Quadriplegia

GENERAL INFORMATION:

What is it? Quadriplegia (kwod-rih-PLEE-jah) is a type of spinal cord injury (SCI) that also may be called tetraplegia (tet-ruh-PLEE-jah). You may become paralyzed (PER-e-liz-ed) if your spinal cord is injured or if you have certain diseases. The spinal cord is part of the central nervous system, which allows your brain to communicate with your body. The spine is made up of bones called vertebrae (VER-te-bray) that are stacked on top of each other. The spinal cord runs from the brain down through the center of the vertebrae. Tough fibrous discs separate the vertebrae, acting as cushions or shock absorbers.

• Quadriplegia means that the part of the spinal cord inside your neck has been injured. This injury causes loss of feeling and movement in your arms, legs, and trunk (center of your body). Spinal cord injuries are described by where on the spinal cord they have happened. Caregivers use letters and numbers to describe where your spinal cord is injured. The letter "C" stands for cervical (SER-vi-kl) or neck. There are eight cervical, 12 thoracic, five lumbar, and four sacral bones. If you have a C3 spinal cord injury, the damage is at the level of the third cervical spinal cord section.
  
  
• Spinal cord injuries are also described as complete or incomplete. This refers to how much function (movement and feeling) is left after you have healed from the injury. A complete SCI means that you have lost total (all) movement and feeling below the injured level. An incomplete SCI does not cause total loss of movement or feeling.

What causes quadriplegia? You may be paralyzed because you were in a car or sports accident that broke your neck. Having a tumor or other diseases in your spinal canal can also cause quadriplegia. It may be possible for the nerves to start working again if your spinal cord is just bruised or swollen. The longer there is no change in feeling or movement, the less likely that you will have improvement.

What happens to your body when you have quadriplegia? The symptoms of quadriplegia differ depending on where, and how badly your spinal cord is injured. You may have one or more of the following signs or symptoms:

• Limp muscles, especially in your arms and legs.
  
  
• Loss of control over your bowel (BMs) or bladder (urine).
  
  
• Low blood pressure.
  
  
• Trouble breathing, or unable to breathe without help.
  
  
• Unable to move and feel anything below the damaged area.

What type of care will I receive if I have quadriplegia? A team of caregivers will work with you to help you learn to live with quadriplegia. This team may include:

• Your regular doctor.
  
  
• Neurology (nu-ROL-oh-jee) nurses.
  
  
• Psychologists (seye-KOL-oh-jists).
  
  
• Physical and occupational therapists (THER-ah-pists).
  
  
• Respiratory therapists.
  
  
• Social workers.
  
  
• Speech pathologist (pah-THOL-oh-jist). These caregivers will help you communicate and swallow. This is especially important if you have a tracheostomy (tray-kee-OS-tah-mee). A tracheostomy is a tube in your windpipe to help you breathe.

What tests will I need? Tests help caregivers find out more about your spinal cord injury. They may also help caregivers plan your treatment. You may need one or more of the following tests.

• Neurologic (nu-roh-LAH-jik) tests: Caregivers may ask you questions and do other tests to learn what area of your spinal cord is injured.
  
  
• X-rays: X-rays help caregivers see the part of the spine that is damaged.
  
  
• CT scan: This test is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of your neck and spine. Your caregivers look at the pictures to see areas that might be injured.
  
  
• MRI: This test is also called magnetic resonance (REZ-oh-nans) imaging. This test may be done to show where and how much damage has occurred. You may need an MRI if you are having pain or muscle spasms.

What treatments will I receive? You will need to stay in the hospital right after the injury. Soon after, you may be moved to a rehabilitation (ree-hah-bil-ih-TAY-shun) center. The goal of rehabilitation is to help you learn to take care of yourself as much as possible. Ask your caregiver if you would like more information on any of the following treatments. You may have one or more of the following treatments during rehabilitation:

• Bowel and bladder programs: Being paralyzed makes you unable to control when you urinate or have a BM. Caregivers will teach you how to manage your bowels and bladder.
  
