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Results for “QUADRIPLEGIA”

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PubMed1977

Steady state hormonal secretion in traumatic quadriplegia.

Physiologically complete cervical spinal cord transection results in motor and sensory quadriplegia and interruption of the sympathetic neural pathways; this condition leads to metabolic deficiencies suggestive of abnormal endocrine function. An investigation of the non-stimulated secretion of some of the hormones influencing metabolism was undertaken by evaluating thyroxine, iodothyronine binding index, testosterone, growth hormone, calcitonin, and parathyroid hormone in venous blood of fasting healthy subjects and quadriplegic patients. The effect of the duration of the paralysis was examined by repeating the evaluations at different periods after onset. The results show that 1) thyroxine was low for 2 months after onset in 21 patients and normal thereafter in 53 patients, 2) testosterone was low throughout the study in 62 patients; the decrease is greatest during the first 2 months, 3) growth hormone was often increased in 46 patients for 8 months after onset, and nearly normal afterward in 25 patients, 4) calcitonin was normal in 22 patients throughout the study, and 5) parathyroid hormone was normal in relation to normal serum calcium as early as 6 days after onset in 79 out of 83 patients. These data do not preclude a parathyroid hormone increase at onset or alterations in the patterns of circadian secretion and in the responses to specific stimulation for the hormones evaluated. Therefore, it may be concluded only that the steady state secretion of these hormones is not altered by traumatic quadriplegia per se, but is temporarily modified by the original insult to the nervous system, and by changes in life pattern and the heavy sedation that follows. The results suggest that the minor endocrin changes occurring in quadriplegic patients during the early period of paralysis will be rapidly overcome by rehabilitation to an active life pattern.

Calcitonin↗

PubMed1994

Chest tubes, lung entrapment, and failure to wean from the ventilator. Report of three patients with quadriplegia.

The cases of three patients with traumatic quadriplegia who had been treated with chest tubes are described. Each had been injured at a neurologic level that typically allows weaning from the ventilator, yet none was able to clear refractory atelectasis or become ventilator free. Each underwent surgery during which lung adhesions, entrapment, or deformation at the former chest tube site were identified and corrected. Subsequently, each patient cleared his atelectasis and weaned from the ventilator. These cases suggest the importance of ruling out lung deformity in individuals with ventilator-dependent quadriplegia who have had chest tubes and unexpectedly fail to wean.

Adult↗

PubMed2002

Quadriplegia in a patient who underwent posterior fossa surgery in the prone position. Case report.

Quadriplegia is a well-known complication of posterior fossa surgery performed while the patient is in the sitting position but is rarely associated with the prone position. A case of an 18-year-old man with a cerebellar medulloblastoma is described. There was no evidence of previous cervical disease. The patient suffered quadriplegia after undergoing surgery in the prone position. Postoperative magnetic resonance imaging demonstrated a long hyperintense C2-T1 lesion on T2-weighted sequences. The authors speculate that, during the prolonged period in which the neck was in hyperflexion, overstretching of the cervical spinal cord and compromise of its blood supply might have caused this devastating complication.

Adolescent↗

PubMedDate not supplied

Primary polyarteritis nodosa presenting as acute symmetric quadriplegia.

We report a case of peripheral neuropathy presenting as acute symmetric areflexic quadriplegia in the setting of a well-defined clinical, histopathologic, and angiographic diagnosis of classic polyarteritis nodosa. While it is usually easy to recognize the typical clinical presentation of necrotizing angiopathy-induced peripheral neuropathy as a mononeuritis multiplex or a distal polyneuropathy in association with a collagen vascular disease, clinicians must be equally sensitive to a number of more challenging possibilities. Acute quadriplegia similar to that seen in Guillain-Barré syndrome can be secondary to primary classic polyarteritis nodosa and the former may be the chief or even the sole manifestation of the latter.

Aged↗

PubMed1975

Bone metabolism in quadriplegia: dissociation between calciuria and hydroxyprolinuria.

