Spinal Cord Injury Levels
Loss of movement and feeling depend on what part of the spine is damaged.
Cervical Vertebrae Levels: C1 – C8
Cervical injuries above the C4 level may require a ventilator for the person to breathe. C6 injuries often result in shoulder and biceps control, but no control at the wrist or hand. C6 injuries generally yield wrist control, but no hand function. Individuals with C7 and T1 injuries can straighten their arms but still may have problems with their hands.
Thoracic Vertebrae Levels: T1 – T12
The first thoracic vertebrae, T1, is located at approximately the same level as the top rib. Injuries in the thoracic region usually affect the chest and legs, and result in paraplegia. For T1 to T8 injuries, there is most often control of the hands, but lack of abdominal muscle control. Lower T-injuries (T9 – T12) allow good trunk control and good abdominal muscle control.
Lumbar Vertebrae Levels: L1 – L5
Injuries to nerves in the area of L1 – L5 generally result in some loss of functioning of the hips and legs. Bowel, bladder and sexual function may also be impacted.
Sacrum Levels: S1 – S5
The Sacral Vertebrae run from the pelvis to the end of the spinal column. Injuries to S1 – S5 generally result in some loss of functioning in the hips, legs, ankles and feet. Loss of control of bowel, bladder and sexual functions is also common.
What Is Quadriplegia?
Paralysis can be either partial, periodic, complete, or incomplete. Paralysis of both the arms and legs has been traditionally been called quadriplegia. Quad comes from the Latin for four and plegia comes from the Greek for inability to move. Currently the term tetraplegia is becoming more popular, but it means the same thing. Tetra is from the Greek for inability to move.
Definition of a Quadriplegic (C1 – C8)
Quadriplegic means a person who as a result of illness or injury, is totally or partially paralysed in all four of his/her limbs.
What is a complete/incomplete quadriplegic?
Complete: A patient with complete quadriplegia has no ability to
move any part of the body below the neck; some people do not even have e.
Incomplete: A patient who is an incomplete quadriplegic has limited
movement, feeling or sensation in any of their four limbs.
So basically they don’t have 100% use of their limbs like
a normal able-bodied person.
What Are The Causes of Quadriplegia?
The primary cause of quadriplegia is a spinal cord injury, but other conditions such as cerebral palsy and strokes can cause a similar appearing paralysis. The amount of impairment resulting from a spinal cord injury depends on the part of the spinal cord injured and the amount of damage done. Injury to the spinal cord can be devastating because the spinal cord and the brain help with communication throughout the body by sending messages through the spine.
Quadriplegia and Functionality
Quadriplegia occurs when the neck area of the spinal cord is injured. The severity of the injury and the place it occurred at determine the amount of function a person will maintain. A major spinal cord injury may interfere with breathing as well as with moving the limbs.
Sometimes people with quadriplegia can move their arms, but have no control over their hand movements. They cannot grasp things or make other motions which would allow them a little independence.
New treatment options have been able to help some of these patients regain hand function. A qualified occupational therapist (OT), helps a quadriplegic by teaching them how to manipulate certain instruments to help them gain their independence and take back their control.
Complications of Quadriplegia
Quadriplegia causes many complications which will need careful management:
• Loss of bladder and bowel control. Because the spinal cord nerves control the function of the bladder and bowels, people with quadriplegia have various degrees of loss of control in this area. Without proper management these problems can lead to urinary tract infections and to constipation. Urinary tract infections can be fatal if not treated in time, particularly if the patient is in a weakened condition. Your health care team will help you deal with bladder and bowel control so that you will not develop an infection.
• Pressure sores. When you are immobile for long periods of time, pressure from the weight of the body can cause your skin to develop sores. If you have quadriplegia you are at great risk of developing pressure sores, because you cannot shift your body weight on your own. Pressure sores can become infected and lead to serious complications, even death. For this reason, once your injuries are stable, nurses and nurse’s aides will turn you at regular intervals in the hospital and your caregivers at home will need to do the same thing. Special mattresses and cushions also help to prevent pressure sores.
• Blood clots. When you have quadriplegia, your blood circulation slows down since you are immobile. This can cause clots to develop. Clots are not always obvious; deep within the muscles are veins which can develop clots (a condition called deep vein thrombosis). An artery in the lungs can also be blocked by a clot (pulmonary embolism). Deep vein thrombosis and pulmonary embolism can be fatal. Your medical team will work to prevent clots. You may be given blood thinners to improve your circulation. Support hose and special inflatable pumps placed on the legs may also be used to increase circulation.
