Quadriplegia & Tetraplegia: Definition, Causes, Symptoms, and Treatment (2024)

What Is Quadriplegia/What Is Tetraplegia?

Quadriplegia, also known as tetraplegia, is a form of paralysis that affects all four limbs, plus the torso (“quad” originates from the Latin word for four). Most people with tetraplegia have significant paralysis below the neck, and many are completely unable to move.

This form of paralysis is typically the product of damage high in the spinal cord, usually in thecervical spinebetween C1-C7. The higher the injury is, the more extensive the damage will be. In fact,spinal cord injuries to the C1 and C2 vertebraeare often immediately fatal because of how they disrupt control over breathing and other critical functions.

You might think that total paralysis of the arms and legs requires damage to those limbs, but most quadriplegics have perfectly healthy (if somewhat atrophied) legs and arms. Instead, the problem usually begins in the brain or spinal cord (or both). Thespinal cordis what relays signals to and from the brain, while the brain processes them and sends out new signals via the spinal cord. Thus a spinal cord injury prevents the brain from sending and receiving these signals, while abrain injuryundermines the brain's ability to process them.

Think of it kind of like a computer: the CPU and motherboard would be the brain that receives and processes signals, while the cables connecting that motherboard to the keyboard, mouse, printer, monitor screen, etc. would be the nerves of the spinal cord that connect to the different parts of the body. If the cables get cut or even damaged slightly, the computer may not be able to work correctly. Meanwhile, damage to the CPU may cause much the same result.

Quadriplegia Symptoms

The basic symptoms of quadriplegia include:

• Numbness/loss of feeling in the body, particularly in the arms and legs;
• Paralysis of the arms and legs (and major muscles in the torso);
• Urinary retention and bowel dysfunction caused by lack of muscle control;
• Difficulty breathing (some quadriplegics require assisted breathing devices); and

Trouble sitting upright (because of an inability to balance).

Causes of Quadriplegia

There are numerous potential causes of quadriplegia. As mentioned earlier most common known cause of quadriplegia is damage to the spinal cord—typically in the cervical vertebrae (the C1-C7 sections of the spine which are nearest to the skull). According to data from a 2019 National Spinal Cord Injury Statistical Center (NSCISC) report, the top causes of spinal cord injuries (SCIs) are:

• Auto Accidents (32.2%)
• Falls (22.9%)
• Gunshot Wounds (15.2%)
• Motorcycle Accidents (6.2%)
• Diving (5.7%)
• Medical/Surgical Complications (2.9%)
• Being Hit by a Flying/Falling Object (2.7%)
• Bicycle Accidents (1.7%)
• Pedestrian Accidents (1.5%)

Another potential cause of tetraplegia/quadriplegia is brain damage, such as from a traumatic brain injury (TBI). When damage occurs to the brain, it can cause many other unpredictable effects, such as changes in a person’s mood or ability to think.

Vertebrae Damage

Damage to the spinal cord is one of the most common factors that contributes to quadriplegia. Specifically, it is usually damage to the cervical portion of the spinal cord that results in quadriplegia. Damage to lower sections of the spine (such as the thoracic or lumbar spinal column) typically result in paraplegia instead of quadriplegia.

The higher up on the cervical spine an injury occurs, the more severe the effects tend to be. Here are some brief explanations of damage to different vertebrae of the cervical spine:

C1, C2, C3 Damage

Damage to the spinal column at the vertebrae nearest the skull (the C1, C2, and C3 vertebrae) is more likely to be fatal than damage lower on the spinal column. C1 and C2 injuries are considered particularly severe, as they are frequently fatal and may impede respiratory function.

In the case of a complete SCI, damage at this level is extremely likely to result in near-total paralysis and may require specialized devices to allow the injured person to breathe.

C4 Damage

SCI survivors with damage to the C4 vertebra may experience:

• Loss of diaphragm control (requiring breathing aids such as a ventilator)
• Limited range of motion or paralysis of the arms, torso, and legs
• Trouble with bowel and bladder control

C5 Damage

Damage to the C5 vertebra may affect the vocal cords and result in paralysis to the legs, wrists, and hands.

While a person with a C5 spinal injury may have difficulty talking, they may still be able to breathe unassisted.

C6 Damage

Damage to the C6 spinal cord and below is less likely to cause complete loss of the function of the arms. A person with a C6 injury may:

• Be paralyzed in the legs, torso, and hands
• Be unable to control their bladder/bowel
• Have difficulty speaking normally

C7 Damage

C7 damage rarely results in quadriplegia without other complicating factors. Instead, C7 SCI survivors may experience a burning pain in their shoulders, back, and arms and/or become paraplegic.

