What is Tetraplegia, Quadriplegia and Paraplegia?

Tetraplegia Epidemiology and Etiology

Many people wonder: “What causes tetraplegia?” after they hear about it for the first time. Knowing the cause (i.e. the etiology) of a condition is often key for preventing it from affecting others (a practice referred to as “epidemiology”).

While the field of epidemiology is traditionally concerned with preventing the spread of infectious diseases (which tetraplegia and paraplegia are not), studying the causes of paralyzing conditions like tetraplegia and paraplegia can be useful for proactively protecting oneself and others.

Spinal Cord Injury and Traumatic Brain Injury

SCIs and TBIs remain the most common causes of paralytic conditions like tetraplegia and paraplegia. So, what are the most common causes of SCIs or TBIs? The National Spinal Cord Injury Statistical Center (NSCISC) lists the top causes of spinal cord injuries as:

• Vehicular Accidents (38.6%)
• Falls (32.2%)
• Acts of Violence (14%)
• Sports Injuries (7.8%)
• Medical/Surgical Injuries (4.2%)
• Other (3.2%)

Vehicular Accidents

There are millions of vehicular accidents in the U.S. every year. According to data cited by Driver Knowledge, there is an average of 6 million car accidents every year and 2 million drivers in car accidents suffer permanent injuries each year.

While not all of these injuries cause the kind of spinal or brain trauma that induces permanent paralysis, vehicular accidents remain the #1 cause of SCIs, and a leading cause of TBIs—both of which are closely related to various forms of paralysis.

Falls

While falls rank behind vehicular collisions in causing SCIs, according to the American Association of Neurological Surgeons (AANS), “The leading causes of non-fatal TBI in the US occur from falls (35%), motor vehicle injuries (17%), and strikes or blows to the head from or against an object (17%). This makes falls a significant contributor to TBIs that can result in paralysis.

Also, as noted by the National Floor Safety Institute (NFSI), “Falls account for over 8 million hospital emergency room visits, representing the leading cause of visits (21.3%).” This makes falls a frequent occurrence, although only a small fraction of them lead to permanent paralysis.

Violence

Acts of violence, such as blows to the head during a struggle, or gunshot wounds impacting the spinal column, or various other forms of harm caused with malicious intent, are a significant factor in SCI and TBI alike.

When an act of violence causes paralysis, it may be necessary for the paralyzed person to pursue a civil lawsuit against their aggressor to recoup their paraplegia or quadriplegia medical costs.

Sports and Recreational Activities

Sports and recreational activities can easily result in permanent paralysis or even death if things go wrong. This is especially true of high-contact sports and high-risk activities like:

• Football
• Boxing
• Skiing
• Diving into shallow water
• Hockey
• Skydiving
• Bungee Jumping
• Cheerleading

Of course, almost any physical activity carries at least some risk of injury—a slip and fall accident can happen while walking in the home and lead to a broken spinal column.

Medical and Surgical Accidents

Medical and surgical procedures always carry a small element of risk to them. If there is an unexpected complication or a doctor makes a minor error while operating on a patient, it could lead to infections or permanent damage.

When avoidable medical or surgical errors lead to permanent injury, that may be referred to as medical malpractice—though patients often face an uphill battle in reclaiming their medical costs from malpractice cases.

Thankfully, such errors only make up a minor percentage of quadriplegia and paraplegia cases.

Stroke

Strokes can come in several varieties, including:

• Ischemic Strokes. Wherein blood vessels are too narrow or get blocked off, reducing the flow of blood to parts of the brain.
• Hemorrhagic Strokes. Wherein blood vessels in the brain leak or burst, creating pressure on the brain with hematomas.
• Transient Ischemic Attacks (TIAs). Also known as “mini-strokes,” these are a temporary restriction of blood to the brain (like ischemic strokes), but do not typically result in permanent damage.

According to the American Stroke Association (ASA), strokes are known to cause hemiplegia or hemiparesis (paralysis or weakness on one side of the body), generally on the side of the body opposite from the side of the brain where the stroke occurred.

However, particularly severe strokes that deprive large portions of the brain of oxygen for too long may cause more extensive forms of paralysis, such as quadriplegia.

Cerebral Palsy

The term “cerebral palsy” actually covers a wide range of neurological disorders that impact muscle control and health. According to Mayo Clinic, cerebral palsy is “caused by damage that occurs to the immature brain as it develops, most often before birth.”

The Cerebral Palsy Group states that one variety of cerebral palsy, spastic cerebral palsy, is known to cause “difficulty in controlling movements in the arms and legs. Those who experience this form of cerebral Palsy will not have paralysis of the muscles, but rather jerking motions that come from stiffness within all four limbs.”

This description more closely matches with tetraparesis/quadriparesis instead of tetraplegia, but further damage to the brain could lead to full paralysis.

