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Introduction
Quadriplegia is a form of paralysis, paralysis defined as the loss of function for one or more muscle groups. (Paralysis, Paraplegia and Quadriplegia, 2010) Paralysis always has a negative impact on the victim and his or her loved ones. This condition often eliminates or reduces the function of muscles, tendons or joints that help control and regulate the basic body movements. (Burgunder, 2001) From the definition Quadriplegia is a type of cerebral palsy that often affects all the four limbs of the body. (Quadriplegia causes, symptoms, treatment, 2010) Quad means four, implying the four limbs, though the condition may involve the entire body trunk from the neck down. This paralysis is more often as a result of neck injuries. (Quadriplegia causes, symptoms, treatment, 2010) The condition limits the neuro-transmitted signals from reaching to these body parts. Quadriplegia ultimately affects the victims quality of life. In addition to loss of mobility, quadriplegia can affect digestive capabilities, bladder control and numerous other aspects of life. (Paralysis, Paraplegia and Quadriplegia, 2010) This paper seeks to establish the causes of Quadriplegia; symptoms and effects on an individuals life and offering care to the victims.
Causes and symptoms of Quadriplegia
The most common cause of Quadriplegia is cervical (neck) injuries which often result into the four limb paralysis. (Quadriplegia causes, symptoms, treatment, 2010)The injuries might be sustained as a result of an accident where the neck region is involved. This may range from car accidents, which is the most common cause, to falls. The traumatic injuries sustained on the spinal cord often lead to the paralysis manifested. The higher the injuries, the more severe the paralysis, injuries above the C4 level often require a ventilator or electrical implant for the person to breathe. (Quadriplegia causes, symptoms, treatment, 2010) This is due to the fact that the diaphragm is controlled by spinal nerves exiting in the upper part of the neck. (Spinal cord injury, 2010) Apart from the traumatic injuries, quadriplegia can result from other causes. Hereditary spastic Quadriplegia (HSD) refers to a group of disorders characterized by a progressive quadriplegia that can occur at a varied ages and is often accompanied by various symptoms. The pathophysiology of the HSD has been better understood by the advancement in molecular genetics which has made it easy to pinpoint the several gene loci involved. (Burgunder, 2001) Presently, the genes, a dominant form, spastin, one recessive form, quadriplegin, and two X-chromosamal forms phospholipoprotein and L1-CAM, have been described. The genes have been classified and described from a clinical phenotypic startpoint. HSD normally presents varied symptoms which may include: Muscle atrophy; decrease in the nerve vibration sense, sensory neuropathy with tropic disturbances of bones and the skin; striations in the retina; sensoryneural deafness due to acoustic nerve defects; dysarthria ataxia and limb ataxia; dementia; simple complex and partial seizures, atonic episodes; there may disorder pigmentation of the skin. Tumors of the spine may also lead to quadriplegia instances, tumors are abnormal tissue growths that are often found at a close proximity to the spine or inside the spine. (Praakshan, 1997) The tumor may be primary, beginning from the spine or may be secondary (metastatic move to the spine from other locations). These tumors often lead to neurological dysfunction which may cause paralysis in form of quadriplegia. (Spine Tumors, 2010) The metastatic tumors usually results from cancers like breast, lung renal and prostate. The higher the tumors on the spinal cord, the higher the chances of a quadriplegic condition.
The spine tumors can be diagnosed by several methods which include:
- Magnetic resonance imaging (MRI) of the spine is the most common test. It will show the soft tissues and nerves of the spinal column.
- X-rays will show vertebral fractures, common when the tumor invades the spinal bones.
- CT scans show the bones more clearly and can help to determine the extent of the bony disease.
- Other tests may include CT scans of the chest, abdomen and pelvis or a PET scan to determine where else the cancer may be.
Effects on an individuals life
After experiencing quadriplegia, individuals often develop the following common problems:
- Deep vein thrombosis (DVT) and pulmonary embolism (EP), these conditions can be life threatening in some instances. (Spinal Cord Injury, 2010)The care providers are taught to identify and teach the affected individuals the signs of PE and DVT. The symptoms of PE include very extreme and sudden chest pain and difficulty in breathing. Blood is normally present in the sputum. (Spinal Cord Injury, 2010) The patients are normally advised to tell the care givers immediately they notice the problem. In the case of DVT, the care givers are advised to give the necessary medicine that slow down or halt the blood clotting process. Other methods that can be used to prevent the blood from clotting include: Pressure stockings which keeps blood moving in the legs and arms and thus reducing instances of blood clotting; Pneumatic boots, are plastic boots or leggings put on the patients foot on the pressure stockings or ace wraps. The boots are normally connected to the air pump machine, the pump normally tightens and loosens and this normally helps push blood back to the heart preventing the clots from forming; the vena cava filter, this is a special filter that is placed into the blood vessel to pick up blood clots. (Spinal Cord Injury, 2010) This often indicated if the other medicines and treatments provided are not sufficient enough to stop the DVT and the PEs.