Relationships between duration of paralysis, recumbency, muscular activity, and urinary loss of calcium (Cau), phosphorus (Pu), and hydroxyproline (OHPu) were studied daily in 32 traumatic quadriplegic patients during comprehensive rehabilitation and randomly in those readmitted for treatment. Within days after onset, quadriplegic patients had increases in Pu, then OHPu, and finally, Cau. Patients actively engaged in rehabilitation exercises showed a steady fall in OHPu, whereas CAU remained high for up to 18 months. Patients paralyzed for over 18 months (late) had low Cau, Pu and OHPu; but if the patients were kept in bed, OHPu increased rapidly. Patients with early quadriplegia have an increased bone remodeling, suggesting that the excess OHPu and Cau are derived from resorbed bone. Patients with late quadriplegia have little bone remodeling, therefore the excess OHPu occurring during recumbency may be derived from the resorption of new collagen produced during the removal of weight bearing without further change in muscular activity. Resorbed new collagen is excreted in part as large, OHP-containing polypeptides; these were found in the urine of quadriplegic patients, and therefore were present in blood and may play a role in initiating ectopic bone and renal calculi. The presence of OHP in 11 bladder calculi from quadriplegic patients tends to support this hypothesis. These studies indicate that muscular activity and weight bearing influence the bone metabolism of quadriplegic patients and suggest that the presence in body fluids of increased catabolic products from bone may have a role in bone-related complications.

Adolescent↗

PubMed1989

The individual with high quadriplegia.

Persons with quadriplegia resulting from disease or trauma have an array of disabling impairments that involve virtually every body system. During the rehabilitation process, each impairment is addressed. This article presents alternatives in three areas: respiration, communication, and environmental control. The importance of tailoring strategies to the individual is emphasized throughout. Appropriate rehabilitation of the person with high quadriplegia goes beyond maintenance of life and health. An interdisciplinary team that includes the patient unites dreams, knowledge, skills, and technology so that the patient has the possibility of noninstitutional living, major control over his or her own destiny, some autonomy, and participation in a full spectrum of life activities. As Maddox noted: "Life is a fragile, fleeting thing, under any circumstances, and living it can be comic or tragic, weird or wonderful--regardless of one's motor limitations."

Communication Devices for People with Disabilities↗

PubMed1989

Quadriplegia from spinal cord injury in muscular dystrophy.

Recommendations for exercise programs in patients with muscular dystrophy are controversial. These programs are designed to keep a patient ambulatory or functional for as long as possible. There have been no reports of a patient with muscular dystrophy who incurred a spinal cord injury. This report details the course of recovery and rehabilitation of a man with facioscapulohumeral muscular dystrophy with quadriplegia from a traumatic spinal cord injury. The patient was admitted to a spinal cord injury unit. After prolonged bedrest, he participated in physical and occupational therapy that was designed to exercise him just short of fatigue. Except for one incident, when the patient reinjured his spinal cord, he did not lose function that he had already attained. The rehabilitation of this patient demonstrates that it is possible for a patient with facioscapulohumeral muscular dystrophy who sustains a traumatic quadriplegia to enter a rehabilitation program with expectations for a good outcome despite a double disability.

Adult↗

PubMed1987

The National Football Head and Neck Injury Registry: 14-year report on cervical quadriplegia (1971-1984).

The specter of catastrophic cervical neurotrauma resulting from athletic participation, although infrequent, has been consistently associated with football, water sports, gymnastics, rugby, and ice hockey. Injury involving intracranial hemorrhage can result in death or permanent neurologic impairment, whereas certain fractures and dislocations of the cervical spine are associated with quadriplegia. Athletic injuries to both the central nervous system and spinal cord demand our attention as an active area of clinical and basic injury. A review of the available literature reveals changing injury patterns as well as current concepts regarding the mechanism responsible for most athletic injuries to these structures. Accurate descriptions of the mechanism(s) responsible for a particular injury transcend simple academic interest. In order that preventive measures be implemented, the manner in which injury occurs must be accurately defined. The purpose of this article is to describe how the application of this principle resulted in the significant reduction of cervical spine injuries associated with quadriplegia that have occurred in tackle football since 1976.

Athletic Injuries↗

PubMed1986

Functional independence in quadriplegia: critical levels.

