Quadriplegia - Wikipedia, the free encyclopedia

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Quadriplegia
From Wikipedia, the free encyclopedia

Tetraplegia, also known as quadriplegia, is paralysis caused

by illness or injury to a human that results in the partial or
total loss of use of all their limbs and torso; Paraplegia is
similar but does not affect the arms. The loss is usually
sensory and motor, which means that both sensation and
control are lost.[citation needed]

Tetraplegia
Classification and external resources
ICD-10 G82.5 (http://apps.who.int/classifications
/apps/icd/icd10online/?gg80.htm+g825)
ICD-9

344.0 (http://www.icd9data.com
/getICD9Code.ashx?icd9=344.0)

Contents
1 Causes
2 Terminology
3 Symptoms, signs and complications
4 Frequency
5 Upper Limb Paralysis
6 Prognosis
7 Related conditions
8 See also
9 References
10 External links

MeSH D011782 (http://www.nlm.nih.gov

/cgi/mesh/2010/MB_cgi?field=uid&
term=D011782)

Causes
It is caused by damage to the brain or the spinal cord at a high level C1 - C7 - in particular, spinal cord injuries
secondary to an injury to the cervical spine. The injury, which is known as a lesion, causes victims to lose partial
or total function of all four limbs, meaning the arms and the legs. Tetraplegia is defined in many ways; C1-C4
usually affects arm movement more so than a C5-C7 injury; however, all quadriplegics have or have had some
kind of finger dysfunction. So, it is not uncommon to have a quadriplegic with fully functional arms and only
have their fingers that don't work.
Typical causes of this damage are trauma (such as car crash, fall or sports injury), disease (such as transverse
myelitis or polio) or congenital disorders, such as muscular dystrophy or multiple sclerosis.
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.

Terminology
The condition is 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
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).[1]

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Spinal cord injuries are classified by the American Spinal Injury Association (ASIA) classification. The ASIA
scale grades patients based on their functional impairment as a result of the injury, grading a patient from A to
D. (see table 1 for criteria) Table 1: ASIA impairment scale
A Complete

no motor or sensory function is preserved in the sacral segments S4-S5.

B Incomplete

sensory but not motor function is preserved below the neurological level and includes the
sacral segments S4-S5.

C Incomplete

Incomplete: motor function is preserved below the neurological level, and more than half of
key muscles below the neurological level have a muscle grade less than 3.

D Incomplete

Incomplete: motor function is preserved below the neurological level, and at least half of key
muscles below the neurological level have a muscle grade of 3 or more.

E Normal

motor and sensory function are normal.

Symptoms, signs and complications

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.[citation needed]
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,[2] deep vein thrombosis, and cardiovascular disease.[3]
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. A common misconception with Tetraplegia is that the victim cannot
move legs, arms or any of the major function; this is often not the case. Some quadriplegic individuals can walk,
use their hands and live a life, as though they did not have a spinal cord injury, while others may use
wheelchairs and they can still have function of their arms and mild finger movement, again, that varies on the
spinal cord damage.
It is common to have movement in limbs, such as the ability to move the arms but not the hands or to be able to
use the fingers but not to the same extent, as before the injury. Furthermore, the deficit in the limbs may not be
the same on both sides of the body; either left or right side may be more affected, depending on the location of
the lesion on the spinal cord.

Frequency
There are about 5,000 cervical spinal cord injuries per year in the United States (~1 in 60,000 - assuming a
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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] It currently costs between
$520,000 to $550,000 per year to care for a ventilator dependent quadriplegic [4]

Upper Limb Paralysis

Upperlimb paralysis refers to the loss of function of the elbow and hand. When upper limb function is absent as
a result of a spinal cord injury it is a major barrier to regain autonomy. There are possibilities for tetraplegic
hand and elbow surgery which allow restoration of upper limb function. At the 2007 world congress in
reconstructive hand surgery and rehabilitation in tetraplegia a resolution was presented and accepted that
indicates that every person with tetraplegia should be examined and informed concerning the options for
reconstructive surgery of the tetraplegic arms and hands. With this resolution it becomes clear that it is
necessary to increase the awareness on this subject.[5] These surgical procedures are further discussed in
Tetraplegic Upper Limb Surgery

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 (C4 and higher) will likely
need constant care and assistance in activities of daily living, such as getting dressed, eating and bowel and
bladder care. Low-level quadriplegics (C5 to C7) can often live independently.[citation needed]
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.[6]
In the case of cerebral palsy, which is caused by damage to the motor cortex either before, during (10%) or after
birth and some quadriplegics are gradually able to learn to stand or walk through physical therapy.

Related conditions
Brown-Sequard Syndrome
Hemiplegia
Locked-in syndrome
Paraplegia

See also
List of people with quadriplegia
Clearing the cervical spine
Monkey helper
Tetraplegic upper limb surgery

References
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1. ^ Spinal Cord Injury - Paraplegic & Quadriplegic, Tetraplegic Information (http://www.apparelyzed.com)

2. ^ Tufts University, Boston, USA - Does sacral posterior rhizotomy suppress autonomic hyper-reflexia in patients
with spinal cord injury? (http://www.urologyjournal.us/studies/sacral-posterior-rhizotomy-hyper-reflexia-spinalcord-injury.html#6-introduction) UJUS 2009, Retrieved 20-04-2010
3. ^ Spinal cord injury: Possible complications (http://www.spinalinjury.net
/html/_complications_of_a_spinal_cor.html)
4. ^ Susanne R. Hayes, M.S., R.N., C.R.R.N., Adaptations, LLC, Estimate of Health Care Costs, October 21, 2010
5. ^ Current concepts in reconstruction of hand function in tetraplegia; J Friden, C Reinholdt, Scandinavian journal of
surgery 97:341-346, 2008
6. ^ The Guardian - Man of steel - Christopher Reeve talks about life as a quadriplegic (http://www.guardian.co.uk
/g2/story/0,3604,793417,00.html) (Tuesday, September 17, 2002)

External links
Spinal cord injury (http://www.dmoz.org//Health/Conditions_and_Diseases/Neurological_Disorders
/Trauma_and_Injuries/Spinal_Cord_Injury//) at the Open Directory Project
European Multicenter Study about Spinal Cord Injury (http://emsci.org)
United Spinal Association (http://unitedspinal.org)
Spinal Cord Injury Support (http://www.apparelyzed.com)
CareCure Community (http://sci.rutgers.edu)
Christopher & Dana Reeve Foundation (http://www.christopherreeve.org)
Sam Schmidt Paralysis Foundation (http://samschmidt.org/)
Retrieved from "http://en.wikipedia.org/wiki/Quadriplegia"
Categories: Cerebral palsy and other paralytic syndromes | Neurotrauma
This page was last modified on 31 January 2011 at 18:33.
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