MXPA97006561A - Supporting apparatus accommodating a portion of the body for the application of localized cooling enáreas of the surface of the body with high contact - Google Patents

Abstract

The present invention relates to an apparatus for supporting at least a portion of a human or animal body ("body portion while cooling a weight bearing area of the body portion, the apparatus is characterized in that it comprises: a supporting article in step: a surface on the article, the surface includes a portion configured corresponding to a shape of the body portion to conform to the portion of the body and at least one cooler positioned to cool an area of the shaped portion receiving pressure that exceeds 20 Torr from a weight bearing area of the body portion

Description

SUPPORT DEVICE THAT ACCOMPANIES A PORTION OF THE BODY FOR APPLICATION OF LOCALIZED COOLING IN AREAS OF THE SURFACE OF THE BODY WITH HIGH PRESSURE CONTACT BACKGROUND OF THE INVENTION 1. Field of the Invention The invention relates to an apparatus that supports at least a portion of the body of a human being or of an animal (portion of the body), at the same time that it applies cooling in the areas of the portion of the body that support weight and that are supported by the apparatus. The invention relates, more specifically, to an apparatus having a shaped portion that conforms to a corresponding shape of the body portion and which applies cooling to one or more body areas that support weight, to avoid or alleviate any tissue damage that results from heat and pressure.

It is known that the application of pressure to a patient's skin over a prolonged period causes pressure ulcerations. Weight-bearing areas of the body surface are exposed to pressures that can easily exceed 100 mmHg (torr.). It has been shown that blood flow ceases in capillaries that are exposed to compressive pressures that exceed 25 torr. Consequently, it can be expected that the areas of the body surface and the subcutaneous tissues that support weight have an inadequate blood flow or even a total lack of blood flow during the time that the weight is being supported.

The normal cellular metabolism depends on the blood circulating properly, so that it delivers oxygen and nutrients to eliminate waste products. Prolonged interference of the local circulation results in a sequence of events divided into two parts, beginning with ischemia (a severe reduction in the supply of blood and oxygen to the tissues) and ending with a necrosis (irreversible cell and tissue death, which results in a slough).

Normally people change positions when they are in a chair or get up and walk to relieve the pressure on their buttocks. Usually people turn from side to side in bed while they sleep, to periodically redistribute their weight in a different surface area. Generally this movement is a reaction to pain caused by ischemia of skin tissue, or deep subcutaneous tissue, which is bearing weight. Patients bedridden or in wheelchairs, or patients who are in operating room tables, may not be aware of ischemic pain if they have brain or spinal cord injury, stroke, dementia, prolonged surgery with anesthesia, or prolonged sedation or mechanical breathing. Alternatively, also serious diseases, neuromuscular disorders or nervous system injuries can prevent the patient from moving even if they realize that they have ischemic pain.

In the operated patients, the incidence of ulcerations due to pressure fluctuates between 12% and 66% in different studies performed. Surveys performed on patients in general hospitals indicate that between 3-4.5% of all patients develop ulcerations due to pressure during their hospitalization. Pressure ulcers usually develop near regions of the body that have a bony prominence near the skin. More than 80% of all pressure ulcerations occur in the following five places: 1. Sacrococcygeal region (upper part of the gluteus), supine position. 2. Great trochanter (lower part of the hip), lateral recumbent position. 3. Ischial tuberosity (lower part of the gluteus), sitting position. 4. Tuberosity of the calcaneus (heel) supine position. 5. Male lateral (external ankle), lateral recumbent position.

Patients with surgical or bed-ridden operations are not the only patients susceptible to developing ulcerations. For example, paralyzed patients spend much of their lives in wheelchairs. There is a study that indicates that the incidence of pressure ulcerations is 21.6% in paraplegics and 23.1% in quadriplegics.

The equipment for the prevention of pressure ulcers has been concentrated in three areas: 1. Flip or periodically move the patient to minimize the time pressure is applied to any surface area. Time is given to the tissue to be perfused again during the period of time when pressure is not being applied. 2. Passive support surfaces, (cushions, mattresses and mats of all kinds), which can use unique special materials to minimize the pressure exerted on any given point of the body surface. Many types of materials have been treated, including: different types of polymeric foams, polymeric gels, and chambers filled with water and air. 3. Active support surfaces, such as a series of air-filled chambers that inflate and deflate alternately to automatically distribute the pressure.

