Tetraplegia

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Tetraplegia , also known as quadriplegia , is a paralysis caused by an illness or injury that causes partial or complete loss of use of all four limbs and bodies; paraplegia is similar but does not affect the arm. Loss is usually sensory and motoric, which means that both sensation and control are lost. Tetraparesis or quadriparesis , on the other hand, means muscle weakness that affects all four limbs. Maybe mushy or cramp.

Video Tetraplegia

Terminology

The condition of paralysis affects four limbs in turn is called tetraplegia or quadriplegia. Quadriplegia combines Latin root quadra , for "four", with the Greek root ?????? plegia , for "paralysis". Tetraplegia using Greek roots ????? tetra for "four". Quadriplegia is a generic term in North America; tetraplegia is more commonly used in Europe.

Maps Tetraplegia

Signs and symptoms

Although the most obvious symptom is damage to the limbs, function is also impaired in the torso. This may mean loss or disturbance in the control of the bowel and bladder, sexual function, digestion, respiration and other autonomous functions. Furthermore, sensation is usually impaired in the affected area. It can manifest as numbness, reduce sensation or burn neuropathic pain.

Second, because of their depressed function and immobility, people with tetraplegia are often more susceptible to pressure sores, osteoporosis and fractures, frozen joints, flexibility, respiratory complications and infections, autonomic dysreflexia, deep venous thrombosis, and cardiovascular disease.

The severity depends on both levels where the spinal cord is injured and the extent of the injury.

A person with an injury to C1 (the highest cervical vertebrae, at the base of the skull) may lose function from the neck down and depending on the ventilator. A person with a C7 injury may lose the function from the chest down but still retain the use of the arm and many hands.

Injury rates are also important. Complete disconnection of the spinal cord will result in complete loss of function from the vertebrae downwards. Partial or even bruising of the spinal cord results in varying levels of mixed function and paralysis. A common misconception with tetraplegia is that the victim can not move the legs, arms or other major functions; this often does not happen. Some individuals with tetraplegia may walk and use their hands, as if they do not have spinal injuries, while others may use wheelchairs and they can still have arm function and light finger movements; again, it varies on spinal cord damage.

It is common to have limb movements, such as the ability to move the arm but not the hands or to be able to use the fingers but not at the same level, as before the injury. Furthermore, the deficit in the legs may not be the same on both sides of the body; either left or right may be more affected, depending on the location of the lesion on the spinal cord.

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Cause

Tetraplegia is caused by damage to the brain or spinal cord at high C1-C7 levels - in particular, spinal injury secondary to injury to the cervical spine. The injury, known as a lesion, causes the victim to lose the partial or total function of the four limbs, which means the arms and legs. Tetraplegia is defined in many ways; C1-C4 usually affects arm movement more than C5-C7 injury; However, all tetraplegics have or have some sort of finger dysfunction. Thus, it is not uncommon to have tetraplegic with fully functioning arms but no nerve control from their fingers and thumbs.

Common causes of this damage are trauma (such as a traffic crash, dive into shallow waters, falls, sports injuries), illness (eg transverse myelitis, multiple sclerosis, or polio), or congenital anomalies (such as muscular dystrophy).

It is possible to suffer a broken neck without becoming tetraplegic if the spine has a fracture or dislocation but the spinal cord is not damaged. Conversely, it is possible to injure the spinal cord without breaking the spine, for example when the disc is ruptured or the bone spurring on the spine protrudes into the spinal column.

A philosopher has called excessive licorice consumption as the cause of Tetraplegia. doi: 10.1177/2042018812454322

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Classification

Spinal cord injuries are classified as complete and incomplete by the American Spinal Injury Association (ASIA) classification. The ASIA scale assesses patients based on their functional damage as a result of injury, by assessing patients from A to D (see table 1 for criteria). This has considerable consequences for surgical planning and therapy.

Table 1: ASIA decline scale

Complete spinal-cord lesions

Pathophysiologically, the spinal cord of tetraplegic patients can be divided into three segments that can be useful for classifying injuries.

First there is a medullary segment that is malfunctioning. This segment has unparalleled functional muscles; the action of these muscles is voluntary, non-permanent and strength can be evaluated by the scale of the British Medical Research Council (BMRC). This scale is used when upper extremity surgery is planned, as it is called in 'International Classification for hand surgery in tetraplegic patients' (see table 2).

The lesional segment (or injured metamere) consists of muscles associated with denervation. The lower motor neuron (LMN) of these muscles is damaged. These muscles are hypotonic, atrophic and have no spontaneous contractions. The presence of joint contractures should be monitored.

Below the degree of injury to metamere there is a subclassic segment that is wounded with a complete undulating motor neuron, which means that the medullary reflex is present, but the upper cortical control is lost. These muscles show some increase in tone when elongated and sometimes flexibility, good trophicity.