Inherited Conditions That Can Cause Quadriplegia

Certain diseases or inherited conditions can also cause quadriplegia (and other forms of paralysis). Here are two conditions that can cause quadriplegia:

• Amyotrophic Lateral Sclerosis (ALS). A well-known disease that causes permanent paralysis. As noted by ALS.org, there are two varieties of ALS: Sporadic and familial ALS. While they note that sporadic ALS is the most common form of the disease (accounting for over 90% of ALS cases), “Familial ALS (FALS) accounts for 5 to 10 percent of all cases in the U.S.” The familial form of the disease is an inheritable condition where each member of the family has a roughly 50% chance of developing ALS.
• Muscular Dystrophy. Muscular dystrophy is different from typical causes of quadriplegia in that it is not caused by damage to the nervous system. Instead, as noted by the Mayo Clinic, “Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass.” Signals still reach the muscles and nerves, but as the condition progresses, the muscles themselves lose the strength needed to respond to those signals. In the early stages, this may cause a loss of ability to walk, then lead to trouble moving the arms and difficulty breathing as various muscles lose their mass and strength. This simulates effects similar to partial quadriplegia, even without damage to the nervous system.

To highlight the difference between a cause and a risk factor, consider someone falling off a tall ladder. On impact, the faller breaks their cervical spine and loses feeling in their arms and legs—becoming quadriplegic. In this instance, the fall was the cause of the quadriplegia, but being on a tall ladder was the risk factor that most contributed to the fall.

Some risk factors that may contribute to the occurrence of SCIs and TBIs leading to the development of quadriplegia include:

• Gender. Males are more likely to suffer an SCI than females. In fact, the 2019 NSCISC report showed that while 27,453 men suffered SCIs from various causes, only 6,672 women suffered SCIs in the same time period. So, being male may be a risk factor for quadriplegia-causing injuries.
• Age. The specific age at which risk for an SCI or TBI is greatest has shifted over the years. According to NSCISC, in the late 70s, the mean “age at injury” (how old the SCI survivor was at the time of their injury) was roughly 28 years old. In the 2015-2019 period, the mean age at injury had increased to around 43 years old. Also, as people age, they become more susceptible to severe SCIs and TBIs—especially if they suffer from osteoporosis or other conditions that impact bone health.
• Risky Behaviors. Doing things like diving, driving dangerously (or without wearing seatbelts), or playing high-contact sports can all contribute to the risk of suffering a spinal cord or brain injury that leads to full-body paralysis.
• Career Choice. Certain careers, such as police officers, construction workers, and professional athletes in high-contact sports all face increased risk of injury from violence or accidents on the job. This, in turn, puts them at higher-than-average risk of becoming a quadriplegic.
• Family Health History. If a condition like ALS (a.k.a. Lou Gehrig’s Disease) runs in your family, there is a risk of developing it and losing control of your arms and legs.

Quadriplegia Prevention

By knowing the major risk factors for quadriplegia, a certain amount of quadriplegia prevention is possible. However, it is important to note that not all risks can be avoided perfectly. It is possible for anyone to have a slip and fall, inherit a congenital disease, or be subjected to a random act of violence that leads to quadriplegia.

Some basic steps for minimizing quadriplegia risk factors include:

• Getting Tested for Congenital Diseases. It is important to discuss your family health history with your doctor and receive screening for various conditions that may run in your family. Catching the warning signs of ALS or other conditions early on can make a major difference in your therapy.
• Wearing Appropriate Safety Equipment. In sports, on motorcycles, or at high-risk work sites, it is important to wear the appropriate safety gear whenever possible. A hard hat/helmet could mean the difference between severe open-head wounds and a concussion (though a concussion is still serious and should be checked by a doctor)!
• Avoiding Risky Behaviors. Avoiding behaviors like drinking and driving, diving (especially in shallow waters), and other activities that can lead to serious bodily harm should be avoided. When risky situations can not be avoided, appropriate safety gear should be used whenever possible.
• Maintaining a Healthy Diet and Exercise Regimen. Bone and muscle health can have a major impact on the severity of certain injuries. An impact that would merely cause pain to someone with a healthy musculoskeletal system may shatter bones in someone with bone and joint disorders. A diet and exercise regimen can help promote bone health—though it may not prevent disorders such as osteoporosis that negatively impact bone strength.

