quadriplegia ppt fathimabi (1) 2.pptx

Quadriplegia

1. What is QUADRIPLEGIA ? Quadriplegia, also known as tetraplegia, is a form of paralysis that affects all four limbs, plus the torso (“quad” originates from the Latin word for four). Most people with tetraplegia have significant paralysis below the neck, and many are completely unable to move . Quadriplegia is caused by damage to the brain or the spinal cord at a high level at lower medulla, at level of crossing over motor fibres or direct injury at cervical spine levels.

2. TYPES OF QUADRIPLEGIA Incomplete Quadriplegia An “incomplete quadriplegic” is different from a complete paraplegic in that they may still retain some function and/or sensation in their arms or legs. This may be the case with incomplete or "partial" SCI , some TBIs, and some inherited conditions that cause quadriplegia. Complete Quadriplegia Complete quadriplegia is characterized by a complete loss of control over the arms and legs. This is a near-total form of paralysis where a person is wholly unable to move their extremities aside from their head. When comparing complete vs incomplete quadriplegia, the complete version of the condition is usually considered more severe. Complete quadriplegia is often caused by severe, complete SCI in the cervical vertebrae or traumatic injuries to the brain. Spastic Quadriplegia Spasticity (or spastic hypertonia) is a common side effect of spinal cord and brain injuries caused by trauma or disease. A spastic quadriplegic is someone who, though they can not consciously control their arms or legs, may experience muscle spasms in their paralyzed limbs. Quadriplegics experiencing spastic hypertonia may experience hyperactive reflexes or involuntary muscle tightness that makes it hard to move into a relaxed posture.

3. VERTEBRAE DAMAGE C1, C2, C3 Damage Damage to the spinal column at the vertebrae nearest the skull (the C1, C2, and C3 vertebrae) is more likely to be fatal than damage lower on the spinal column. C1 and C2 injuries are considered particularly severe, as they are frequently fatal and may impede respiratory function. In the case of a complete SCI, damage at this level is extremely likely to result in near-total paralysis and may require specialized devices to allow the injured person to breathe. C4 Damage SCI survivors with  damage to the C4vertebra may experience: Loss of diaphragm control (requiring breathing aids such as a ventilator) Limited range of motion or paralysis of the arms, torso, and legs Trouble with bowel and bladder control

4. C5 Damage Damage to the C5 vertebra may affect the vocal cords and result in paralysis to the legs, wrists, and hands.  While a person with a C5 spinal injury may have difficulty talking, they may still be able to breathe unassisted. C6 Damage Damage to the C6 spinal cord and below is less likely to cause complete loss of the function of the arms. A person with a C6 injury may: Be paralyzed in the legs, torso, and hands Be unable to control their bladder/bowel Have difficulty speaking normally

5. ETIOLOGY There are numerous potential causes of quadriplegia. As mentioned earlier most common known cause of quadriplegia is damage to the spinal cord—typically in the cervical vertebrae (the C1-C7 sections of the spine which are nearest to the skull). Auto Accidents (32.2%) Falls (22.9%) Gunshot Wounds (15.2%) Motorcycle Accidents (6.2%) Diving (5.7%) Medical/Surgical Complications (2.9%) Being Hit by a Flying/Falling Object (2.7%) Bicycle Accidents (1.7%) Pedestrian Accidents (1.5%)

6. PATHOPHYSIOLOGY MECHANISM OF INJURY Destruction of cord parenchyma from direct trauma. Compression by bone fragments, heamatoma or disc material. Ishchaemia from damage or impingement on spinal arteries.

7. CLINICAL FEATURES Loss of movement Loss of sensation Loss of bowel and bladder control Exaggerated reflex activities or spasms Changes in sexual function , sexual sensitivity & fertility Pain and tingling Difficulty in breathing , coughing or clearing secretions from your lungs.

8. INVESTIGATIONS MRI Scans Spinal taps (Lumbar punctures) Blood tests Electomyography (EMG) Tests

9. Acute onset quadriplegia Complete quadriplegia Traumatic quadriplegia

10. MANAGEMENT Immobilization by cervical support/ rigid neck collar as soon as signs of quadriplegia are recognized to prevent brain stem injury that can cause immediate death. Imaging modality like MRI brain and Cervical cord. CT/MR angiography may be indicated if initial scans fails to clinch diagnosis. Steroids coverage , in initial state reduce local inflammation , swelling and compression . Patient evaluated for Surgical intervention as required to rapidly decompress spinal cord and to remove external objects / bone fragments. Long term rehabilitation and physiotherapy is indicated in such patients.

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