Quadriplegia and tetraplegia

• Tetraplegia
• Quadriplegia

• 344.0 Quadriplegia unspecified

• G82.50 Quadriplegia unspecified

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

Description

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

Essentials of Diagnosis

• 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.

General Considerations

• 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

Demographics

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

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• 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 ...