Types of Quadriplegia

Many people think that all quadriplegics are the same—that none of them are able to move their arms and legs at all. However, there are several types of quadriplegia—including incomplete, complete, and spastic quadriplegia that have some key differences.

Incomplete Quadriplegia

An “incomplete quadriplegic” is different from a complete paraplegic in that they may still retain some function and/or sensation in their arms or legs. This may be the case with incomplete or "partial" SCI, some TBIs, and some inherited conditions that cause quadriplegia.

Depending on the cause, some people with incomplete quadriplegia may see improvement in their ability to control their limbs with certain quadriplegia therapies and exercises. However, others may see their incomplete quadriplegia progress into complete quadriplegia as their condition progresses.

Complete Quadriplegia

Complete quadriplegia is characterized by a complete loss of control over the arms and legs. This is a near-total form of paralysis where a person is wholly unable to move their extremities aside from their head.

When comparing complete vs incomplete quadriplegia, the complete version of the condition is usually considered more severe. Complete quadriplegia is often caused by severe, complete SCI in the cervical vertebrae or traumatic injuries to the brain.

Recovery and exercise will be more difficult for a complete quadriplegic than an incomplete quadriplegic, though there are still quadriplegia therapy options!

Spastic Quadriplegia

Spasticity (or spastic hypertonia) is a common side effect of spinal cord and brain injuries caused by trauma or disease. A spastic quadriplegic is someone who, though they can not consciously control their arms or legs, may experience muscle spasms in their paralyzed limbs.

Quadriplegics experiencing spastic hypertonia may experience hyperactive reflexes or involuntary muscle tightness that makes it hard to move into a relaxed posture.

Spasticity may be caused by cysts in the spinal cord that formed after an SCI, infections of the nervous system, or other blockages—which is why it is important to have a qualified doctor diagnose the cause of the quadriplegia and recommend an appropriate therapy regimen.

Diagnosing Quadriplegia

Many people wonder about “how to diagnose quadriplegia.” While some may assume that it is easy to tell if you have developed quadriplegia because of the loss of limb function, with some conditions that lead to quadriplegia, it is not that clear-cut. Being able to diagnose it early can help expand your therapy options and improve your overall prognosis by treating contributing factors early.

Doctors may use several methods to diagnose different causes of quadriplegia, such as:

• MRI Scans. Doctors can use MRI scans to check for abnormalities such as brain tumors, cysts, and herniated disks in the spinal cord that may be impeding signals from the brain.
• Spinal Taps (Lumbar Punctures). Doctors may need to draw some cerebrospinal fluid from the spinal column to analyze it and check your spinal health.
• Blood Tests. To check for deficiencies or to check for genetic markers that could indicate that a congenital condition that causes paralysis was inherited.
• Electromyography (EMG) Tests. Doctors may test nerve function to help differentiate between muscle and nerve disorders.

Living with Quadriplegia

Living with quadriplegia can be an enormous challenge that requires both the quadriplegic and those around them to make significant adjustments to their lifestyle.

Without control over their arms and legs, quadriplegics are often reliant on assistants for getting around, going to the bathroom, eating, and every other daily activity. Some motorized wheelchairs can allow quadriplegics to control them with head motions, but it may take some adjustment to get used to it.

Quadriplegics will experience significant changes in their daily activities and even their life expectancy as a result of their condition.

Quadriplegia Life Expectancy

People living with quadriplegia may have a shorter life expectancy than uninjured persons of the same age. For example, according to the NSCISC’s report, a 15-year old with no SCI has an average life expectancy of another 64.2 years. Meanwhile, a 15-year old with a C1-C4 SCI (which can cause quadriplegia) has a life expectancy of about 37.6 years—a drop of more than 26 years!

If the SCI causes that person to become ventilator dependent (meaning they need a respirator to breathe), their average life expectancy drops to just 19.5 years.

Of course, not all quadriplegics are the same. It is possible to, with effort, maintain a healthy lifestyle with quadriplegia that helps prolong life expectancy. It is also possible be active and even achieve great things while living with quadriplegia.

Take, for example, Stephen Hawking, who suffered from ALS and was confined to a wheelchair and even lost the ability to speak unaided (though he retained some limited hand function). Despite his worsening condition, he still achieved worldwide renown as a famous physicist and remained an active contributor to the scientific community until his death at the age of 76.

