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Quadriplegia/Tetraplegia

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Introduction

 Quadriplegia is caused by damage to the cervical spinal cord segments at levels C1-C8. Damage to the spinal cord is usually secondary to an injury to the spinal vertebrae in the cervical section of the spinal column. The injury to the cellular structure of the spinal cord is known as a lesion and may result in the loss of partial or total function in all four limbs, i.e. the arms & the legs.

Quadriplegia is also termed Tetraplegia. Both terms mean "paralysis of four limbs. "Tetraplegia is more commonly used in Europe than in the United States. In 1991, when the American Spinal Cord Injury Classification system was revised, it was recommended that the term tetraplegia be used to improve consistency ("tetra", like "plegia", has a Greek root, whereas "Quadra" has a Latin root).

It is possible to injure the spinal cord without fracturing the spine, such as when a ruptured disc or bony spur on the vertebra protrudes into the spinal column, but Quadriplegia can be caused from the damage to the spinal cord from:

  • Trauma, such as a car crash.
  • Sports & Recreation injuries, such as Rugby or Diving.
  • Diseases such as polio.
  • Congenital disorders, such as muscular dystrophy.

Whatever  the cause of the disability, persons with disabilities require a different set of emotional and physical needs & may need to use some sort of equipment for assistance with mobility & for them to be able to fully participate in society. There are also various organizations in South Africa that assist & support different disability groups with a wide variety of services.

Support Organizations

There are a wide range of these advocacy and self-help organization which exist in South Africa, they include organizations such as the overtly political Disabled People South Africa, aligned with the ruling African National Congress, the National Council of and for Persons with Disabilities (NCPD) and Champion Of Hope, as well as single-issue national organizations such as the QuadPara Association of South Africa to name just a few.

The QuadPara Association of South Africa (QASA)

The QuadPara Association of South Africa (QASA) is a non-profit organisation (NPO 000-881) of Quadriplegics and Paraplegics living in South Africa. QASA’s mission is to be an effective “co-ordinating, policy-making and supporting organisation striving to prevent spinal cord injury and to improve the lives of quadriplegics and paraplegics by securing resources to advocate, educate, capacitate, support and mobilise.”

QASA now has six regions and has provincial organizations within QASA, which are able to assist it's members in a particular province. The six Regional Associations which are affiliated to QASA are: Gauteng South, Gauteng North, Eastern Cape, Western Cape, North West and KwaZulu-Natal. The QASA Management Board is made up of representatives of each Regional Association.QuadPara Association of South Africa

QASA runs a number of Projects and Services which include: Conducting awareness campaigns on the cause and prevention of spinal cord injury; providing equipment such as Beach Wheelchairs to rent & Advocacy & lobbying; Publication and distribution of information on disability rights; Rural outreach; Developing social enterprises to sustain individuals and Regional Associations; Providing sport and hobby activities; driver training in adapted vehicles, Provision of transport, Provision of education bursaries and facilitating skills development through internships, Computer training, Consulting, Disability sensitizing and workshops.

QASA is sustained by strategic relationships with corporates, social enterprise, the National Lottery Commission and a number of campaigns & events. Some of QASA’s projects generate revenue which services the essential non-revenue generating projects. Read the article below to find out more about these Products that QASA rent out, or visit our Organizations - QASA Page. You can also contact them through their website at www.qasa.co.za.

Awareness Campaigns

QASA Conducts various Awareness Campaigns and prevention programmes which aim to prevent future injuries by simply making the public aware of simplest things, these prevention programmes include the "Diving Prevention Campaign" & "Buckle Up"' - "We Don’t Want New Members". QASA also does awareness talks at school and have a strong relationship with the Chris Burger Petro Jackson Players Fund.

1. Diving Prevention Program: QASA produced a DVD warning of the dangers of diving, which is a major cause of spinal cord injury. This DVD was flighted on eTV and shows the dangers of diving into water without checking the water depth first. QASA also does awareness talks at school.

2. Chris Burger Petro Jackson Players Fund: QASA has a strong relationship with the Chris Burger Petro Jackson Players Fund. The Chris Burger Petro Jackson Players Fund assists all spinal cord injured persons, who have injured themselves playing sport. Furthermore, they promote the wellness of rugby and prevention of spinal cord injury in rugby. Read More: ....

