- Complete (Traumatic)
- Incomplete (non-traumatic)
- Flaccid Paralysis
- Facial Paralysis
- Partial Paralysis
- Sleep Paralysis
- Periodic Paralysis
- Todd’s Paralysis
- Tick Paralysis
A complete spinal cord injury means that there is no movement or sensation below the level of the injury. In a complete injury, both sides of the body are equally affected. Complete spinal cord injuries will result in complete paraplegia or complete tetraplegia.
Complete paraplegia is a condition that results in permanent loss of movement and sensation at the T1 level or below. At the T1 level there is normal hand function, and as the levels move down the spinal column improved abdominal control, respiratory function, and sitting balance may occur.
Some patients with complete paraplegia have some degree of trunk function, and can stand or even walk short distances with supportive leg braces and a walker. In this situation, the abdominal muscles are used the propel the paralyzed legs forward, while body weight is supported by a walker.
Complete tetraplegia is a condition that results in permanent loss of movement and sensation in all four limbs. Spinal cord injuries that result in complete tetraplegia most often occur at levels C1 through C8. The degree of functionality is a direct result of where the injury to the spine occurred.
An incomplete spinal cord injury is characterized by some movement or sensation below the point of injury. As acute treatment becomes much more advanced, incomplete injuries are becoming more common. In an incomplete injury, the patient can often move one limb more than another, may have more function on one side than the other, or might have some sensation in parts of the body that can’t be moved.
The effects of an incomplete injury are dependent upon whether the front, back, side, or center of the spinal cord was affected. There are five classifications of incomplete spinal cord injuries: anterior cord syndrome, central cord syndrome, posterior cord syndrome, Brown-Sequart syndrome, and cauda equina lesion.
- Anterior Cord Syndrome: The injury occurs at the front of the spinal cord, leaving the person with partial or complete loss of ability to sense pain, temperature, and touch below the level of injury. Some people with this type of injury later recover some movement.
- Central Cord Syndrome: The injury occurs at the center of the spinal cord, and usually results in the loss of arm function. Some leg, bowel, and bladder control may be preserved. Some recovery from this injury may start in the legs, and then move upward.
- Posterior Cord Syndrome: The injury occurs toward the back of the spinal cord. Usually muscle power, pain, and temperature sensation is preserved. However, the person may have trouble with limb coordination.
- Brown-Sequard Syndrome: This injury occurs on one side of the spinal cord. Pain and temperature sensation will be present on the injured side, but impairment or loss of movement will also result. The opposite side of the injury will have normal movement, but pain and temperature sensation will be affected or lost.
- Cauda equine lesion: Damage to the nerves that fan out of the spinal cord at the first and second lumbar region of the spine can cause partial or complete loss of movement and feeling. Depending upon the extend of initial damage, sometimes these nerves can grow back and resume functionality.
Monoplegia is the paralysis of one limb, quite frequently an arm.
Causes of Monoplegia
Cerebral palsy is the most common cause of monoplegia. Other causes include:
- Lacunar strokes
- Brain tumor
- Multiple sclerosis
- Brown Sequard Syndrome
- Motor neuron disease
- Lumbar radiculopathy
- Nerve trauma
- Nerve inflammation
- Nerve impingement
- Malignancy impinging on nerves
- Mononeuritis multiplex
Treatment of Monoplegia
Treatment will vary depending upon the cause of monoplegia. In some cases monoplegia is temporary; in other cases partial recovery is possible. In still other cases, monoplegia is permanent and the best treatment is physical therapy and counseling designed to help the patient function with the condition.
Diplegia is a term used to describe paralysis of like parts on both sides of the body, such as both legs or both arms.
Causes of Diplegia
The causes of diplegia may originate in the brain or spinal cord. Common causes of diplegia include:
- Multiple sclerosis
- Cerebral palsy
- Metabolic disorder
- Neurodegenerative disease
- Guillain-Barre syndrome
- Spinal Cord Injury
Treatment of Diplegia
Treatment will vary depending upon the cause of diplegia. In some cases diplegia is temporary, in other cases partial recovery is possible. In still other cases, diplegia is permanent and the best treatment is physical therapy designed to help the patient function with the condition.
Hemiplegia is a term used to describe paralysis, severe weakness, or rigid movement on either the right or left side of the body. Hemiplegia can also be associated with limited use of the hand, balance issues, speech issues, and visual field problems.
