quadriplegia

Quadriplegia, also known as tetraplegia, is a symptom in which a human experiences the loss of use of all of his/her limbs. This often includes both sensation and control.

Causes

It is caused by damage to the brain or the spinal cord at a high level - in particular spinal cord injuries secondary to an injury to the cervical spine. The injury, known as a lesion, causes victims to lose partial or total mobility of all four limbs, meaning the arms and the legs.^[1]

Typical causes of this damage are trauma (such as car crash, gunshot wound, fall, or sports injury) or disease (such as transverse myelitis, polio, or spina bifida).

It is possible to suffer a broken neck without becoming quadriplegic, such as when the vertebrae are fractured or dislocated but the spinal cord is not damaged. Conversely, it is possible to injure the spinal cord without breaking the spine, such as when a ruptured disc or bony spur on the vertebra protrudes into the spinal column.

Symptoms

Although the most obvious symptom is impairment to the limbs, functioning is also impaired in the torso. This can mean a loss or impairment in controlling bowel and bladder, sexual function, digestion, breathing, and other autonomic functions. Furthermore, sensation is usually impaired in affected areas. This can manifest as numbness, reduced sensation, or burning neuropathic pain.

Secondarily, because of their depressed functioning and immobility, quadriplegics are often more vulnerable to pressure sores, osteoporosis and fractures, frozen joints, spasticity, respiratory complications and infections, autonomic dysreflexia, deep vein thrombosis, and cardiovascular disease.^[2]

Severity depends on both the level at which the spinal cord is injured and the extent of the injury.

An individual with an injury at C1 (the highest cervical vertebra, at the base of the skull) will probably lose function from the neck down and be ventilator-dependent. An individual with a C7 injury may lose function from the chest down but still retain use of the arms and much of the hands.

The extent of the injury is also important. A complete severing of the spinal cord will result in complete loss of function from that vertebra down. A partial severing or even bruising of the spinal cord results in varying degrees of mixed function and paralysis. For example, there are quadriplegics who have impairment in all four limbs but can still walk and use their hands owing to the relatively minor extent of their injury. Others cannot walk but are able to maintain control of bladder, bowel, and sexual function.

It is common to have partial use of some limbs, such as the ability to move the arms but not the hands, or to be able to use the fingers but not have enough grip strength to lift objects. Furthermore, the deficit in the limbs may not be the same on both sides of the body; the left or right side may be more affected, depending on the location of the lesion on the spinal cord.

Terminology

The condition is also termed tetraplegia. Both terms mean "paralysis of four limbs"; tetraplegia is more commonly used in Europe than in the US. In 1991, when the American Spinal Cord Injury Classification system was being revised, it was recommended that the term tetraplegia be used to improve consistency ("tetra", like "plegia", has a Greek root, whereas "quadra" has a Latin root).^[3]

However, quadriplegia is still the term more commonly used by the general public in the US. Pentaplegia is a less common term referring to paralysis which also substantially affects head movement.).^[4]

Frequency

There are about 5,000 cervical spinal cord injuries per year in the United States (~1 in 60,000 - assuming a population of 300 million), and about 1,000 per year in the UK (also ~1 in 60,000 - assuming a population of 60 million). In 1988, it was estimated that lifetime care of a 27-year-old rendered tetraplegic was about US $1 million and that the total national costs were US $5.6 billion per year.^{[citation needed]}

Prognosis

Delayed diagnosis of cervical spine injury has grave consequences for the victim. About one in twenty cervical fractures are missed, and about two-thirds of these patients have further spinal-cord damage as a result. About 30% of cases of delayed diagnosis of cervical spine injury develop permanent neurological deficits. In high-level cervical injuries, total paralysis from the neck can result. High-level quadriplegics (C5 and above) will likely need constant care and assistance in things such as getting dressed, eating, and bowel and bladder help. Low-level quadriplegics (C6-C7) can often live independently.

Even with "complete" injuries, in some rare cases, through intensive rehabilitation, slight movement can be regained through "rewiring" neural connections, as in the case of the late actor Christopher Reeve.^[5]

Related conditions

• Back-Up Trust
• clearing the cervical spine
• hemiplegia
• paraplegia
• locked-in syndrome
• Brown-Sequard Syndrome

See also

• monkey helper

References

External links

Look up quadriplegia in Wiktionary, the free dictionary.

• Spinal cord injury at the Open Directory Project
• European Multicenter Study about Spinal Cord Injury
• United Spinal Association
• Spinal Cord Injury Support