Cliquez pour retourner à la Page d'accueil... Cliquez pour retourner à la Page d'accueil...










Quadriplegics and remote travel
Medical Aspects

- J. Francois Porret -
Translation by Richard Jessup -

 The observations gathered in this chapter are the result of more than 15 years of Off Road Wheelchair (ORWC) riding in many countries, some of which provide very rudimentary comforts and hygiene considerably below Western standards. This resulted in a number of surprises, lessons, difficulties and foul-ups that make up what we will modestly call “experience”.

This is a quadriplegic’s experience, enriched by other quadriplegic and paraplegic travel companions. The adaptations, tricks and medical comments that were appropriate for some cases are probably not directly suitable to other situations.

These comments are aimed at so-called “adventure” travel, with nights spent in local hotels or bivouacking directly on the ground. For those travelling in an air-conditioned BMW, eating and sleeping at the Hilton, there is no need for this information. Well, sometimes maybeJ… Furthermore, before starting out on a big trip, it is important to have tested your capabilities and limits in a few progressively more difficult expeditions. Individuals differ considerably, some will adapt better to heat or cold (the time of year, type of trip, choice of itinerary are all key factors).

Your comments and suggestions are welcome, in order to broaden and enrich the shared experience on this page.

A quadriplegic’s body temperature control is considerably diminished (there is no perspiration or blood flow regulation through blood vessel dilation below the injury level, except for a few insufficient reflex mechanisms). The resulting sensitivity to outside temperature produces (as is the case for cold-blooded animals, like lizards…) a rise in core body temperature. The risk of overheating is critical, since it can lead to death if the body temperature exceeds 41oC for an extended period of time (e.g. the European heat wave of summer 2003).

Passive prevention:
- shade (use a large umbrella like the ones used on baby strollers, take breaks during the warmest hours of the day under a shade tree, sit in the back of a car…)
- Clothing (loose, light coloured, long sleeves…).
- A hat (a wide brim cap covering your neck, a Bedouin’s headscarf …).
- A space blanket (bright side to the outside) over your legs and upper body.
Take advantage of the wind if it is cool (choose the best route).

Active prevention:
- Frequent spraying (head, neck), letting the water evaporate for better effectiveness.
- Be careful in humid climates where there is little evaporation (e.g. the Amazon).
- Lower the body temperature before sunrise (since a quadriplegic’s body accumulates heat, somewhat like a stone, he/she can make use of the cooler periods, for example by sleeping unclothed, to start the day with a body temperature that will rise slower).
- Drink a lot of cool water (don’t forget to insolate your Camelbak®)

Better to look silly than dead…

(Refer also to the scientific study on this subject published by GERTP contact and

A quadriplegic’s body temperature control is considerably diminished (no blood flow regulation through blood vessel constriction and especially no muscular contractions or shivers below the injury level). The resulting sensitivity to cold temperatures produces (as is the case for cold-blooded animals, like lizards…) a drop in core body temperature and therefore a deep feeling of cold. No case of serious or deadly hypothermia has been reported in these conditions so far, but care must be taken since serious hypothermia can lead to cardiac fibrillation or a coma. On the other hand, the risk of frostbite in the paralysed area of the body is lower than expected, precisely because of the lack of blood vessel constriction. The only aggravating factor is the forced immobility. If you really try, you can die of cold, but without frostbite ;-) !
Wind or, more accurately, the wind-chill factor, is the quadriplegic’s prime enemy (as much as it is an ally in the case of heat).

Excerpt from the GERTP study:
Comparative trends of the internal temperature of two quadriplegic and two able bodied subjects. All are wearing a 7 mm thick wet suit and are immersed in 18oC water for thirty minutes. The temperature is recorded during the phases of immersion, drying, dressing and rest (four hours total).

The quadriplegic’s core body temperature vulnerability to outside temperature conditions is clearly shown.

Passive prevention:
- Retain body heat (sleeping bag, parka, foam pads, multiple layers of clothing)
- Stop radiation heat loss (space blanket with the bright side inside, but beware of condensation).
- Reduce conductive heat loss (foam pad, self inflating mattress, waterproof protection).
- Reduce wind-chill with a good wind breaker.
- Protect your head (> 60% of total heat loss occurs there).