3. Buckle Up: "We Don’t Want New Members": Is a road safety campaign aimed at getting motorists to use their seatbelts. The QuadPara Association of South Africa asks motorists to wear their seat belts in order to prevent a spinal cord injury in the event of an accident! This Road safety initiative is a partnership between the Association and Arrive Alive and the campaign was awarded the S.A.Guild of Motoring Journalists “Road Safety Project of the Year” award. QASA also does awareness talks at school.Buckle Up: "We Don’t Want New Members"

The road safety campaign also includes motorcyclists, the Associations members also deploy the “Gear Up – We don’t want new members” campaign which is in partnership with the Steelwings Motorcycle Club who have funded this campaign.
The QuadPara Association is adamant that if you are wearing your seatbelt and are in an accident, your chances of sustaining a spinal cord injury is drastically reduced. More than 450 people become spinal cord injured in South Africa and half of these are from road accidents, the impact on their lives and the lives of their families is devastating. QASA are proud to deliver a road safety programme to the public which will not only reduce the number of persons sustaining spinal injuries in accidents, but QASA will employ their members in implementing the project. Some of the very victims of road accidents, will be at the garage sites, encouraging road safety to the public. Motorists are approached at the garages by quadriplegics and paraplegics and asked to sign a pledge to Buckle Up, and in return they will receive a free license disk sticker. Motor Cycle users will receive a Button Badge for their riding jacket if they sign the Gear Up pledge form.

Quadriplegics and Paraplegics involved with this road safety campaign are branded with bibs which identify them as campaigners and will introduce themselves in order to encourage motorists to wear their seat belts on their journey. On average, 42 members of the QuadPara Association are employed for this project and the Association is proud to be part of road safety in their prevention programme.

Read More: .....

You can visit our Organizations - Mobility Impairments page to find out more about The QuadPara Association of South Africa (QASA), & other organizations that assist persons with Mobility Impairments, or read the page below to find out more about the signs and symptoms of Quadriplegia and how this disability can effect many South Africans. You can also view more information about other Mobility Impairments, by clicking on the menu on the left.

Symptoms of Quadriplegia

Upon visual inspection of a quadriplegic patient, the first symptom of quadriplegia is of motor or sensory impairment to the arms & legs, this function is also impaired in the torso. The loss of function in the torso usually results in a loss or impairment in controlling the bowel & bladder, sexual function, digestion, breathing & other autonomic functions. Sensory loss can manifest itself as numbness, reduced sensation or sore burning, which is called neuropathic pain.

Quadriplegic symptoms vary depending on the level of damage to the spinal cord. The spinal column is divided into levels or segments of the spinal cord & its corresponding spinal nerve, the function below the level of spinal cord injury will be either lost or impaired.spinal_cord Quadriplegia will result in complete loss or impaired function below the following cervical levels of injury.

  • C1- C2 are the highest cervical vertebra, & are at the base of the skull. If your injury is at this level & your spinal cord is damaged, you will probably lose function from the neck down and require permanent assistance with breathing in the form of a machine called a ventilator.
  • C3-C4 Supply the diaphragm & the large muscle between the chest & the belly which we use to breath with, it also effects arm sensation and movement.
  • C5 also supplies the shoulder muscles (deltoid) & the muscle that we use to bend our elbow (biceps), it also includes loss of finger movement.
  • C6 Bends the wrist back (extension), and externally rotates the arm (supinates).
  • C7 Straightens the elbow and wrist (triceps and wrist flexors), straightens fingers and pronates wrist.
  • C8 spinal cord injury may lose function from the chest down, but still retain use of the arms and much of the fingers and can bend the fingers (flexion).

The degree of this loss of feeling & movement depends largely on the injury to the cellular structures of the spinal cord. A complete severing of the spinal cord will result in complete loss of function from below that spinal segment, whila a partial severing, bruising or swelling of the spinal cord results in varying degrees of mixed function & paralysis.
In some cases, it is possible for a quadriplegic to have movement of their legs & arms or have control of their major bodily functions. Some quadriplegics can even walk & use their hands, while others may use wheelchairs but still have function in their arms & mild finger movement despite the level of the injury. The amount of movement is largely dependent on the degree of damage done to the spinal cord.

