Temperature Regulation Tips for Wheelchair Users
How to Stay Safe and Comfortable
July 1, 2023
Bob Vogel
Among the many ways our bodies work differently with a spinal cord injury is temperature regulation, in part because SCI impedes our ability to sweat below our injury level and compromises blood flow in the legs. This makes it tougher to remain cool when it’s hot, and difficult to stay warm when it’s cold. Compromised temperature regulation can quickly become uncomfortable and dangerous, ranging from overheating and heat stroke to hypothermia — harmfully low body temperature.
Here are some tips and tales from veteran wheelchair users on how to stay comfortable and safe when the mercury rises or falls outside the norms.
Staying Cool When It’s Hot
The body compensates for heat by producing sweat and triggering vasodilation, which directs warm blood flow toward the skin to cool down. However, SCI impairs this process below the injury level and makes us more susceptible to hyperthermia — body temperature that is too hot. The higher the SCI level, the less we’re able to cool. And the higher the body temperature, the greater the danger. The stages of hyperthermia are:
Heat Cramps, with symptoms including painful muscle spasms and muscle tightening.
Heat Exhaustion, with symptoms like blurred vision, dizziness, headache, nausea and muscle cramps.
Heat Stroke, which is a life-threatening condition that occurs when body temperature rises to 104 degrees or higher and causes confusion, slurred speech, altered mental status and/or loss of consciousness.
Overheating is an emergency, and immediate cooling is a must. This means get out of the sun, take off things like compression hose, and apply cold, wet towels. If you know you are going to be in the heat, have options ready to help cool you down.
During summer months, Jarred Evans, 43, a C6 incomplete quad for 18 years, carries an emergency cooldown kit in his car that has instant ice packs — the kind where you break the tab and shake for instant cold. Dan Gibson, a 63-year-old C5-6 quad, says you don’t have to overthink it. “When I need to cool down, I go for the obvious — dump a lot of cool water on my head and put a cold, wet towel on my neck and body.”
If overheating is not addressed in a timely manner, it can quickly become dangerous. “I’ve had probably 10 times when I’ve gotten so hot I can’t think straight,” says Todd Wolfe, 54, a C5-6 incomplete quad for 18 years. The worst incident was when he overheated and passed out on a summer outing while in inpatient rehab. He woke up after clinicians had moved him to the shade, doused him with cold water and placed cool, moist towels on him.
Hydration Matters
“An important component for both cold and hot temperature regulation is to stay hydrated. It helps with cooling in the heat and helps keep skin from drying out and cracking in cold, dry air,” says Debbie Shultz, advice nurse for Craig Hospital. Ideally, drink 8-12 glasses of water a day and adjust for intermittent catheterizing and bladder/fluid output. An easy way to tell if you are properly hydrated is urine color. Urine in the clear-to-straw colored range suggests optimal hydration; darker colored urine and/or less output is generally a sign you need to drink more water.
The best way to deal with overheating is taking steps to avoid it in the first place. Stay hydrated and stay out of the sun. “When it’s hot, I move like Luxor, my service dog, and we go from one shade patch to another,” says Wolfe. His “super-go-to” for staying cool is a straw lifeguard hat from Walmart. Keeping a handheld umbrella in your car or on your chair is a great way to create your own shady spots and avoid burns.
Another tip is to keep a mister bottle on hand. Add ice for extra cooling. At less than $10, Wolfe suggests loading up. “I always buy two mister bottles because they are affordable, but it seems the lid tends to come off when it’s really hot, so it’s good to have a backup.”
Gibson and Wolfe both rely on cheap cooling neck wraps available at most stores. “They are only about $9 and they really work. I have a bigger one for my head, and a skinny one for my neck. I usually stick the bigger cooling towel under my hat and let it drape over the back of my neck for cooling and sun protection combined,” says Wolfe. When it gets very hot, Evans adapts. “When I’m playing rugby, my core really heats up, so I put ice packs between my chest strap and stomach to keep me cool,” he says.
