Paralysis
Paralysis is loss of sensation or power to move voluntary part of the body as a result of neurologic injury or diseases. Paralysis can make people dependent on others partially to completely. In United States 1 in 50 people is living with paralysis approximately 5.4 million people. It adds up a huge burden to the family and society both physically and financially.
Eye-sight, Speech and Communication and Walking are three most important fundamental functions for life. It may impair all these functions and make patients depended on others.
Other difficulties in paralysis and patients require support for
Inability or difficulty Sitting, Walking and Lying
Activities of Daily Living – Dressing, Brushing, Use bathroom,
Symptoms
Loss of sensation
Inability to move voluntary parts of body
Numbness / tingling sensation
Nausea, Vomiting
Loss of eye-sight, hearing, taste, smell
Constipation, Gastrointestinal Upset
Incontinence of stool and urine
Pressure sores on bony prominences
In hospitals we find people asking if they are vulnerable to Paralysis. As opposed to that some people are told repeatedly about the risk of Paralysis for their hypertension uncontrolled for years but they keep denying starting anti-hypertensive medications and they ultimately land with Paralysis.
Some myths about hypertension in our current society prohibiting use of anti-hypertension which accounts for 29 % of Paralysis cases
1. Once started, anti-hypertensive has to be taken life long and they have fear of starting the drugs.
2. They can control Hypertension with leaves of Neem tree (Azadirachta indica ).
Because of this many people are denying to start anti-hypertensive medications despite having capacity to purchase the medicine.
Rural superstitious thoughts about Cerebral Palsy which is one of the causes of Birth Related Paralysis
1. This is the hand of God; this is God’s will that Sunu has CP. One of her uncles, Janakpur.
2. Parental sin in previous life, the child’s sin in previous life
(Rebecca et. Al.
Because of this, children with Cerebral Palsy are neglected, and improperly treated in families and our societies. We also don’t have access to proper centres for treatment in community level. We also lack social awareness that children with Cerebral palsy can benefit from specialist consultation.
Basic understanding of Nerve supply and Paralysis in human Body (Anatomy)
Basic building block of nervous system and brain are Neurons which are electrically excitable and receive external stimuli from the environment which are about 100 billion in number. Glial cells support them which outnumber neurons. They are connected with 10,000 other neurons and pass signals through 1000 trillion synaptic connections. Some experts claim that the electrochemical impulse transfer is about 1 trillion bit per second in computer speed. Human brain capacity is 1 to 10,000 terabytes.
Diagrammatic Representation of a Neuron
Afferent and Efferent Nerves
Nerves relay information from brain to body parts and vice versa. Those nerves which transmit information from brain and spinal cord to peripheral organs (body parts both voluntary and involuntary) are called efferent or motor nerves. Those which transmit from peripheral organs to spinal cord and finally to brain are called afferent or sensory nerves. Some of them work both ways and are called Mixed nerves.
If there is any disturbance due to any external factor in the circuit above like cut injury, compression with collected blood (bleeding), mass effect (due to tumor) then it leads to Paralysis.
Some terms about Paralysis in Medical Literature
Monoplegia – Only one limb will be involved in paralysis.
Diplegia – Both the limbs will be paralysed.
Triplegia- 3 limbs will be paralysed.
Tetraplegia- It’s usually due to injury of Spinal cord at the level of cervical vertebrae or higher in brain. All four limbs become paralysed.
Paraplegia- It’s due to injury of Spinal cord lower in thoracic or lumbar vertebrae. Both the lower limbs will be paralysed along with part of the body. Patients require wheel chair mobilization.
Causes of Paralysis
Stroke (29 % of all cases of Paralysis)
Spinal Cord Injury (23 % of all cases of Paralysis )
Other causes of Paralysis
Multiple sclerosis (17%)
Cerebral palsy (7%)
Post-polio syndrome (5%)
Traumatic brain injury (4%)
Neurofibromatosis (4%)
Birth defects (2%)
Less common causes of Paralysis
1. Brain
1. Tumor
2. Developmental Disorder like Aneurysm of Major Vessels e.g. Berry’s Aneurysm
2. Spinal Cord Diseases
. 1. Motor Neuron Diseases
Upper Motor Neuron Diseases
Bulbar Palsy,
Pseudobulbar Palsy,
Primary Lateral Sclerosis
Lower Motor Neuron Diseases
Progressive Muscular Atrophy
Spinal Muscular Atrophy
Both upper and lower motor neuron disease
Amyotrophic Lateral Sclerosis
2. Genetic Diseases
Friedrich’s Ataxia
Muscular Dystrophy
3. Guillain-Barre Syndrome
4. Transverse Myelitis
5. Syringomyelia and Tethered Cord
3. Involvement of Peripheral Nerves can lead to paralysis of whole or part of the limbs.
1. Selective or whole of Brachial Plexus Injury
2. Femoral Nerve Injuries
3. Sciatic Nerve Injuries
4. Other Nerves – Radial / Ulnar / Median / Common Peroneal Nerve Injuries
So the list of causes of Paralysis is vague and not complete yet. A thorough history including age of patient, past illnesses and family history along with findings on physical examination clue the diagnosis. In fact, all of above problems may cause Paralysis, but describing all diseases together is not easy because their causes and presentation are varied widely and method of approach their diagnosis is also different. However it’s an attempt to simply the topic and bring different diseases into highlight.
Commonly following investigations are done.
CBC, ESR to rule out infection.
Electrocardiography (ECG ) to assess function of heart
X-ray rules out fracture or infection
CT scan to see blood collection insider brain or inadequate blood supply (infarction)
MRI to see smaller infarction, tumor, spinal cord and nerves
Nerve Conduction studies and Electromyography are done to confirm and assess recovery of nerve injuries.
Treatment of Paralysis
1. Preventive Measures
Use of anti-hypertensives and regular medical check up to prevent strokes,
Adopting measures that minimizes road traffic accidents
(zero tolerance in alcohol intake during driving has significantly decreased road traffic accidents in major cities of Nepal)
Good maternal and delivery services to prevent perinatal birth complications and preventing birth related paralysis
2. Supportive
Physical Therapy to to stimulate nerves and muscles using heat, massage or exercises.
Occupational therapy is aimed to support activities of daily living.
Mobility aids like wheel-chairs, and scooters.
Supportive Devices – like braces and walkers
Assistive Technology- like voice activated computers, lighting and doors.
3.Treatment of the primary disease that leads to the Paralysis
for more information for medical students see
orthonp.blogspot.com
Sources
http://library.open.oregonstate.edu/aandp/chapter/12-1-structure-and-function-of-the-nervous-system/
Rebeeca Saul David Phillips.Cerebral Palsy in Nepal-A cultural exploration of cosmology and disability. CNAS Journal ,Vol.25,No. 2 (July 1998).
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