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  • Tetraplegia
  • Quadriplegia

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  • 344.0 Quadriplegia unspecified

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  • G82.50 Quadriplegia unspecified

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  • 5H: Impaired Motor Function, Peripheral Nerve Integrity, and Sensory Integrity Associated with Nonprogressive Disorders of the Spinal Cord

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Description

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  • Loss of motor and/or sensory function due to damage in the cervical spinal cord

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Essentials of Diagnosis

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  • Diagnosis is made by level of injury, severity of injury, and use of the American Spinal Injury Association (ASIA) assessment.
  • Quadriplegia is complete loss of sensory and motor function due to damage in cervical spine.
  • Quadriparesis is the partial loss of sensory or motor function due to damage in the cervical spine.
  • Quadriplegia is most commonly the result of trauma but can also occur due to infarction, hemorrhage, spinal stenosis.

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General Considerations

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  • Damage to the cervical spinal cord results in complications to many body systems.
    • The individual will likely experience most of the following:
      • Loss of motor and/or sensory function
      • Neurogenic bowel and bladder
      • Autonomic dysfunction
      • Orthostatic hypotension
      • Loss of bone density
      • Decreased ventilatory capability
      • Cardiac deconditioning
  • Working with this population requires the PT to be aware of this wide range of complications in order to be safe and effective with patient care

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Demographics

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  • Men 4 times as likely as women2
  • Most common cause is motor vehicle accident (MVA), second is falls.2

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Signs and Symptoms

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  • Upper motor neuron signs present
  • Complete injury is defined as no motor or sensory function spared in the lowest sacral segments; incomplete injury is defined as partial or full function spared in the lowest sacral segments.
  • Altered or lost trunk control and balance
  • Altered or lost head/neck control
  • Altered or lost ambulation/locomotion
  • Altered or lost bed mobility
  • Altered or lost transfer ability
  • Altered or lost muscle strength
  • Altered or lost sensations
  • Altered deep tendon reflexes (DTRs)
  • Altered or lost bowel and bladder function
  • Altered or lost autonomic control
  • Altered blood pressure
  • Spasticity
  • Altered thermoregulation

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Functional Implications

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  • Impaired bed mobility
  • Impaired upright tolerance
  • Impaired sitting balance
  • Impaired w/c mobility
  • Impaired movement of upper extremity (UE)/lower extremity (LE), trunk, head, and neck
  • Respiratory impairment
  • Impaired coordination
  • Impaired muscular strength
  • Gait abnormalities
  • Impaired transfers
  • Decreased endurance and energy efficiency
  • Neuropathic pain
  • Postural/orthostatic hypotension
  • Bladder and bowel dysfunction
  • Sexual dysfunction
  • Increased risk of pressure sores
  • Increased risk of deep vein thrombosis
  • Increased risk of contracture
  • Increased risk of heterotopic ossification
  • Dysesthesias
  • Osteoporosis and renal calculi

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Possible Contributing Causes

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  • Traumatic
    • Most frequent cause in adults
    • MVA 45.6%2
    • Fall 19.6%2
    • Acts of violence, including gun shots 17.8%2
    • Recreational sports 10.7%2
    • Other 6.3%2
  • Non-traumatic/pathological influence 30% of all spinal cord injuries (SCIs)
    • Vascular malfunctions (arteriovenous malformation, thrombosis, embolus, or hemorrhage)
    • Vertebral subluxations due to rheumatoid arthritis or degenerative ...

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