For more extreme cooling, Evans turns to an AlphaCool ice vest ($69-$500). The lightweight vest offers extra cooling, thanks to a battery pack that circulates cold water. Should you choose a more affordable one, he adds a word of caution about use of refreezable ice packs: “I use ones designed to stay at a temp of 40 degrees or higher, because ones that get below freezing can cause frostbite and skin-freeze damage on areas with no sensation.”
Staying Warm When It’s Cool
A primary reason why SCI makes it difficult to stay warm when it’s cold outside is because of reduced blood flow in the legs. Typically, flexing leg muscles act like a second heart, pumping blood up to the body. Because SCI inhibits or halts muscle-flexing in the legs, blood flow becomes greatly reduced, and the stagnant blood remains at the surrounding temperature. As the cooler blood from the legs circulates into the rest of the body, it makes us colder, and that is exacerbated when we lie down.
Besides being uncomfortable, coldness can lead to hypothermia when the body temperature falls below 95 F. Symptoms include shivering, a feeling of exhaustion or extreme fatigue, and confusion. If not addressed, it can be fatal.
The simplest way to avoid hypothermia is to limit your time in the cold, and dress warmly. Wear a warm hat and scarf, and warm socks in shoes or boots. Layer up as much as you need, and avoid using any type of artificial heating below your level of sensation. If electric socks or blankets malfunction, you won’t feel it, and they can cause severe burns. “I’ve been severely burned by putting a heating pad on a body part that doesn’t have sensation, like my legs,” says Gibson.
Burn Dangers in Winter and Summer
Summer or winter, it’s important to take precautions to avoid burns with SCI-compromised sensation.
Summertime burn dangers include severe sunburns, especially on areas like exposed knees when wearing shorts — I wear longer shorts that go over my knees, or drape a towel over them — and also burns from objects that have been heating in the sunlight. Wolfe learned this the hard way at a summer tennis clinic. “I transferred into a tennis chair, and the ratchet strap that goes over your legs was black and had been cooking in the sun,” he says. “I ratcheted it over my legs and didn’t think about it until I removed it, and there was a nasty burn on my thighs where the strap had been.” Gibson’s lesson came when he leaned against his van on a hot, sunny day. “I was resting part of my arm that doesn’t have sensation against the van and didn’t realize how hot it was in the sun. When I got home, I saw I had a bad burn on my arm,” he says. Other potential burn dangers are car seats that have been in the sun and/or metal seat belt buckles.
In winters come burn dangers from exposed skin being too close to hot air vents, stoves and fires, which can directly burn skin or heat up wheelchair parts. “One day I was in my chair and had my back to the wood stove with my hands on my push rims and I asked my wife, ‘What smells?’” Wolfe says. “She said, ‘Oh my God, it’s your elbows’ — where I don’t have sensation. They got so hot they were actually smoking, and I ended up with severe blisters.”
Heated car seats also pose potential burn danger because they can malfunction and inflict severe burns. This happened to Arwen Bird, 48, a T8 para for 30 years, who purchased a new car with heated seats. “I was driving home from the coast and switched on the seat heater for the first time,” she says. During the drive home she started to feel nauseous but chalked it up to fatigue. The fatigue lingered the next day and she thought it must be an SCI thing. “That afternoon I did a transfer and saw two wet spots on my seat cushion. I went to the bathroom and could feel that I had wounds on my skin that were the size of silver dollars!” Her dad rigged a thermometer held under two water jugs to simulate sitting on the car seat, and it heated up to 180 degrees!
Her burns were so severe that a burn specialist had to remove the damaged tissue and surgically close the wounds. She was extremely fortunate that she only had to spend a few weeks in bed. “These days I never turn the car seat heater on,” says Bird, “and even then, I will take my hands and feel the seat to make sure I know what my butt is getting exposed to and be sure I’m not getting burned.”
