Paralysis : Root cause, Symptoms and Remediation

Definition

Paralysis is the inability – whether temporary or permanent – to move a part of the body. In almost all cases, paralysis is due to nerve damage, not to an injury to the affected region. For instance, an injury in the middle or lower regions of the spinal cord is likely to disrupt function below the injury, including the ability to move the feet or feel sensations, even though the actual structures are as healthy as ever.

The spinal cord is like the brain’s relay system, so when something in the spinal cord doesn’t work or is injured, paralysis is often the result. These injuries can be the product of traumatic accidents, or diseases such as strokes and polio. Most spinal cord injuries are incomplete, which means that some signals still travel up and down the cord. With an incomplete injury, you may retain some sensation and movement all the time, or the severity of the paralysis may change sometimes on a highly unpredictable basis. A complete spinal cord injury, by contrast, completely compressed or severs the nerves in the spinal cord, making it impossible for the signal to travel.

Types of Paralysis

Temporary and permanent paralysis

• Paralysis can either be temporary or permanent.
• Bell’s palsy is a relatively common cause of temporary paralysis that causes temporary facial paralysis.
• Sometimes paralysis that occurs after a stroke can also be temporary.
• Paralysis caused by serious injury, such as a broken neck, is usually permanent.

Examples of localized paralysis include:

• Facial paralysis – which is usually limited to one side of the face
• Paralysis of the hand
• Paralysis of the vocal cords – vocal cords are bands of tissue and muscle used to generate speech; paralysis usually only affects one vocal cord, which means the person is able to speak but their voice will be hoarse

There are four generalized paralysis, however, which have to do with the portion of the body that is affected.

Monoplegia

Monoplegia is paralysis of a single area of the body, most typically one limb. People with monoplegia typically retain control over the rest of their body, but cannot move or feel sensations in the affected limb. Cerebral palsy, injuries, and ailments can lead to this form of partial paralysis, including:

• Strokes
• Tumors
• Nerve damage due to injuries or diseases
• Nerve impingement
• Motor neuron damage
• Brain injuries
• Impacted or severed nerves at the affected location

Hemiplegia

Hemiplegia affects an arm and a leg on the same side of the body, and as with monoplegia, the most common cause is cerebral palsy. Hemiplegia often begins with a sensation of pins and needles, progresses to muscle weakness, and escalates to complete paralysis.

Hemiplegia should not be confused with hemiparesis, which refers to weakness on one side of the body. Nevertheless, hemiparesis is often a precursor to hemiplegia, particularly for people with neurological issues.

Paraplegia

Paraplegia refers to paralysis below the waist and usually affects both legs, the hips, and other functions, such as sexuality and elimination. Though stereotypes of paraplegia hold that people with this condition cannot walk, move their legs, or feel anything below the waist, the reality of paraplegia varies from person to person and sometimes, from day today. Spinal cord injuries are the most common cause of paraplegia. These injuries impede the brain’s ability to send and receive signals below the site of the injury. Some other causes include:

• Spinal cord infections
• Spinal cord lesions
• Brain tumors
• Brain infections
• Rarely, nerve damage at the hips or waist; this more typically causes some variety of monoplegia or hemiplegia.
• Brain or spinal cord oxygen deprivation due to choking, surgical accidents, violence, and similar causes.
• Stroke
• Congenital malformations in the brain or spinal cord

Quadriplegia

Quadriplegia, which is often referred to as tetraplegia, is paralysis below the neck. All four limbs, as well as the torso, are typically affected. Some quadriplegics spontaneously regain some or all functioning, while others slowly retrain their brains and bodies through dedicated physical therapy and exercise.

Spinal cord injuries are the leading cause of quadriplegia. The most common causes of spinal cord injuries include automobile accidents, acts of violence, falls, and sporting injuries, especially injuries due to contact sports such as football. Traumatic brain injuries can also cause this form of paralysis. Other sources of quadriplegia include:

• Acquired brain injuries due to infections, stroke, and other disease-related processes.
• Loss of oxygen to the brain and spinal cord due to choking, anesthesia-related accidents, anaphylactic shock, and some other causes.
• Spinal and brain lesions
• Spinal and brain tumors
• Spinal and brain infections
• Catastrophic nerve damage throughout the body
• Congenital abnormalities
• Early brain injuries, especially pre-birth or during-birth injuries that lead to cerebral palsy, which can produce a range of symptoms, including varying degrees of paralysis
• Allergic reactions to drugs
• Drug or alcohol overdoses

Partial or complete paralysis

Paralysis can be:

• Partial – where there are some muscle function and sensation; for example, if a person can move one leg but not the other, or feel sensations such as cold and heat
• Complete – where there is a complete loss of muscle function and sensation in affected limbs

Spastic or flaccid paralysis

Paralysis can be:

• Spastic – where muscles in affected limbs are unusually stiff or display spasms, and movements are not under the control of the individual (read about spastic paraplegia)
• Flaccid – where muscles in affected limbs are floppy and weak; muscles in flaccid paralysis may shrivel

Epidemiology about paralysis in the US

Paralysis is dramatically more widespread than previously thought. Approximately 1.7 percent of the U.S. population or 5,357,970 people were living with some form of paralysis, defined as a central nervous system disorder resulting in difficulty or inability to move the upper or lower extremities. The leading cause of paralysis was stroke (33.7 percent), followed by spinal cord injury (27.3 percent) and multiple sclerosis (18.6 percent).