Effects of Quadriplegia

Aside from the direct symptoms of quadriplegia mentioned earlier, quadriplegics may experience several other effects caused by the condition. Some common effects of tetraplegia/quadriplegia include:

• The Development of Sores. An inability to move or readjust one’s position in a seat or bed for prolonged periods of time can result in sores. This, in turn, can lead to secondary infections.
• Spastic Limbs. Some quadriplegics may experience uncontrolled muscle spasms in their arms or legs. This may be the result of incomplete nerve damage or other conditions that contributed to the quadriplegia.
• Urinary Tract Infections (UTIs). Urinary tract infections (UTIs) are a common side effect of quadriplegia. The loss of bladder control makes it difficult to clear the urethra of contaminants, contributing to infections.
• Muscular Atrophy. Because of an inability to move, quadriplegics often lose muscle mass in their arms and legs—which is known as muscular atrophy. Some exercises and physical therapy can help minimize this side effect of quadriplegia.
• Chronic Pain. It is common for damaged nerve connections to cause SCI and TBI survivors pain. However, the amount of pain experienced varies from one person to the next, making it hard to generalize about this side effect.
• Difficulty with Bodily Awareness. A loss of sensation can naturally lead to an inability to gauge where one’s limbs are at all times. This can interfere with spatial awareness.
• Weight Gain. Quadriplegics who are unable to exercise or move may experience rapid weight gain because of their inability to burn calories.
• Respiratory infections. A leading cause of death among new quadriplegics, respiratory infections are common in the first few months following an injury.
• Loss of Fertility/Sexual Function. Men may struggle to achieve an erection and ejacul*tion while women may have difficulty with lubrication. Quadriplegics of both genders may have difficulty achieving org*sm or experience changes in their libido after an injury.

Quadriplegia Exercises

Exercises for quadriplegics can be useful for reducing the occurrence of sores, limiting muscular atrophy from inactivity, and relieving pain from spastic muscles. It can also help to promote cardiovascular health and mental wellbeing.

However, exercise is inherently difficult for people who cannot move their arms or legs on their own.

Here, it can help to go to an activity-based therapy center where trainers can recommend reliable exercises or help paralyzed patients move their uncontrollable limbs. Aside from exercises done at the center, some therapists may be able to suggest lifestyle changes that may be important for your health and wellness.

Quadriplegia Therapies

Though some quadriplegics experience significant improvements in their symptoms, quadriplegia is not typically curable with treatment. This means that no surgical procedure, drug, or form of therapy can guarantee a return of function in the arms and legs, and few quadriplegics will ever regain full control of their limbs.

Instead, the goals of quadriplegia therapies include improving the long-term prognosis, reducing immediate threats to the quadriplegic’s life and health, and “teaching” the brain and spinal cord how to work around the injury. Some therapy options include:

• Brain and spinal cord surgeries to address obstructions, reduce bleeding, and manage any swelling.
• Medication to reduce the risk of infection; you may also take other drugs, such as blood thinners or blood pressure medications.
• Education about quadriplegia, as well as training on your rights under theAmericans With DisabilitiesAct and other relevant laws. Some therapy facilities also offer occupational skills training.
• Family education and support.
• Speech and language therapy to help you maintain or regain your ability to speak.
• Physical therapy to help you regain functioning.
• Exercise therapy to keep your body in optimal health.
• Psychotherapy to help you deal with the social and psychological effects of quadriplegia. Your doctor might also recommend drugs such as antidepressants.
• Participation in support groups.

Quadriplegia Support Groups

Nobody should go through the changes brought by quadriplegia alone. Support from friends and family can be a crucial tool for quadriplegics to keep them going. However, sometimes it helps to find support from someone who understands exactly what you are going through because they have been there themselves.

To that end, finding quadriplegia and SCI/TBI support groups can be an important part of recovering from quadriplegia.

Many of the people in these support groups have experience in adapting to different forms of paralysis and may be able to provide insights and advice that is more personal and practical than simple health advice from your doctor.

Additionally, support groups can be invaluable for airing out personal frustrations or challenges in a place where people will understand what you are feeling and why.

Additional Resources:

• Ellis M. 10 Tips for Coping with a Spinal Cord Injury. Spinal Cord Injury & Brain Injuries Resources & Legal Help. Accessed May 11, 2020. Learn More
• Quadriparesis. Healthline. Accessed May 11, 2020. Learn More
• Spinal cord injury. Mayo Clinic. Learn More Published September 17, 2019. Accessed May 11, 2020.
• Spinal Cord Injury. AANS. Accessed May 11, 2020. Learn More