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Quadriplegia & Paraplegia
Defination
• Quadriplegia/tetraplegia (quad = 4)
– Paralysis of both the arms and legs
– Occur when cervical segment of sp...
Quadriplegia
• C1-4 Quadriplegia
– C1 & C2 - may have functional phrenic nerves.
– C3 – impaired breathing, ventilator dep...
• C-5 Quadriplegia
– Have functional deltoid and/or biceps musculature.
– can feed themselves, perform oral facial hygieni...
• C7-8 Quadriplegia
– have functional triceps, they can bend and
straighten their elbows
– may also have enhanced finger e...
Paraplegia
• arms and hands not affected.
• T-1 to T-8 - retain control of the arms and hands
- poor trunk control and bal...
Pathophysiology
Mechanism of injury
• Destruction of cord parenchyma from direct trauma.
• Compression by bone fragments, ...
Damage to the spinal cord parenchyma is
classified as:
• Concussion: transient neurological signs with rapid
resolutions o...
Causes
• Traumatic causes
– Car accidents, sports accidents gunshot and
stabbing injuries.
– falls from high, electric sho...
• Medical causes
– Infectious or parasitic causes: spinal cord abscess,
Pott's disease (tuberculous abcess), tuberculous
e...
Signs
• Loss of movement.
• Loss of sensation
• Loss of bowel or bladder control.
• Exaggerated reflex activities or spasm...
Complications
• Pain.
• Blood clots.
• Pressure sores.
• Related injuries.
• Spastic muscles.
• Respiratory problems.
• Au...
Doctor Management
• Medications
– Methylprednisolone (Medrol) is a treatment
option for an acute spinal cord injury.
– If ...
• Surgery
– remove fragments of bones, foreign objects,
herniated disks or fractured vertebrae.
– needed to stabilize the ...
• Healing Broken Bones Without Surgery
– A more conservative and less invasive approach is
by using halo traction.
– This ...
PT Management
• Range of Motion
– Active ROM exs.
– Passive stretching
– Ankle boots and nights splints
• Contraindication...
• Strengthening
– Exs for UL
– Functional strengthening: under water walking,
static bicycling.
• Muscle Tone
– ES of para...
• Pain
– Traumatic: TENS
– Nerve root: TENS
• Orientation to upright position
– Tilt table
– Abdominal binders & stockings...
FES
• Functional Electric Stimulation has been
applied to various nerves in the LL to facilitate
a more normal gait.
• The...
Reference
• http://www.spinal injury.net/quadriplegia.htm
• http://cirrie.buffalo.edu/encyclopedia/en/article/359/
• http:...
Quadriplegia & Paraplegia
Quadriplegia & Paraplegia
Quadriplegia & Paraplegia
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Quadriplegia & Paraplegia