Causes

The nerve damage that causes paralysis may be in the brain or spinal cord (the central nervous system) or it may be in the nerves outside the spinal cord (the peripheral nervous system). The most common causes of damage to the brain are:

• Stroke
• Tumor
• Trauma (caused by a fall or a blow)
• Multiple sclerosis (a disease that destroys the protective sheath covering nerve cells)
• Cerebral palsy (a condition caused by a defect or injury to the brain that occurs at or shortly after birth)
• Metabolic disorder (a disorder that interferes with the body’s ability to maintain itself)

Damage to the spinal cord is most often caused by trauma, such as a fall or a car crash. Other conditions that may damage nerves within or immediately adjacent to the spine include:

• Tumor
• Herniated disk (also called a ruptured or slipped disk)
• Spondylosis (a disease that causes stiffness in the joints of the spine)
• Rheumatoid arthritis of the spine
• Neurodegenerative disease (a disease that damages nerve cells)
• Multiple sclerosis

Damage to peripheral nerves may be caused by:

• Trauma
• Compression or entrapment (such as carpal tunnel syndrome)
• Guillain-Barré syndrome (a disease of the nerves that sometimes follows fever caused by a viral infection or immunization)
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (a condition that causes pain and swelling in the protective sheath covering nerve cells)
• Radiation
• Inherited demyelinating disease (a condition that destroys the protective sheath around the nerve cell)
• Toxins or poisons

Symptoms

Usually, paralysis occurs along with some of the following symptoms –

• Loss of consciousness (could be brief) or confusion
• Clumsiness and numbness
• Severe headache
• Difficulty breathing
• Drooling
• Cognitive difficulties, difficulty writing or speaking
• Changes in mood or behavior
• Loss of bladder or bowel control
• Loss or changes in vision and/ or hearing
• Nausea with or without vomiting

Complications

Because paralysis causes immobility, it has a rather significant effect on the other systems in the body. These include:

• Changes to circulation and respiration
• Changes to the kidneys and gastrointestinal system
• Changes to muscles, joints, and bones
• Spasticity of the limbs
• Muscle spasms
• Pressure sores
• Edema
• Blood clots in the lower limbs
• Feelings of numbness or pain
• Skin injury
• Bacterial infection
• Disruption of the normal working of the tissues, glands, and organs
• Constipation
• Loss of control of urination
• Sexual difficulties
• Abnormal sweating
• Abnormal breathing or heart rate
• Balance problems
• Difficulty thinking
• Behavioral issues
• Difficulty speaking or swallowing
• Vision problems

Diagnosis of Paralysis 

The first step in the diagnosis of paralysis is a physical exam by the doctor. Next the doctor will talk about the symptoms and family history. Diagnosing will not be difficult if the cause of paralysis is obvious, for example, paralysis after a stroke. If the cause is not obvious, then the physician will order specialized tests such as:

• X-ray
• CT scan (Computed tomography)
• MRI (Magnetic Resonance Imaging) scans
• Electromyography (usually used to diagnose Bell’s palsy)

If required the patient will then be referred to a neurologist.

Treatment and Medications

• A wearable electronic device that helps recover arm function by delivering tiny electrical currents to the nerves thereby activating hand and arm muscles. This method is called Functional Electrical Stimulation or FES.
• If cure or recovery from paralysis is not possible, various mobility aids such as wheelchairs and orthoses are available for people with paralysis.
• Prosthetics and orthoses:
• The prosthesis is a device that replaces or extends a limb, extremity, or other body parts.
• Orthoses are external mechanical devices that support, prevent, correct, and assist body segments in neuromuscular skeletal conditions.

Medication and aids for managing paralysis

• In most cases, spinal cord injury and paralysis result in the loss of normal bowel and bladder function. So, a catheter is used to empty urine from the bladder. Bowel retraining, enemas, and sometimes colostomy (surgery of the bowel) are done to help people with paralysis empty their bowel.
• Pain caused by nerve damage is normally relieved through medicines such as amitriptyline or pregabalin since common painkillers like paracetamol or ibuprofen are ineffective in such type of pain.
• Breathing difficulties that arise through spinal cord injury to the upper neck is often treated using positive pressure ventilators that are either invasive or non-invasive.
• For abnormally stiff muscles (spasticity) and involuntary muscle spasms, treatment involves the use of muscle relaxants such as Baclofen, Tizanidine, or Dantrolene. Sometimes, Botox is given for localized spasms.
• A relatively new treatment for the management of spastic paralysis is the intrathecal baclofen (ITB) therapy in which consistent optimal dosage of Baclofen is delivered via a programmable drug pump implanted in the fluid-filled space around the spinal cord.
• It is important to note that pressure ulcers can develop if a person is unable to move regularly due to paralysis. Care must be taken to ensure that preventive measures such as changing positions regularly or pressure-relieving devices are used.
• Rehabilitation may involve:
• Physiotherapy – to improve mobility
• Speech therapy – to improve communication
• Occupational therapy – to improve daily functions such as eating, cooking, toileting, and washing.

Prevention of Paralysis 

Reducing the number of controllable risk factors is the best way to prevent a stroke.  This can include:

• Stopping smoking
• Losing weight
• Eating a balanced diet low in sodium and saturated and trans fat
• Moderating alcohol intake (no more than 2 small drinks per day)
• Exercising regularly in order to stay physically fit
• Maintaining good control of existing medical conditions such as diabetes, high blood pressure, and high cholesterol.