Paralysis is the loss of the ability to move some or all of the body.
Types of Paralysis:
Complete paralysis is when you can’t move or control your paralyzed muscles at all. You also may not be able to feel anything in those muscles.
Partial or incomplete paralysis is when you still have some feeling in, and possibly control over, your paralyzed muscles. This is sometimes called paresis.
Localized paralysis affects just one specific area, like face, hands, feet, or vocal cords.
Generalized paralysis is more widespread in your body and is grouped by how much of your body is affected. The type usually depends on where your brain or spinal cord is injured.
• Monoplegia is a kind of generalized paralysis that affects just one limb.
• Diplegia affects the same area on both sides, like both arms, both legs, or both sides of your face.
• Hemiplegia affects just one side of your body. It is usually caused by a stroke, which damages one side of the brain.
• Quadriplegia (or tetraplegia) is when all four limbs are paralyzed, sometimes along with certain organs.
• Paraplegia is paralysis from the waist down.
• Locked-in syndrome is the rarest and most severe form of paralysis, where a person loses control of all their muscles except the ones that control their eye movements.
Paralysis can be spastic, when muscles are tight and jerky.
It can also be flaccid, when muscles sag and eventually shrink.
Causes
Paralysis is most often caused by strokes, usually from a blocked artery in the neck or brain.
Some kinds of paralysis are caused by certain conditions or diseases linked to specific genes:
Paralysis after a serious accident or injury – a severe head injury or spinal cord (back) injury
Demyelinating diseases. These happen when the protective coating around nerve cells, called the myelin sheath, is damaged over time. That makes it harder for neurons to send signals throughout the body. It weakens muscles and eventually causes paralysis.
There are several demyelinating diseases, but the most common is multiple sclerosis.
Motor neuron diseases (MNDs). Motor neurons are the nerve cells that control the muscles you use to walk, breathe, speak, and move limbs.
There are two types: upper motor neurons, which send signals from the brain down to the spinal cord, and lower motor neurons, which get those signals and send them to muscles. MNDs are diseases that damage these cells over time.
• Upper motor neuron diseases, like primary lateral sclerosis (PLS), affect just the upper motor neurons. This makes muscles stiff and spastic.
• Lower motor neuron diseases, like spinal muscular atrophy (SMA), affect only the lower motor neurons. This makes muscles floppy or flaccid, which makes them weak and sometimes causes them to twitch uncontrollably.
• The most common MND is amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), which affects both upper and lower neurons.
Periodic paralysis. This is caused by changes in specific genes. It involves random attacks of paralysis, often triggered by something in the person’s diet.
Sleep paralysis. This happens while waking up or falling asleep. Sometimes people who have sleep paralysis will also see things that aren’t there (hallucinate).
Todd’s paralysis. This often happens for a brief period after a person with epilepsy has had a seizure, usually just on one side of their body.
Tick paralysis and Lyme disease. Some ticks have neurotoxins in their spit glands that can cause paralysis, starting in your feet and legs and moving upward.
Muscular dystrophy (MD). MD is when changes in genes in these proteins make muscles weak and cause them to break down over time.
HTLV-1 associated myelopathy. Also called tropical spastic paraparesis (TSP), this type of spastic paralysis comes on gradually after infection with human T-cell leukemia virus type 1.
How paralysis is diagnosed?
• X-ray: This test uses small amounts of radiation to produce detailed images of the dense structures inside the body, such as the bones.
• CT scan: CT uses computers to combine many X-ray images into cross-sectional views of the inside of the body.
• MRI: MRI uses a large magnet, radio waves, and a computer to create clear images of the body.
• Myelography: This test uses a contrast dye that is injected into the spinal canal to make the nerves show up very clearly on an X-ray, CT scan, or MRI.
• Electromyography (EMG): This test is used to measure the electrical activity in the muscles and nerves.
• Spinal tap: A long needle is injected into the spine to collect spinal fluid.
Standard Treatment
• Physical therapy uses treatments such as heat, massage, and exercise to stimulate nerves and muscles.
• Occupational therapy concentrates on ways to perform activities of daily living.
• Mobility aids include manual and electric wheelchairs and scooters.
• Supportive devices include braces, canes, and walkers.
• Assistive technology such as voice-activated computers, lighting systems, and telephones.
• Adaptive equipment such as special eating utensils and controls for driving a car.
Non-Standard Treatment
Functional Electrical Stimulation (FES)
FES bikes allow people with little or no voluntary leg movement to pedal a stationary leg-cycle called an ergometer. Computer generated, low-level electrical pulses are transmitted through surface electrodes to the leg muscles. This causes coordinated contractions and the pedaling motion.
Each bike has a program cartridge set up for the specific needs of each rider, including run times, resistance, etc.
