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Paralysis

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Paralysis1-Cycles.jpg

Paralysis a condition where part of the body loses the ability to control its muscular movement. Paralysis can occur due to injury or disease, which results in damage to the spinal cord. Since the spinal cord is part responsible for motion and sensation, injury causes inability to both send and receive signals that control motor, sensory, and autonomic functions between the brain and the body. Paralysis can occur anywhere in the body, and each injury can differ in severity. This leads to multiple side effects of paralysis, which is why treatment must immediately follow and the person must be aware to monitor for these possible issues. The number of Americans living with paralysis is nearly 1 in 50, or about 6 million people, a 33% jump from previous estimates. [1] [2] However, recent developments in technology are allowing those with paralysis to regain function more than ever before.

Causes

Diagram and picture of a herniated disk

Paralysis is a result of damage to the body's nervous system, when there is a dysfunction in the passing of signals between the brain and the muscles. [3] [4] Most cases of paralysis are the effects of strokes or injuries, such as those of the spinal cord, as well as broken necks and brain damage. [3][4] When the spinal cord is injured and there is damage to the nerves within the protective bone, paralysis is usually the result. The spine does not have to be completely severed in order to lose function; being bruised, stretched, and crushed will also have the same effect. Trauma, whether consisting of a broken spinal cord, a herniated vertebral disk, or affecting nerves directly, is the leading cause of spinal cord injury, encompassing motor vehicle accidents, falls, diving in shallow water, acts of violence, and sports related injuries. [2] In data surveying 1,275,000 people regarding the cause of their paralysis, 24% stated their condition was due to motor vehicle accidents; 28% due to accidents while working; 9% due to falls; 16% due to sporting or recreation accidents; 4% due to violence; 3% due to birth defects; 1% due to natural disasters; 6% due to other reasons; and 9% did not respond or had unknown causes. [1]

Nerve diseases can also be the cause of paralysis. [4] The origins of these diseases can be found at birth or later in life, some examples being tumors, electric shock, and oxygen loss due to surgery or accidents underwater. [2] Some neurological diseases include Cerebral palsy, Bell's palsy, Multiple sclerosis, and Peripheral neuropathy. Autoimmune or infectious diseases, such as HIV, Lyme disease, Spondylitis, and Guillain-Barre Syndrome, also have the potential to paralyze. Hemorrhages, along with other aforementioned life threatening situations like brain tumors, trauma, and strokes, are also causes associated with symptoms of paralysis. Finally, environmental factors may also play a role in paralysis, through toxins, radiation, and poisons. [3] In a survey of 5,596,000 people with paralysis, 24% attributed their condition to stroke; 23% to spinal cord injuries; 17% to Multiple sclerosis; 2% to unspecified birth defects; 4% to traumatic brain injury; 4% to neurofibromatosis (a genetic disorder causing tumors to grow on nerve tissue) [5]; 7% to Cerebral palsy; 5% to Post-polio Syndrome; and 9% to other causes. [1]

Types

MRI of Transverse myelitis

Any part of the body can be affected by paralysis; the arms, legs, or the trunk are all capable of experiencing paralysis, depending on the cause and severity of the condition. [3] Paralysis can occur on one side or both sides of the body, can be present in one area or widespread, and can be complete or partial. [4] Incomplete, or non-traumatic paralysis is characterized by some feeling and movement below the injured area. [6] Complete, or traumatic, paralysis, on the other hand, results in no feeling or movement below the point of injury. In these types of injuries, there is an equal effect in both sides of the body. [7] If the lower half of the body is paralyzed, it is called paraplegia. If both the arms and legs are paralyzed, the condition is called quadriplegia. If the spinal cord is completely severed, there will be permanent loss of sensation and movement in the areas affected. [4] [7]