Cause of Hemiplegia
The main cause of hemiplegia is brain damage as the result of disrupted blood flow. This can occur at birth, or may occur after birth as a result of stroke, cerebral palsy, perinatal strokes in infants, and traumatic brain injury. If the person experiences injury on the right side of the brain, then the left side of the body will be affected. If the person experiences injury on the left side of the brain, then the right side of the brain will be affected.
Types of Hemiplegia
There are several different types of hemiplegia. They include:
- Facial hemiplegia— Paralysis occurs on one side of the face
- Cerebral hemiplegia— A brain lesion disrupts the flow of blood to the brain
- Spastic hemiplegia— Characterized by paralysis and spastic movements on the affected side
- Spinal hemiplegia— Caused by lesions that have formed on the spine
Paraplegia results when an injury to the spinal cord is below the first thoracic spinal nerve. This results in the loss of feeling and movement, to some degree, of the legs. Paraplegics can experience anything from impairment of leg movement to complete loss of leg movement all the way up to the chest. Paraplegics are able to move their arms and hands.
Paraplegia and Functionality
The degree of function that a person with paraplegia will experience depends upon the level of injury, type of injury, and whether the injury was complete or incomplete.
Complications of Paraplegia
Complications of paraplegia include:
- Skin care issues
- Loss of bladder control
- Loss of bowel control
- Loss of sensory function
- Loss of motor function
Treatment for Paraplegia
Treatment during the acute phase will focus on returning as much function as possible. Long-term treatment will focus on learning to compensate with disabilities, and keeping complications at bay. Clinical trials are also available to the paraplegic.
Paralysis can be either partial or complete. 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.
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 are the main parts of the central nervous system, which sends messages throughout your body. When the spinal cord is injured the brain cannot properly communicate with it and so sensation and movement are impaired. The spinal cord is not the spine itself; it is the nerve system encased in the vertebrae and discs which make up 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. A patient with complete quadriplegia has no ability to move any part of the body below the neck; some people do not even have ability to move the neck.
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.
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 you 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 not 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
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 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 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.
Flaccid paralysis is a condition characterized by extreme weakness of muscles and loss of muscle tone.
Causes of Flaccid Paralysis
A common cause of flaccid paralysis is anterior spinal artery syndrome, in which the anterior spinal artery is blocked. Blockage can be caused by spinal cord trauma, cancer, arterial disease, or thrombosis. Other causes of flaccid paralysis include:
- Central pontine myelinolysis— The protective layer around the brainstem nerve cells is destroyed, preventing the transmittal of nerve signals
- Hyperkalemia— Caused by an excess of potassium in the body
- Hypokalemic periodic paralysis— An inherited muscle condition characterized by severe episodes of paralysis and muscle weakness which can last for hours or days
- Japanese encephalitis— A form of encephalitis transmitted by mosquitoes
Treatment for Flaccid Paralysis
The doctor determines the location of activity using evaluation and special testing. Once the presence of muscle activity is determined, a therapist can help the patient regain some strength and muscle tone by reinforcing correct movement patterns.
Facial paralysis is a condition defined by the total lack of voluntary muscle movement on one side of the face.
Causes of Facial Paralysis
About 75% of facial paralysis is caused by Bell’s Palsy, a condition that causes the nerves in the face to become inflamed. Other common causes of facial paralysis include:
- Brain Tumor
- Lyme disease
- Birth trauma in newborns
Diagnosing Facial Paralysis
Doctors will ask patients with facial paralysis questions in order to determine the cause. The patient will be asked about medical history, current symptoms of the facial paralysis, whether any other symptoms are present, and whether the patient has recently been sick or injured. Tests to confirm the cause may include blood tests, MRI, CT scan, and electromyography.
Treatment for Facial Paralysis
A combination of physical, speech, and occupational therapy is generally used. In some cases, plastic surgery is used to improve the ability of the eye to close, as well as to improve appearance.
Partial paralysis is characterized by some movement or sensation in affected muscles or muscle groups. While the function of a muscle or a group of muscles is affected to some degree, there is not a total loss of function. In partial paralysis, the patient can often move one limb more than another, may have more function on one side than the other, or might have some sensation in parts of the body that can’t be moved.