Multiple Sclerosis (MS)

Multiple Sclerosis, or MS, is an autoimmune disease wherein the immune system of the body attacks the nervous system (the brain and spinal cord). As noted by Healthline, “This causes inflammation and scar tissue, or lesions” to form, which can “make it hard for your brain to send signals to the rest of your body.”

Because the damage done by MS can vary so much from one case to the next, it is hard to predict all of the symptoms it can cause. However, permanent paralysis is one such potential symptom. Whether MS lead to paraplegia or quadriplegia may depend on where scar tissues form and how long the condition goes undiagnosed and untreated.

Tetraplegia and Quadriplegia Symptoms

Tetraplegia (Quadriplegia) can be unpredictable and vary as time goes on. Age at injury, overall prior health, complications commonly associated with quadriplegia, and the quality of care immediately after the injury can all have a major effect on the outcome. The prognosis a doctor gives may need to be adjusted, as there are many factors that can cause the condition to worsen or improve.

In general, the following tetraplegics may experience one or more of the following symptoms: 

Chronic Pain

Chronic pain can develop due to muscle atrophy, increased muscle tone called spasticity, nerve damage from the injury that causes sensory changes that could be painful from disuse or changes in sensory perception. 

Loss of Sensation

Loss of sensation below the site of the injury. For some tetraplegics, this sensation loss is complete and permanent. In others, sensations are merely reduced, or the paraplegic/tetraplegic may intermittently feel some sensations, but not others. A “pins and needles” feeling is especially common.

Loss of Movement

Inability to move the limbs below the site of the injury. Though some movement may return, the overwhelming majority of quadriplegics continue to struggle with loss of muscle control and generalized weakness.

Spasticity

Any injury to the central nervous system (a brain or spinal cord injury) can result in increased muscle tone known as spasticity.  This can make moving parts of the body even harder due to increased muscle tone.

Tetraplegia and Quadriplegia Diagnosis

There are a variety of diagnostic tests that a doctor may conduct to verify a case of paraplegia or tetraplegia. The specific examinations used may vary from one case to the next depending on the suspected cause of the condition, though additional tests may be used to check for other issues.

How Is Tetraplegia (Quadriplegia) Diagnosed?

Generally speaking, a tetraplegia or paraplegia diagnosis begins with a general review of the patient's symptoms, comprehensive physical exam focusing on muscle strength, sensation exam and reflexes, and general health. An extensive examination to determine specifics about a spinal cord injury is called the "International Standards for Neurological Classification of Spinal Cord Injury", previously known as the "ASIA" exam and this information can give the doctor a rough idea of which specific follow-up procedures, imaging and examinations they should conduct to get a more specific prognosis.

Differential Diagnoses

Most of the time, a case of tetraplegia or paraplegia will have a set cause that a doctor can readily determine. So, differential diagnoses (lists of alternative conditions that could be causing the same symptoms) are generally considered a non-factor. So much so that, for quadriplegia, Physiopedia states that "There is no differential diagnosis, the ASIA classification excludes other disorders." However, the cause of quadriplegia and tetraplegia vary and this needs to be determined by the physician as noted above.

Diagnostic Procedures and Examinations

After a basic physical, a doctor may use several diagnostic procedures to learn more about a paraplegic or tetraplegic's condition:

• MRI Scans. A magnetic resonance imaging (MRI) scan of the brain and spinal cord can check for issues like tumors or herniated disks.
• Spinal Taps. A doctor may extract and test some cerebrospinal fluid (CSF) to analyze it for potential warning signs of infection or other issues that may impact spinal health.
• Blood Tests. A blood test can reveal nutritional deficiencies, potential problems with oxygen being carried by the blood (such as sickle cell anemia) which could increase the risk of stroke, and other issues.
• Electromyography (EMG) Tests. As noted by Healthline, EMGs are “a nerve function test that reads electrical activity from the muscles” used to differentiate muscle and nerve disorders.

Tetraplegia and Quadriplegia Therapy

There are no current treatments for spinal cord injuries, however there are many promising research studies focusing on this subject. However, some tetraplegics do experience significant improvements in their tetraplegia symptoms with the right therapy.

It is important to know that the goal of therapy is not to be completely “cured” and regain all lost sensations and muscle control. Instead, the goals of tetraplegia therapy include improving the condition’s long-term prognosis, reducing immediate threats to life and health, and teaching the brain and spinal cord how to work around the injury. Some therapy options include:

Surgical interventions

Doctors may frequently use surgical procedures to remove foreign bodies from the spinal column, relieve pressure off the spinal cord and/or brain and hopefully prevent infections that may make symptoms worse.

The specific surgical procedures involved may vary from case-to-case.

Physical Therapy

Physical therapy is frequently used to help paralysis patients not only build muscle mass and fight atrophy, but to re-learn how to control their bodies after a paralyzing injury. Activity-based therapy centers offer a broad range of exercises and activities for paraplegics and quadriplegics to help them live a healthier lifestyle.