Taking into account the high incidence of pressure ulcerations, despite the availability of many of these passive support surfaces (various materials and shapes), it is clear that the simple fact of distributing pressure to a larger surface area, and on itself It will not effectively prevent pressure ulcerations. Although active support surfaces have been used to avoid pressure ulcerations, however, it is clear that they are very expensive, uncomfortable and noisy. Consequently, it is not possible to use active support surfaces in many situations to prevent pressure ulcerations.

Finally, apart from the obvious pain and risk to the patient's health (with chronic infections in chronically open wounds), pressure ulcerations are extremely expensive and very slow to heal. The healing of an ulceration by normal pressure costs between $ 30,000 and $ 40,000 and takes between 3 and 6 months approximately. The high incidence of pressure ulcerations, the lack of a proven method to avoid pressure ulcerations, and the extremely high cost of curing them once they develop, indicate that there is a great need for new technology.

It is reasonable to assume that heat is an important factor in the formation of pressure ulcerations. All tissues increase between 7 and 10% metabolic rate each time the temperature increases 1 ° C. The increased metabolic rate increases the oxygen demand of cells by 7-10% similar for every 1 ° C increase in temperature. In a patient whose tissue injury is already compromised by external pressure or by vascular insufficiency, this increased metabolic oxygen demand could increase the speed of tissue perfusion. We hypothesized that this increased metabolic demand was the cause of the frequent "burns" that were observed after a warm-water mattress therapy during surgery, despite the relatively low temperatures of the mattresses (39 ° -42). ° C). These low temperature injuries can result in damage to the entire thickness of the skin, which looks identical to third-degree burns that result from exposing the skin to high temperatures. Although the damage throughout the thickness of the skin is identical to a thermal injury caused by high temperature ("burn"), in fact the injury is caused by pressure necrosis which accelerates due to the higher metabolic rate of the tissue. Although this existing interrelation between temperature, pressure and tissue ischemia is logical from the scientific point of view, it had never been proven before carrying out our recent experiments.

In addition, it is known that hypothermia decreases the cellular metabolic rate and increases the tolerance of the cells to periods of inadequate blood flow. This is the reason why patients are cooled when they have a cardiac vascularization. Consequently, we hypothesize that cooling the skin and subcutaneous tissue will make it more time, in fact, to appear a lesion when there is a risk of ischemia caused by inadequate local blood flow resulting from the pressure exerted against that tissue. .

To test this hypothesis, we created a porcine model to investigate the formation of pressure ulcerations. Twelve metal discs were applied to the back of an anesthetized pig. The pressure in the skin under each disc was approximately 100 torres (totally occlusive to the blood flow), during a lapse of 10 hours. The temperature of the discs was carefully controlled at 25 ° C. 35 ° C, 40 ° C and 45 ° C. The normal temperature of the porcine body is 38 ° C (the normal temperature of the human body is 37 ° C). The severity of the resulting tissue lesions was directly correlated with the increase in temperature. No tissue damage was found under the 25 ° C discs. Under the discs of 45 ° C severe damage was seen in the skin, in the subcutaneous tissues and in the deep ones. The discs of 35 ° C and 40 ° C also caused serious damage but of medium type in relation to extreme temperatures. The results of this experiment proved for the first time (to our knowledge) that our two hypotheses were correct: 1. Even moderate heat will accelerate the speed of tissue injury due to pressure-induced ischemia. 2. Moderate cold will protect against tissue damage due to ischemia caused by pressure.

For decades, water mattresses have been used in which fresh, or even cold, water circulates to cool patients with fever. However, experience has shown us that the application of cold in large surface areas of the body is very annoying and causes hypothermia and tremor. 2. Description of Related Inventions In the prior invention of US Pat. No. 3,738,702, a seat structure is described which cools a portion of the human body resting on the seat, in reaction to body heat, in the part where the body contacts the seat. In order to maximize the sensitivity of the cooler in relation to body heat, the cooler is placed as close as possible to the surface of the seat with which the body contacts.