As previously mentioned, there are numerous diseases and conditions that paralyze. Besides more commonly associated terms such as Cerebral palsy, Multiple sclerosis, and stroke, the list also includes Amyotrophic Lateral Sclerosis (ALS), Post-polio syndrome, muscular dystrophy in which there is a degeneration of the skeletal muscles, Brachial plexus injury from extensive stretching or tearing, the gradually damaging and inherited Frederich's ataxia, and Spina Bifida where the spinal column is not completely closed. Guillain-Barre syndrome, where part of the peripheral nervous system is attacked by the immune system, Syringomyelia/Tethered cord that deteriorates the spinal cord, and Transverse Myelitis, in which a segment of the spine is inflamed, are also paralysis related conditions. [8] More conditions include more general names such as Flaccid paralysis, Facial paralysis, Periodic paralysis, and Todd's paralysis. Interestingly, there exists a condition known as Sleep paralysis, where the person is cannot move after falling asleep or waking up. This occurs to an early disconnection of the brain and body while exiting or entering REM (Rapid Eye Movement) sleep. [9]

Effects in the Body

Besides the loss of movement and feeling that can happen immediately or gradually, paralysis can have several other effects on the body, depending on the severity of condition and location. Due to creating a lack of mobility, paralysis has a considerable impact on other systems of the body. Paralysis can cause changes in circulation, respiration, the kidneys, the gastrointestinal system, muscles, joints, bones, and disturbance in the functioning of the tissues, glands, and organs; it can also result in limb spasticity, muscle spasms, pressure sores, edema (fluid build-up in the tissues), blood clotting in the lower limbs, experiencing numbness or pain, skin injury, bacterial infection, constipation, lack of control of urination, sexual dysfunction, balance problems, and abnormal sweating, breathing, or heart rate. Other complications may include trouble thinking, behavioral issues, problems speaking or swallowing, and vision problems. [3]

Some Secondary Issues Described:

Blood clots can be a common occurrence during the first months following injury to the spinal cord. The chance of having blood clots is increased due to the paralysis causing walking to become inhibited, and causing more time in bed.

Autonomic Dysreflexia (AD) is a serious medical injury and an emergency situation that must be dealt with immediately. It is caused by the autonomic nervous system being over-active and creating a sudden rise in blood pressure.

Pneumonia can result from the lungs being unable to inhale and exhale properly due to paralysis in those areas. Because the body cannot cough out the unwanted substances, the secretion builds up in the lungs and there is a bacterial infection.

Skin ulcers and Pressure sores usually occur in bony areas of the body. Skin ulcers can result from simple cuts and scrapes, which is why those conditions should not be ignored with one with paralysis. Pressure sores are when areas of the body undergo a continued amount of pressure, and result in a decrease in blood flow. The condition of low blood pressure, or hypotension, can also be an effect of paralysis.

Spasticity is when there is an increased amount of stiffness, muscle jerks, and involuntary spasms in muscle groups below the point of injury. It occurs due to the body's loss of ability to inhibit reflex muscle activity related to the injury in the central nervous system.

Pain itself, while natural, can become chronic pain or neuropathic pain (nerve pain), caused not by a direct stimulus, but from the cluttered sensory signals being transmitted from below the injury point past the injured part of the cord. This type of pain can also occur irregularly besides chronically.

Bladder and Urinary Tract infections may be another effect of paralysis. Besides infections, control over these functions can be affected, the two most common conditions being spastic bladder, called high tone, when the bladder fills and then suddenly reflexes and empties, and flaccid bladder, called low tone, when the bladder's reflexes are slow or nonexistent.

Bowel Management is affected similarly to the loss of control in the bladder, with spastic and flaccid bowel conditions. [10]

Upper Extremity Care is an issue some can experience by being in a wheelchair for prolonged periods of time, with pain in the shoulder, arm, and wrist. [11]

Treatment

Test pilot and ambassador for Ekso Bionics, wearing a human exoskeleton

Treatment for paralysis consists of two phases: the acute phase and the rehabilitation phase. The acute phase starts as soon as the injury occurs, and lasts until the person is stabilized. Within those first days following injury, the person will experience spinal shock, in which their reflexes will not function as normal. Other types of injuries may also have to be dealt with, such as brain injury, broken bones, and bruises. Due to later possible differences in the patient's condition it is not easy to determine exactly how the injury and its effects will develop. During the acute phase it is essential for the patient to receive immediate medical attention. The sooner the patient receives care the higher the chance of them having the least amount of damage in the long term. Treatment for paralysis may include medication, undergoing surgery, and always has physical therapy as a requirement. In regards to surgery, doctors have differing views. Some feel that performing an operation immediately is more beneficial to the patient, while others feel that waiting for the patient to enter a more stable state before surgery has better effects. However, research conducted in 2008 by the Surgical Treatment of Acute Spinal Cord Injury Study (STASCIS) pointed toward the first opinion. [12] [13]

