A Comprehensive Guide to Understanding Quadriplegia

Paraplegia

Paraplegia is the paralysis of the lower body, particularly the legs. Typically caused by damage to the spinal cord, a traumatic injury or congenital condition may be to blame. In most cases, paraplegia results from an injury to the vertebrae and spinal cord in the thoracic, lumbar, or sacral spine.

Understanding Paraplegia

How a person experiences paraplegia can vary widely based on the location and completeness of their injury as well as many other factors. When a spinal cord injury occurs, the nerves receive damage, and the brain can no longer communicate with the body below the level of injury. In a complete injury, the victim loses all sensory feedback and motor function below the level of the injury.

In an incomplete spinal cord injury, the person may retain some sensation, experience tingling, or have a complete loss of feeling. They may also have limited motor functioning or no movement at all.

Diagnosis and Prognosis

When a doctor sees a patient with a spinal cord injury in the emergency department, stabilizing them, so their life is not in danger is the priority. Because of how low in the back injuries to the thoracic, lumbar, and sacral spine occur, most patients can breathe on their own unless they suffered other injuries as well.

Once the patient’s life is not in danger, it is time for the doctor to assess their spinal cord injury. This requires X-rays, CT scans, and other medical imaging as well as neurological tests to determine sensation and motor function.

It is important to note that there is no way to offer an accurate prognosis this early in the process. Some injuries that appear complete at first glance are, in fact, incomplete. It is possible to recover sensation and motor function in an incomplete injury after the swelling goes down and through rehabilitation.

Common Causes of Spinal Cord Injuries and Paraplegia

Most acquired spinal cord injuries and brain injuries that lead to paraplegia are traumatic. Tripping over a hazard in the walkway and falling a few feet is unlikely to cause paraplegia. However, tripping over the same hazard and tumbling down a flight of stairs might. The top causes of paraplegia include:

• Car, truck, and motorcycle accidents
• Falls from a height
• Violence, such as gunshot wounds or stabbings
• Sports and recreation, often diving or contact sports
• Medical or surgical mistakes

Many people living with paraplegia suffer from congenital conditions such as spina bifida that left them paralyzed from birth.

Living with Paraplegia

Living with paraplegia generally means you suffer a loss of sensation and motor functioning below the site of your injury. A higher injury, such as those in your thoracic spine, will cause you to lose sensation in a greater portion of your body. An injury to the upper thoracic spine may make it difficult to control your trunk while an injury to the sacral spine may allow you to have continued control of your bladder and bowels.

Other signs and complications of paraplegia may include:

• Phantom sensations in the lower body including phantom pain
• Inability to control your bladder and bowel functions
• Impotence
• Depression, anxiety, and other changes in mood
• Weight gain
• Bed sores and other secondary infections
• Chronic pain

Because every injury is different and every person has a different capacity for dealing with this type of catastrophic injury, the psychological effects of spinal cord injuries are difficult to predict. Many people do suffer from depression following a paralyzing injury, but some maintain a positive attitude. Even those who go through a deep depression may recover quickly as they rehabilitate and regain independence.

Treatment and Rehabilitation Following a Spinal Cord Injury Accident

After determining the location and nature of your injury, your doctor will put a plan in place to stabilize your spine, allow it to heal, and then help you regain as much sensation and motor function as possible. Even in complete injuries when recovery of skills may be impossible, rehabilitation and therapy can help those with paralysis improve mobility and live independent lives.

Treatment for a spinal cord injury may include:

• Surgery to stabilize the spine
• Medication to reduce swelling
• Immobilization through a back brace or other device while healing

Therapy and rehabilitation following a spinal cord injury accident may include:

• Physical therapy to help regain function and rebuild strength
• Exercise therapy to retain muscle mass in the lower body and build muscle mass in the upper body
• Psychotherapy to reduce depression and offer emotional support while you fight to regain independence
• Occupational therapy to help you learn to live with your new impairments, how to provide self-care despite your paralysis, and to gain independence using tools and resources when necessary

While people with paraplegia generally do not regain sensation or motor control during inpatient rehabilitation or outpatient therapy, it is a good investment of their time and a key part of treating these injuries. Learning to adapt and work around your impairments is an integral part of living independently and getting around without relying on others for assistance.

Pursuing Compensation Following a Spinal Cord Injury and Paralysis

If you or a loved one suffers paraplegia following an accident and spinal cord injury, our team of attorneys is here to help. You may be eligible to pursue damages based on your expenses and losses. The Newsome | Melton team offers free case reviews and consultations.

For more than two decades, the attorneys from Newsome | Melton have fought for the rights of their clients. We may be able to pursue damages including:

• Medical expenses
• Ongoing care costs
• Property damages
• Lost wages
• Diminished earning capacity
• Pain and suffering
• Mental anguish

Let us evaluate your case today. Call us at (866) 510-5970 to learn more.