Secondary Complications

Due to a quadriplegic's depressed physical functioning & immobility, quadriplegics are often more susceptible to a variety of Secondary Complications, including:

  • Pressure sores
  • Spasticity,
  • Osteoporosis & fractures
  • Frozen joints
  • Pneumonia
  • Respiratory complications & infections
  • Kidney stones
  • Autonomic Dysreflexia,
  • Deep vein Thrombosis
  • Cardiovascular disease
  • Obesity

These problems can be prevented or kept under control through correct eating & drinking, exercise, regular physiotherapy & medication, visit our Health Care & Rehabilitation - Mobility Impairments Page to find out how these Secondary Complications can be prevented or kept under control and which Health Care professionals can assist you.

Incomplete Spinal Cord Injuries

 When an individual damages there spinal cord, which often happens if you break your neck, spinal cord syndromes may be either:

  • complete
  • incomplete

 In most clinical scenarios, physicians should use a best-fit model to classify the spinal cord injury syndrome.

A complete cord syndrome is characterized clinically as complete loss of motor and sensory function below the level of the traumatic lesion, while an incomplete injury means that you may regain some or all of the motor and sensory function below the level of the traumatic lesion .

Diagnosis of Incomplete Spinal Cord Injuries

In order to diagnose someone with an incomplete spinal cord injury, a thorough neurological examination must be performed upon admission to the hospital and re-evaluated on an on-going basis months after spinal shock and inflammation of the spinal cord has subsided.

Incomplete spinal cord injuries can present themselves in a multitude of ways. It only takes several nerve fibres within the spinal cord to be preserved to carry messages to or from the brain for someone to be classified with an incomplete spinal cord injury resulting in incomplete paraplegia or incomplete tetraplegia (quadriplegia).

If after an initial neurological examination of an individual 24 hours after the spinal cord injury the diagnosis is determined to be incomplete with preservation of motor or sensory function, the chances of recovery are greatly increased. Incomplete spinal cord injuries can present themselves generally in three ways:

  • The damage to the spinal cord can be so mild that the muscle weakness or sensory impairment can be hardly noticeable.
  • The damage to the spinal cord can be so severe that the muscle or sensory weakness or loss can resemble that of a complete injury.
  • The symptom of the incomplete spinal cord injury can be somewhere between the two above examples.

Incomplete Spinal Cord Injury Classification

Incomplete spinal cord injuries are classified using the American Spinal Association (ASIA) Impairment scale. The examination to determine the ASIA classification is based on touch and pinprick sensations, tested at key dermatome levels. Motor (muscle) function is also tested at key points on each side of the body. The resultant evaluation is categorised into five different classifications of spinal cord injury.

  • A indicates a "complete" spinal cord injury where no motor or sensory function is preserved in the sacral segments S4-S5.
  • B indicates an "incomplete" spinal cord injury where sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5. This is typically a transient phase and if the person recovers any motor function below the neurological level, that person essentially becomes a motor incomplete, i.e. ASIA C or D.
  • C indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade of less than 3, which indicates active movement with full range of motion against gravity.
  • D indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.
  • E indicates "normal" where motor and sensory scores are normal. Note that it is possible to have spinal cord injury and neurological deficits with completely normal motor and sensory scores.

Incomplete Spinal Cord Injury Statistics Upon Discharge From Hospitals

At the time of discharge neurologically incomplete tetraplegia ranked first for level of injury at time of discharge (30.9%), followed by neurologically complete paraplegia (25.1%),neurologically complete tetraplegia (19.8%), and neurologically incomplete paraplegia (18.6%). Source: 2011 NSCISC Annual Statistical Report. The degree of incompleteness is unique from person to person, and may or may not be an indicator to full recovery from a spinal cord injury.

Types of Incomplete Spinal Cord Injury 

The symptoms of incomplete spinal cord lesions depend upon the area of the spinal cord (front, back, side, etc) damaged. The part of the cord affected depends on the direction and power of the forces involved during the initial injury.

There are four types of incomplete spinal cord injury:

  • Anterior Cord Syndrome
  • Posterior Cord Syndrome
  • Central Cord Syndrome
  • Brown-Séquard Syndrome

It is not uncommon for a spinal cord injury to result in a combination of the above injury types which result in incomplete paraplegia or incomplete tetraplegia.

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References

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QuadPara Association of South Africa

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