Types of Paralysis - Quadriplegia (Tetraplegia) and Paraplegia

When a person suffers a spinal cord injury, information travelling along

the spinal nerves below the level of injury, will be either completely or
partially cut off from the brain, resulting in Quadriplegia (Tetraplegia) or
Paraplegia.

The body will still be trying to send messages from below the level of
injury to the brain known as sensory messages, and the brain will still be
trying to send messages downwards to the muscles in the body, known
as motor messages. These messages however, will be blocked by the
damage in the spinal cord at the level of injury. Nerves joining the spinal
cord above the level of injury will be unaffected and continue to work as
normal.

Quadriplegia / Tetraplegia

Quadriplegia / Tetraplegia: is when a person has a spinal cord injury

above the first thoracic vertebra, paralysis usually affects the cervical
spinal nerves resulting in paralysis of all four limbs. In addition to the arms
and legs being paralyzed, the abdominal and chest muscles will also be
affected resulting in weakened breathing and the inability to properly
cough and clear the chest. People with this type of paralysis are referred
to as Quadriplegic or Tetraplegic.

Paraplegia

Paraplegia: is when the level of injury occurs below the first thoracic
spinal nerve. The degree at which the person is paralyzed can vary from
the impairment of leg movement, to complete paralysis of the legs and
abdomen up to the nipple line. Paraplegics have full use of their arms and
hands.

Cauda equina lesion: The Cauda Equina is the mass of nerves which
fan out of the spinal cord at between the first and second Lumbar region of the spine. The spinal cord ends at L1 and L2
at which point a bundle of nerves travel downwards through the Lumbar and Sacral vertebrae. Injury to these nerves will
cause partial or complete loss of movement and sensation. It is possible, if the nerves are not too badly damaged, for
them to grow again and for the recovery of function. The resultant paralysis results in paraplegia, but this is known as a
Cauda Equina Syndrome injury.

Level of injury (Lesion)

The level of injury, otherwise known as a lesion, is the exact point in the spinal cord at which damage has occurred. The
levels are determined by counting the nerves from the top of the spine downwards, and these nerves are grouped into
four different area’s. These are the Cervical, Thoracic, Lumbar and Sacral parts of the spinal cord.

These area’s are important in defining quadriplegia and paraplegia, as damage to the spinal cord as these points
directly determines how groups of muscles, organs and sensations will be affected.

How the spinal cord has been damage is also a consideration when evaluating a spinal cord injury. There are two types
of lesion, these are a complete injury and an incomplete injury. Someone with a complete injury will have complete loss
of muscle control and sensation below their level of lesion. An incomplete injury is where maybe only the muscles have
been paralyzed, or where there is impaired sensation.

Functionality after a Spinal Cord Injury

The degree to which a persons body will work following a spinal cord injury resulting in quadriplegia or paraplegia will
depend on the level of injury, and whether the injury was complete of incomplete. In order to show what functionality will
be possible following a complete spinal cord injury, we have put together the most common abilities for varying degree's
of paralysis.

Incomplete Spinal Cord Injuries

Anterior Cord Syndrome: is when the damage is towards the front of the spinal cord, this
can leave a person with the loss or impaired ability to sense pain, temperature and touch
sensations below their level of injury. Pressure and joint sensation may be preserved. It is
possible for some people with this injury to later recover some movement.

 
Central Cord Syndrome : is when the damage is in the centre of the spinal cord. This
typically results in the loss of function in the arms, but some leg movement may be
preserved. There may also be some control over the bowel and bladder preserved. It is
possible for some recovery from this type of injury, usually starting in the legs, gradually
progressing upwards.

 
Posterior Cord Syndrome : is when the damage is towards the back of the spinal cord. This
type of injury may leave the person with good muscle power, pain and temperature
sensation, however they may experience difficulty in coordinating movement of their limbs.

 
Brown-Séquard syndrome : is when damage is towards one side of the spinal cord. This
results in impaired or loss of movement to the injured side, but pain and temperature
sensation may be preserved. The opposite side of injury will have normal movement, but pain
and temperature sensation will be impaired or lost.

