Quadriplegia

Quadriplegia, also known as tetraplegia, is thusly named because it affects all four limbs, plus the torso (quad originates from the Latin word for four). Most people with tetraplegia have significant paralysis below the neck, and many are completely unable to move. This form of paralysis is inevitably the product of damage high in the spinal cord, usually in the cervical spinebetween C1-C7. The higher the injury is, the more extensive the damage will be, and very high spinal cord injuries are often immediately fatal.

What is Quadriplegia?

You might think that total paralysis of the arms and legs requires damage to the limbs, but most quadriplegics have perfectly healthy legs and arms. Instead, the problem begins in the brain or spinal cord, and occasionally in both. The spinal cord is charged with sending signals to and from the brain, while the brain processes and interprets these signals. Thus a spinal cord injury prevents the brain from sending an receiving these signals, while a brain injury undermines the brain's ability to process them.

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 we 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.
What Causes Quadriplegia?

Any injury high in the spinal cord or that affects multiple regions in the brain can lead to paralysis in all four limbs. Spinal cord injuries account for the majority of quadriplegia cases, with the leading causes of spinal cord injuries as follows:  

1. Car accidents (37%)
2. Falls (30%)
3. Violence (28%); gun shots are the leading cause of violent injuries, accounting for fully 14% of all spinal cord injuries.
4. Sports and recreational activities (9%)
5. Medical and surgical accidents (4%)

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.

Non-traumatic injuries are those that do not involve a sudden injury. For example, spinal cord infections and lesions, brain tumors, and some congenital defects can cause quadriplegia, particularly if left untreated. In some cases, quadriplegia caused by non-traumatic factors such as infections may be reversible, but only if the cause of your paralysis is caught sufficiently early to allow treatment.

How Does Quadriplegia Affect the 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:

1. 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. 
2. 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. 
3. 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. 
4. Spasticity; this involves sudden, uncontrolled movements, particularly in areas most affected by the paralysis. 
5. 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. 
6. Respiratory infections; particularly common in the months following an injury, these infections are the leading cause of death among spinal cord injury survivors. 
7. 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. 
8. Secondary infections due to inability to move, including bedsores. 
9. Psychological concerns, particularly anxiety and depression. 
10. 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. 
11. 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. 

How is Quadriplegia Treated?

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. Some treatment options include:

1. Brain and spinal cord surgeries to address obstructions, reduce bleeding, and manage swelling.
2. Medication to reduce the risk of infection; you may also take other drugs, such as blood thinners or blood pressure medications.
3. 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.
4. Family education and support.
5. Speech and language therapy to help you maintain or regain your ability to speak.
6. Physical therapy to help you regain functioning.
7. Exercise therapy to keep your body in optimal health.
8. Psychotherapy to help you deal with the social and psychological effects of quadriplegia. Your doctor might also recommend drugs such as antidepressants.
9. Participation in support groups.

Paraplegia

What is Paraplegia?

Paraplegia is a medical condition where a person experiences loss of movement and/or loss of feeling in the body. This usually occurs after an injury to the nervous system. Paraplegia can involve complete or partial paralysis of the legs and/or the trunk. The severity and location of the damage to the nervous system determines the extent of the paralysis. In paraplegia, only the lower half of the body is paralyzed. Paralysis of the complete body, including arms, is known as Quadriplegia and Paraplegia.

Depending on the extent and location of the damage to the nervous system, there are some patients who can resume minimal function. Majority of the patients suffering from paraplegia will have this condition permanently. Treatment depends on the cause and comprises mainly of rehab and physical therapy.

Causes of Paraplegia

The most common cause of paraplegia is any trauma or injury to the nervous system. Other causes include:

1. Injury to the neck resulting in fracture of the cervical vertebrae.
2. Fractured or broken back where the lumbar vertebrae are fractured.
3. Injury to the spinal cord.
4. Stroke.
5. Hereditary spastic paraplegia, which is a genetic disorder.
6. It can be congenital, i.e. present at birth.
7. Presence of tumor within the spinal cord or constricting the spinal cord.
8. Autoimmune diseases.
9. Spinal cord disorders, such as syrinx.
10. Infection.

Symptoms of Paraplegia

Symptoms depend on the extent of the involvement of the spinal cord.