SUMMARY OF THE INVENTION The object of this invention is to provide a weight-bearing apparatus, such as a chair or wheelchair cushion, a prosthesis or a bed cushion, having a support surface which prevents pressure ulcerations. The support surface has a shaped or structured portion that conforms to the shape of a portion of the body that is being supported. In this aspect, the shaped portion traps the body portion, preventing lateral movement of the body portion on the supporting surface. This portion of the surface conforms to the portion of the body so that the portion of the body can be positioned so that the weight-bearing part or parts of the body, specifically the areas where there is alreknown to be a "high" pressure contact (for example, greater than 20-25 torr.), are located in one or more specific parts ("zones"), or on them, of the support surface cooled to a temperature below the body's normal. The support surface applies a reduced temperature (or, to be more precise, removes heat) to those areas of the support surface in which it is acted upon by specific body areas that are known to have a "high" pressure contact with the surface, to be able to eliminate heat from those areas of the body.

The metabolic heat generated by the ischemic tissue is trapped by insulating cushions and raises the temperature of the tissue. Metabolic heat can not be eliminated internally due to inadequate blood flow and can not be eliminated externally due to the thermal insulation characteristics of padded cushions or mattresses. Metabolism continues (anaerobically) despite inadequate blood flow, and the heat generated by this metabolism continues to accumulate. Our studies with pigs show that any heating of the tissue is obviously harmful and that the fact of cooling the tissue below the body temperature is beneficial to avoid tissue injury caused by pressure. A cooling below the normal body temperature will be beneficial. Accordingly, this invention prevents the formation of metabolic body heat naturally generated in the ischemic tissue.

The invention will not cool the surface areas of the body that are not experiencing a "high" pressure contact. Because of the minimal blood flow in the "high" pressure areas, the cooling effect will be limited, in large part, to these tissues and will not cause total body hypothermia or discomfort.

Accordingly, the main purpose of this invention is to provide an apparatus that locally cools surface areas of body portions that are subject to a "high" pressure contact.

Another object is to provide a support apparatus having a support surface, with a shaped, contoured or structured portion, to retain a portion of the body, while cooling portions of the body portion that support weight that is retained. inside the portion of the surface.

A further object is to provide a support surface of a support apparatus with means for retaining a portion of the body on the surface, and means for applying localized cooling to areas of the body portion, which bear weight, which have a contact of "high pressure.

Other objectives and advantages will be obvious when reading the following detailed description along with what is described below.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a side view of a person seated on a cushion illustrating the invention.

Figure 2 shows a plan view, from the top, of the cushion illustrated in Figure 1, showing a support surface.

Figure 3 is a cross-section of the seated patient, taken in section 3-3 of Figure 1.

Figure 4 is a partially schematic illustration of the support cushion of Figure 2.

Figures 5A and 5B are cross sections, respectively, of B-B in Figure 4 of the preferred embodiment.

Figure 6 is a partially schematic illustration of a first alternative embodiment of the support cushion illustrated in Figure 2.

Figures 7A and 7B are cross sections, respectively, taken in C-C of Figure 6.

Figure 8 is a partially schematic illustration of a second alternative embodiment of the support cushion of Figure 2.

Figure 9 is a cross section in D-D of Figure 8.

Figures 10A and 10B are, respectively, drawings with a side view and profile cut of a prosthesis that are used to illustrate the invention.

Figure 11 is a profile cut drawing illustrating a preferred embodiment of the invention with reference to the profile section of Figure 10B.

Figure 12 is a cross-sectional view of the preferred embodiment of the prosthesis, taken along section E-E of Figure 11.

Figures 13 and 14 correspond, respectively, to the lateral and transverse views of figs. 11 and 12, and illustrate a first alternative embodiment of the invention.

Figures 15 and 16 correspond, respectively, to the lateral and transverse views of figs. 11 and 12 and illustrate a second alternative embodiment of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS With reference now to the Figures, in which similar reference numerals indicate similar elements in all the drawings, one can find illustrations of our invention. Our invention is a weight bearing apparatus having a support surface with a shaped portion that conforms to the shape of a portion of the body that is being supported. The portion of the surface that is shaped includes one or more zones. The areas are interconnected with weight-bearing areas of the body portion that are at risk of pressure injury. The zones are cooled below body temperature in order to reduce or eliminate the risk of injury. The illustrations show our invention made on a support cushion or mat in the manner in which it can be used, for example, in a chair or wheelchair, to support a portion of the body of a human being or of an animal and in a prosthesis to support a portion of the body that remains after it is amputated (hereinafter referred to as "body portion").

