A person with a spinal cord injury has limited autonomic control of heat dissipation below the level of injury. This includes sweat gland secretions, redistribution of cardiac output, and vasodilation of blood vessels in the skin. Because the autonomic nervous system is important for the control of the body's heat loss, the severity of the thermoregulatory impairment is related to the level and completeness of the spinal cord lesion; the higher the level and the more complete the lesion, the more severe the impairment.

The risk and danger of severe hyperthermia is greatest when exercise is performed in a hot environment. Severe hyperthermia (heatstroke) is life-threatening. It is important for wheelchair users to exercise, or perform ADL in a cool environment. A good indication of whether someone is suffering from hyperthermia is to feel in their armpit. If it is hot, then the person is probably suffering from hyperthermia.

To prevent hyperthermia, stay well hydrated, wear lightweight clothing, use fans and air conditioning, and remain indoor in extreme heat and humidity. If hyperthermia does occur, move to a cooler climate, e.g., shade, indoors, drink fluids, and sponge the skin with cool water. If the hyperthermia is severe, e.g., person is unable to drink, loses consciousness, or is incoherent, then emergency medical treatment is necessary.