- Stress and depression, quadriplegia patients may often feel sad and hopeless about themselves due to the inability to use any of their limbs. This feeling is often dangerous as many patients often contemplate committing suicide or dying. The depression may last for a short duration or may be long-term. This feeling is more often brought by the feeling that one is depending on others to provide care, care givers often provide a range of equipment that helps the person to do some activities for themselves. But this often depends on severity of the paralysis; severe cases will require comprehensive care. (Praakshan, 1997) The most sufficient equipment for a quadriplegic patient is the wheelchair. However this good enough only if the paralysis is limited to the limbs, in addition, caution should be taken to prevent the patients from falling as their centre of balance normally shifts under they often have no body. To prevent falling care givers are advised to help the patient remember to lock the wheelchair while transferring to and from it and when conducting pressure shifts. (Spinal Cord Injury, 2010) This should be done slowly and carefully to prevent the patients from developing dizziness.
Therapy for Quadriplegic patients
Therapy is often indicated to help the patients improve their feeling and heal if possible. It is also offered to prevent the development of other complications and boost the patients self esteem and morale. Therapy for these patients often depends on the severity of the condition and may include:
Spinal cord treatment
This focuses on preventing further injury and enabling the patient to go back to normal and productive life within the limits of their disability. (Quadriplegia causes, symptoms, treatment, 2010) Its often done by prompt emergency treatment and provision of follow up care. The treatment includes conservative treatment for the pressure sores, debridement of necrotic tissue, optimization of nutrition, release of pressure and minimization of muscle spasticity. (Quadriplegia causes, symptoms, treatment, 2010)
Physical therapy
This therapy is indicated to help the patient increase his/her strength and endurance and improve coordination. (Sterlin, 2000)The physical therapists (PT) works with the patient to ensure that the muscles are strong, the skin is free from pressure sores and reduction of spasticity (movement of arms and legs when not required to). The PT also helps the patients to have a better control over the bladder and bowel and make better use of assistive devices such as wheelchairs and braces. (Spinal Cord Injury, 2010) The physical therapists offer the therapies using various methods such as hot packs, ice and sometimes use ultrasound.
Recreational therapy
This helps the patient participate in recreational activities such as sports and other pass times activities that are available in that particular community. Though the participation may be limited to observation and cheering since the patient is paralyzed in all the limbs. However, the intended objective of boosting the patients feeling is often achieved.
Rehabilitation
Patients who have suffered quadriplegia, especially as a result of accidents will normally develop psychological disorders such as stress and depression. Rehabilitation service is given by specially trained care givers who help the patient to learn how to deal with the changes in life that follows paralysis.
Vocational therapy
Vocational therapists offers the help required for the patient to make an assessment of his/her job skills. They go further to link up with the relevant agencies and state departments to obtain the required equipment and train the patient on its use. (Sterlin, 2000) Vocational therapists can assist the patient get new employment if he or she cant get back to the initial job. The vocational therapy is indicated for initially quadriplegic patients who have managed to restore some lost functions, especially in the arms.
Nursing care for quadriplegic patients
Nursing care for patients with spinal cord injuries demands continuous support, observation for detection of complications and if possible to offer corrective measures. (Nursing care for neurological patients, 2010) Patients with severe forms of Quadriplegia often require the services of a care giver around the clock. The patients may have developed conditions such as: autonomic dysreflexia, a condition that occurs when the body acts to a certain problem. The common mechanisms that result to dyreflexia include a full bladder or inability of the bowel to move. Autonomic dysreflexia often results to the blood pressure rising to dangerous levels and is often life threatening. (Spinal Cord Injury, 2010) Patients who experience this condition always require somebody to be around them and offer the necessary help. Quadriplegia and Paraplegia also affects the signals from the brain to the bladder resulting in a condition referred to as neurogenic bladder. This may result in partial or complete loss of bladder control and the patient fails to tell when the bladder is filled and or is emptying. Care givers will often try to work with the patient and help train his/her body to urinate at specific times. (Sterlin, 2000) Patients suffering from severe paraplegia may also present with Neurogenic bowel, a situation where by the brain and nervous system cannot control the bowel functions. (Spinal Cord Injury, 2010) Most patients often learn how to control their bowel functions. The bowel program helps the patients eliminate enough BM and keep down instances of bowel accidents. (Praakshan, 1997) Some pateints may have sustained Spinal cord injuries above the C4 and therefore affecting the function of the diaphragm. This pateints often require a ventilator or electrical impants to assist the person to breath. (Quadriplegia causes, symptoms, treatment, 2010)
Nursing care will include close observation to ensure that the patients is breathing. (Nursing care for neurological patients, 2010)
Conclusion
When one is involved in an accident that leads to a spinal cord injury or other conditions that lead to the development of quadriplegia, life for the individual and family members changes drastically. (Nursing care for neurological patients, 2010) Sometimes it may be so difficult for such individuals to accept that they are paralyzed. The individuals and his loved ones may feel so angry about themselves. Care givers are trained to offer help to the paralyzed individuals and help family members to understand how best they can help.
Reference list
Burgunder, J. (2001). Hereditary Spastic Paraplegia and quadriplegia. Berne: University of Berne.
Nursing Care for neurological patients. (2010). Web.
Paralysis, Paraplegia and Quadriplegia. (2010). Web.
Praakshan, S. (1997). Causes, symtoms and diagnosis of paralysis. New Delhi: Vistaar Publications.
Quadriplegia causes, symptoms, treatment. (2010). Web.
Spinal Cord Injury. (2010). Web.
Spine Tumors. (2010). Web.
Sterlin, G. (2000). Comprehensive Patient Care. London: McMillan publishers.
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