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.