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quadriplegia

Quadriplegia

Quadriplegia also known as tetraplegia is defined as paralysis below the neck, including both arms and legs. Paralysis of the lower half of your body, including both legs, is called paraplegia. Quadriplegia affects the use of a person’s upper limbs and hands. This loss of upper limb function means many people rely on family or carers to help them with basic activities of daily living like eating, showering and writing. However, some people with quadriplegia can achieve a useful grasp that enables them to live more independent lives after a highly specialized surgical procedure called tendon transfer surgery.

Quadriplegia is defined in many ways; C1-C4 usually affects arm movement more than a C5-C7 injury, however all quadriplegics have or have had some kind of finger dysfunction. So, it is not uncommon to have a quadriplegic with fully functional arms, only having their fingers not working.

Injuries above the C-4 level may require a ventilator or electrical implant for the person to breathe. This is because the diaphragm is controlled by spinal nerves exiting at the upper level of the neck. Refers to paralysis from approximately the shoulders down. Most spinal cord injuries result in loss of sensation and function below the level of injury, including loss of controlled function of the bladder and bowel.

In the 1970s, the average survivor of a spinal cord injury was just 29 years old, but now the age age has increased to 42. Most (82%) spinal cord injury survivors are men. 250,000 Americans currently live with spinal cord injuries, with about 12,500 new cases each year. A number of issues cause the remainder of injuries that lead to quadriplegia, though most such injuries are traumatic in nature.

Today, spinal cord injury treatment focuses on preventing further injury and enabling people with a spinal cord injury to return to an active and productive life within the limits of their disability.

Complete versus incomplete spinal cord injury

One of the terms you will hear often in reference to your spinal cord injury is complete or incomplete.

An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. Additionally, some sensation (even if it’s faint) and movement is possible below the level of injury.

A complete injury is indicated by a total lack of sensory and motor function below the level of injury.

The absence of motor and sensory function below the injury area does not necessarily mean there are no remaining intact axons or nerves crossing the injury site, just that they are not functioning appropriately as a result of the trauma.

Cervical spine anatomy

Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.

The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine.

Other parts of your spine include:

  • Spinal cord and nerves. These “electrical cables” travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae (foramen).
  • Intervertrebral disks. In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when you walk or run.

Intervertebral disks are flat and round and about a half inch thick. They are made up of two components:

  • Annulus fibrosus. This is the tough, flexible outer ring of the disk.
  • Nucleus pulposus. This is the soft, jelly-like center of the disk.

Figure 1. Cervical spine

Cervical spine

Figure 2. Cervical disc

cervical disc

Quadriplegia causes

Quadriplegia is usually the result of an injury to the spinal cord in the neck C1-C8 that disrupts messages from the brain to the body so that movement and sensation are impaired causing paralysis or weakness in both arms and legs. All regions of the body below the level of injury or top of the back may be affected. At times, a cervical injury is accompanied by the loss of physical sensation, respiratory issues, inability to regulate body temperature, bowel, bladder, and sexual dysfunction.

The most common causes of quadriplegia continue to be:

  • vehicle related accidents – car, motorbike, bicycle (37%)
  • violence (28%); gun shots are the leading cause of violent injuries, accounting for fully 14% of all spinal cord injuries.
  • work-related accidents
  • falls (30%)
  • diving injuries
  • sports injuries and recreational activities (9%)
  • medical and surgical accidents (4%)

Quadriplegia can also be caused by diseases, such as:

  • Multiple sclerosis
  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease

Risk factors for quadriplegia

Factors that may increase your chance of quadriplegia and paraplegia include:

  • Jobs or sports activities that increase your chances of spinal injury—high-risk sports such as football, rugby, wrestling, gymnastics, diving, surfing, ice hockey, and downhill skiing
  • Family history of certain inherited nerve diseases
  • History of cancer—can cause compression of the spinal cord

Quadriplegia prevention

The following measures are advised to reduce your chance of getting a spinal cord injury:

  • Drive safely. Motor vehicle accidents are the leading cause of spinal cord injuries. Wear a seat belt every time you drive. Make sure your children wear seat belts or are in child safety seats.
  • Don’t drive if you have been drinking or using drugs.
  • Be safe with firearms. Lock guns and ammunition in a safe place. Store them separately in locked containers.
  • Take measures to avoid falls. Use a stool or stepladder to reach high places. Add handrails along stairways. Place nonslip mats in your bathroom, shower, and under carpets. To keep children safe, use safety gates to block stairs. Install window guards.
  • Always wear safety gear when playing sports. Avoid head-first moves, such as:
    • Diving into shallow water
    • Spear tackling in football
    • Sliding headfirst in baseball
    • Skating headfirst into the boards in ice hockey
  • Use a spotter in gymnastics. Do not jump from very high places.

Quadriplegia symptoms

Paralysis due to spinal cord injuries may be total or partial. This depends on how much of the spinal cord is damaged. In addition to paralysis of the arms and/or legs, you may also suffer from:

  • Incontinence —bladder or bowel
  • Sexual dysfunction— male or female
  • Trouble breathing
  • Difficulty sitting upright depending on the level of the damage

Inactivity due to paraplegia and quadriplegia can cause additional problems, like:

  • Bed sores
  • Spastic limbs
  • Pneumonia
  • Urinary tract infection
  • Weakened bones
  • Chronic pain

People with paraplegia and quadriplegia may also become depressed because of:

  • Social isolation
  • Lack of emotional support
  • Increased dependence on others.