Warming up can be as simple as getting out of the cold and adding more clothing or a blanket. A quicker way is to take a warm shower or bath, or wrap yourself in a warm, moist towel, because moisture better transfers the heat. Also, drink warm liquids. As a para who loves the outdoors, I can attest to the warm shower or tub. There are times I’ve come in from a day of sailing or skiing and my legs feel frozen. My only hope of warming them is to soak in a warm bath or shower.
Gibson’s wife makes “corn cuddler” heating pads from dry corn kernels or dry rice sewn inside a cloth pad. “You heat them in a microwave to a temperature that you want, but not too hot,” he says. When it’s really cold outdoors, he puts them in his shirt and on his shoulders for hours of warmth. “I will also put them on my legs when I lie down. It’s important to make sure they are not hot — just warm to the touch — so you don’t get burned.” Corn cuddlers can be purchased online for $10-$20.
For Wolfe, wearing the right clothing goes a long way toward staying warm. He favors a Filson hunting hat with a short bill and a warm flap for his ears and neck, or a wool Stetson hat ($175) that keeps him warm and blocks snow and rain from going down his neck. He also had a friend sew a warm poncho that he can wrap around his legs along with a small woolen blanket. “This really comes in handy when I’m watching my son play a full game of outdoor ice hockey,” he says.
Jason Fowler, 49, a T5-6 for 32 years, has two products that help him stay warm while training in Boston’s brutal cold winters. “I use a wireless muscle stimulator called PowerDot ($199) that I put on the back of my calves, which causes muscle contractions and promotes more blood flow. It seems to help keep my lower legs warm when I’m training on a cold day,” he says. “The other thing that really helps keep my legs warm in cold climates are thigh-high compression stockings.”
Evans gears up with electric heated gloves from Fly Racing and a heated jacket made by Gobi Heat. He carries reusable cold packs that can be microwaved and will remain at room temperature until you press on a metal tab inside the pack, causing them to heat up and stay warm for several hours.
Finding gloves to keep your hands warm — and most importantly, dry — while pushing a wheelchair is critical. In my 38 years of trying every option available, I’ve found that winter gardening gloves by companies like Atlas offer the best blend of warmth, water protection, traction for pushing, and price, at around $8-$12 a pair.
Resources
- Craig Hospital Nurse Advice Line, 800/247-0257.
- Wintertime SCI Skin Protection
- Hydration With a Spinal Cord Injury
- Escaping the Hot Seat
- Hotel Hot Water and Rental Car Burn Dangers
Products
- AlphaCool, mycoolingstore.com/alphacool-original-cooling-ice-vest.html
- Vanvene Cooling Neck Wrap, amazon.com/VANVENE-Cooling-inflated-Soaking-Activities/dp/B089B1D1ZB
- Mission Cooling Towel, homedepot.com/p/Mission-Hydro-Active-12-in-x-33-in-Unisex-Blue-Microfiber-Large- Cooling-Towel-107100/312468491
- Liberty21 Corn-Filled “Corn Cuddler” Heating Pad, amazon.com/Heating-Removable-Washable-Natural-Shoulders/dp/B07G4L2LSR/
- Fly Racing Heated Gloves, speedaddicts.com/motorcycle/fly-racing-ignitor-heated-black-gloves
- Glacial Comfort Gel Ice Pack, amazon.com/Glacial-Comfort-Pack-Back-Pain/dp/B0BDQPPNSQ
- Gobi Heat Heated Outerwear, gobiheat.com
- Swiss Tech Straw Lifeguard Hat, walmart.com/ip/Swiss-Tech-Men-s-Straw-Lifeguard-Hat/1206710542?athbdg=L1600
- Stetson Wool Hat, huckberry.com/store/stetson/category/p/67477-the-rawlins-cowboy-hat-exclusive
- Therabody PowerDot muscle stimulator, therabody.com/us/en-us/powerdot-muscle-stimulation-devices/
- Savior Heat Heated Gloves, saviorglove.com
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I use a wheelchair because of a rare disease called Erythromelalgia, and temperature control is a big issue for me as well. Thanks for sharing all the great tips!