1. Patient experiences loss of movement or muscle control in the legs, feet, toes, or trunk.
2. Patient experiences loss of sensation in the legs, feet, toes or trunk.
3. Tingling in the legs, feet, toes or trunk can also be felt.
4. Bladder and bowel incontinence.
5. Sexual dysfunction.

Tests to Diagnose Paraplegia

1. Medical history and physical exam.
2. CT scan to assess any injuries to the head or spine.
3. MRI scan, where magnetic waves are used to take pictures of the structures within the head and spine.
4. Myelography is a type of x-ray, which uses an injection of a contrast medium to see the spinal cord more clearly.
5. Blood tests such as CBC.
6. Evoked potential nerve test is done to assess the pathways of the nerve.
7. Lumbar puncture is done where a sample of the CSF or cerebrospinal fluid is taken from the lower back.

Treatment of Paraplegia

1. Patient should be taken to ER immediately if the cause is an injury. Emergency treatment is required so that further damage to the nervous system can be prevented.
2. Steroids can be given to reduce the swelling of the spinal cord in injury.
3. Surgery is done to stabilise the spine.
4. Surgery is also required if the cause is a tumor, which is compressing the spinal cord.
5. Radiation therapy can also be done.
6. In majority of the patients, physical therapy and rehabilitation greatly helps in restoring the muscle function, strength and range of motion.
7. Occupational and speech therapy is also beneficial.
8. Patients should also learn how to use the wheelchair, as most of the paraplegics are dependent on a wheelchair for transportation.

Hemiplegia

Hemiplegia is a form of paralysis that affects just one side of the body, often just one arm and one leg, but occasionally with symptoms extending partially into the torso. A related condition, hemiparesis, is significant loss of strength and mobility on one side of the body, but without full paralysis. Some people with hemiplegia develop the condition after a bout of hemiparesis. Others may alternate between times of hemiparesis and hemiplegia.

What is Hemiplegia?

The brain is divided into two hemispheres, separated by a bundle of fibers called the corpus callosum. Generally speaking, the right side of the brain controls muscles and other functions on the left side of the body, while the left side of the brain controls much of the right side of the body. Thus hemiplegia and hemiparesis almost always indicate a problem with one side of the brain.
Hemiplegia may come on suddenly, or develop slowly over time. A condition related to hemiplegia, spastic hemiplegia, causes the muscles to get stuck in a contraction, resulting in little muscle control, chronic muscle pain, and unpredictable movements. People with hemiplegia often show other signs of brain damage or head injury, and may experience issues with other areas of their bodies.
Hemiplegia, like other forms of paralysis, is characterized by significant loss of sensation and control in the affected area. People with hemiplegia may experience intermittent pain, and may be better able to control their limbs at some times than at others.

What Causes Hemiplegia?

Though the arms, legs, and possibly torso are the regions of the body most obviously affected by hemiplegia, in most cases of hemiplegia these body regions are actually perfectly healthy. Instead, the problem resides in the brain, which is unable to produce, send, or interpret signals due to disease or trauma-related damage. Less frequently, hemiplegia results from damage to one side of the spinal cord, but these sorts of injuries more typically produce global problems, not just paralysis on one side of the body.
Some common causes of hemiplegia include:

• Traumatic brain injuries to one side of the brain only. These may be caused by car accidents, falls, acts of violence, and other factors.
• Cardiovascular problems, particularly aneurysms and hemorrhages in the brain.
• Strokes and transient ischemic attacks (better known as TIA or mini-strokes).
• Infections, particularly encephalitis and meningitis. Some serious infections, particularly sepsis and abscesses in the neck, may spread to the brain if left untreated.
• Conditions that cause demyelination of the brain, including multiple sclerosis and some other autoimmune diseases.
• Reactions to surgery, medication, or anesthesia.
• Loss of oxygen to the brain due to choking or anaphylactic shock.
• Brain cancers.
• Lesions in the brain, even if non-cancerous, since these lesions can impede function on one side of the brain.
• Congenital abnormalities, including cerebral palsy and neonatal-onset multi-inflammatory disease.
• Rarely, psychological causes; some states of catatonia can cause hemiplegia, and people with parasomnia—a sleep disorder leading to unusual nighttime behavior—may experience nighttime episodes of hemiplegia.
  

