Quadriplegia

WHAT YOU SHOULD KNOW:

  • Quadriplegia (kwod-rih-PLEE-jah) is a type of spinal cord injury (SCI) that also may be called tetraplegia (tet-rah-PLEE-jah). You may become paralyzed (PER-e-liz-ed) if you were in a car or sports accident that broke your neck. Having a tumor or other diseases in your spinal canal also can cause quadriplegia. Quadriplegia means that the part of the spinal cord inside your neck has been injured. The symptoms of quadriplegia are different depending on where and how badly your spinal cord is injured. You may have one or more of the following signs or symptoms:

    • Your muscles may be limp, especially in your arms and legs.

    • You may not be able to move and feel anything below the damaged area.

    • You may not be able to control your bowel (BMs) or bladder (urine).

  • It may be possible for the nerves to start working again if your spinal cord is just bruised or swollen. The longer that there is no change in your symptoms, the less likely that you will see improvement.

AFTER YOU LEAVE:

Take your medicine as directed.

Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

  • Pain medicine: Pain medicine affects your nervous system, helping you to feel less pain. Your caregiver will tell you how much medicine to take and how often to take it. Take the medicine regularly as directed. Do not wait until the pain is too bad before taking your pain medicine. If you wait too long, the medicine may be unable to control your pain. Tell caregivers if the pain does not go away or comes back too soon. If you are taking pain medicine as a shot or in an IV, your family should learn how to give it. Ask your caregiver to show you how to do this.

  • Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.

  • Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.

  • Antiulcer medicine: This medicine helps decrease the amount of acid that is normally made by the stomach.

  • Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.

  • Blood thinners: This medicine helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.

  • Steroids: This medicine may be given to decrease inflammation.

  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

How may a brace help me?

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. Ask caregivers for information about how to live with and care for your brace.

What will be done if I have breathing problems?

  • How much trouble you have breathing depends on where your spinal cord is injured. Caregivers will work closely with you to help your lungs work as well as possible and to prevent problems. You may need a mechanical ventilator (VEN-ti-lay-ter), which is a machine that breathes for you. An endotracheal (en-doh-TRAY-kee-al) or "ET" tube is put in your throat. Caregivers may put a tube called a trach in the front of your neck. The ET tube or trach is hooked to the ventilator so oxygen can be given to you with each breath.

  • Pulmonary hygiene is a group of exercises and treatments to help you breathe better and to keep your lungs healthy. Pulmonary hygiene includes breathing exercises and treatments, postural (POS-chur-al) drainage, chest physiotherapy (fiz-ee-oh-THER-ah-pee), quad assist coughing, and suctioning. Ask caregivers for information about pulmonary (PUL-mo-ner-ee) care for people who have an SCI.

What are contractures?

Contractures (kon-TRAK-chers) happen when muscles, tendons, or ligaments in your body shorten. This results in less movement of a joint, such as your wrist, elbow, shoulder, or ankle. Contractures can happen as early as one week after your spinal cord injury. Contractures can be caused by nerve changes from the spinal cord to the muscles. This causes you to move less. Spasticity (spas-TIS-ih-tee) is when your arms or legs move uncontrollably, and may also cause contractures. Ask caregivers for more information about preventing and treating contractures.

What are common problems after a spinal cord injury?

  • Deep vein thrombosis (throm-BOH-sis) (DVT) and pulmonary embolism (EM-boh-lizm) (PE) are common problems after an SCI. These problems can be life-threatening. A DVT is a condition that happens when a thrombus (blood clot) forms in a vein. A PE is a condition that happens when a thrombus blocks a pulmonary (lung) artery.

  • Caregivers will teach you the signs and symptoms of a DVT and PE. The symptoms of a DVT include tenderness, pain, swelling, warmth, or skin color changes at a spot on your leg. The symptoms of a PE include very bad and sudden chest pain and difficulty with breathing. Blood in your sputum (spit) is another symptom of a PE. Tell your caregivers if you feel or see any of these problems.

What can be done to prevent or treat a DVT?

Caregivers may give you medicine to slow your blood from clotting. You may have a bed that rotates to keep your blood moving well through your body. The bed also helps stop pressure from being placed on any part of your body for too long.

  • Pressure stockings: These tight elastic stockings keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®.

  • Pneumatic (noo-MAT-ik) boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the boot or legging. This helps push the blood back up to your heart to help keep clots from forming.

  • Vena cava filter: Caregivers may suggest that you need a special filter called a vena cava filter put into a blood vessel to collect clots. You may need this surgery if medicines and other treatments are not enough to stop DVTs and PEs.

What is depression?

  • Depression is when you feel sad and hopeless. It can make you feel so bad that you think about committing suicide (killing yourself). Depression may be short term or long term. Many things can cause depression, like getting divorced, having a loved one die, or losing a job. Having a spinal cord injury can cause depression. It can make you feel tired, lose your appetite, and you may develop pressure sores and chronic (long-term) pain. Sometimes, you may be very sad and wish for the way your life was before the SCI. You may be angry and blame yourself or others for what happened to cause the SCI.