The support cushion embodying our invention is illustrated in FIGS. 1-3, wherein a person 12 is seated on a cushion 14, which has a support surface 15, which supports a portion of the person's body. As clearly shown in Figures 1 and 3, the portion of the body that is supported includes the buttocks and the posterior surfaces of a person's legs. As best seen in Figure 2, at least a portion of the support surface 15 is structured so that it can accommodate the shape of the portion of a body that is being supported. In particular, the structured portion, indicated by the reference numeral 16, of the surface 15, has a shape very similar to a tractor seat that prevents lateral movement of the body portion on the surface. In this way, when the person sits on the structured portion 16 of the support surface 15, it will always be positioned almost in the same place as the cushion 14. In the support cushion of the embodiment of the invention, the structured portion 16 of the support surface 15, therefore, incorporates a positioning means for receiving a portion of the human body and adjusting to it. In the case illustrated in figs. 1-3, that portion are the gluteals and the posterior surfaces of the upper part of the thighs. Of course, the support cushion can be made in various sizes to suit different people.

The ischemic tuberosities that support the weight of the person 12 (such as those of the gluteal bones) and the areas of the skin that contain the adjacent tissue that can undergo ischemia, can be foreseen in the structured portion 16. Such areas correspond to areas with contact of "high" pressure between the body portion of the person 12 and the support surface 15. These zones are identified by the reference number 18 of Figure 2. In the invention, these areas with "high" contact Pressure are cooled by cooling means.

As can be seen in Figure 3, the cushion 14 can be made of a compressible material that "remembers" its uncompressed shape and returns to that shape when released from compression. However, in the invention, the non-compressed form shows the structured area 16 of the support surface 15 with a shape corresponding to the portion of the human body that is being supported by the cushion 14.

Referring now to Figures 4, 5A and 5B, wherein the structured portion 16 of the support surface 15 of the cushion 14 includes, in the areas 18, an illustrative means for applying cooling in the areas 18 to thereby reduce the temperature of the fabric of the areas of the body portion that support weight and that are being supported by the cushion 14 and to reduce the risk of tissue damage. In this aspect, the cooling means consist of circulating liquid mats 20 through which a cold liquid can circulate. Each of the mats 20 includes an inlet hose 21 and an outlet hose 22 through which the cold liquid can flow from a source of pressurized cold liquid. Cooling mats, such as mats 20, may consist of structures made of two sheets of material, such as flexible polyethylene or polyvinyl films, which are thermoformed into a series of liquid channels and then heat sealed together around their peripheries. The cold liquid circulates through the mats 20 with the help of an external pump with means to control the temperature of the fluid (the pump is not shown). The circulating cold liquid causes each of the circulating fluid mats 20 to become a primary heat sink. The heat is finally dissipated in a secondary heat sink (not shown) that is generally at room temperature. To connect the primary heat sink to the secondary heat sink in the case of the invention illustrated in Figure 4, a pipe (provided by the inlet pipes 21 and the outlet pipes 22), a pump, a tank and cooling means are required (the last three are not shown in the Figures). The cooling means may consist of compression cooling, thermoelectric cooling, radiator cooling, ice cooling, phase change cooling or any other suitable method for cooling the circulating fluid.

As best seen in Figure 5A, the circulating fluid mats 20 each include a surface that is continuous to the surface 15 that is within the structured portion 16. The mats 20 cool the zones 18 when the liquid cold is circulating through the mats. In Figure 5A, the upper surfaces of the mats 20 have direct thermal contact with a person. The structured portion 16 guides the ischemic tuberosities of the person so that they come into contact with the chilled zones 18.

In Figure 5B, the circulating fluid mats of the zones 18 are disposed respectively below the layers 24 of thermally conductive material. The layers 24 are optional and are intended to match any irregularity of the surfaces of the mats 20 caused by the thermoformed channels. The mats that are full of liquids or polymeric gels, are examples of mats that incorporate layers 24.

