Quadriplegia

Quadriplegia, or tetraplegia, is paralysis of your arms, hands, trunk, legs, and pelvic organs. Quadriplegia is caused by damage to your spinal cord. When the spinal cord is damaged, you lose feeling and movement. Your symptoms may depend on the location and severity of your spinal cord injury.

• 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.

INSTRUCTIONS:

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.

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

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

What will be done if I have a breathing problems?

• Caregivers will work very closely with you to help your lungs work as well as possible and to prevent problems. You may need a 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 into the front of your neck. The ET tube or trach is hooked to the ventilator so you will receive oxygen with each breath.
• Pulmonary hygiene is a group of exercises and treatments to help you breath better and to keep your lungs healthy. This may include 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. Spasticity 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) (DVTs) and pulmonary embolisms (EM-boh-lizms) (PEs) are common problems after an SCI. These problems can be life-threatening. A DVT happens when a blood clot forms in a vein. A PE happens when a thrombus blocks an artery (AHR-ter-ee) in your lung. Caregivers may give you medicine to slow the blood from clotting. You may also have a special bed that rotates to keep blood moving through your body. Caregivers may give you pressure stockings to keep blood from staying in the legs and causing clots. Caregivers will teach you the signs and symptoms of a DVT and PE.

What is depression?

Depression is when you feel sad and hopeless. Depression can make you feel so bad that you think about committing suicide (killing yourself). Depression can be treated. Ask caregivers for more information about how to cope with your feelings after an SCI.

What if I fall down?

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 can I do if I am feeling pain?

Caregivers will work with you to find ways to control pain. Many different kinds of medicine can be used. 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 also suggest you go to a pain clinic to help you learn new ways to live with your pain.

Can I have sex after my spinal cord injury?

Many problems with sex after an SCI can be helped. Sexual and family counseling are an important part of your rehabilitation (ree-hah-bil-ih-TAY-shun). Specially trained caregivers help you better understand sexual function and family planning. Ask caregivers for more information about sexual functions after an SCI.

Why is skin care so important?

• You may develop decubitus (de-KU-bi-tus) ulcers on your skin. These are also are called pressure ulcers or sores, bed sores, or ischemic (is-KEE-mic) ulcers. Pressure sores grow when blood flowing to the skin area is slowed down or stopped. To help prevent pressure sores, get help to shower or bathe often. Make sure the areas between the folds of your skin are washed. Be sure your skin is dried well, and kept dry. Use an electric shaver to keep from nicking your skin when shaving.
• If you sit or lie in one place for a long period of time, shift positions often. Because your skin may tear without you knowing it, transfer carefully from bed to chair or toilet. Have someone help or watch you while transferring. 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. This very serious emergency 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 spasticity?

Spasticity (spas-TIS-ih-tee) is when your arms or legs move uncontrollably. Your arms and legs may also be very hard to move. It may be hard to find out what causes spasticity. 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 spasms and how to control them.

What is neurogenic bladder and bowel?

Neurogenic (noor-oh-JEN-ik) bladder is a condition where you cannot tell when your bladder is full or cannot stop it from emptying. Neurogenic bowel is a condition where you are unable to control bowel functions after an SCI. These problems can be treated by following bladder and bowel training programs. Ask caregivers for more information about these problems and how they may be treated.

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.
• You may want to join a support group with 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.

What treatments might I need?

You will need to stay in the hospital right after your injury. You will then be moved to a rehab center. The goal of rehab is to help you learn to take care of yourself as much as possible. A team of healthcare providers will help you learn to function with quadriplegia. Ask for more information on any of the following rehab treatments:

• Respiratory care includes exercises and treatments to help you breathe and keep your lungs healthy. You may need respiratory care if you have trouble breathing. You may need a machine called a ventilator to breathe for you.
• Skin care helps prevent pressure sores. Specialists will help you learn how to keep your skin healthy.
• A physical therapist teaches you exercises to help improve your movement and strength.
• An occupational therapist teaches you skills to help with your daily activities.
• Bowel and bladder programs help you manage when you urinate or have a bowel movement.

When should I or someone close to me contact my healthcare provider?

• You have a fever.
• You have trouble urinating or urinate less than usual.
• Your abdomen is swollen and firm.
• You have blood in your urine or bowel movement.
• You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

• You feel lightheaded, short of breath, and have chest pain.
• You cough up blood.
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
• You have blurred vision or see spots.
• You have cold, dry skin with goose bumps below your spinal cord injury.
• You have hot, sweaty, red skin above your spinal cord injury.
• You have a sudden throbbing headache.