Thermodysregulation in persons with spinal cord injury: case series on use of the autonomic standards

Abstract

The three cases demonstrate the signs and symptoms that may accompany hyperthermia in persons with SCI. The onset may be quite rapid and the condition persistent, despite ambient temperatures being much less intense than expected to be necessary to induce similar conditions in able-bodied (AB) persons. The responses of the persons in the case studies to the temperature regulation and autonomic control of sweating sections of the Autonomic Standards would identify them as being vulnerable and warrant providing appropriate exposure guidelines and precautions to them and their caregivers.

Hyperthermia due to heat retention in chronic spinal cord injury: A case report

“…Core body temperature is regulated within a narrow range by hypothalamus via several mechanisms including heat production and release. However, SCI above the T6 level interrupts the ability to thermoregulate, and stability of the core body temperature is compromised, which can lead to hyperthermia even at mild, ambient temperature, as reported in patients with SCI who developed accidental hyperthermia . To date, hyperthermia due to heat retention has been reported in not only SCI but also multiple system atrophy …”

“…However, SCI above the T6 level interrupts the ability to thermoregulate, and stability of the core body temperature is compromised, which can lead to hyperthermia even at mild, ambient temperature, as reported in patients with SCI who developed accidental hyperthermia. 5 To date, hyperthermia due to heat retention has been reported in not only SCI but also multiple system atrophy. 6 Under high temperatures, heat is released by increased skin blood flow and heat of vaporization due to sweating.…”

Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

“…Hypothalamic regulation of sympathetically mediated vasodilation and hidrosis is disrupted after upper SCI, leading to ineffective heat dissipation in response to warm ambient temperatures and hyperthermia. 90 Conversely, large portions of insentient skin and loss of skeletal muscle activity delay or prevent hypothalamic initiation of shivering in response to cold ambient environments. Combined with impaired sympathetically mediated peripheral vasoconstriction, cervical SCI patients are highly vulnerable to hypothermia from ineffective heat conservation.…”

Efficacy of water spray for evaporative cooling in athletes with spinal cord injury

“…Clearly, impaired heat dissipation increases the risk of potentially unsafe Tc elevation during heat stress conditions, which is documented in SCI literature [11,19,20]. It follows that identification of an effective cooling strategy would increase safety during exercise, especially for those with TP, who often exhibit no sweating whatsoever [19].…”

“…Clearly, impaired heat dissipation increases the risk of potentially unsafe Tc elevation during heat stress conditions, which is documented in SCI literature [11,19,20]. It follows that identification of an effective cooling strategy would increase safety during exercise, especially for those with TP, who often exhibit no sweating whatsoever [19]. Although ice vests provide whole body cooling before/pre-cooling (PRE) and during exercise [21,22], they can be cumbersome to don and impractical; as they interfere with upper body movements required for wheelchair propulsion and ball handling.…”