This technology allows persons with little or no voluntary leg movement to pedal a stationary leg-cycle called an ergometer. Computer generated, low-level electrical pulses are transmitted through surface electrodes to the leg muscles. This causes coordinated contractions and the pedaling motion.
Treadmill or Locomotor Training
Locomotor Training is a rehabilitation approach that has been emerging over the last decade. It involves a kind of activity-triggered learning whereby practicing a series of specific movements (in this case, stepping) triggers the sensory information that somehow reminds the spinal cord how to initiate stepping.
Locomotor Training uses repetitive motion to teach the legs how to walk again. A paralyzed person is suspended in a harness above a treadmill, reducing the weight the legs will have to bear. As the treadmill begins to move, therapists manually move the person’s legs in a walking pattern.
Functional electrical stimulation
Functional electrical stimulation (FES) applies small electrical pulses to paralyzed muscles to restore or improve their function.
FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. It can also lead to improved bladder and bowel function. There’s even evidence that FES may reduce the frequency of pressure sores and urinary tract infections.
Bladder or bowel FES
Sacral stimulators are surgically implanted FES systems for on-demand control of the paralyzed bladder and bowel. The stimulator, called the Finetech-Brindley device, has a strong track record for improving bladder and bowel control in the vast majority of users.
Upper extremity
The FreeHand system was well received and people living with paralysis gained significant function in grip, writing, eating, computer work, etc.
Walking
There is a available device called Parastep that is FDA approved for some paraplegics (T4 to T12 ) to support stepping. Parastep, which has been approved by Medicare for reimbursement, facilitates stepping by firing leg muscles and uses a front-wheeled walker fitted with a control pad.
New technologies
Brainwave communication: In clinical trials, people are already controlling computer cursors and opening email with just their thoughts. People can precisely move robotic arms using only brainwaves.
BrainGate is an investigational brain implant system from a biotech company called Cyberkinetics that places a computer chip into the brain, which monitors brain activity and converts the intention of the user into computer commands.
Overview of orthoses
Orthoses and braces are tools common in rehabilitation, though somewhat less than in years past. This is due in part to cost cutting, limited clinical expertise and reduced time in rehab. There is also a general feeling among many users that orthoses are cumbersome and appear too bionic or “disabled” looking.
An orthosis might be used for positioning a hand, arm or leg, or to magnify or enhance function. It can also be as simple as a splint or as a complex as functional electrical stimulation (FES) brace for ambulation in paraplegics.
Wrist-hand orthosis
Wrist-hand orthosis (WHO) transfers force from an active wrise to paralyzed fingers. This offers a grasping function for those with cervical injuries (generally between C4-C7). The WHO, also called a tenodesis splint, has been modified and simplified over the years, sometimes with the addition of batteries for power.
Ankle-foot orthosis
Ankle-foot orthosis (AFO) is commonly used in people who have experienced strokes, multiple sclerosis, and incomplete spinal cord injury to assist the ankle and allow the foot to clear the ground during the swing phase of walking.
Knee-ankle-foot orthosis
Knee-ankle-foot orthosis (KAFO) allows someone living with paralysis (usually L3 and above) to stabilize the knee and ankle. While it’s very hard work, people using KAFO’s, even those with no hip flexion, can take steps by swinging their legs while supported by forearm crutches.
Reciprocating gait orthosis
Reciprocating gait orthosis (RGO), for children with spina bifida, consist of a pair of KAFOs with solid ankles, locking the knee joints, and legs and thigh straps. Each leg of the brace is attached to a pelvic unite with a hip joint, supporting hip flexion and extension. A steel cable assembly joins the two hip joints to limit step length.
By rotating the torso, the user shifts the weight to the forward leg; this permits the opposite leg to move forward. This kind of walking is stable and balanced, but slow and requires a great deal of energy.
Parastep
A parastep is a “neuroprothesis,” a device that affects both the structure of the body ( as a brace) and the nervous system (substitute for damaged nerves). It is a portable FES system that facilitates reciprocal walking by stimulating leg muscles on cue. The movement is a bit robotic, but independent and functional for short periods of time.
Exoskeleton
Exoskeletons and the role they are playing in both the rehabilitative care and home life of people living with paralysis became an important emerging technology only a few years ago. Essentially, exoskeletons are battery powered bionic legs, with small motors on the joints.
The Parker Indego® is a “powered lower limb orthosis enabling people with mobility impairments to walk and participate in over-ground gait training.”
The Hybrid Assistive Limb (HAL), developed by Japanese robot maker Cyberdyne, is moving through the medical device approval processes.
Next time I will try to give an overview of ALTERNATIVE methods of treatment based on Tradicional Medicine.