- When camping, use a small tent inside a large one.
Active prevention:
- A hot water bottle. Extremely effective inside a sleeping bag and easy to use. Chemical or battery powered heating devices can be effective if worn during the day, but they are inconvenient and heavy for long trips. Beware of burns on parts of your body where there is no feeling.
- Place your shoulders (they are the quadriplegic’s thermal source) in the space being warmed, generally a sleeping bag (if not, your legs will remain at a constant temperature, i.e. cold).
- Drink warm beverages (but be careful about the ensuing self catheterizations)
- Avoid humidity (soaking clothes, rain).

- If logistics permit, take a long bath or shower at 38oC.

(See the 1993 study with a quadriplegic subject spending a month in the Tibet’s high elevetions, by professors Geyssant (“Physiologie et Physiopathologie de l'Exercice et Handicap”) and Minaire from St Etienne Hospital).
For quadriplegics, the risks are related to their lowered respiratory capacity and impaired thoracic muscles. They will be more susceptible to hypoxia induced problems, such as high altitude pulmonary oedema.

Irregular breathing at night also seems to increase while acclimating, especially when sleeping on one’s back. There doesn’t seem to be any increase in the incidence of headaches versus the overall, non-acclimated population.
Acclimatisation leads to lower blood fluidity. This will require more vigilance about sores, since the skin becomes more sensitive.
Prevention will require, as for the able bodied, tests to determine your adaptability to high altitude and a careful acclimatisation. Once you start out, climbs should be gradual (“climb high, sleep low”), with limited exertion.
Be careful of the effect on catheterizations of any prescription drugs (avoid self prescribed medication) such as diuretics (Diamox®is preventive, Lasix®is curative). Viagra® seems to work as well as Diamox®, but the side effects are different. Any volunteers to test it?
Even if this is unproven in medical literature, many mountaineers believe that the body retains a memory of its previous forays into high altitudes. A body accustomed  to hypoxia previously will react positively when exposed again to rarefied oxygen. Or is it just accustomed to suffering? There is a wide range of capacities among individuals that we cannot really explain specifically: it may be from previous sports activities, or maybe a quadriplegic is used to facing breathing irregularity (overweight, sleeping on his back) and therefore hypoxia.
We can also ask ourselves if there is a correlation in a quadriplegics’ better adaptation to hyperbaric (scuba diving) as well as high altitude activities compared to their able-bodied companions (refer to the GERTP tests and the study by Dr. Wuyam from the “laboratoire d’explorations fonctionnelles respiratoires” of the Grenoble hospital

Adventure travel punishes your skin with unusual sitting conditions (up to 10 hours non stop per day in an ORWC, sometimes for more than a week at a time, long trips in local buses with hard seating, rattled for hours in a 4x4 vehicle with long dead shocks, interminable airplane trips with your knees under your chin, etc…)
Rain and humidity can leave you soaking in water, exacerbating the risk of hypothermia and skin damage. The right protection is required (cover, poncho, parka, hat, tent) and the areas at risk need to be well ventilated. Be careful about bug bites that you won’t be able to feel (scorpions in the desert, all kind of nasty things in the Amazon…)
Situations where washing is difficult increase skin risks. Disposable wipes and skin lotions will be appreciated.
The same prevention and protection is recommended for skin abrasion (sand, especially during a storm where it seeps in everywhere) and friction. Be careful with sunburn risks due to excessive exposure to the sun (i.e. shorts or slacks that are too short).
Watch for pressure points from foreign objects that might have inadvertently slipped inside your sleeping bag.
Also, beware of the effects of altitude on blood viscosity, making skin more susceptible to sores.

