Why Heat Is a Bigger Issue After SCI
Injuries at or above the mid-thoracic level interrupt sympathetic pathways that normally trigger sweating and skin-blood-flow changes; below the injury, sweat glands stay almost “switched off.” This loss of autonomic control means core temperature can climb quickly, while early warning sensations (feeling flushed or drenched in sweat) may be absent. People with higher or complete injuries are therefore at greatest risk for heat exhaustion or heat stroke.
Ten Ways to Stay Safe in the Heat
| # | Strategy | Key Points & Evidence |
|---|---|---|
| 1 | Plan your day around cooler hours | Whenever possible, schedule outdoor activities before 10 a.m. or after 6 p.m.; even a 5.4°F drop in ambient temperature markedly slows the rise in core temperature during wheelchair propulsion. |
| 2 | Create a cool home base | Aim to keep indoor temperatures ≤ 78.8°F with air conditioning or powerful fans; portable room thermometers provide objective feedback when your own sensation is unreliable. |
| 3 | Dress smart | Loose-fitting, light-colored, moisture-wicking fabrics promote evaporation above the level of injury; avoid dark, non-breathable materials that trap heat. |
| 4 | Hydrate early and often | Start the day with ~500 ml (16 oz) of cool water and sip 250 ml (8 oz) every 20–30 min in the heat; add an electrolyte solution if sweating above the lesion is profuse or urine turns dark. |
| 5 | Use active cooling tools | • Misting and fanning: A spray bottle and handheld fan can lower skin temperature by 3.6–5.4°F. • Cooling towels/packs: apply to neck, armpits, groin. • Cooling vests: Phase-change or water-circulating vests have shown significant reductions in skin temperature and improved comfort scores during 30-minute arm-crank exercise in 86°F environments. Emerging “smart” vests under development by VA aim to maintain vest temperature at 18-27°F below skin temperature in a controlled, safe range. |
| 6 | Shade and wheelchairs | Attach an umbrella or canopy to your chair; reflective seat-cushion covers the limit of radiant heating of cushion foam, reducing risk of skin burns. |
| 7 | Monitor your body, not just the weather | Check forehead or ear thermometer readings every 30–60 min in hot conditions; unexplained headache, dizziness, or sudden heavy sweating above the injury may signal overheating. |
| 8 | Know heat-illness first aid | If core T ≥ 101.3 °F with nausea or confusion, move to shade/AC, start active cooling (icy towel to neck, cold drinks), and call EMS if symptoms persist beyond 10 min. |
| 9 | Review medications | Many bladder, spasticity, or pain drugs (e.g., anticholinergics, baclofen) decrease sweating or cause drowsiness—ask your clinician whether summer dose adjustments are prudent. |
| 10 | Build fitness safely | Regular upper-body exercise improves cardiovascular reserve, but incorporate pre-cooling (cool vest or cold-water ingestion) and frequent rest breaks; Research show pre-cooling lowers thermal strain and extends exercise tolerance in persons with tetraplegia and paraplegia. |
Quick Checklist Before You Head Out
- Weather app shows a heat index < 95°F, or you have a robust cooling plan.
- Pre-hydrate and pack at least 32 oz of fluid with electrolytes.
- Wearing breathable clothing and a hat; keep cooling tools accessible.
- Keep a thermometer and phone on hand for regular checks and emergencies.
- Let someone know your route and the expected return time.
When to Seek Immediate Help
- Core temperature ≥ 102°F or any altered mental status.
- Hot, dry skin below the lesion with pounding headache or nausea.
- Persistent dizziness, rapid pulse, or blood pressure drop despite cooling.
Call 911 and continue active cooling while awaiting medical assistance.
Maintaining a proactive cooling routine turns summer from a season of worry into one of safe enjoyment. Discuss these strategies with your rehabilitation team to tailor them to your level of injury, daily activities, and local climate.