How Does Hemiplegia Affect the Body?

The course of hemiplegia is highly variable, and heavily dependent on the cause. For many people with hemiplegia, the condition is a temporary one, but others may struggle with hemiplegia for the rest of their life. For some, the paralysis is extensive and complete, producing a total loss of sensation and bodily control. For others, symptoms are less severe. Some of the ways hemiplegia affects the body include:

• Total or partial loss of sensation on just one side. 
• Changes in cognition, mood, or perception. 
• Difficulty speaking. 
• Changes on the other side of the body, since those muscles may begin to atrophy or become painful due to chronic muscle spasms. 
• Spastic attacks during which the muscles move without your conscious control. 
• Seizures. 
• “Pusher syndrome.” With this symptom, people with hemiplegia shift their weight to the paralyzed side of the body, resulting in significant loss of motor control. 

How is Hemiplegia Treated?

There's no single treatment approach that works for all people. Instead, treatment is largely dependent on the cause of hemiplegia. Some treatment options include:

• Blood thinners to reduce cardiovascular blockages and decrease the chances of future strokes.
• Antibiotics, usually delivered intravenously, to combat brain infections.
• Surgery to remove swelling on the brain or objects lodged in the brain.
• Muscle relaxant drugs.
• Surgery to address secondary issues, particularly involuntary muscle contractions, spinal damage, or damage to the ligaments or tendons on the unaffected side of the body.
• Physical therapy designed to help the brain work around the injuries. Physical therapy can also strengthen the unaffected side and help you reduce the loss of muscle control and tone.
• Support groups, family education, and advocacy.
• Psychotherapy to help you deal with the psychological effects of the disease.
• Exercise therapy to help you remain healthy in spite of your disability.
  
  Source : https://www.spinalcord.com

Monoplegia

Monoplegia is a form of paralysis that affects just one limb. It is almost always the product of cerebral palsy, though a limited number of other medical conditions may cause monoplegia. Because monoplegia is rare, it is still poorly understood, and research into ideal treatments, the progression of the disease, and best practices for assisting patients is still in its infancy. 

 

 

What is Monoplegia?

Monoplegia is paralysis limited to a single limb—usually an arm. Occasionally, the paralysis is even further limited, to just a single muscle. Though this can substantially impede function, most people with monoplegia are able to care for themselves, perform daily tasks, and find ways to work around their symptoms. In people with cerebral palsy, monoplegia is considered a sign of a good prognosis, since it's one of the most minor symptoms of the disease.
Most people with monoplegia experience a gradual deterioration in functioning, beginning with weakness or limpness in the affected limb. Over time, the effects intensify, eventually leading to full or partial paralysis of the affected limb.

What Causes Monoplegia?

Monoplegia is the product of damage to parts of the brain that control the affected area. Less commonly spinal cord damage may also be implicated, but this is more likely to cause other symptoms, such as paraplegia or quadriplegia.
Cerebral palsy is the leading cause of monoplegia. Indeed, so heavily associated with cerebral palsy is this symptom that some doctors consider it a telltale sign of CP. Rather than a single disorder, cerebral palsy is actually a group of related neurological disorders that typically manifest early in life. It's the most common movement disorder in children, affecting about .2% of all births. A number of injuries and infections can cause CP, including oxygen deprivation at or immediately following birth, toxoplasmosis, rubella, and exposure to high levels of toxins such as mercury.
Cerebral palsy appears in childhood, not midlife. Most children with cerebral palsy have other symptoms, so adults who only experience monoplegia likely have another condition, not undiagnosed CP. Some other symptoms of cerebral palsy include:

• Spasticity of movement.
• Curling of the hands or toes.
• Difficulties with vision or hearing.
• Difficulties with speech.

A limited number of other disorders can cause monoplegia. Those include:

• Head injuries. 
• Spinal cord injuries. 
• Strokes and aneurysms.
• Infections of the brain or spinal cord. 
• Lesions or cancer of the brain or spinal cord. 

How Does Monoplegia Affect the Body?