The purpose of this study was to examine the self-care abilities of individuals with quadriplegia at two critical functional levels, once they resumed community living. Twenty-nine individuals with quadriplegia (17 with wrist extensors as the lowest functional muscle and 12 with triceps), were surveyed three months to four years after discharge, to determine self-care independence and change in ability since discharge in ten self-care areas. Personal care assistance, use of equipment, and present living situation also were surveyed. Results indicated that subjects with triceps as the lowest functioning muscle had significantly greater independence levels in self-care activities than those with wrist extensors. Changes in abilities from discharge to follow-up were noted for both groups, especially in the areas of bowel and bladder care, dressing, and mobility activities. Most subjects lived at home with their family and used personal care assistance to accomplish part of their self-care. Equipment use was decreased upon community living for both groups. It is concluded that the functioning of triceps is a significant determinant for functional independence in self-care tasks.

Activities of Daily Living↗

PubMed1980

[Hypokalemic states in clinical practice. A case of severe hypokalemia combined with flaccid quadriplegia].

The biochemical data relating to the physiological distribution of potassium and its regulating factors in the normal human body are explained. Reference is then made to the clinical symptoms and aetiopathogenesis of hypokalaemia. A serious case coupled with flaccid quadriplegia in a 34-yr-old male is presented. Stress is laid on the usefulness of correct investigation of the history, and the fundamental resort to complete electrolytic screening in patients presenting with polyuria, polydipsia, arrhythmia and flaccid quadriplegia.

Adult↗

PubMed1995

Exercise prescription for sitting and supine exercise in subjects with quadriplegia.

Although in able-bodied individuals heart rate (HR) indicates exercise intensity, the linearity of the HR/oxygen uptake (VO2) relationship has not been established in persons with quadriplegia with impaired sympathetic function. The HR/VO2 relationship and four ACSM recommended methods of exercise prescription were evaluated in 11 individuals with quadriplegia during intermittent progressive peak exercise tests. Tests were conducted in either a supine or sitting position using an arm ergometer. The HR response was highly variable, with HR/VO2 correlation coefficients ranging from 0.22 to 0.99. A 2 x 2 ANOVA revealed an interaction between injury level, high-level (above C7) vs low-level (C7 and below) and exercise position, with the high-level group exhibiting the lower coefficient (0.68) between the HR/VO2 relationship in the sitting position. For all subjects, the target of 55-90% peak HR (mean = 72.5%) corresponded to 34% peak power output (PO) in sitting and 44% peak PO in supine. Similarly, 70% peak VO2 corresponded to 46% and 50% of peak PO (sitting and supine, respectively). A rating of perceived exertion (RPE) of 10-12 corresponded to 50-60% peak PO and was associated with a higher PO than that predicted by the HR or VO2 methods. The results of this study indicate that exercise intensity for quadriplegics be based on 50-60% peak PO and/or an RPE of 10-12.

Adult↗

PubMed1993

Quadriplegia: focus on rehabilitation.

Spinal cord injury resulting in quadriplegia is one of the most devastating types of injury. The rehabilitation process actually begins at the time of injury. Emphasis on independence, however, is usually not a major factor until the client reaches the rehabilitation unit. This paper will focus on the rehabilitation management of a client with quadriplegia. Nursing interventions and teaching related to skin care, bowel and bladder care, nutrition, mobility, hygiene, and dressing will be discussed. Discharge planning, an integral component of the rehabilitation process, will also be addressed.

Activities of Daily Living↗

PubMed1994

Electrodiagnosis of upper limb weakness in acute quadriplegia.

Clinical and neuropathologic observations after cervical spinal cord injury suggest varying involvement of gray and white matter. The resulting upper limb weakness may reflect varying degrees of upper motoneuron (UMN) and/or lower motoneuron (LMN) involvement. This study uses electrophysiologic measures, including compound muscle action potential (M response) amplitude, root mean square (RMS) of the surface electromyographic activity during voluntary muscle contractions and the firing rate of motor units, to distinguish UMN and LMN weakness in upper extremities after acute quadriplegia. M response amplitude did not correlate with strength; many muscles had large M responses given their strength. These muscles manifest: (1) high M/RMS ratios (ratio of electrically elicited to voluntarily recruited electromyographic activity) and (2) slow firing rates of single motor units during maximal isometric contractions. For muscles with normal M amplitudes, M/RMS ratio correlates inversely with strength. For muscles with normal M/RMS ratios, M amplitude correlates positively with strength. Cluster analysis was used to distinguish UMN, LMN or Mixed types of weakness. Distinguishing these different types of weakness in acute quadriplegia may allow individualized rehabilitation for the type of weakness present.