What Is Quadriplegia?

Paralysis can be either partial, periodic, complete, or incomplete. Paralysis of both the arms and legs has been traditionally been called quadriplegia. Quad comes from the Latin for four and plegia comes from the Greek for the inability to move. Currently, the term tetraplegia is becoming more popular, but it means the same thing. Tetra is from the Greek for the inability to move.

What Are The Causes of Quadriplegia?

The primary cause of quadriplegia is a spinal cord injury, but other conditions such as cerebral palsy and strokes can cause a similar appearing paralysis. The amount of impairment resulting from a spinal cord injury depends on the part of the spinal cord injured and the amount of damage done. Injury to the spinal cord can be devastating because the spinal cord and the brain are the main parts of the central nervous system, which sends messages throughout your body.

When the spinal cord is injured the brain cannot properly communicate with it and so sensation and movement are impaired. The spinal cord is not the spine itself; it is the nerve system encased in the vertebrae and discs which make up the spine.

Quadriplegia and Functionality

Quadriplegia occurs when the neck area of the spinal cord is injured. The severity of the injury and the place it occurred at determine the amount of function a person will maintain. A major spinal cord injury may interfere with breathing as well as with moving the limbs. A patient with complete quadriplegia has no ability to move any part of the body below the neck; some people do not even have the ability to move the neck.

Sometimes people with quadriplegia can move their arms, but have no control over their hand movements. They cannot grasp things or make other motions which would allow them a little independence. New treatment options have been able to help some of these patients regain hand function.

Complications of Quadriplegia

Quadriplegia causes many complications which will need careful management:

• Loss of bladder and bowel control. Because the spinal cord nerves control the function of the bladder and bowels, people with quadriplegia have various degrees of loss of control in this area. Without proper management, these problems can lead to urinary tract infections and to constipation. Urinary tract infections can be fatal if not treated in time, particularly if the patient is in a weakened condition. Your health care team will help you deal with bladder and bowel control so that you will not develop an infection.
• Pressure sores. When you are immobile for long periods of time, pressure from the weight of the body can cause your skin to develop sores. If you have quadriplegia you are at great risk of developing pressure sores, because you cannot shift your body weight on your own. Pressure sores can become infected and lead to serious complications, even death. For this reason, once your injuries are stable, nurses and nurse’s aides will turn you at regular intervals in the hospital and your caregivers at home will need to do the same thing. Special mattresses and cushions also help to prevent pressure sores.
• Blood clots. When you have quadriplegia, your blood circulation slows down since you are immobile. This can cause clots to develop. Clots are not always obvious; deep within the muscles are veins that can develop clots (a condition called deep vein thrombosis). An artery in the lungs can also be blocked by a clot (pulmonary embolism). Deep vein thrombosis and pulmonary embolism can be fatal. Your medical team will work to prevent clots. You may be given blood thinners to improve your circulation. Support hose and special inflatable pumps placed on the legs may also be used to increase circulation.
• Respiratory problems. The nerve signals to your chest and diaphragm may be weakened or distorted by a spinal cord injury, making breathing on your own difficult or impossible. If your diaphragm is wholly paralyzed, you will be intubated and placed on a ventilator. A special pacemaker is sometimes used to simulate the diaphragm’s nerves and allow the patient to breathe without a ventilator. Some people are able to wean away from the ventilator by learning how to consciously control their breathing. People with quadriplegia are at increased risk for pneumonia and other respiratory infections even if they have not had trouble breathing on their own. Medications and respiratory exercises are used to help prevent respiratory problems when mobility is a problem.
• Autonomic dysreflexia. A dangerous, occasionally fatal problem called autonomic dysreflexia can afflict people with spinal cord injuries located above the middle of the chest. This means that irritation or pain below the site of your injury may send a signal which will not reach the brain, but will cause a nerve signal that disrupts your body’s functions. As your heart rate drops, your blood pressure may rise, putting you at risk for a stroke. Ironically, simple problems such as irritating clothes or a full bladder may trigger this reflex; fortunately, removing the cause of the irritation or changing position may relieve the negative effects.
• Spastic muscles. Some people with quadriplegia experience muscle spasms which cause the legs and arms to jerk. Although you may be tempted to think that this is a sign of regaining movement or sensation, it is simply a symptom of the damaged spinal cords inability to properly relay remaining nerve signals to the brain. Most people with quadriplegia will not develop spastic muscles.
• Related injuries. People with quadriplegia may experience an injury, such as a burn, without realizing it, since they have no sensation in their limbs. For this reason, it is important that your caregivers do not place a heating pad or electric blanket on you.
• Pain. Although people with quadriplegia may not feel external sensations, it is possible to feel pain within your arms, legs, back, and other areas that do not respond to external stimuli. Pain medications prescribed by your doctor can relieve the pain.