Passive protection
- Always use an excellent seat cushion (e.g. Roho®). Beware about the effects of the cold on gel cushions (they harden), and of the sun (they burn). Altitude makes some foam cushions’ (e.g. Jay®) closed cells burst, then collapse. Also be careful about the effect of altitude variations on inflatable cushions.
- Always keep a small closed cell foam pad (40 x 40 x 3 cm) or a thin gel cushion on hand to protect your back in buses, your ribs in 4x4 vehicles, your shins in charter flights and your backside on bad mattresses.
- On the ground, sleep on two or three 5cm thick foam mattresses or on a slightly inflated air mattress (be careful about air leaks: you might only find them out after a night spent on a hard spot on the ground). Alternatively: a thick, self-inflating mattress: very comfortable, and with a battery operated pump it’s ready in one minute.
- Fragile areas of your body can be protected with special blister-preventing bandages.
Active protection:
- You will learn to appreciate and even to seek (!) rough and bumpy transportation (ORWC or 4x4 vehicles). It will massage your skin (on an inflated cushion), even if your vertebrae will have to bear it.
- Lift your weight off of your seat as often as possible. Find the best positions to alleviate critical pressure points.
- Whenever possible, massage your skin in the evening and pay special attention to areas exposed to pressure. Never let red spots persist, they will lead to skin sores. Treat them immediately (bandages, Conveen).
- Let your skin breathe as much as possible.
- Sleep on your side and roll over once or twice each night (in cold weather, you can be lying down for up to 12 hours, waiting for the sun to show up).
- You can use padding on sensitive points (i.e. heels, knees, buttocks, elbows), securing it with straps or Velcro.

Digestive tract
Digestive disorder risks increase in countries with rudimentary hygiene. A bout of diarrhoea can create serious problems for a quadriplegic if you can’t take the time to stop or if there is no water available. Prevention: wash your hands with antiseptic solutions before every meal, avoid all salads, fresh vegetables and fruit and drink only sealed, bottled water or purified water (MicroPure®, Potable Aqua®…). Be paranoid, don’t worry about ironic comments (the ones making them might be the ones running for the bushes a few days later…).
Use an ultra light (2.5kg) portable toilet chair, inside a small tent if you have that luxury. It is better to switch your daily care to a 2 day frequency, with a preference for the evening as you arrive at the bivouac, especially if mornings are very cold. Use disposable wipes if there is no water.

Use the same preventive measures as for the intestines, washing your hands with an antiseptic solution before every meal and self catheterization. Use disposable catheters (but don’t dispose of them just anywhere, it pollutes, and in some countries locals collect them and re-sterilize them!)
In public transportation (i.e. airplanes), you can use a blanket or a cloth hanging on the seat in front of you to hide a bit while self cath’ing. Your neighbour will usually understand if you explain that you need a few minutes of privacy. However, with today’s terrorism paranoia, it might be harder to explain…
For a night time catheterization, remember to use a back support. For a quadriplegic without any balance, it is difficult to lean against a tent wall or to sit with a back rest (use a beach chair or stacked backpacks).

Transportation is a major source of potential problems (sores, infections, etc.). Rigorous care is required.


BewBeware of oedema during long flights (use full-length, custom stockings or elastic leg bandages). Drink a lot, even if means more self caths.
Take aspirin  regularly during the trip. Athletes do this when travelling; it helps avoid blood clots and favours recovery.
Do a catheterization before and after the flight, if possible (the rest rooms in most airports are usually suited to this purpose, otherwise behind a quiet counter or partition). In the plane, explain the issue to your neighbour and hang a cloth between your seat and the one in front of you for privacy.
Some airports, and not necessarily third-world ones, transfer you very carelessly (feet first and higher than your head when seating you, bumping you on the armrests, no wheelchair available on arrival…)

Bus Always difficult to get in and out of, requiring a difficult lift. Protect your buttocks with your hands to avoid trauma. Seats are often small, be careful not to hit your legs in front. They can be quite hard, use your handy little foam pad.
Automobiles All terrain vehicles and their bouncing ride are, in fact, rather beneficial, but use a cushion to absorb the bumps and avoid hard spots. Use a foam pad in addition to the inflatable cushion underneath your buttocks to protect you against lateral shocks.

Countries that inspired these comments:
The Amazon, Cabo Verde, China, Egypt, Ecuador, Ethiopia, Hawaii, Jordan, Lebanon, Morocco, Mauritania, Perou, Nepal, Senegal, Tibet

Last update : 09/26/2005 12:25

Le Site      Avertissement