Quadriplegia

Quadriplegia or Tetraplegia is a condition of paralysis that affects all the limbs and body from the neck to the down. The most common cause of quadriplegia is an injury to the spinal cord at the level of the neck. Quadriplegia is sometimes treatable but in most cases injury results in permanent paralysis.
Quadriplegia is when the person can’t deliberately control or move his muscles and it can affect a person from the neck to down. Depending on how and why it happens, it can affect the ability to move parts of the body, as well as some of the body’s automatic processes that keep the person alive.

Types of Quadriplegia:
Incomplete Quadriplegia: In this type, the quadriplegia blocks some signals from getting through, and thus a person might still have some ability to move, feel sensations, or control automatic body processes like bowel and bladder function.

Complete Quadriplegia: In this type, the quadriplegia blocks all signals from getting through, i.e a person loses muscle control, and the ability to feel sensations, and their brain can’t manage any automatic processes that rely on the signals sent by the brain to work.
 
Two ways that paralyzed muscles act in Quadriplegia:
Flaccid Quadriplegia:
Flaccid quadriplegia means that muscles don’t work at all and remain flaccid.

Spastic Quadriplegia:
Spastic quadriplegia results in muscles that don’t work by themselves and contract uncontrollably.

Effect of the location of a problem on Quadriplegia?
The spine has several sections. The cervical spine or C-spine is the section in the neck. There are seven vertebrae interlocking bone segments, which make up the C-spine. The C-spine also includes eight spinal nerves, which run in-between vertebrae and lead to different areas of the body.
The effects of a problem with the spinal cord injury can vary widely depending on where exactly it happens. For example, the 6th cervical spinal nerve is known as C6. Quadriplegia can occur when there’s an incomplete or complete spinal cord injury anywhere between C1 and C8. The higher the injury, the more dangerous the effects are. The effects, depending on location:

• C1 to C2: Injury at this level causes complete paralysis of all four limbs and the muscles that control breathing. These injuries are almost always deadly without immediate care, especially breathing support or ventilation. Injuries at this level can also cut off the brain’s connection to other parts of the autonomic nervous system, which manages automatic functions like blood pressure control, sweating, digestion, and the muscles in the bladder and bowels.
• C3 to C4: Same as above, an injury that is close to C4 may not block the brain’s control of breathing muscles, but breathing problems may occur. Coughing is severely affected and can increase the risk of developing pneumonia.
• C4 to C8: Varying levels of paralysis in the arms and hands. The further down the spinal cord, the less widespread the effects of paralysis.

There are many causes of quadriplegia, the most common ones are mentioned below:

• Trauma to the spinal cord.
• Motor vehicle accidents
• Injury to the spinal cord.
• Falls.
• Gunshot wounds, blunt impact, stab wounds, etc
• Infection that attacks or compresses the spinal cord.
• Cysts or fluid-filled cavities within the spinal cord (syringomyelia).
• Lack of blood flow due to a ruptured blood vessel or blocked blood vessel rupture.
• Sports-related injuries.
• Spine tumors.
• Cerebral palsy.
• Congenital conditions like Spina Bifida.
• Autoimmune or inflammatory conditions like multiple sclerosis. G B syndrome, etc.

The basic symptoms of quadriplegia include:

• Numbness in the arms and legs;
• Loss of sensations.
• Paralysis of the arms and legs.
• Urinary retention and bowel dysfunction.
• Difficulty breathing.
• Trouble sitting upright.
• Loss of balance, etc.

Pathology
Quadriplegia can result from acute cervical spinal cord trauma, compression by tumor, or spinal artery infarction. Injuries at or above C3 to C5 involve the phrenic nerves and can cause partial to complete bilateral Hemi diaphragmatic paralysis.

Physical examination:
The therapist carries out the physical examination to check whether there is a loss of limb function, with some symptoms that lead to quadriplegia. It is not easy to diagnose but it can help expand the therapy options and improve the overall prognosis by treating contributing factors early.

MRI Scans:
MRI scans are done to check for the abnormalities such as herniated discs, brain tumors, and cysts in the spinal cord that may block the signals from the brain.

Spinal Taps (Lumbar Punctures):
Spinal punctures are required to draw some cerebrospinal fluid from the spinal column to analyze it and check spinal health.

Blood Tests:
Blood tests are done to check for deficiencies or to check for genetic markers that can indicate a congenital condition that causes inherited paralysis.

Electromyography (EMG) Tests:
An electromyography test is done to help differentiate between muscle and nerve disorders.

Medications: Painkillers, Diuretics, stool softeners, steroids, antianxiety, anticonvulsants, antinausea medicines, etc.

Note: Medication should not be taken without the doctor’s prescription.

Surgery: The surgical treatment for quadriplegia can vary widely depending on the cause and where in the spine the problem occurs. Surgery is done to relieve pressure around the spinal cord and to stabilize or fuse vertebrae to keep them from damaging the spinal cord.

Immobilization:
Immobilization is recommended as it can help provide pain relief, but active rehabilitation is often better. Immobilization is done by using collars, specialized backboards, or braces to keep the spinal cord stable and prevent anything from pressing into or damaging it.

Thermotherapy:
Thermotherapy or heat therapy helps increases blood circulation and decreases spasticity when given before stretching exercises.

TENS:
Transcutaneous electrical stimulation (TENS) helps to reduce pain after an injury or surgery.

Functional Electrical Stimulation (FES):
Functional electrical stimulations (FES) help the patient to perform functional exercises while he is on stimulations.

Passive Range of Motion:
Passive range of motion exercises helps increase circulation and prevent the formation of pressure sores and contractures.

Active range of motion Exercises:
Active range of motion exercises helps maintain mobility also strengthen the surrounding muscles and improve mobility.

Movement awareness Training:
Movement awareness training helps improve movement and strength. Teaches the importance of posture awareness and reduces the stress on the back while sitting or standing.

Strengthening Exercises: 
Strengthening exercises are recommended to strengthen weak areas and strengthen the surrounding muscles and improve mobility.

Stretching Exercises:
Stretching exercises are done to decrease the stiffness of the joints and muscles to increase flexibility and movement.

Balance and Coordination Training: 
In quadriplegic patients, balance and coordination training can help to relearn and adjust. Especially for patients who may be more prone to fall injuries after surgery or who are in a recovery stage.

Cardiovascular Exercises: 
Cardiovascular exercises help to keep the heart healthy and also help maintain good circulation after an injury to the spine.

Respiratory muscle Strength Training: 
Respiratory muscle strength training helps if the patient has a problem in breathing that occurs when there is damage in the cervical and thoracic areas of the spine. The physiotherapist teaches the patient to breathe again and improve respiratory muscle strength.

Mobility Training: 
Mobility training improves mobility by teaching the patient to use an assistive device like a wheelchair, walking frame, or crutches, depending on the patient’s condition.

Living with quadriplegia can be extremely challenging as it requires both the quadriplegic and those around them to make significant adjustments in their lifestyle. As these patients do not have control over their arms and legs, they are often dependent on their caretakers for going to the bathroom, getting around, eating, and other daily activity. Some motorized wheelchairs can allow quadriplegic patients to control them with head motions, but it may take some adjustment to get used to it. All quadriplegic patients are not the same. With effort, it is possible to maintain a healthy lifestyle that helps prolong life expectancy. It is also possible to be active and even achieve great things while living with quadriplegia.