  • Suddenly having to depend on others for your care may make you feel depressed. Not being able to do the things you like to do can make you sad or depressed. Some medicines that you take for your SCI may also make you feel depressed. Depression can be treated. Ask caregivers for more information about how to cope with feeling depressed after an SCI.

What if I fall down?

Falling is a problem for people with an SCI because your center of balance may have changed. Your upper body strength will also decrease after an SCI. To prevent falls, always lock your wheelchair. Lock it before transferring to and from the wheelchair, and when doing pressure shifts or other movements. Slowly move from one position to another slowly so that you do not get dizzy. If you feel yourself falling, tuck your chin to your chest to keep from hitting your head on the ground. Wear an alert bracelet so that you can call for help if you fall and cannot get back up. You can get a medic alert tag or bracelet by contacting the following organization:

  • Medicalert Foundation
    2323 COLORADO AVENUE
    TURLOCK , CA 95382
    Phone: 1- 209 - 6683333
    Phone: 1- 888 - 633-4298

What types of therapy will I need when I leave the hospital?

You may need many types of therapy when you leave the hospital. Therapy will help increase feeling and movement if it is possible for you to get it back. It will help prevent other medical problems, and may help you feel better about yourself.

  • Occupational therapy:

    • Occupational (ok-u-PAY-shun-al) therapists (OT) will help you learn how to care for yourself as much as possible. This therapy teaches you special skills for bathing, dressing, preparing a meal, house cleaning, eating, and possibly driving. An occupational therapist will help you choose special equipment to use at home. You may be able to return to the kind of work you did before the SCI. Occupational therapists can help you learn new ways to do things.

    • An OT also looks at your home and workplace, and suggests changes that you will need. The OT also teaches your family members and caregivers safe ways to help care for you. He may suggest ways to keep your home or workplace safe. These ideas may prevent falls and keep you from being injured. Occupational therapy may also help you become active in your community.

  • Physical therapy:

    • Physical (FIZ-i-kal) therapists (PT) help you increase strength and endurance and improve coordination. The therapists work with you to keep muscles strong, protect your skin from pressure sores, and reduce spasticity. Spasticity is when your arms or legs move without you wanting them to, or they resist being moved.

    • Physical therapists can help you have better control over bladder and bowel function. PTs also teach you ways to use assistive devices, such as wheelchairs or braces. They will teach you how to prevent falls and injuries. PTs may work with your joints to help you keep full range of motion. Physical therapists also use methods such as ultrasound, hot packs, and ice.

  • Recreation therapy: Recreational therapists help you find sports and other recreation options available in your community.

  • Rehabilitation (ree-hah-bil-i-TAY-shun) psychologists (seye-KOL-oh-jists): These specially trained caregivers help you learn to deal with life changes that happen after an SCI.

  • Vocational therapy: Vocational (voh-KAY-shun-al) therapists help you assess your job skills. They work with you and the State Department of Vocational Rehabilitation or other agencies to obtain equipment and training. They can help you find a new job if you cannot return to the job you had before the SCI.

What can I do if I am feeling pain?

  • Some people continue to have pain after an SCI. Caregivers will work with you to find ways to control this pain. Many different kinds of medicine can be used including narcotics, muscle relaxants, antiseizure medicine, and antidepressants. Treatments such as nerve blocks and transcutaneous (trans-ku-TAY-nee-us) electrical nerve stimulation may also help. Ask caregivers for more information about these treatments.

  • Your caregiver may suggest that you go to a pain clinic to help you learn new ways to live with pain. There are many ways to help control pain, such as relaxation therapy or special breathing exercises. People at the clinic can teach you these and other ways to help control pain.

Can I have sex after my spinal cord injury?

Some people have problems with sex after an SCI. Many problems can be helped. Sexual and family counseling are an important part of your rehabilitation. Specially trained caregivers help you better understand sexual function and family planning. Talk to caregivers if you are worried. Ask for more information about sexual functions after an SCI.

Why is skin care so important?

  • Being paralyzed can cause serious problems for your skin. You may develop decubitus (de-KU-bi-tus) ulcers. These are also called pressure ulcers or sores, bed sores, or ischemic (is-KEE-mic) ulcers. A pressure sore happens when an area of skin or the tissue under the skin is dead or dying. This is caused when the blood flowing to the area is slowed down or stopped.

  • Pressure sores happen most often when you sit or lie on a bony area for too long. Bladder or bowel accidents can wet your skin, making your skin even weaker. You may not feel a cut or scratch until it has become a larger problem. Sliding from the bed to a chair or having muscle spasms can rub or tear your skin. Caregivers will help you prevent pressure sores. Therapists will teach you how to move to keep from putting pressure on one area for too long. Ask for more information about how to care for your skin when you have an SCI.

