Quadriplegia: The challenge of thermoregulation

Quadriplegia (aka tetraplegia) as a result of cervical spinal cord injury results in the significant loss of physiological function; both sensory and motor. One key challenge of quadriplegia, which distinguishes this specific high level of spinal injury from other lower levels of injury (i.e., thoracic and lumbar lesions resulting in paraplegia), is that of thermoregulation. From a sensory perspective, there is reduced afferent information from the skin and deep body temperature receptors, thus reducing the level of thermal input to the hypothalamic thermoregulatory centre. In addition, due to the level of spinal cord injury being above that of the sympathetic nervous system, there is a complete loss or severe reduction in sweating and the ability to redistribute cutaneous circulation, both of which are key thermoregulatory effectors. Furthermore, the ability to vasoconstrict cutaneous vessels to conserve heat in cold environments is impaired along with reduced shivering capacity as a result of paralysis. This chapter will evaluate the literature pertaining to thermoregulation in persons with quadriplegia at rest and under a range of thermal challenges such as heat, cold and exercise, comparing to paraplegia where appropriate.