Now we will refer to Figures 6, 7A and 7B for an explanation of a first alternative embodiment of a support cushion according to the invention. In the first alternative embodiment, the zones 18 are cooled by the thermoelectric devices 30. Each device includes a heat dissipating metal plate 31 with a contoured upper surface conforming to the shape of the shaped portion 16, and integrating with the same, of the support surface 15. Underneath the heat dissipating metal plate 31 is placed a thermal insulator 32 and surrounds a thermoelectric module 34. Underneath the thermoelectric module is placed a heat-radiating metal plate 36 comprising of a plurality of fins 38. The thermoelectric module 34 is in direct thermal contact with the heat dissipating metal plate 31, with the heat radiating metal plate 36 and with the fins 38. When operating, when a person's buttocks are brought into contact with the contoured upper surface of the heat dissipating plate 31, the heat is brought from the gluteal area supporting weight through a path The thermal conductor 31, 34, 36 and is dissipated by the fins 38. Generally, a power source consisting of a battery and a temperature controller (not shown) is provided to operate the thermoelectric module 34. As shown in FIG. Figure 7B, the optional thermal conductive mats 24 may be interposed between the upper surfaces of the heat dissipating metal plates 31 and the portion of the body that is being supported by the cushion 14.

Figure 8 is a partially schematic illustration of a second alternative embodiment of the support cushion shown in Figure 2. In this second alternative embodiment, the cushion 14 is constituted by two separate sections 40 and 42, with the support surface 15 and the shaped portion 16 being formed in upper section 40. Sections 40 and 42 join and trap a support mesh disposed between two anchor tubes 46. Zones 18 are defined by two spaces 48 that open through section 42. Preferably, a fan is placed under a mesh 44 in each of the spaces 48. The fans 50 are positioned so as to send cool air or ambient air to the meshes 44 at a non-perpendicular angle so as to be able to circulate air around the meshes 44, and through them, in the zones 18. The air exits through the meshes 44 and through the bottom of the spaces 48. Each mesh 44 is preferably a woven fabric of synthetic, natural or metal fibers, or of a combination thereof. The meshes 44 are, preferably porous, with a non-tight fabric, so that air and water vapor can pass through them. Therefore, the air circulating around the meshes 14 and through them cools the weight-bearing areas of the body portion that rest on the zones 18.

Figures 10A and 10B show a side view and a cut-away view in profile of a prosthesis 50, resulting from a normal amputation above the knee ("a.k.a.", for its acronym in English). The prosthesis 50 includes an adapter receptacle 52 having an outer wall surface 54 and an inner wall surface 56, shaped to receive and fit the end that supports the weight of a stump of a leg 58. The Figures show the stump 58 inserted in the adapter receptacle 52, and supported thereby, of the prosthesis 50. The adapter receptacle is attached at its lower end to a knee joint 60, to a segment of a lower member 62, to an ankle joint 64 and to a foot 66. A similar arrangement of prosthesis and adapter socket is used for the prosthesis of amputation below the knee ("bka" for its acronym in English). The adapter receptacle 52 is generally made of fiber-reinforced plastic resin (such as fiberglass), which is molded to fit the trunnion 58.

In addition to the fiberglass adapter housing 52 being an excellent thermal insulator, the trunnion 58 is generally covered by a thick protective liner which serves as a pad between the trunnion and the adapter receptacle 52. Since the end of the femur (upper bone) of the leg) is cut, it is obvious that pressure of great magnitude is applied to the tissue that is between the cut end of the femur and the lower interior of the adapter receptacle 52. A pressure of such high magnitude can cause ischemia and necrosis in the skin and the tissue, creating ulcerations in the stump that are very difficult to heal. The heat that forms inside the adapter receptacle 52 increases and accelerates tissue damage.

Figure 11 shows a sectional profile view of a preferred embodiment of the invention in a prosthesis, as illustrated in Figures 10A and 10B, according to the invention. The preferred embodiment is also illustrated in Figure 12, which is a cross section taken along the EE of Figure 11. In Figures 11 and 12, the stump 58 is shown with the cut end of the femur 70. It is important to do note that there is no bulbous end of bone 70, as there would be in a normal joint or in a series of bones such as those found in the foot, whose function is to distribute the weight over a wider area. In the preferred embodiment, the support surface, comprising the surface of the inner wall 56, is formed at its lower end to conform to the end of the trunnion 58. A zone of "high" pressure between the end of the trunnion 58 and the surface of the inner wall 56 of the adapter receptacle 52, is cooled by a circulating fluid mat 72 corresponding to the mats 20 described above. In this regard, the circulating fluid pad 72 circulates a cold fluid by conventional means (not shown) and acts as a heat sink, removing the accumulated heat in the interconnection between the end of the die 58 and the interior of the adapter receptacle 52. The circulating fluid mat 72 is in thermal contact with the end of the trunnion 58, either directly or through a mat 74 filled with water or gel. A cold fluid, such as water, is circulated through the channels of the mat 72 by, for example, an external pump with cooling capacity and having the characteristics described above in relation to the means for cooling the circulating fluid for the mats 20.

