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 DiSA, 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 in South Africa. QASA’s mission is “to improve lives by securing resources to advocate, educate, capacitate, support and mobilize”. QASA’s vision is that “all quadriplegics and paraplegics
will live their lives to their full potential”. QASA develops products, programmes and services for quadriplegic and paraplegic members to build their capacity and ensure opportunities for societal integration and empowerment.
These projects include but are not limited to the Disability Awareness & Sensitization Workshops/Sessions:
Disability Awareness & Sensitization is an ongoing programme to ensure the successful integration of persons with disabilities into society and the workplace. The aim of the programme is to equip employers and employees the skills and knowledge required to interact with persons with disabilities with confidence. This half-day training workshop will enable employers and employees have a better understanding of the variety of disabilities they may encounter and how to deal with this in a sensitive and practical manner; it will help them to overcome the natural fear we may have when we interact with a disabled person and give tips on awareness and etiquette in these situations. The training defines and describes disability, unpacks many of the myths which are associated with disabilities, provides a list of some do’s and don'ts and touches on the language of disability.
QASA offers tailor-made sensitization training to suit the needs of the company or organization.
Click on the link above to find out more about "Work Readiness and Employment Programme", or visit our Organizations - QASA Page to find out more about QASA and the other Projects and Services that they provide, or visit their website at www.qasa.co.za.
Awareness Campaigns
Organisations around South Africa such as 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:
Road Safety Early Intervention & Prevention Programme
Spinal cord injury is one of the more devastating types of personal injury resulting in full or partial paralysis. Motor vehicle crashes are the leading cause of spinal cord injury in South Africa. In 2003, QASA initiated its "Road Safety Early Intervention & Prevention Campaign" to promote responsible road-user behaviour. The campaign has two focuses:
- Distracted Driving- aimed at reducing motor vehicle accidents
- ‘Buckle Up - We Don’t Want New Members!’ - aimed at reducing injury.
Take the pledge to save lives!
This campaign was awarded the SA Motoring Guild of Journalists award for the “Best Road Safety Project” and has been acknowledged by the United Nations (Global Road Safety Partnership) and the Road Accident Fund as ground-breaking and effective.
Campaign rollout:
- Throughout the year - at taxi ranks, schools and companies
- Festive/Holiday Seasons -at petrol stations along national routes (N1, N2, N3 & N12)
Click on the link above to find out more about "Road Safety Early Intervention & Prevention Campaign" ", or visit our Organizations - QASA Page to find out more about QASA and the other Projects and Services that they provide, or visit their website at: www.qasa.co.za.
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.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:
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:
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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