How does being quadriplegic affect my body?

Quadriplegia is an unpredictable condition that can change over time. Individual factors, such as the age at injury and overall health, as well as quality of care immediately following the injury, can greatly affect outcomes. Just as a doctor’s estimate about how long a cancer patient might survive is not a guarantee, the prognosis your doctor gives you is merely a guess, not a promise or a final opinion.

Generally speaking, quadriplegics struggle with the following symptoms:

  • Chronic pain: this can be due to changes in sensory perception, but also the product of chronic disuse. A quadriplegic who regains some sensation may find that his arms ache due to muscle atrophy.
  • Loss of sensation below the site of the injury. In some cases, this sensation loss is complete and permanent. In other cases, sensations are merely reduced, or you may intermittently feel some sensations, but not others. A “pins and needles” feeling is especially common.
  • Inability to move the limbs below the site of the injury. Though some movement may return, the overwhelming majority of quadriplegics continue to struggle with loss of muscle control and generalized weakness.
  • Spasticity: this involves sudden, uncontrolled movements, particularly in areas most affected by the paralysis.
  • Difficulties with bladder elimination: loss of sensation and muscle control below the site of the injury can lead to fecal or urinary incontinence, difficulty eliminating without help, and frequent urinary tract infections.
  • Respiratory infections: particularly common in the months following an injury, these infections are the leading cause of death among spinal cord injury survivors.
  • Changes in or difficulties with fertility and sexual function. Men may struggle to get erections, while women may struggle with lubrication. Both sexes often experience changes in libido, difficulties with orgasm, decreases in fertility, and even complete cessation of sexual functioning.
  • Secondary infections due to inability to move, including bedsores.
  • Psychological concerns, particularly anxiety and depression.
  • Difficulties with bodily awareness. Depending upon the extent to which you have lost sensation, you may struggle to know where your legs or arms are without looking.
  • Weight gain, particularly if you are unable to exercise, do not pursue physical therapy, or chronically overeat. Many quadriplegics find they must reduce their calorie consumption to avoid weight gain.

Quadriplegia diagnosis

Diagnosis involves finding out where and how badly the brain and spinal cord are damaged. To do this, doctors will likely do the following tests:

Imaging tests evaluate the spine and other structures. These may include:

  • CT scan
  • MRI scan
  • Myelography (rarely used)

Your nerve function may be tested with:

  • Nerve conduction study
  • Somatosensory evoked potentials (rarely used)

Your bodily fluids may be tested. This can be done with a lumbar puncture if some specific neurologic diseases are suspected.

Quadriplegia treatment

Immediate treatment of spinal cord injuries includes bracing the bony spine to keep it from moving and further injuring the spinal cord. Steroids and other medications may be used to lessen damage to nerves and nearby tissue.

Though some quadriplegics experience significant improvements in symptoms, and even total cure, quadriplegia is not curable with treatment. This means that no surgical procedure, drug, or form of therapy can guarantee a return of functioning, and few quadriplegics will ever regain all functioning. Instead, the goals of treatment include improving the long-term prognosis, reducing immediate threats to your life and health, and teaching your brain and spinal cord how to work around the injury.

Recovery and rehabilitation usually begins in the acute care hospital setting. Depending on the cause and extent of the condition, treatment options include:

  • Brain and spinal cord surgeries to address obstructions, reduce bleeding, and manage swelling.
  • Medication to reduce the risk of infection; you may also take other drugs, such as blood thinners or blood pressure medications.
  • Education about quadriplegia, as well as training on your rights under the Americans With Disabilities Act and other relevant laws. Some treatment facilities also offer occupational skills training.
  • Family education and support.
  • Speech and language therapy to help you maintain or regain your ability to speak.
  • Intensive physical therapy to help you regain functioning.
  • Exercise therapy to keep your body in optimal health.
  • Psychotherapy to help you deal with the social and psychological effects of quadriplegia. Your doctor might also recommend drugs such as antidepressants.
  • Participation in support groups.
  • Counseling

During this time, patients are fitted for mobility aids, including wheelchairs. For most people, the majority of recovery happens within the first year.

Quadriplegia prognosis

Injuries that cause quadriplegia are unpredictable, since numerous complex structures are often involved. The delicate nature of the brain and spinal cord means there much doctors still don’t understand about these organs. Research suggests, for example, that the brain can compensate for injuries in some areas, and even for extensive damage, but that recovery from injuries in other areas is virtually impossible.

For this reason, it can be difficult to give an accurate prognosis to people with quadriplegia. As the swelling at the site of the injury goes down, some function may return. Some tetraplegics even spontaneously recover. Surgery and other treatments can help, particularly if the surgeon is able to remove something that is compressing the spinal cord or impeding the brain’s function.

Health Jade Team

The author Health Jade Team

Health Jade