Figure 13 is a sectional profile view of the first alternative embodiment of the prosthesis, according to the invention. The first alternative embodiment is also shown in the section illustrated in Figure 14, which is taken along GG of Figure 13. In the first alternative embodiment of the prosthesis, according to the invention, the area that is going to to be cooled is defined by the upper concave surface of a heat dissipating metal plate 80. The concave shape of the upper surface of the plate 80 houses the shape of the end of the trunnion 58. In the illustration of the first alternative embodiment shown in FIGS. figs 13 and 14, four thermoelectric cooling devices operate to cool the heat sink plate 80. Each of the thermoelectric devices includes a thermoelectric module 82 in direct thermal contact with the heat sink plate 80 and with a heat radiator plate 84 in which mount the fins 86 of the heat radiator. A thermal insulator 83 is provided, for example, with molding material which can be conformed to the concave shape of the lower surface of the heat dissipating metal plate 80. Also shown is the optional thermally conductive mat 74, which consists of a cushion full of gel or water.

A second alternative embodiment of the prosthesis of the invention is illustrated in Figures 15 and 16, in which Figure 15 is a sectional cut corresponding to Figure 10B, while Figure 16 is a cross-sectional view taken along II of Figure 15. In the second alternative embodiment, the journal 58 is supported against the internal surface 56 of the adapter pocket 52 of a mesh 90 material, which is woven or sewn to the shape of the end of the journal 58 The mesh 90 is preferably porous and with a non-tight fabric which is permeable by air and by water vapor, and may be of metal, synthetic, natural or glass fibers, or a combination thereof. same. The mesh 58 is joined by a clamping mesh flange 92 to the surface of the inner wall 56 along its upper edge. An air space 95 is disposed between the shaped mesh 90 and the interior of the adapter receptacle 52. The air gap 95 is in communication with the ambient air through the holes 96 through the adapter receptacle 52. The holes 96 provide ventilation natural between the air space 95 and the ambient atmosphere. With each step, the weight of a person will extend the mesh 90 and thus force the air out of the air space 95. In turn, the air will be extracted into the air space 95 when the weight is transferred to the other leg, thus creating a natural ventilation. Optionally, a means of ventilation, such as a fan or a fan combined with a cooler (neither of these two is shown in the drawings), can be incorporated to drive cold air thickness of the metallic wool elastic support 62 is sufficient to provide good thermal insulation between the surface 63 and the cooling chamber 30. For example, the metal wool mat 62 may have a thickness ranging from 0.5"to 2.0". As with the previously described embodiments, the metal wool mat 62 is compressible and has a reduced thermal resistance in the portions that lie between the areas of the human body that support weight and the cooling layers 30. In its compressed state, the Heat conduction or compressed metal fibers is high.

All the specific embodiments of our invention have been described and set forth in drawings for purposes of illustration, and it should be understood that many alternative variants and constructions may be made without departing from the spirit and scope of the invention, which is limited only by the following claims.

Claims (34)

1. An apparatus for supporting at least a portion of a human or animal body ("portion of a body"), while cooling an area of the weight-bearing portion of the body, the apparatus includes: an article that supports weight; a surface on the article; the surface includes a shaped portion corresponding to the shape of a portion of the body to conform to the body portion; Y at least one cooler positioned to cool an area of the shaped portion receiving pressure from a weight-bearing area of the body portion.

2. The apparatus of Claim 1, wherein the article consists of a cushion of compressible material.

3. The apparatus of Claim 1, wherein the article is an adapter receptacle for prostheses.

4. The apparatus of Claim 1, wherein the article consists of a cushion, its shaped portion being structured to conform, at least, to the buttocks of a person.

