BP Monitoring Devices

Tough Cuff & Other Blood Pressure Monitoring Devices for Great Apes

The first blood pressure monitoring device to be used with great apes was the “Tough Cuff”. The Tough Cuff was developed by Georgia Institute of Technology (GA Tech) and Emory University. In July 2009, Zoo Atlanta received the first prototype of the Tough Cuff, which was designed for use in adult male gorillas.

The complete, original Tough Cuff protocol is available for download here: Tough Cuff Manuscript

Zoo Atlanta Blood Pressure Training Program materials and notes (PDF)
See also Cameron Park Zoo’s Blood Pressure materials and notes (PDF)

Videos of the Tough Cuff being used at Zoo Atlanta:

Gorillas: https://www.youtube.com/watch?v=pzs6NfOXIPc

Orangutans: https://www.youtube.com/watch?v=UANxqkH_ZQw

Atlanta-Journal Constitution (AJC) news interview with Dr. Hayley Murphy about the Tough Cuff:



What is the Tough Cuff?

The Tough Cuff refers to the casing that holds the inflatable blood pressure cuff in place. The Tough Cuff diameter is 6.5 inches and was designed specifically for the size of an adult male gorilla’s arm. It may work with larger orangutan males and male chimpanzees, but is not an accurate fit for females or other apes with smaller arm sizes.

Tough Cuff with Blood Pressure Sleeve
Cage Mesh Sleeve with Tough Cuff

Why use a Tough Cuff?

Adult great apes are estimated to be at least 7 times stronger than a human, if not stronger. Therefore, zoo professionals rely on protective caging to interact with non-anesthetized great apes. Having cage mesh barriers makes it impossible to take blood pressure on a great ape like you would on a human. In order to work around this issue, zoo professionals use a cage mesh “sleeve” which allows an ape to extend his or her arm outwards for various training activities. A Tough Cuff is used to keep a blood pressure cuff in place within the cage mesh sleeve.

How can I obtain a Tough Cuff for adult male gorillas?

Zoo Atlanta has found a reputable company, Medical Engineering, Inc., to manufacture the Tough Cuff and Cage-Mesh Sleeve.  Because the manual labor involved in producing one cuff or multiple cuffs is relatively similar, the price varies depending on how many cuffs are being manufactured. For that reason, the Great Ape Heart Project has offered to help coordinate orders from multiple zoos with the manufacturer, Bruce Harshe of Medical Engineering, Inc., so that the individual cost for each institution will be less.  If you are interested in ordering a cuff, please email us at gahpinfo@gmail.com for more information.

How can I obtain a Tough Cuff for smaller apes like orangutans?

Several zoos across the country, including but not limited to Zoo New England, Houston Zoo, Disney’s Animal Kingdom® , San Francisco Zoo, and Cameron Park Zoo, have created inserts for the Tough Cuff to minimize the circumference for smaller apes, produced smaller Tough Cuffs, or created their own cuff-holder devices.

Cameron Park Zoo created a 5.25 inch Tough Cuff to use with female orangutans at their zoo. The device is produced for them by Larry Cobb at Alpha Technology. See Cameron Park Zoo’s Blood Pressure materials and notes (PDF) for ordering information.

Disney’s Animal Kingdom® and Houston Zoo have each created their own blood pressure monitoring devices. The protocols are not available online, but you can email gaphinfo@gmail.com for more information about their devices.

What are the dimensions for the cage mesh sleeve that holds the Tough Cuff in place?

The cage-mesh sleeve is the protective area that separates staff from the ape’s arm and holds the blood pressure cuff components in place.  The sleeve is attached to the ape holding area/enclosure via an attachment plate which aligns with a 8″ diameter arm hole. At Zoo Atlanta (pictured here), our mesh sleeve measures 42″ x 8.5″ x 8.5″ inches.

Does the GAHP have any recommendations for blood pressure monitors?

The GAHP does not recommend any specific blood pressure monitors. In most cases, whatever your zoo’s veterinary department uses may be used for blood pressure monitoring.

Why are finger-cuff blood pressure monitors only used with bonobos?

Bonobos are the smallest of the great apes. Their fingers are much more slender than gorillas or even orangutans and chimpanzees, and it appears that finger cuff monitors may not be as accurate in thick-fingered apes. It is possible that finger-cuff monitors could be used in other great apes like orangutans and chimpanzees, however this needs to be further investigated.

For now, the GAHP is only working with bonobo-holding institutions in the United States to study finger-cuff blood pressure. Please visit the Bonobo Blood Pressure Monitoring Project page for more information.