Action Potentials↗

PubMed1996

Injury zone denervation in traumatic quadriplegia in humans.

In order to obtain an electrophysiological characterization of the injury zone in traumatic quadriplegia, we performed electromyography and nerve conduction studies on the upper limbs of 15 patients with cervical cord trauma. Evidence of significant axonal loss was found in multiple myotomes of all patients. In most cases, the level of the most severe denervation, as determined by the absence or diminution of the compound motor action potential and the density of fibrillation potentials, was 2-5 spinal segments below the clinically and radiologically defined injury levels. In patients with injuries, the rostral extent of which is at C5 or higher, the most obvious clinical and electromyographic denervation was seen in the intrinsic hand muscles (C8/T1), with complete loss of C8/T1 motor axons in a subset of these patients. Our results document that spinal cord trauma can cause loss of motor axons in regions several segments caudal to the rostral level of injury. This finding may have implications for the pathophysiology of secondary injury, for recovery potential, and for the design of rehabilitation strategies.

Action Potentials↗

PubMed1987

Sudden quadriplegia complicating ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis.

The association of ossification of the posterior longitudinal ligament (OPLL) and diffuse idiopathic skeletal hyperostosis (DISH) has been recently described. It may result in devastating compressive myelopathy. We report a case of quadriplegia complicating OPLL in a patient with DISH. In addition, we present a brief review of the literature on OPLL. This report illustrates the importance of appropriate neurologic and radiologic evaluation of persons with DISH, to help prevent severe neurologic complications.

Accidental Falls↗

PubMed1979

Neurofibrillary degeneration in a case of quadriplegia and myoclonic movement.

A case of spastic quadriplegia with myoclonic movement was studied by both light and electron microscope. Argentophilic inclusions were found in a unique distribution involving the cerebral cortex, brain stem, cerebellum, and the spinal cord, including the motor neuron system. The fine structure of the inclusions consisted of accumulation of previously undescribed straight or wavy tubules approximately 120A wide devoid of periodic constriction.

Brain Stem↗

PubMed1998

Dramatic development of quadriplegia in a young man while engaged in heavy manual labour: a post-traumatic spinal cord injury?

A healthy 16-year-old male suddenly developed paraesthesiae in his hands during heavy manual labour. He was able to walk to the nearest doctor's practice himself. The symptoms worsened dramatically, and within a short period of time cardiac arrest occurred. After resuscitation and intensive care, quadriplegia due to a high cervical cord lesion was diagnosed. The patient died 70 days later without any changes in the neurological symptoms. Post mortem revealed severe focal ischaemic lesions in the cervical spinal cord in a mixed arterial/venous distribution, but no evidence of direct traumatic changes in the spinal cord, the spine or the soft tissues. All other possible causes than trauma were excluded. The clinical development of the symptoms suggest that this spinal cord lesion should be classified as a secondary traumatic spinal cord injury caused by a subluxation of the cervical spine. The pathogenesis of post-traumatic ischaemic damage to the spinal cord appears to be related to localized hypercoagulability resulting in the formation of microthrombi. Impaired microcirculation in a limited area and for a limited period of time may have caused the irregularly distributed ischaemic necrosis.

Adolescent↗

PubMed1988

Atlantoaxial dislocation presenting as sudden onset of quadriplegia in Down's syndrome.

A sudden onset of quadriplegia and dyspnea occurred in a 4-year-old girl with Down's syndrome, who had been noted to have atlantoaxial dislocation. She underwent cervical immobilization initially with a halo-vest and subsequently by posterior fusion, resulting in significant functional recovery. The catastrophic myelopathy that occurred in this patient emphasizes the necessity of treatment even for asymptomatic atlantoaxial instability in some individuals with Down's syndrome.

Atlanto-Axial Joint↗