5. The apparatus of Claim 4, wherein at least one cooler includes a mat with circulating fluid.

6. The apparatus of Claim 5, further including a mat of thermally conductive material between at least one cooler and the surface.

7. The apparatus of Claim 4, wherein at least one cooler includes a thermoelectric cooling apparatus.

8. The apparatus of Claim 7, further including a mat of thermally conductive material between at least one cooler and the surface.

9. The apparatus of Claim 9, wherein at least one cooler includes means for circulating air through the zone.

10. The apparatus of Claim 9, wherein the zone includes a mesh of permeable material.

11. The apparatus of Claim 1, further including a prosthesis, wherein the article consists of an adapter receptacle for prostheses.

12. The apparatus of Claim 11, wherein at least one cooler includes a mat with circulating fluid.

13. The apparatus of Claim 12, further including a mat of thermally conductive material between a cooler, at least, and the surface.

14. The apparatus of Claim 11, wherein at least one cooler includes a thermoelectric cooling apparatus.

15. The apparatus of Claim 14, further including a mat of thermally conductive material between a cooler, at least, and the surface.

16. The apparatus of Claim 11, wherein at least one cooler includes means for circulating air to the zone.

17. The apparatus of Claim 16, wherein the zone includes a mesh of permeable material.

18. A cushion for supporting at least a portion of the body of a human being or an animal ("body portion"), which consists of: a surface; the surface including a means for receiving the body portion on the surface; Y means for cooling an area of the surface receiving pressure from an area, supporting weight, of the body portion.

19. The cushion of Claim 18, wherein the cushion includes a compressible material.

20. The cushion of Claim 18, wherein the housing means includes a shaped portion of the surface corresponding to a shape of the body portion.

21. The cushion of Claim 20, wherein the cooling means includes a circulating fluid pad.

22. The cushion of Claim 21, further including a mat of thermally conductive material between the circulating fluid mat and the surface.

23. The cushion of Claim 20, wherein the cooling means includes a thermoelectric cooling apparatus.

24. The cushion of Claim 23 further includes a mat of thermally conductive material between the thermoelectric cooling apparatus and the surface.

25. The cushion of Claim 20, wherein the cooling means includes means for circulating air through the zone.

26. The apparatus of Claim 25, wherein the zone includes a mesh of permeable material.

27. A prosthesis for supporting at least a portion of the body of a human or animal ("body portion"), including the prosthesis: an adapter socket; a surface in the adapter receptacle; the surface including a shaped portion corresponding to a shape of the body portion to conform to the body portion; Y means for cooling an area of the shaped portion receiving pressure from a weight-bearing area of the body portion.

28. The prosthesis of Claim 27, wherein the cooling means includes a circulating fluid pad.

29. The prosthesis of Claim 28, further including a mat of thermally conductive material between the circulating fluid mat and the surface.

30. The prosthesis of Claim 27, wherein the cooling means includes a thermoelectric cooling apparatus.

31. The prosthesis of Claim 30, further including a mat of thermally conductive material between the thermoelectric cooling apparatus and the surface.

32. The prosthesis of Claim 27, wherein the cooling means includes means for circulating air through the zone.

33. The apparatus of Claim 32, wherein the zone includes a mesh of permeable material.

34. A method for supporting a body on a weight bearing article, including a surface, while at the same time selectively cooling the areas of the body that are in contact with the article, which consists of the following steps: retaining a portion of the body ("body portion") on a portion of the surface; Y cooling one or more zones of the portion of the surface, each zone being pressed by an area, which bears weight, of the body portion. SUPPORT DEVICE THAT ACCOMPANIES A PORTION OF THE BODY FOR APPLICATION OF LOCALIZED COOLING IN AREAS OF THE SURFACE OF THE BODY WITH HIGH PRESSURE CONTACT SUMMARY OF THE INVENTION A weight-bearing apparatus, such as a cushion, a prosthesis, or a bed mattress, that includes a support surface having a shaped or structured portion that conforms to the shape of a portion of the body that is being supported. The shaped portion fits the body portion, thereby positioning the body portion to place one or more weight bearing portions of the body portion on specific areas of the support surface that are cooled below the body portion. the normal temperature of the body. The reduced temperature applied to the areas of the support surface removes heat from the areas that are supporting weight, which reduces the risk of injury to the tissues of those areas.