Functionality of C1, C2, C3 Quadriplegic

Mobility & Movement

Limited head and neck movement depending on muscle strength.

Complete paralysis of arms, body and legs.

Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.

Electric wheelchair may possibly be controlled by either a chin or "sip and puff" controller, this will vary depending on
dexterity.

The person will require total assistance when transferring from a bed to a wheelchair and from a wheelchair into a car. A
hoist will have to be used, possibly by two assistants for safety.

Complete assistance required during mealtimes.

Respiratory System

Inability to breathe using chest muscles or diaphragm, therefore the person will be dependant on a ventilator to breathe.
A portable ventilator can be attached to the back of a wheelchair during transport.

Oxygen and humidification may be required.

Assistance required to clear secretions from trachea, and assistance in coughing will be required.

Spinal Cord Injury Levels - Functionality of C4 Spinal Cord Injury

Mobility & Movement

Full head and neck movement depending on muscle strength. Limited shoulder movement.

Complete paralysis of body and legs. No finger, wrist or elbow flexion or extension.

Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.

Electric wheelchair may be controlled by either a chin or "sip and puff" controller, this will vary depending on dexterity.
The person will require total assistance when transferring from a bed to a wheelchair and from a wheelchair into a car. A
hoist will have to be used, possibly by two assistants for safety.

Complete assistance required during mealtimes.

Respiratory System

Able to breathe without a ventilator using diaphragm.

Assistance required to clear secretions and assistance in coughing will be required.

Spinal Cord Injury Levels - Functionality of C5 Spinal Cord Injury

Mobility & Movement

Full head and neck movement with good muscle strength. Good shoulder movement.

Complete paralysis of body and legs. No finger or wrist movement. No elbow extension, good elbow flexion.

Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.

Electric wheelchair can be controlled with a hand control for uneven surfaces. A manual wheelchair may be used for
short distances on flat surfaces.

The person will require total assistance when transferring from a bed to a wheelchair and from a wheelchair into a car. A
hoist will have to be used, possibly by one to two assistants for safety.

Ability to feed self using feeding strap and fork or spoon during mealtimes. Food will need cutting.

Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair into car independently.

Respiratory System

Able to breathe without a ventilator using diaphragm. Low stamina.

Assistance required to clear secretions and assistance in coughing will be required.

Spinal Cord Injury Levels - Functionality of C6 Spinal Cord Injury

Mobility & Movement

Full head and neck movement with good muscle strength. Good shoulder movement.

Complete paralysis of body and legs. No finger movement, no elbow extension, no wrist flexion. Good wrist extension,
good elbow flexion.

A passive key grip may be present by flexing the wrist backwards, but will be weak.

Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.

Electric wheelchair can be controlled with a hand control for uneven outdoor surfaces. A manual wheelchair may be
used for short distances on flat surfaces.

The person will require total assistance when transferring from floor to chair. Assistance will vary for transfer from bed to
wheelchair, and wheelchair to car. A sliding board may be used in assisting with the transfer

Ability to feed self using feeding strap and fork or spoon during mealtimes. Food will need cutting. Able to make hot
drinks with adapted kettle using a "kettle tipper".

Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair into car independently.

Respiratory System
Able to breathe without a ventilator using diaphragm. Low stamina.

Assistance required to clear secretions and assistance in coughing may be required. Additional coughing techniques
can be applied to assist in coughing by leaning forward whilst exhaling.

Spinal Cord Injury Levels - Functionality of C7 - C8 Spinal Cord Injury

Mobility & Movement

Full head and neck movement with good muscle strength. Good shoulder movement.

Complete paralysis of body and legs. Partial finger movement,full elbow extension and flexion, full wrist extension and
flexion.

A C7 injured person will have movement in the thumb.

Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.

May use an electric wheelchair for long independent travel or uneven outdoor surfaces. A manual wheelchair may be
used for short distances on flat surfaces.

Ability to transfer independently from bed to chair, and chair to car. Car transfers may need assistance depending on
upper body strength.

Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair into car independently.

Ability to feed self independently during mealtimes. Food may need cutting. Able to make hot drinks , may require an
adapted kettle using a "kettle tipper".

Respiratory System

Able to breathe without a ventilator using diaphragm. Low stamina.