Symptoms of monoplegia are typically limited to a single limb, though other symptoms of cerebral palsy will likely be present. Symptoms of monoplegia include:

• Weakness or limpness in a single limb that does not appear related to another injury, such as a sprain, strain, or broken bone. 
• Decreased sensation in a single limb. Some people also experience unusual “electrical” sensations, pins and needles, or unexplained pain. 
• Curling of the toes or fingers attached to the affected limb. 
• Difficulty with moving the limb that eventually leads to full paralysis. 
• Pain in areas near the limb due to muscle stiffness and loss of muscle control. Some people may experience headaches, shoulder pain, and other ailments.

How is Monoplegia Treated?

Treatment for monoplegia depends on its cause. When the product of cerebral palsy, monoplegia may change or even remit over time, but cerebral palsy itself has no cure. Treatments for CP include a wide range of medications, physical therapy, surgery, assistance integrating into the community, biofeedback, and some alternative treatments. Because CP is incurable, a number of promising experimental treatments have emerged in recent years, though results have varied and there is still no single treatment that works for every patient.
People with monoplegia due to other causes have a range of treatment options. Those include:

• Treating the cause of the monoplegia. Monoplegia due to an infection in the brain or spinal cord, for instance, may improve with high doses of antibiotics.
• Physical therapy to teach the brain and spinal cord how to work around the injury.
• Exercise therapy to reduce pain in the surrounding area and to retain as much muscle function and tone as possible.
• Psychotherapy to help you deal with the challenges of living with a disability.
• Surgery to correct anatomical abnormalities.
• Occupational skills training.
• Participation in support groups.
• Education about monoplegia, as well as advocacy about disability rights issues.
  
  Source : https://www.spinalcord.com/

What is Paralysis?

In childhood, you probably learned that paralysis means the complete inability to move, to sense touch, or to control bodily sensations. As with most things we learn as children, the real meaning of paralysis is actually significantly more nuanced. Paralysis comes in many forms, and the extent to which a person is immobilized my change over time as physical therapy, changes in health, and sheer luck alter the way the body responds to physical damage.

What is Paralysis?

Paralysis is the inability—whether temporary or permanent—to move a part of the body. In almost all cases, paralysis is due to nerve damage, not to an injury to the affected region. For instance, an injury in the middle or lower regions of the spinal cord is likely to disrupt function below the injury, including the ability to move the feet or feel sensations, even though the actual structures are as healthy as ever.
So what happens to the body when it is paralyzed? That depends on the cause of the paralysis, but generally at least one of the following factors is in play:

• The brain is unable to relay a signal to an area of the body due to injuries to the brain.
• The brain is able to sense touch and other sensations in the body, but is unable to effectively relay a response due to injuries in the spinal cord.
• The brain can neither send nor receive signals to an area of the body due to injuries in the spinal cord.

The spinal cord is like the brain's relay system, so when something in the spinal cord doesn't work or is injured, paralysis is often the result. These injuries can be the product of traumatic accidents, or diseases such as strokes and polio. Most spinal cord injuries are incomplete, which means that some signals still travel up and down the cord. With an incomplete injury, you may retain some sensation and movement all the time, or the severity of the paralysis may change—sometimes on a highly unpredictable basis. A complete spinal cord injury, by contrast, completely compressed or severs the nerves in the spinal cord, making it impossible for the signal to travel.
Rarely, injuries to the affected area cause paralysis. This is more common among people who have another medical condition, such as diabetes. For instance, diabetic nerve damage can cause nerves in some area of the body, particularly the feet, to cease functioning. You'll still be able to move, but you might have reduced or little sensation. This can result in more laborious movements, a loss or decrease in your ability to walk, and an increased risk in some other health issues, such as cardiovascular episodes.

What Causes Paralysis?

Strokes are the most common cause of paralysis because of their ability to injure the brain and impede its relationship with the spinal cord. They account for 29% of all paralysis cases. Spinal cord injuries account for 23% of paralysis cases, with car accidents, falls, sporting injuries, and act of interpersonal violence causing most spinal cord injuries.
Other common causes of paralysis include:

• Multiple sclerosis (17%)
• Cerebral palsy (7%)
• Post-polio syndrome (5%)
• Traumatic brain injury (4%)
• Neurofibromatosis (4%)
• Birth defects (2%)

Types of Paralysis

In reality, there are many types of paralysis because there are innumerable ways that the body can be injured. There are four main categories of paralysis, however, which have to do with the portion of the body that is affected.