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Quadriplegia & Paraplegia

  1. 1. Quadriplegia & Paraplegia
  2. 2. Defination • Quadriplegia/tetraplegia (quad = 4) – Paralysis of both the arms and legs – Occur when cervical segment of spinal cord injured • Paraplegia – Complete paralysis of the lower half of the body including both legs. – Occur when thoracic and lumbar segment injured
  3. 3. Quadriplegia • C1-4 Quadriplegia – C1 & C2 - may have functional phrenic nerves. – C3 – impaired breathing, ventilator dependent – C4 – may be free from advanced respiratory support but require functional equipment need as C3 *C1-4 Quadriplegics require assistance for all personal care, turning, and transfer functions.*
  4. 4. • C-5 Quadriplegia – Have functional deltoid and/or biceps musculature. – can feed themselves, perform oral facial hygienic and upper body dressing activities. – Require assistance to perform bathing , bowel and bladder care, and for transfers. • C-6 Quadriplegia – have musculature that permits most shoulder motion, elbow bending, but not straightening and active wrist extension. – can perform upper & lower body dressing without assistance. – can perform some transfers independently with a transfer board.
  5. 5. • C7-8 Quadriplegia – have functional triceps, they can bend and straighten their elbows – may also have enhanced finger extension and wrist flexion. – They can turn and perform most transfers independently.
  6. 6. Paraplegia • arms and hands not affected. • T-1 to T-8 - retain control of the arms and hands - poor trunk control and balance due to poor abdominal muscle control. • T-9 to T-12 - retain good truck control and good abdominal muscle control. • The sitting balance of people with lower spinal cord injuries is usually very good. • Lumbar and Sacral injuries result in decreased control of the hip flexors and legs.
  7. 7. Pathophysiology Mechanism of injury • Destruction of cord parenchyma from direct trauma. • Compression by bone fragments, heamatoma or disc material. • Ischaemia from damage or impingement on spinal arteries.
  8. 8. Damage to the spinal cord parenchyma is classified as: • Concussion: transient neurological signs with rapid resolutions of deficits. • Contusion: as a result of compression, gross structural continuity of cord is intact. • Laceration: discruption of s. c. as a result of severe displacements of the vertebral column.
  9. 9. Causes • Traumatic causes – Car accidents, sports accidents gunshot and stabbing injuries. – falls from high, electric shock injuries, diving accidents related to sudden depressurization. – Other causes: • arachnoiditis (inflammation of arachnoid mater) • pathologic fractures due to rheumatic diseases
  10. 10. • Medical causes – Infectious or parasitic causes: spinal cord abscess, Pott's disease (tuberculous abcess), tuberculous epiduritis, schistosomiasis or bilharziosis (parasitic disease). – Vascular causes: ischemic softening of the spinal cord (spinal cord infarction or myelomalacia), spontaneous spinal extradural hematomas, spinal arteriovenous malformations (angioma), aortic aneurysms. – Tumor-related causes: neurilemmomas, metastases of spine, neurofibromatoses, Hodgkin's disease and myeloma.
  11. 11. Signs • Loss of movement. • Loss of sensation • Loss of bowel or bladder control. • Exaggerated reflex activities or spasms. • Changes in sexual function, sexual sensitivity and fertility. • Pain & tingling • Difficulty breathing, coughing or clearing secretions from your lungs.
  12. 12. Complications • Pain. • Blood clots. • Pressure sores. • Related injuries. • Spastic muscles. • Respiratory problems. • Autonomic dysreflexia. • Loss of bladder and bowel control.
  13. 13. Doctor Management • Medications – Methylprednisolone (Medrol) is a treatment option for an acute spinal cord injury. – If given within eight hours of injury, some people experience mild improvement. – reducing damage to nerve cells and decreasing inflammation near the site of injury. – not a cure for a spinal cord injury.
  14. 14. • Surgery – remove fragments of bones, foreign objects, herniated disks or fractured vertebrae. – needed to stabilize the spine to prevent future pain or deformity. • Immobilization – traction to stabilize spine and correct alignment – traction is accomplished by securing metal braces, or a body harness. – In some cases, a rigid neck collar may needed to keep head from moving. – A special bed also may help immobilize body.
  15. 15. • Healing Broken Bones Without Surgery – A more conservative and less invasive approach is by using halo traction. – This approach may mean up to two months complete bed rest.
  16. 16. PT Management • Range of Motion – Active ROM exs. – Passive stretching – Ankle boots and nights splints • Contraindications – Quadriplegia :stretching shoulder – Paraplegia :SLR above 60°, hip flex. beyond 90°
  17. 17. • Strengthening – Exs for UL – Functional strengthening: under water walking, static bicycling. • Muscle Tone – ES of paralysed ms. – Facilitation and inhibition technique. – Emphasis on weight bearing activities. – PNF
  18. 18. • Pain – Traumatic: TENS – Nerve root: TENS • Orientation to upright position – Tilt table – Abdominal binders & stockings can be used • Pressure sores – Turning and positioning for prevention • Bowel and Bladder retraining – Kegel Exs. • Gait training
  19. 19. FES • Functional Electric Stimulation has been applied to various nerves in the LL to facilitate a more normal gait. • Theory is that FES applies the appropriate sensory input necessary to normalize reflex output of the spinal cord. • Therefore the disruption caused by the SCI is removed.
  20. 20. Reference • http://www.spinal injury.net/quadriplegia.htm • http://cirrie.buffalo.edu/encyclopedia/en/article/359/ • http://www.spinal-injury.net/treatment-of-spinal-cord- injury.htm • www.apparelyzed.com/paraplegia-paraplegic.html • http://www.apparelyzed.com/quadriplegia- quadriplegic.html • http://www.mayoclinic.com/health/spinal-cord- injury/DS00460/DSECTION • http://www.scribd.com/doc/8557448/Spinal-Cord- Injury-Physical-Therapy-Management

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