Assistance required to clear secretions and assistance in coughing may be required. Additional coughing techniques
can be applied to assist in coughing by leaning forward whilst exhaling.

Spinal Cord Injury Levels - Functionality of T1 - T4 Paraplegic

Mobility & Movement

Full head and neck movement with normal muscle strength. Normal shoulder movement. Full use of arms, wrists and
fingers.

Complete paralysis of lower body and legs. Upper body strength will vary depending on level of injury, but the lower the
level, the stronger the upper body strength and balance.

A T4 injured person will have good strength in the chest muscles, however this will get progressively weaker the higher
up the injury.

Sympathetic nervous system may be compromised, possibility of Autonomic Dysreflexia.

May use an electric wheelchair for long distance independent travel or uneven outdoor surfaces. A manual wheelchair
may be used for everyday living, with the ability to go over uneven ground for short distances.

Ability to transfer independently from bed to chair, and chair to car. Car transfers may need assistance depending on
upper body strength.

Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair into car.

Ability to feed self independently during mealtimes.

Respiratory System

Ability to breathe normal, although respiration capacity and endurance may be compromised.
Spinal Cord Injury Levels - Functionality of T5 - T9 Spinal Cord Injury

Mobility & Movement

Full head and neck movement with normal muscle strength. Normal shoulder movement. Full use of arms, wrists and
fingers.

Complete paralysis of lower body and legs. Upper body strength will vary depending on level of injury, but the lower the
level, the stronger the upper body strength and balance.

A manual wheelchair may be used for everyday living, with the ability to go over uneven ground.

Ability to transfer independently from bed to chair, and chair to car. Car transfers may need assistance depending on
upper body strength.

Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair into car.

Respiratory System

Ability to breathe normal, although respiration capacity and endurance may be compromised.

Spinal Cord Injury Levels - Functionality of T10 - L1 Spinal Cord Injury

Mobility & Movement

Full head and neck movement with normal muscle strength. Normal shoulder movement. Full use of arms, wrists and
fingers.

Partial paralysis of lower body and legs. Upper body strength and balance will vary depending on level of injury, but the
lower the level, the stronger the upper body strength and balance.

A manual wheelchair may be used for everyday living, with the ability to go over uneven ground.

Ability to transfer independently from bed to chair, and chair to car. It may be possible to transfer from floor to chair
depending on upper body strength. It may also be possible to transfer from sitting position to standing frame
independently.

Ability to drive a car adapted with hand controls. Ability to load wheelchair into car independently.

Respiratory System

Normal respiratory system.

Spinal Cord Injury Levels - Functionality of L2 - S5 Spinal Cord Injury

Mobility & Movement

Full head and neck movement with normal muscle strength. Normal shoulder movement. Full use of arms, wrists and
fingers.

Full upper body control and balance.

Some hip, knee and foot movement depending on the level of injury. The lower the injury, the more control over
movement.

A manual wheelchair may be used for everyday living, with the ability to go over uneven ground.

Ability to transfer independently from bed to chair, and chair to car. It may be possible to transfer from floor to chair
depending on upper body strength.

Depending on the level of injury, walking may be possible with assistance or aids. Walking will be slow and difficult
though.

Ability to drive a car adapted with hand controls. Ability to load wheelchair into car independently.
Respiratory System

Normal respiratory system.

Each muscle in the body is supplied by a particular level or segment of the spinal cord and by its corresponding spinal
nerve. The muscle, and its nerve make up a myotome. This is approximately the same for every person and are as
follows:

C3,4 and 5 supply the diaphragm (the large muscle between the chest and the belly that we use to breath).

C5 also supplies the shoulder muscles and the muscle that we use to bend our elbow .

C6 is for bending the wrist back.

C7 is for straightening the elbow.

C8 bends the fingers.

T1 spreads the fingers.

T1 –T12 supplies the chest wall & abdominal muscles.

L2 bends the hip.

L3 straightens the knee.

L4 pulls the foot up.

L5 wiggles the toes.

S1 pulls the foot down.

S3,4 and 5 supply the bladder. bowel and sex organs and the anal and other pelvic muscles.