This study investigated heart rate variability (HRV) in individuals with quadriplegia who have disruption of autonomic control of the heart. Seven male subjects with neurological complete quadriplegia and seven with incomplete quadriplegia were studied at rest and during provocation. HRV was measured by power spectral analysis using a fast Fourier transform. Two spectral components were generated: 1) the high-frequency (HF) peak, a reflection of parasympathetic activity, and 2) the low-frequency (LF) peak, primarily sympathetic activity with some parasympathetic input. Results of the provocative maneuvers were grouped into one composite variable. Significant differences in the LF spectral component were found between the groups with complete and incomplete lesions in the supine position and after provocation (LF supine: P = 0.01; LF provocation: P = 0.002). After provocation, significant differences were demonstrated in the HF spectral component between these groups (P = 0.005). In contrast to previous findings, a LF component in subjects with complete quadriplegia was observed; this LF component decreased after provocation, suggesting the parasympathetic component withdrew during stressful maneuvers. There also appeared to be general downregulation of parasympathetic activity to the heart in subjects with complete quadriplegia. The presence of an increased LF spectral component during provocation in those with incomplete lesions implies sympathetic stimulation of the heart and may be used as a marker of sympathetic activity in individuals with quadriplegia.