• Respiratory problems. The nerve signals to your chest and diaphragm may be weakened or distorted by a spinal cord injury, making breathing on your own difficult or impossible. If your diaphragm is wholly paralyzed, you will be intubated and placed on a ventilator. A special pacemaker is sometimes used to simulate the diaphragm’s nerves and allow the patient to breath without a ventilator. Some people are able to wean away from the ventilator by learning how to consciously control their breathing. People with quadriplegia are at increased risk for pneumonia and other respiratory infections even if they have no trouble breathing on their own. Medications and respiratory exercises are used to help prevent respiratory problems when mobility is a problem.
• Autonomic dysreflexia. A dangerous, occasionally fatal problem called autonomic dysreflexia can afflict people with spinal cord injuries located above the middle of the chest. This means that an irritation or pain below the site of your injury may send a signal which will not reach the brain, but will cause a nerve signal that disrupts your body’s functions. As your heart rate drops, your blood pressure may rise, putting you at risk for a stroke. Ironically, simple problems such as irritating clothes or a full bladder may trigger this reflex; fortunately, removing the cause of the irritation or changing position may relieve the negative effects.
• Spastic muscles. Some people with quadriplegia experience muscle spasms which cause the legs and arms to jerk. Although you may be tempted to think that this is a sign of regaining movement or sensation, it is simply a symptom of the damaged spinal cords inability to properly relay remaining nerve signals to the brain. Most people with quadriplegia will not develop spastic muscles.
• Related injuries. People with quadriplegia may experience an injury, such as a burn, without realizing it, since they have no sensation in their limbs. For this reason it is important that your caregivers do not place a heating pad or electric blanket on you.
• Pain. Although people with quadriplegia may not feel external sensations, it is possible to feel pain within your arms, legs, back, and other areas which do not respond to external stimuli. Pain medications prescribed by your doctor can relieve the pain.
Treatments for Quadriplegia
Trauma Care
Immediate treatment of quadriplegia consists of treating the spinal cord injury or other condition causing the problem. In the case of a spinal cord injury, you will be immobilized with special equipment to prevent further injury, while medical personnel work to stabilize your heart rate, blood pressure, and over all condition. You may be intubated to assist your breathing. This means that flexible tube carrying oxygen will be inserted down your throat. Imaging tests will be used to determine the extent of your injury.
Surgery may be needed to relieve pressure on the spine from bone fragments or foreign objects. Surgery may also be used to stabilize the spine, but no form of surgery can repair the damaged nerves of the spinal cord.
Unfortunately, the nerve damage caused by the initial spinal cord injury has a tendency to spread. The reasons for this tendency are not completely understood by researchers, but it is related to spreading inflammation as blood circulation decreases and blood pressure drops.
The inflammation causes nerve cells not directly in the injured area to die. A powerful corticosteroid, methylprednisolone (Medrol) can sometimes help prevent the spread of this damage if it is given within eight hours of the original injury; however, methylprednisolone can cause serious side effects and not all doctors are convinced that it is beneficial.
Rehabilitation
Rehabilitation for quadriplegia once consisted primarily of training to learn how to deal with your new limitations. Passive physical therapy was given to help prevent the muscles from atrophying. Today, many new options are offering quadriplegia patients new hope. These new options combine older methods with new technology with encouraging results.
While passive physical therapy once consisted solely of the therapists manipulating the patient’s arms and legs in an effort to increase circulation and retain muscle tone, today therapists can use electrodes to stimulate the patient’s muscles and give them an optimal workout. This technology is called functional neuromuscular stimulation (FNS). FNS stimulates the intact peripheral nerves so that the paralyzed muscles will contract.
The contractions are stimulated using either electrodes that have been placed on the skin or that have been implanted. With FNS, the patient may ride a stationary bicycle to improve muscle and cardiac function and prevent the muscles from atrophying. An implantable FNS system has been used to help people with some types of spinal injury regain use of their hands.
This is an option for people with quadriplegia, who have some voluntary use of their arms. The shoulder’s position controls the stimulation to the hand’s nerves, allowing the individual to pick up objects at will. Tendon transfer is another option which allows some people with quadriplegia more use of the arms and hands. This complicated surgery transfers a nonessential muscle with nerve function to the shoulder or arm to help restore function. FNS may be used in conjunction with tendon transfer.
Other forms of treatments for quadriplegia are still in the experimental stage. Many clinical trials of new treatment options are run every year. If you or a loved one suffers from quadriplegia, you may want to consider one of these trials. Ask your doctor to help you find a suitable trial.
What is a/the “socially acceptable” term for a “quadriplegic or disabled person”?
When referred to as a “quad” or a “disabled person” or “handicapped” we find it okay but referring to us as “retarded” or “crippled” is offensive in the very least.