Monoplegia

Monoplegia is paralysis of a single area of the body, most typically one limb. People with monoplegia typically retain control over the rest of their body, but cannot move or feel sensations in the affected limb. Though cerebral palsy is the leading cause of monoplegia, a number of other injuries and ailments can lead to this form of partial paralysis, including:

• Strokes
• Tumors
• Nerve damage due to injuries or diseases
• Nerve impingement
• Motor neuron damage
• Brain injuries
• Impacted or severed nerves at the affected location

Monoplegia is sometimes a temporary condition, and is especially common in the aftermath of a stroke or brain injury. When the nerves affecting the paralyzed area are not fully severed, it is often possible to regain significant function through physical therapy.

Hemiplegia

Hemiplegia affects an arm and a leg on the same side of the body, and as with monoplegia, the most common cause is cerebral palsy. With hemiplegia, the degree of paralysis varies from person to person, and may change over time. Hemiplegia often begins with a sensation of pins and needles, progresses to muscle weakness, and escalates to complete paralysis. However, many people with hemiplegia find that their degree of functioning varies from day to day, and depending on their overall health, activity level, and other factors.

Hemiplegia should not be confused with hemiparesis, which refers to weakness on one side of the body. Nevertheless, hemiparesis is often a precursor to hemiplegia, particularly for people with neurological issues.

Hemiplegia is sometimes temporary, and the overall prognosis depends on treatment, including early interventions such as physical and occupational therapy.

Paraplegia

Paraplegia refers to paralysis below the waist, and usually affects both legs, the hips, and other functions, such as sexuality and elimination. Though stereotypes of paraplegia hold that people with this condition cannot walk, move their legs, or feel anything below the waist, the reality of paraplegia varies from person to person—and sometimes, from day to day.
Thus paraplegia refers to substantial impairment in functioning and movement, not necessarily a permanent and total paralysis. Rarely, people with paraplegia spontaneously recover. This may be due to brain or spinal cord functions that are not yet understood, such as regeneration of neurons. More typically, paraplegics are able to regain some functioning with physical therapy, which works to retrain the brain and spinal cord to work around limitations while strengthening muscles and nerve connections.
Spinal cord injuries are the most common cause of paraplegia. These injuries impede the brain's ability to send and receive signals below the site of the injury. Some other causes include:

• Spinal cord infections
• Spinal cord lesions
• Brain tumors
• Brain infections
• Rarely, nerve damage at the hips or waist; this more typically causes some variety of monoplegia or hemiplegia.
• Brain or spinal cord oxygen deprivation due to choking, surgical accidents, violence, and similar causes.
• Stroke
• Congenital malformations in the brain or spinal cord

Quadriplegia Quadriplegia, which is often referred to as tetraplegia, is paralysis below the neck. All four limbs, as well as the torso, are typically affected. As with paraplegia, though, the degree of disability and loss of function may vary from person to person, and even from moment to moment. Likewise, some quadriplegics spontaneously regain some or all functioning, while others slowly retrain their brains and bodies through dedicated physical therapy and exercise.

Occasionally, quadriplegia is a temporary condition due to brain injuries, stroke, or temporary compression of spinal cord nerves. Some spinal cord injury survivors temporarily suffer from quadriplegia immediately after the injury, then experience a less systematic form of paralysis as swelling goes down, the nerves become less compressed, or surgery reverses some damage.

As with paraplegia, spinal cord injuries are the leading cause of quadriplegia. The most common causes of spinal cord injuries include automobile accidents, acts of violence, falls, and sporting injuries, especially injuries due to contact sports such as football. Traumatic brain injuries can also cause this form of paralysis. Other sources of quadriplegia include:

• Acquired brain injuries due to infections, stroke, and other disease-related processes.
• Loss of oxygen to the brain and spinal cord due to choking, anesthesia-related accidents, anaphylactic shock, and some other causes.
• Spinal and brain lesions
• Spinal and brain tumors
• Spinal and brain infections
• Catastrophic nerve damage throughout the body
• Congenital abnormalities
• Early brain injuries, especially pre-birth or during-birth injuries that lead to cerebral palsy, which can produce a range of symptoms, including varying degrees of paralysis
• Allergic reactions to drugs
• Drug or alcohol overdoses.
  
  Source : https://www.spinalcord.com/