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Quadriplegia

Name:
Quadri means four and refers to the motoric paralysis of legs and arms.

Cause:
Accident involving fragmentation of the vertebral bodies and contusion or transection of the spinal cord (e.g. bathing accidents by diving into water of unknown depth), syringomyelia, tumour, after-effects of anaesthesia, epidural anaesthetic, gunshot or stab wound, diseases.

Effect:
Damage of the spinal cord between the 3rd and 7th cervical vertebra (C 1-8).

Partial quadriplegia or complete paralysis (quadriplegia) of both legs and arms with a high degree of impairment to respiration and the function of the arms.

Consequences:
The musculature of both arms, both legs and the body is paralysed from the location of the transection of the spinal cord downwards. The existing muscles can no longer be tensed and moved voluntarily. In the affected regions there is no longer any perceptible sensation of pain, pressure, temperature, injury and touch. Owing to this loss of depth sensitivity, the sufferer can no longer localise the position of his or her legs and - depending on the height of the paralysis - of part of his arms and body without being able to see them. Bowel movements and the urge to pass urine can no longer be perceived, so that there is a need for emptying the bowels and the bladder at regular intervals by artificial means.
Uncontrolled muscle cramps may cause spasms of the extensors and flexors in the legs. These can range from tembling legs to fully extended knees, hips and feet.
The hands are slightly or largely limited in their functions, manoeuverability and strength. Frequently the rotating movement in the wrist is no longer possible. As a rule the biceps (flexor) is intact so that active flexing of the elbow can be controlled. The extensor muscle (triceps) is often impossible to reactivate. The arm can then only be extended passively by simply letting the arm drop down. The fingers can only grip by means of a special technique (functional hand). By constantly keeping the hands in a special position right from the beginning of treatment a hand position is achieved by shortenng the extensor muscles which enables a passive fist to be formed, the prerequisite for jamming an object between thumb and forefinger. Owing to the paralysed muscles in the region of the ribs, only diaphragmatic respiration is possible which inevitably causes a low lung volume. This in turn affects strenth, resilience and motility and causes great fluctuations in the course of a day.

Supplying a car:
The functions of the hands and arms and the strength thus generated is very or extremely restricted. Owing to the extensive paralysis there are hardly any back or chest muscles available for active use. This means that sitting stability is greatly reduced when driving round bends. The limited strength and motility is particular perceptible in the turning movement in the upper region of the steerig wheel (in terms of the face of a clock between 11 and 1 o'clock).
A rotating movement in the wrist, which can no longer be carried out has an impact on using the car key to start the engine and for various control elements (interval setting of the windscreen wiper on the indicator lever, light switch on the instrument panel etc.). Moreover, it is impossible for the wrist to assume a stable position. This makes it advisable to fix the wrist by means of a steering wheel yoke or even the whole hand by a tri-pin on the steering wheel.
The constantly restricted respiration also reduces strength and causes performance to dwindle in the course of the day. This must be taken into account when measuring strength and movement.

Spasms that may shoot into the legs may cause the gas or brake pedals to be pressed inadvertently. It is therefore mandatory to cover up the pedal system.

General categorisation according to height of paralysis (overlaps may occur):

C4  usually only parts of the arm flexor (biceps) available and almost no hand function.

C5  arm flexor (biceps) available, active extension of the arm can be replaced by extending the arm via the outward rotation of the arm in the shoulder joints.This can be learned by practice and is required to be able to turn the steering wheel far enough when driving round bends.

C6  if kept in the right position in the phase immediately after injury the passive closed fist and passive gripping of objects with the thumb and forefinger is possible.

C7
  arm extensor (triceps) available, i.e. it will probably be possible to turn the steering wheel when driving around bends with little technical support.

C8
  the muscles for bending the fingers are functional, hand functions are almost all available.

Air conditioning is indispensable as it's opposite an independent vehicle heater because quadriplegics (like "reptiles") adapt to the respective temperature and can therefore become undercooled or overheated. For example, it is possible to die of heat at temperatures above 40 degrees Celsius!

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