You can have a rather mentally stimulating conversation with a quad or para. Their disability is affected physically at the most, there is nothing wrong with their mental capacity or ability.
Rather, speak to the person directly than to their caregiver or the person with whom they are with. They can hear and understand, don’t treat them like they are deaf, dumb or mute. They are people just like you with feelings and emotions, don’t diminish their self-worth cause of your insecurities.
What is Paraplegia?
Paraplegia is a medical condition involving impairment in motor or sensory function of the lower extremities, which is a classification of paralysis, he universal term to describe the loss of movement or sensation following damage to a nerve in the body.
Definition of a Paraplegic (T1 – T12)
Paraplegic means a person who as a result of illness or injury, is totally or partially paralysed in both his/her lower limbs.
Cause’s of Paraplegia?
Paraplegia is predominantly the result of a spinal cord injury due to an accident or other trauma. Most common accidents include motor vehicle accidents and falls in those aged over 65.
Spinal injuries aren’t always immediately apparent and numbness or paralysis can be delayed or immediate. Additional injury can occur from resultant swelling and bleeding. For this reason, it is important that medical attention is sought out immediately, as the time frame is critical for optimal recovery and assessment.
Additionally, congenital conditions such as spina bifida, where the neural elements of the spinal canal are affected, are also a known cause. Damage can also ensue from tumors or blood clots, however this is less common.
Paraplegia is most prevalent in males as they are assumed to have a greater tendency towards risky behavior.
Loss of Function
The extent of function lost due to paraplegia corresponds to the extent of damage to the spinal cord and the area affected. Areas of the spinal cord that result in paraplegia are the thoracic, lumbar or sacral regions.
An injury to the upper thoracic (T1 to T8), which is approximately adjacent to the chest, often results in poor trunk control. This can include impairment in breathing. Damage to the lower thoracic (T9 to T12) allow for good trunk function and posture. Lumbar and sacral damage results in poor function of flexors and hips.
Categorization
If the arms are also affected by paralysis, quadriplegia is the proper terminology, whereas if only one limb is affected the correct term is monoplegia.
Paraplegia is further categorized into complete or incomplete. Complete paraplegia is absolute damage of the region of the spinal cord. An individual with complete paraplegia may have total sensory and motor function loss. On the other hand, incomplete paraplegia defines partial damage. For example, someone with incomplete paraplegia may have sensory function but no movement, or vice versa.
Management of Paraplegia
While some people with paraplegia can walk to a degree, many are dependent on wheelchairs or other aids (like crutches or callipers). Some individuals may also experience pain and muscle spasms at a varying degree.
Impotence and various degrees of urinary and fecal incontinence are very common in those affected. Many use catheters or a bowel management programs (often involving suppositories, enemas, or digital stimulation of the bowels) to address these problems.
With successful bladder and bowel management, paraplegics can prevent the vast majority of accidental urinary or bowel discharges.
If an individual is suspected of having a back or neck injury, they should not be moved from their position and remain still as complications and permanent paralysis can ensue. Contacting emergency medical assistance is recommended.
Support
Given adequate support, equipment and adaptations to the work/ home environment are available; paraplegics are perfectly capable of living productive, fulfilled lives.
The Difference between Paraplegia and Quadriplegia
Paraplegia and quadriplegia are two completely different issues that result from a myriad of spinal cord injuries. They both refer to a type of paralysis that can occur in someone of any age as a result of an injury to the spinal cord. Paralysis is a general term that is used to describe the general loss of movement or sensation following damage to the nervous system.
The human nervous system is comprised of millions of nerves and neural cells that send chemical signals throughout the body. These chemical signals result in movement and function. The majority of the nerves in the nervous system sprout from the human spinal cord. When it becomes injured, the injured area contains many nerves that are also injured. A large spinal cord injury could result in some form of paralysis and loss of function.
Paraplegia is a type of paralysis that occurs when a patient only loses function or sensation in their lower extremities but does not lose function in their arms.
Quadriplegia is a type of paralysis that occurs when a patient loses function and sensation in their arms and legs. Both types can be complete or incomplete depending on the nerves that were affected.
Lumbar Vertebrae Levels: L1 – L5
The five vertebrae that make up the spine in the lower back are referred to as the lumbar vertebrae. There are openings in the vertebrae through which the nerves pass. Lumbar Stenosis is a condition in which either the spinal canal or the vertebral openings in the lumbar spine become narrow.
Sacrum Levels: S1 – S5
The sacrum consists of five vertebrae fused together. At the end of the sacrum is the tailbone (coccyx). A wide range of abnormalities may potentially occur in infants with caudal regression syndrome including abnormal development (agenesis) of the sacrum and coccyx and abnormalities of the lumbar spine.