After the acute phase has ended, the rehabilitation phase begins. Following stabilization, the patient is then able to begin working towards the goal of returning as much normal functioning to their body as possible. It is necessary for rehabilitation to start as soon as possible in order to prevent muscle atrophy in the body. As each injury is different, a unique plan is set up for each patient to follow. The basic ideas in all of them, however, are to help the person understand their injuries and the details regarding their care, and thus how to instruct their caretakers, learn to accept their new lifestyle, prepare for returning to an occupation through vocational rehabilitation, and achieve as much independence as they can. Beginning in the hospital, therapy will then continue in a rehabilitation center or possibly the person's home, depending on their needs and preferences. Various specialists may aid the person during the period of rehabilitation, including a physical therapist, occupational therapist, recreational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, and physician that specializes in physical medicine known as a physiatrist. [12] [13]

Some newer developments in technology for helping those paralyzed include FNS (or FES) and exoskeletons. Functional Neuromuscular Stimulation, or Functional Electrical Stimulation, utilizes electrical currents to activate nerves by sending small electrical pulses to paralyzed muscles. They are often used for exercise, and restoring or improving the body's function. FES is capable of aiding breathing, grasping motions, standing, walking, and bladder and bowl functions in a paralyzed person. The electrodes used in this technology can be placed outside the person or implanted into the body. [14] [13] Exoskeletons are a very recent advancement, with the ReWalk Personal System for home and community use being the first model FDA approved--just last year. The exoskeleton, like its name describes, is an exterior device worn as a walking aid, consisting of bionic legs powered by batteries with small motors at the joints. [15]

Video

New technology giving hope to those paralyzed

References

  1. 1.0 1.1 1.2 Paralysis Facts and Figures Christopher & Dana Reeve Foundation. Web. Accessed 11 January 2015.
  2. 2.0 2.1 2.2 Newly Paralyzed Christopher & Dana Reeve Foundation. Web. Accessed 11 January 2015.
  3. 3.0 3.1 3.2 3.3 3.4 Symptoms of Paralysis BrainandSpinalCord.org. Web. Accessed 11 January 2015.
  4. 4.0 4.1 4.2 4.3 4.4 Paralysis Medline Plus. Web. Accessed 11 January 2015.
  5. Neurofibromatosis Mayo Clinic. Web. Accessed 12 January 2015.
  6. Incomplete (non-traumatic) BrainandSpinalCord.org. Web. Accessed 12 January 2015.
  7. 7.0 7.1 Complete (traumatic) BrainandSpinalCord.org. Web. Accessed 12 January 2015.
  8. Basic Conditions A to Z Christopher & Dana Reeve Foundation. Web. Accessed 11 January 2015.
  9. Sleep Paralysis BrainandSpinalCord.org. Web. Accessed 12 January 2015.
  10. What are the secondary issues related to SCI that might impact my health? Christopher & Dana Reeve Foundation. Web. Accessed 27 January 2015.
  11. Upper Extremity Care Christopher & Dana Reeve Foundation. Web. Accessed 27 January 2015.
  12. 12.0 12.1 Spinal Cord Injury Rehabilitation BrainandSpinalCord.org. Web. Accessed 28 January 2015.
  13. 13.0 13.1 13.2 Spinal Cord Injury Treatment BrainandSpinalCord.org. Web. Accessed 28 January 2015.
  14. Functional Electrical Stimulation Christopher & Dana Reeve Foundation. Web. Accessed 28 January 2015.
  15. Exoskeletons Christopher & Dana Reeve Foundation. Web. Accessed 28 January 2015.