Causes of Partial Paralysis
Common causes of partial paralysis include:
- Trauma to the spinal cord
- Illness or disease
Treatment for Partial Paralysis
Treatment will depend upon the cause of partial paralysis, and might include physical therapy, occupational therapy, surgery, prescription medications, or a combination of the above. Treatment is designed to return as much function as possible to the patient, while also helping him or her learn to cope with any long-term disabilities.
Outcome for Partial Paralysis
The long-term outcome of partial paralysis depends upon the cause of the paralysis, the timeliness and quality of treatment, and the patient’s response to treatment. In some cases full or partial recovery is possible, while in other cases partial paralysis is permanent.
Sleep paralysis is a disorder characterized by the inability to move upon falling asleep or waking up. Sleep paralysis occurs as a person is moving in our out of rapid eye movement (REM) sleep, and is the result of a premature disconnection between the brain and body. While the brain and body normally disconnect during REM sleep, those who suffer from sleep paralysis experience the disconnection as they are about to enter or exit REM instead.
Symptoms of Sleep Paralysis
Symptoms of sleep paralysis include:
- Sensations of noise or smells
- Feelings of levitation
- Inability to move the body
- Feelings of terror
- Images of intruders
Causes of Sleep Paralysis
Sleep paralysis can be caused by any incident that disrupts normal REM patterns, including jet lack, insomnia, inconsistent sleep hygiene, and brain injury.
Treatment of Sleep Paralysis
The best way to banish sleep paralysis is to reestablish normal REM patterns. Going to bed and rising at the same time every day will reintroduce a normal brain-body connection.
Periodic paralysis comprises a group of rare genetic diseases that cause symptoms such as muscle weakness, muscle stiffness, and complete paralysis.
Types of Periodic Paralysis
While there more than 30 different strains of periodic paralysis have been identified, the most common include:
- Hypokalemic Periodic Paralysis— Caused by reductions in potassium levels, causing the patient to experience weakness and paralysis after eating certain foods or strenuous exercise.
- Thyrotoxic Periodic Paralysis— Associated with an overactive thyroid gland.
- Hyperkalemic Periodic Paralysis— Weakness, paralysis, and stiffness is experienced after fasting or exercise.
- Paramyotonia Congenita— Causes muscle stiffness or weakness as a result of cold temperatures, activity, or low potassium.
- Potassium Aggravated Myotonia— Causes muscle stiffness as a result of ingesting potassium.
- Malignant Hyperthermia—Caused by a reaction to drugs used in general anaesthetics.
Diagnosis and Treatment of Partial Paralysis
While diagnosis of partial paralysis can be extremely difficult, research is offering some new developments. Incidents of partial paralysis can be avoided by staying away from certain hormones, foods, and medications.
Todd’s Paralysis is a condition characterized by brief, temporary paralysis that follows a seizure.
Causes of Todd’s Paralysis
During the postictal state? following a seizure—the time during which the person’s brain is still recovering from the effects of the seizure—a person can experience drowsiness, confusion, vision changes or blindness, and also severe weakness or paralysis of a limb or one side of the body.
Treatment of Todd’s Paralysis
It is important to be able to differentiate Todd’s Paralysis from stroke, as the treatments differ. Because the paralysis generally disappears within 48 hours, treatment is supportive and symptomatic.
Prognosis of Todd’s Paralysis
Todd’s paralysis is generally confined to one side of the body, and the patient usually makes a full recovery within 48 hours. However, the effects of the seizure itself will determine the overall prognosis for the patient.
Tick paralysis is a loss of muscle strength and function, resulting from a tick bite. Tick paralysis is not caused by an infectious agent. Instead, it is caused by a chemical substance that attacks the nervous system. This substance is released when the tick bites the human. Most cases of tick paralysis are confined to children.
Symptoms of Tick Paralysis
Symptoms of tick paralysis include:
- Restlessness, weakness, and irritability
- Paralysis that begins in the lower extremities, and moves upward
- Respiratory failure
Diagnosis of Tick Paralysis
Because there are no tests that determine tick paralysis, diagnosis is based on exposure to ticks, as well as whether a tick is found. If a tick is found and removed and symptoms improve, the diagnosis is confirmed.
Treatment for Tick Paralysis
Removal of the tick and symptomatic, supportive care are the only treatments for tick paralysis. Oxygen therapy or mechanical ventilation may be necessary if breathing is compromised. As soon as the tick is removed the chemicals no longer enter the body, and symptoms generally improve quickly.