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Quadriplegia, also known as quadriplegia, is a paralysis caused by disease or injury that results in partial or complete loss of use of all four limbs and the torso. Paraplegia is similar except that it does not affect the arms. The loss is usually sensory and motor, i.e. there is a lack of sensation and control.
Complete or partial, reversible or irreversible
The severity of quadriplegia depends on both the location of the spinal cord injury and the extent of the injury.
A person with an injury to C1 (the highest cervical vertebra at the base of the skull) is likely to lose the use of all 4 limbs and be dependent on a ventilator. A person with a C7 injury may lose the use of the torso and legs, but preserve the use of the arms and most of the hands.
The extent of the injury is also important. An injury to a complete section of the spinal cord will result in total loss of function in the area from this vertebra to the lower extremities. Injury to a partial section or even a contusion of the spinal cord can result in varying degrees of paralysis. A misconception about tetraplegia is that the patient cannot move their legs, arms or any other part of their body. This is not always the case. Some people are able to walk and use their hands, while others need to use wheelchairs, although they may be able to use their arms and fingers.
Although the most obvious symptom is the weakening of the limbs, function is also impaired in the abdomen. The affected person may experience loss or impairment of bowel and bladder control, sexual function, problems with digestion, breathing and a range of other functions. In addition, sensation is often altered in the affected areas. This may manifest as numbness or neuropathic pain.
Quadriplegia in numbers
Most studies have shown that a higher proportion of men (80%) than women suffer from tetraplegia. There is a particular incidence in the group of people under 30 years of age, as almost 50% of patients were between 18 and 25 years of age at the time of the accident.
Road traffic accidents are usually the most common cause of tetraplegia (almost 60%) followed by falls in the elderly population. The most affected areas are the C4 and C7 vertebrae.
Causes and risk factors for tetraplegia
Typical causes of tetraplegia are trauma (such as car accidents, shallow water diving, falls, sports injuries), diseases (such as transverse myelitis, multiple sclerosis or poliomyelitis) or congenital disorders (such as muscular dystrophy).
It is possible to suffer a fracture in the neck and for the vertebrae to fracture or dislocate without necessarily resulting in quadriplegia, as long as the spinal cord is not damaged. On the other hand, it is possible to injure the spinal cord without damaging the spinal column, for example, when a ruptured disc or spur on a vertebra penetrates the spinal column and damages the spinal cord.
Treatment of quadriplegia
The treatment of quadriplegia depends on the severity of the injury and the particular needs of the patient. Treatment aims to treat the patient's loss of vital functions and sensation in the paralysed areas of the body, as well as the loss or impairment of any organ function.
If the cause is a haematoma or inflammation of the spinal cord, the nerves can be restored to function. Steroids are given to the patient to prevent and reduce inflammation of the spinal cord.
If the cause is an injury, urgent treatment will be necessary to prevent further damage to the spinal cord.
There is no particular treatment to cure it. Surgery can help in part and if performed immediately after the injury, can help support and stabilise the vertebrae and bones of the spine.
In the case of a fracture, bones or discs compress the spinal cord and surgery can relieve this pressure by removing bone fragments and realigning the bones.
Functional electrical stimulation also helps paralysed muscles to partially regain movement.
It is also very important that patients suffering from tetraplegia do not neglect nutrition.
Therapies and medical care
Orthopaedics and movement therapy (kinesiotherapy)
Quadriplegic patients may need an orthopaedic device depending on their injuries, as their vertebrae are damaged and need to be stabilised.
Kinesiotherapy is essential for the patient to keep their muscles strong and active. Treatments are based on active or passive movements of the affected joints or muscles to recover or improve their functionality. There are also other techniques based on electronic stimuli or temperature contrasts in the affected area.
Physiotherapy
The mission of the physiotherapist is to strengthen the muscle and teach the patient to control and manage it autonomously.
Several studies have shown that there are different training techniques that help to improve the functioning of the arms and hands in patients who have suffered a spinal and cervical spinal cord injury that has caused tetraplegia. There is evidence to suggest that task-oriented training (accompanied by electrical and functional stimulation if the patient's grip is weakened) is ideal for improving hand function. Almost all studies have shown improved function and/or activity levels of the arms and hands.
Innovative techniques such as the use of functional electrical stimulation of the lower extremities, indoor cycling, treadmill exercise and electrical stimulation during walking are used to regain or maintain muscle mass in the legs.
How can I regain my autonomy?
Any quadriplegia with an injury above the C4 vertebra involves the daily use of a wheelchair.
Wheelchairs can be divided into two main groups: manual and powered. The choice depends largely on the level of paralysis of the patient. For example, power wheelchairs are usually more suitable in case of a complete injury. They allow the person to steer the wheelchair effortlessly via controls. The movement of the wheelchair can be controlled by buttons, push buttons, movement sensors on the head or chin, or a variety of joysticks for different needs.
The manual wheelchair is most suitable for people with tetraplegia who have mobility in their arms and hands, as it allows them to transfer and propel themselves. Today's wheelchairs are lightweight and very manoeuvrable, which makes everyday activities easier.
All chairs can be equipped with postural aids such as headrests, positioning and anti-decubitus cushions, ergonomic backrests and footrests. It is also possible to opt for a wheelchair with standing function.
On a day-to-day basis, it is convenient to reorganise the places where the person with a disability moves around. There are many accessories to make life easier. There are special chairs for the shower, grab bars for the bathroom, ramps for moving around, electric beds, adapted furniture, etc.
In addition, home automation has progressed significantly and today there is a wide variety of solutions that will make life easier for these people: voice commands to activate the heating, the light, opening or closing doors, etc.
Quadriplegia can take different forms, but there is still a long way to go to ensure that the patient retains some of his or her autonomy and is able to perform certain activities independently.
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