Thermodysregulation
Thermodysregulation is a well-recognized, clinical phenomenon after SCI (Colachis & Otis 1995; Schmidt & Chan 1992). It typically occurs during the acute phase of SCI though it can potentially last a lifetime. Although thermoregulation is at least partly regulated by autonomic function, the precise mechanisms of thermodysregulation after SCI are not yet fully understood. The degree of dysregulation appears to be related to injury level and perhaps to degree of completeness of SCI, similar to the pattern of AD (Guttman, 1976). Body temperature is under direct autonomic control via hypothalamic regulation; peripheral cold and warm receptors send messages to the hypothalamus via the spinal cord (Downey et al, 1973). Overall, temperature is easy to measure and classify, even in the early stages post-injury, and therefore tracking thermodysregulation may be a useful means of early assessment of autonomic function.
Even under conditions when the environment is temperature controlled (i.e., not too hot or too cold), people with SCI can have difficulty regulating their body temperature. Individuals with tetraplegia and those with lesions at T6 or above usually exhibit more marked differences in thermoregulation than individuals with paraplegia, most likely due to a lack of hypothalamic connections to the spinal sympathetic circuits and the reduced surface area that can respond (Krassioukov et al. 2007).
Data suggests that individuals with tetraplegia after SCI have episodes of subnormal body temperature in normal ambient environments, and that cold temperatures have a greater negative impact on personal comfort and ability in people with tetraplegia compared to those without SCI (Khan et al. 2007; Hanrakis et al. 2016). There is a clinically recognized, though not widely studied, phenomenon known as “quad fever” where people with tetraplegia or high paraplegia present with a fever exceeding 40 °C (101.5 °F) without a significant rise in core body temperature or an infectious source (Krassioukov et al. 2007).