Incomplete spinal-cord lesions

Incomplete spinal cord injury results in varying post-injury presentations. There are three main syndromes described, depending on the exact location and lesion.

1. Central cord syndrome: most umbilical cord lesions are in gray matter in the spinal cord, sometimes lesions continue in white matter.
2. The Brown-SÃÆ' Â © quard syndrome: hemi part of the spinal cord.
3. Anterior cord syndrome: lesion of the anterior horn and anterolateral tract, with the possibility of anterior spinal artery division.

For most patients with ASIA A (complete) tetraplegia, ASIA B (incomplete) tetraplegia and ASIA C (incomplete) tetraplegia, the level of the International Classification of patients can be established without major difficulties. Surgical procedures according to the International Classification level can be performed. In contrast, for patients with ASIA D (incomplete) tetraplegia it is difficult to establish International Classification other than International Classification level X (others). Therefore, it is more difficult to decide which surgical procedure should be performed. A much more personal approach is needed for these patients. Decisions should be based more on experience than on text or journals.

The results of tendon transfer for patients with complete injuries can be predicted. On the other hand, it is well known that the muscles lacking normal excitation do not do right after surgical tendon transfer. Although an unexpected aspect in incomplete lesion transfer of the lesion may be useful. The surgeon must be sure that the muscle to be transferred has sufficient strength and is under good voluntary control. Pre-operative assessment is more difficult to assess in incomplete lesions. Patients with incomplete lesions also often require therapy or surgery before the procedure returns the function to correct the consequences of the injury. These consequences are hypertonicity/spasticity, contractures, painful hypertension and proximal upper limb muscles paralyzed by distal muscle division. Spasticity is a frequent consequence of incomplete injury. Spasticity often decreases function, but sometimes the patient can control the flexibility in a way that is useful for its function. The location and effects of spasticity should be carefully analyzed before treatment is planned. Injection of Botulinum toxin (Botox) into muscle spasms is a treatment to reduce flexibility. This can be used to prevent muscle contraction and premature contractures.

Over the last ten years an incomplete increase of incomplete traumatic lesions was seen, due to better traffic protection.

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Treatment

The upper limb paralysis refers to the loss of elbow and hand function. When upper limb function does not exist as a result of spinal cord injury it is a major barrier to regaining autonomy. People with tetraplegia should be examined and given information about options for reconstructive surgery of the tetraplegic arm and hands.

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Prognosis

The delayed diagnosis of a cervical spine injury has serious consequences for the victim. About one in 20 cervical fractures are not found and about two thirds of these patients have further spinal damage as a result. About 30% of cases of delayed diagnosis of cervical spine injury develop permanent neurological deficits. In high-grade cervical injuries, total paralysis of the neck may occur. High-level Tetraplegics (C4 and higher) will likely require constant care and assistance in everyday life activities, such as dressing, eating and bowel and bladder treatments. Low level Tetraplegics (C5 to C7) can often live independently.

Even with "complete" injuries, in some rare cases, through intensive rehabilitation, little movement can be recovered through a "repetitive" nerve connection, as in the case of the late actor Christopher Reeve.

In the case of cerebral palsy, which is caused by damage to the motor cortex either before, during (10%), or after birth, some people with tetraplegia may gradually learn to stand or walk through physical therapy.

Quadriplegics can increase muscle strength by performing endurance exercises at least three times per week. Incorporating resistance training with proper nutrition intake can greatly reduce comorbidities such as obesity and type 2 diabetes.

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Epidemiology

There are about 5,000 cervical spine injuries per year in the United States (~ 1 in 60,000 - assuming a 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 2009, it was estimated that the lifetime care of a 25-year-old given with low tetraplegia was about US $ 1.7 million and with high tetraplegia of $ 3.1 million, and that the total national cost for all SCIs in the United States was US $ 9.7 billion per year. Currently (2010) costs between $ 520,000 to $ 550,000 per year to care for people who are dependent ventilators with tetraplegia.

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See also

• Brown-SÃÆ' Â © quard syndrome
• Cleans the cervical spine
• Hemiplegia
• List of people with quadriplegia
• Syndrome is locked
• Paraplegia
• Sexuality after spinal cord injury
• Research on spinal cord injury

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References

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Further reading

Taylor-Schroeder S, LaBarbera J, McDowell S, et al. (2011). "SCIRehab Project: the time of care spent in SCI rehabilitation Time of physical therapy treatment during rehabilitation of inpatient spinal cord injury". Med Medinal of Spine . 34 (2): 149-61. doi: 10.1179/107902611x12971826988057. PMC 3066500 . PMID 21675354.

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External links

• spinal cord injury in Curlie (based on DMOZ)

Source of the article : Wikipedia