Treatments for Quadriplegia

Trauma Care

Immediate treatment of quadriplegia consists of treating the spinal cord injury or other condition causing the problem. In the case of a spinal cord injury, you will be immobilized with special equipment to prevent further injury, while medical personnel works to stabilize your heart rate, blood pressure, and overall condition. You may be intubated to assist your breathing. This means that a flexible tube carrying oxygen will be inserted down your throat. Imaging tests will be used to determine the extent of your injury.

Surgery may be needed to relieve pressure on the spine from bone fragments or foreign objects. Surgery may also be used to stabilize the spine, but no form of surgery can repair the damaged nerves of the spinal cord. Unfortunately, the nerve damage caused by the initial spinal cord injury has a tendency to spread. The reasons for this tendency are not completely understood by researchers, but it is related to spreading inflammation as blood circulation decreases and blood pressure drops.

The inflammation causes nerve cells not directly in the injured area to die. A powerful corticosteroid, methylprednisolone (Medrol) can sometimes help prevent the spread of this damage if it is given within eight hours of the original injury; however, methylprednisolone can cause serious side effects and not all doctors are convinced that it is beneficial.

Rehabilitation

Rehabilitation for quadriplegia once consisted primarily of training to learn how to deal with your new limitations. Passive physical therapy was given to help prevent the muscles from atrophying. Today, many new options are offering quadriplegia patients new hope. These new options combine older methods with new technology with encouraging results.

While passive physical therapy once consisted solely of the therapists manipulating the patient’s arms and legs in an effort to increase circulation and retain muscle tone, today therapists can use electrodes to stimulate the patient’s muscles and give them an optimal workout. This technology is called functional neuromuscular stimulation (FNS). FNS stimulates the intact peripheral nerves so that the paralyzed muscles will contract.

The contractions are stimulated using either electrodes that have been placed on the skin or that have been implanted. With FNS, the patient may ride a stationary bicycle to improve muscle and cardiac function and prevent the muscles from atrophying. An implantable FNS system has been used to help people with some types of spinal injury regain use of their hands.

This is an option for people with quadriplegia, who have some voluntary use of their arms. The shoulder’s position controls the stimulation to the hand’s nerves, allowing the individual to pick up objects at will. Tendon transfer is another option that allows some people with quadriplegia more use of the arms and hands. This complicated surgery transfers a nonessential muscle with nerve function to the shoulder or arm to help restore function. FNS may be used in conjunction with a tendon transfer.

Other forms of treatments for quadriplegia are still in the experimental stage. Many clinical trials of new treatment options are run every year. If you or a loved one suffers from quadriplegia, you may want to consider one of these trials. Ask your doctor to help you find a suitable trial.

Spastic Quadriplegia

Cerebral palsy is the name for a condition in which brain damage has disrupted normal muscle functioning. For accuracy of diagnosis and treatment, researchers have divided the condition into nine different forms; some individuals with CP have something referred to as mixed cerebral palsy. The three forms of spastic CP, spastic diplegia, spastic hemiplegia, and spastic quadriplegia, are the most common. Spastic quadriplegia is the most serious and disabling form of spastic cerebral palsy.

Spastic quadriplegia affects the entire body. Spastic refers to the muscle stiffness which accompanies the condition. Quadri—comes from the Latin for four; it means that all four quadrants of the body are affected by spastic quadriplegia. Plegia comes from the Greek term for a form of paralysis.

Distinct Symptoms of Spastic Quadriplegia

Most patients with spastic quadriplegia cannot walk and their speech may also be profoundly affected. The limbs may be extremely stiff, yet the patient’s neck may be “floppy” meaning that they have no voluntary control of it. Seizures are common in spastic quadriplegia.

This type of CP can significantly affect the intelligence. People with spastic quadriplegia may have mental retardation, ranging from moderate-to-severe. Because of the communication difficulties which often accompany this disorder, the person’s IQ level may be difficult to assess.

Causes of Spastic Quadriplegia

Spastic quadriplegia is caused by extensive brain damage or by congenital malformations in the brain. Many factors, including maternal and fetal infections and exposure to toxins, can cause the unborn baby’s brain to develop abnormally. The brain is especially susceptible to abnormal development during the first twenty weeks of pregnancy.

During the twenty-sixth to thirty-fourth week of pregnancy, the white matter of the baby’s brain is very susceptible to damage. The brain’s white matter sends signals within the brain and to the rest of the body, so when it is damaged, it can significantly affect the entire body. Spastic quadriplegia and other forms of cerebral palsy may be caused by periventricular leukomalacias—holes or lesions in the white matter.

