The contribution of central and peripheral mechanisms in the etiology of CIVD
paraplegia
COLD, PARAPLEGIA
The present study was designed with the view of contributing to the resolution of the issue regarding the contribution of central and peripheral (local) mechanisms in the initiation of CIVDs during immersion of either the hands or feet in cold water. We considered that our approach of comparing the CIVD response in fingers and toes of able-bodied and paraplegic individuals would provide evidence in support of one or the other. The evidence generated by this study has, perhaps, generated more questions than it has resolved. Indeed, the absence of CIVDs in toes of able-bodied individuals in thermoneutral and cool ambient conditions, but not in the toes of the paraplegics, would favor a local mechanism. As discussed above, the observed skin temperature fluctuations in individuals with paraplegia may have been initiated by nonthermal factors (e.g., bladder stretching), thus confounding our ability to discern the origin of the responses. In this sense, our results favor a central origin of the CIVD response (Flouris and Cheung 