure in patients who are cold hypersensitive after hand and arm injuries.

METHODS

A series of 22 patients followed a classical conditioning procedure consisting of exposing the body to cold outdoor temperatures and immersing the hands in warm water, every other day, for five weeks. The McCabe Cold Sensitivity Severity scale (CSS) was used to measure cold hypersensitivity twice before treatment, at four weeks, and at one year after treatment; Likert scales was used for the patients ratings of improvements. A cold stress test was performed to evaluate rewarming capacity in injured fingers.

RESULTS

From the 20 patients, who returned questionnaires at all assessment points, 9 reported a small and three reported a moderate improvement in cold hypersensitivity after treatment. There was a trend toward improvement in the CSS (median 36; interquartile range--19 to 60) and in the rewarming pattern of fingers that were initially slow to rewarm. The improvements were sustained or increased at one-year follow-up.

CONCLUSION

These preliminary results suggest that the classical conditioning procedure to treat cold hypersensitivity has potential and should be further explored in a trial with more rigorous design.

Conditioning of skin conductance levels through a combined instrumental-classical conditioning procedure

A paucity of studies and inconsistent results characterize attempts to instrumentally condition tonic electrodermal activity. The present study was conducted to further explore the classical and instrumental conditioning of skin conductance levels (SCLs) through auditory analogue feedback. Fifty undergraduates were randomly assigned to one of five groups of equal size: instrumental conditioning alone, classical conditioning alone, instrumental and classical conditioning combined, and two control groups. The combined training group achieved significantly higher SCLs relative to the group receiving instrumental conditioning alone.

Comparability of skin temperatures from three sites on the hand

Skin temperature from three recording sites (web dorsum and two digital sites) on one hand were compared over a 30-minute period during which room temperature was raised from 66 degrees to 80 degrees F causing skin temperatures to range from 78.5 degrees to 92.3 degrees F. The web dorsum remained significantly warmer than either digital site at the lowest skin temperatures; no significant inter-site differences were seen as skin temperature gradually increased. These findings imply that none of the three sites is more advantageous than the others when recording hand temperature values around or above 85 degrees F. However, at the lower levels of skin temperature, there is a "floor" below which the web dorsum is no longer a sensitive indicator. More generally, basic data of this type provide a necessary but often absent foundation for routine practice of clinical biofeedback.

The persistence and transfer of voluntary hand-warming in natural and laboratory cold settings after 1 year

Hayduk (1980) used a classical conditioning-biofeedback overlap (CBO) design to teach six volunteers to warm their hands in an ambient temperature of - 14 degrees C. He found voluntarily warmed hands to be more dexterous, more sensitive, and less painful in the cold laboratory setting than unwarmed hands. The present paper reports a 1-year follow-up of five of Hayduk's original six volunteers. Ability to hand-warm was reevaluated, both at room temperature and at - 14 degrees C and was found to be essentially unchanged from post-training performance of the previous year. The effects of hand-warming on performance, sensation, and cold pain were remeasured in the cold laboratory and found to be essentially unchanged from the effects following training the previous year. Finally, the volunteers were asked to describe the degree to which they had used their hand-warming, and the circumstances under which they had used it, in natural settings throughout a Canadian winter. The volunteers reported only minimal use of hand-warming, primarily to reduce cold pain.