The deleterious effects of hyperthermia are well appreciated in able-bodied persons.
However, the consequences of impaired regulation of normal body temperature on cognitive
performance of persons with tetraplegia is not known. This study will provide the
preliminary findings necessary for future work to design and explore physical and medical
interventions to improve temperature regulation in those with tetraplegia with the goal of
improved clinical care, health, and quality of life.
The proposed study consists of 1 visit during which 20 subjects (10 with tetraplegia, 10
controls) will be exposed to 81°F for 40 minutes and then 95° F for up to 2 hours.
Physiological as well as psychological processes will be monitored in all subjects during
the study for safety and to determine differences in responses to exposure to hot ambient
After a cervical spinal cord injury (SCI) the motor, sensory and autonomic deficits cause,
among other detriments, a blunted ability to maintain a constant core temperature. Impaired
thermoregulation leaves persons with tetraplegia more susceptible to hyperthermia than
able-bodied persons (AB). There has been a paucity of work addressing the thermoregulatory
responses of persons with SCI to hot ambient temperatures, and even less study addressing
the effect of these temperatures on cognitive performance. The goals of this pilot study
are: to improve our understanding of the thermoregulatory mechanisms of individuals with
tetraplegia when exposed to heat and to determine the effect of impaired thermoregulatory
mechanisms on cognitive performance during exposure to 35°C for up to 2 hours. In order to
address our goals we have designed a study methodology which consists of comparing the
physiological and psychological responses of the two study groups (tetraplegia versus AB
controls) from thermoneutral (27°C) to hot (35°C) environments.
1. Between 18 and 65 years of age;
2. Duration of injury ≥ 1 year;
3. Level of SCI C4-T1;
4. Euhydration (Subjects will be instructed to avoid caffeine and alcohol, maintain
normal salt and water intake, and avoid strenuous exercise for 24 hours prior to
5. Age (± 5 years) and gender matched AB control group.
1. Known heart and/or blood vessel disease;
2. High blood pressure;
3. Kidney disease;
4. Diabetes mellitus;
5. Acute illness or infection;
7. Pregnant women;
8. Untreated thyroid disease, and
9. Broken, inflamed, or otherwise fragile skin.
John P Handrakis, PT, DPT, EdD
Center of Excellence for the Medical Consequences of SCI, James J Peters VAMC