Exercise Therapy

Paraplegics often engage in various forms of exercise, such as water aerobics, lifting weights, and more to improve circulation and prevent muscle atrophy.

Psychotherapy

To treat psychological conditions such as chronic depression that may affect a tetraplegic following their injury or illness, they may seek psychotherapy treatment. A therapist might recommend medications or group therapy sessions to help their patients adjust to their new lifestyle.

Education and Support

Spinal cord injury support groups can help tetraplegics (quadriplegics), paraplegics, and others learn how to cope with life after paralysis. Many SCI and TBI survivors find these support groups to be a valuable source of advice and emotional support. This can make an enormous difference in someone’s quality of life after an injury.

Tetraplegia and Quadriplegia Recovery and Outlook

Injuries that can cause tetraplegia/quadriplegia are often unpredictable because the brain and spinal cord are such delicate and complex structures. Research suggests, for example, that the brain can compensate for even extensive injuries in some areas, but that recovery from injuries in other areas is virtually impossible. Since there is still so much about the brain and spinal cord that we do not yet know, it can be difficult to give an accurate prognosis to quadriplegics. A thorough exam by a physician can assist with general prognosis based on severity and level of injury, however each patient and each case is unique.

Some functions and sensations may return once swelling at the injury has receded. Some tetraplegics even spontaneously recover. Surgery and other types of therapy can help, particularly if the surgeon is able to remove something that is compressing the spinal cord or impeding the brain's function. Since it cannot guarantee a full recovery, therapy instead attempts to improve the long-term prognosis, better the quality of life, and adjust to living around the injury.

Impact on the Body, Complications and Challenges

Aside from the basic symptoms outlined previously, tetraplegics and paraplegics may experience several complications and side effects. These complications of tetraplegia/paraplegia include:

Difficulties with elimination

Difficulties with elimination, i.e. a lack of control over bladder and bowel function, difficulty eliminating waste without help, and frequent urinary tract infections can result from the loss of sensation and muscle control below the site of the paralyzing injury. 

Respiratory Infections

This is a leading cause of death among spinal cord injury survivors. Respiratory infections are especially common in the months following an injury and among quadriplegics who require assistive breathing devices.

Sexual Dysfunction

Men may struggle to get erections, while women may struggle with lubrication. Both sexes often experience changes in libido, difficulties with orgasm, decreases in fertility, and even a complete cessation of sexual function following an SCI or TBI.

Pressure Sores

A lack of movement and altered or absent sensation may allow pressure sores to develop. This can cause pain or even secondary infections at the site of the sore.

Anxiety and Depression

Anxiety and depression are common for people who have lost function in their limbs. For many SCI/TBI survivors with paralysis, finding emotional support from family and friends as well as lifestyle support from other survivors can be critical.

Difficulties with Bodily Awareness

Tetraplegics/quadriplegics and paraplegics who have lost sensation in their body may have difficulty with their spatial and bodily awareness—causing them to more frequently impact obstacles or misjudge distances to nearby objects.

Unhealthy Weight

Many tetraplegics can find themselves gaining an unhealthy amount of weight if they do not reduce their calorie consumption, are unable to exercise, or do not pursue physical therapy. Others may overcompensate and lose too much weight, which can make muscle atrophy and other effects worse.

Conversing with a doctor to establish a healthy nutrition and exercise plan can be critical for maintaining a healthy weight.

Living with Quadriplegia and Tetraplegia

Learning how to live with paraplegia or tetraplegia/paraplegia is a long and difficult process. Recovering from the worst of the symptoms and adapting to life after an SCI will take time—how much time may vary from one case to the next.

It can help to seek out assistance not just from doctors, but from support groups with other SCI and TBI survivors who have gone through the same struggles and provide advice. These groups can also be an excellent place to air out frustrations and find a helping hand.

Tetraplegics/quadriplegics and paraplegics may also need to make significant renovations to their homes—layouts that would be simple enough to navigate on two legs may not be practical for someone in a wheelchair. Counters may need to be lowered, tables redesigned to accommodate a wheelchair, bathrooms altered, and hallways cleared of clutter to allow the chair to pass through unhindered.

For multi-story homes, stairways may need to be modified with lift systems to allow people in wheelchairs to get to the second floor.

Additional Sources and Resources

• Hostettler. What Is the Difference Between Paraplegia and Tetraplegia? ICF Case Studies. Published March 6, 2018. Accessed May 11, 2020.
• Sedgwick, Frankel. Spinal cord potentials in traumatic paraplegia and quadriplegia. Journal of Neurology, Neurosurgery & Psychiatry. Published September 1, 1980. Accessed May 11, 2020.
• Quadriplegia and Paraplegia. Winchester Hospital. Accessed May 11, 2020.
• Respiratory health. Reeve Foundation. Accessed May 11, 2020.