  • Shower or bathe often making sure to wash between the folds of your skin. Use an electric shaver to keep from cutting your skin when shaving. Ask caregivers for information about how to care for your skin when you have an SCI.

What is autonomic dysreflexia?

Autonomic (aw-toh-NOM-ik) dysreflexia (dis-ree-FLEK-see-ah) is a condition that happens when your body reacts to a problem. Common problems causing autonomic dysreflexia include having a full bladder, or being unable to have a bowel movement. It is also called "AD" or autonomic hyperreflexia (hi-per-ree-FLEK-see-ah). This very serious emergency can be life threatening. AD causes your blood pressure to go dangerously high. High blood pressure can cause a stroke, seizure, and even death. It is most common in people who have an SCI at or above the sixth thoracic (chest) level (T6). Ask caregivers for more information about autonomic dysreflexia.

What is neurogenic bladder?

Having an SCI can interrupt the nerve pathways from your brain to your bladder (the organ where urine is stored). Neurogenic (noor-oh-JEN-ik) bladder is when you cannot tell when your bladder is full or cannot stop it from emptying.

  • Bladder training: You may lose some or all of your bladder control after a spinal cord injury. Caregivers can work with you to teach your body to urinate at specific times each day. This helps prevent urine from building up and overflowing from your bladder. A bladder training program includes this and other methods to empty your bladder. Ask caregivers for more information about neurogenic bladder and a bladder training program.

What is neurogenic bowel?

Neurogenic bowel is when the brain and nervous system cannot control bowel functions after an SCI. Having an SCI can interrupt the nerve pathways from your brain to your gastrointestinal (gas-troh-in-TES-ti-nal) or "GI" system.

  • Bowel program: Most people with an SCI can learn how to control their bowel function. Bowel programs help you eliminate (get rid of) enough BM at regular planned times, which prevents or decreases BM accidents. A bowel program is started when you are in the hospital after having an SCI to prevent constipation, impaction, and obstruction. Ask caregivers for more information about neurogenic bowel and a bowel training program.

What is spasticity?

  • Spasticity is a condition where your arms or legs move without your wanting them to. Your arms or legs may also not move when you want them to. Normally, the body responds in a particular way to different stimuli. For instance, if you burn your hand on the stove, you pull your hand quickly away. You do not have to think about it to make it happen. The stimulus (the burn) travels from your hand through nerves to your spinal cord and up your spinal cord to your brain. Your brain processes the information and sends a message back down your spinal cord to the nerves in your hand. Then your hand receives the messages and moves quickly away from the stimulus.

  • After a spinal cord injury, stimuli from the environment no longer reach your brain. Your brain is no longer able to control reflex actions. With time, your normal reflexes increase, causing spasticity. Spasms may be caused by many things. A pin prick, cold air, pressure sores, tight shoes, or kidney stones can cause spasms. Feeling worried or anxious can make spasms worse. Caregivers can help you learn what causes the spasms and how to control them. Doing range of motion exercises and taking medicine can help control spasms.

  • There are also implants that can be put in during surgery to control spasticity. Spasms can be helpful for some people. They may help keep your muscles toned. Some people can even learn to use the spasms to help them turn over in bed and move in other ways. Ask caregivers for more information about spasticity.

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 paralyzed 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 of people 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
      1 Church Street, Suite 600
      Rockville , MD 20850
      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

CONTACT A CAREGIVER IF:

  • You have signs and symptoms of a DVT, such as:

    • Tenderness, pain, or swelling.

    • Warmth or skin color changes at a spot on your leg.

  • You have signs and symptoms of a pulmonary embolism (PE), such as:

    • Very bad and sudden pain.

    • Difficulty breathing (feel like you cannot catch your breath).

    • Chest pain.

    • Blood in your sputum (spit).

  • You have signs and symptoms of a urinary tract infection (in-FEK-shun), such as:

    • You have a fever.

    • Blood or blood clots in your urine.

    • Nausea (upset stomach) or vomiting.

    • Increase in bladder spasms.

    • Decrease in your urine output.

    • Pain in your back around your waist (if you have feeling there).

  • You have signs and symptoms of bowel problems, such as:

    • Abdominal (belly) pain or a distended (swollen) abdomen that is worse than normal and is not better after performing bowel care.

    • Bleeding from your rectum (rear end).

    • You have a fever.

    • Vomiting or diarrhea for two or more days.

  • You think you are developing a joint contracture or have trouble performing your range of motion exercises.

SEEK CARE IMMEDIATELY IF:

  • You have the symptoms of autonomic dysreflexia that are not relieved by your bowel program or bladder emptying. These may include:

    • Sudden increase in blood pressure.

    • Blurred vision or seeing spots.

    • Cold, dry skin with goose bumps below your SCI.

    • Hot, sweating, flushed (red) skin above your SCI.

    • Sudden throbbing headache.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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