Unborn babies may also suffer brain damage from strokes which cause bleeding in the brain. Fetal strokes are sometimes caused by blood clots in the placenta which obstruct blood flow. Weak or mal-formed blood vessels in the brain can also cause fetal strokes and so can circulation abnormalities.

The mother’s health can also impact her unborn baby’s health. The babies of women who have high blood pressure during pregnancy have a greater risk of stroke; maternal high blood pressure is a common problem and it needs to be closely monitored for both the woman’s and the child’s sake. Maternal infections, particularly inflammatory pelvic disease, can cause fetal strokes.

Maternal infections caused by viruses can infect the uterus and placenta. Immune cells called cytokines increase in response to infection and produce inflammation to fight the problem; unfortunately, while inflammation is part of the infection fighting process, it can also damage the baby’s brain.

Lack of oxygen to the baby’s brain can also cause damage. Doctors originally thought that lack of oxygen due to a difficult deliver caused most cases of CP; researchers now think that less than ten percent of CP cases are caused by a lack of oxygen during delivery. A lack of oxygen can occur at any point in the pregnancy and it is more likely to cause damage in utero. Rupture of the womb, damage to the umbilical cord or the placenta can cause lack of oxygen and so can severe maternal low blood pressure.

Possible Complications of Spastic Quadriplegia

Because spastic quadriplegia affects the person’s entire body, it can lead to several types of limb deformities. The pull of spastic muscles on the bones can cause severe problems. About a quarter of patients with CP develop scoliosis (curvature of the spine) and people with spastic quadriplegia are especially prone to this back deformity. Scoliosis makes walking even more difficult for the CP patient.

Foot deformities are also common in spastic quadriplegia. Ankle equinus, a condition in which ankle flexibility is limited and the person walks on the toes may be present. Foot drop (sometimes called drop foot), a condition which makes it hard to raise the front of the foot, is also sometimes a problem for people with spastic quadriplegia.

People with spastic quadriplegia may have great difficulty swallowing and this can lead to respiratory difficulties if food is aspirated. Because of the swallowing difficulties, proper nutrition is also a concern. In addition, this form of CP makes the person especially prone to bladder and bowel difficulties.

Age at Diagnosis

Spastic quadriplegia is usually diagnosed in infancy when physicians or parents notice a significant delay in the baby’s development. Some infants with spastic quadriplegia may experience seizures before they are six months old; other people with the disorder never develop seizures.

Treatment of Spastic Quadriplegia

Increasing the patient’s mobility and making the patient more comfortable are two major goals in the treatment of spastic quadriplegia. There is no cure, but life can be made easier for the patient through a combination of various treatments.

As with the other forms of CP, spastic quadriplegia is always treated with physical therapy. The goal of physical therapy is to strengthen the limbs and to prevent contractures—a condition in which the muscles becomes so stiff that they will not move and actually cause the limb to bend and become deformed. There are many methods of physical therapy

Medicines are used to reduce spasticity in spastic quadriplegia. Medications are also used to control the seizures which sometimes accompany this disorder. Surgery may sometimes be used to repair limb deformities and allow the patient to move more easily.

Alternative forms of medicine such as massage therapy help improve the quality of life for some spastic quadriplegia patients. Caution should be used when considering alternative therapies for CP, since unscrupulous individuals may offer so-called “cures” which may be unsafe. Quality alternative treatments are helpful, but they are not cures for spastic quadriplegia. If you want to seek out alternative treatments, do so only with the advice of a qualified physician and choose a professional provider to administer the therapy.

Sources“Ankle Equinus: in CP” Wheeless’ Textbook of Orthopaedics. Retrieved March 29, 2009 from the World Wide Web: http://www.wheelessonline.com/ortho/ankle_equinus_in_cp

Banta, John V. “Cerebral Palsy, Myelodysplasia, Hydrosyringomylia, Rett Syndrome, and Muscular Dystrophies” in Spinal Deformities: the comprehensive text. Ronald L. Dewald, ed. New York: Thieme, 2003.

“Cerebral Palsy: Hope Through Research” National Institute of Neurological Disorders and Stroke. Retrieved March 27, 2009 from the World Wide Web:https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Palsy-Information-Page

“Cerebral Palsy” March of Dimes. Retrieved March 28, 2009 from the World Wide Web:https://www.marchofdimes.org/complications/cerebral-palsy.aspx

“Cerebral Palsy” MayoClinic.com Retrieved March 27, 2009 from the World Wide Web:http://www.mayoclinic.com/health/cerebral-palsy?DS00302

“Foot drop” The Mayo Clinic. Retrieved March 30, 2009 from the World Wide Web:https://www.mayoclinic.org/diseases-conditions/foot-drop/symptoms-causes/syc-20372628