  
• Braces: You may need a halo brace or a Philadelphia collar if the bones or ligaments that support your spine are injured. Another type of brace may be used if the injury is in your chest or lower back area. These braces include a clamshell (plastic body jacket) or a plaster or plastic body cast.
  
  
• Medications: Caregivers will teach you what medicines you need, why you need them, and how to take them. You may need one or more of the following medicines:
  
  
  • Steroids: This medicine is used to prevent and reduce spinal cord swelling and improve blood flow.
    
    
  • Osmotic diuretics: An osmotic (oz-MAH-tik) diuretic (deye-yoo-RET-ik) is medicine that may help decrease and prevent spinal cord swelling.
    
    
  • Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  
• Mental health therapy: Being quadriplegic can cause you and your family to be depressed or sad. Mental health therapists help you and your family learn to cope with your spinal cord injury.
  
  
• Occupational therapy: Occupational (ok-u-PAY-shun-al) therapists (OT) teach you how to use special equipment so that you can care for yourself. They help you relearn how to perform your activities of daily living. This means learning how to eat, get dressed, and care for yourself. Your OT also teaches you work-related skills.
  
  
• Physical therapy: Physical (FIZ-i-kal) therapists (PT) teach you how to keep your muscles strong. They also help your joints stay limber (able to move easily) and teach you how to stay active. This therapy includes learning how to use a wheelchair. Caregivers teach you how to move from your bed to the chair and to the commode (toilet).
  
  
• Recreational therapy: Recreational therapists continue your skills training so that you can be active in your community. You may also learn fun activities.
  
  
• Respiratory care: Depending on how high on the spinal cord your injury is, you may have trouble breathing. You may need a machine called a ventilator (VEN-ti-lay-ter) to breathe for you. Respiratory (RES-pir-ah-tohr-ee) therapists make sure that your respiratory system (breathing system) stays healthy.
  
  
• Skin care: Being paralyzed puts your skin at risk for getting decubitus (de-KU-bi-tus) ulcers (sores). These also are called pressure sores. Caregivers help you learn how to keep your skin healthy, and what to do if you develop skin problems.

What types of surgery may I need? The injury to your spinal cord cannot be repaired, even with surgery.

• You may need surgery to stabilize (support) the bones in your spine. Pieces of vertebra or disc may be pressing on the spinal cord or nerve roots coming out of the spinal cord. You may need surgery to remove these pieces of bone or disc. Surgery also can be done to line up the bony spinal column. Caregivers may use bone from your hip or metal rods and screws to support your spine.
  
  
• You may be able to have surgery or use pieces of equipment to help you move better. Some of these procedures are called muscle tendon transfer, or functional electrical stimulation (FES). These procedures may be done about a year after your spinal cord injury. This will allow you to recover as much as possible.
  
  
• If your injury is high up on your spinal cord, you may need a ventilator to help you breathe. You may be able to have a phrenic (FREH-nik) nerve pacer. This surgery is expensive, but has some advantages over a ventilator. Talk to your caregiver about a phrenic nerve pacer.

Where can I go for support?

• Having a spinal cord injury and becoming quadriplegic is life changing for you and your family. Accepting that you are quadriplegic is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with quadriplegia.
  
  

• You may want to join a support group with others who also have quadriplegia. Ask your caregiver for the names and numbers of support groups in your town. You can contact one of the following national organizations for more information.
  • Paralyzed Veterans of America
    801 Eighteenth Street NW
    Washington, DC, 20006
    Phone: 1-800-424-8200
    Web Address: www.pva.org
    
  • National Spinal Cord Injury Association
    6701 Democracy Blvd, Ste 300-9
    Bethesda, MD 20817
    Phone: 1-800-962-9629
    Web Address: www.spinalcord.org
    
  • American Spinal Cord Association
    2020 Peachtree Road, NW
    Atlanta, Georgia, 30309-1402
    Phone: 1-404-355-9772
    Web Address: www.asia-spinalinjury.org
    

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about quadriplegia. You can then discuss choices with your caregivers. Work with them to decide what choices may be best for you. You always have the right to refuse and make your own decisions.

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