Definition | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Return to Work | Failure to Recover | Medical Codes | Hospital Costs | References

Paralysis, Paraplegia, and Quadriplegia

Factors Influencing Duration

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Medical Codes

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Rehabilitation

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If an individual becomes a quadriplegic or paraplegic either through illness or trauma, there is a lengthy rehabilitation process involved. The duration and frequency of the rehabilitative process is dictated by the degree of injury and disability. In the hospital, therapy goals focus on prevention of further illness. Respiratory therapy includes deep-breathing exercises and chest percussions performed by the therapist to keep the lungs clear of mucus. Respiratory therapists also routinely assess individuals on ventilators to determine their continued need for assisted breathing. Physical therapists establish a routine for changing an individual's position in bed to prevent skin breakdown, and teach family members how to comply with a positioning schedule. Physical therapists also instruct family members in how to stretch the individual's limbs to maintain flexibility and begin strengthening exercises for any muscles that may have movement. Occupational therapists assess an individual's potential for self-care. Both physical and occupational therapists focus on increasing sitting tolerance and balance. Psychologists and psychiatrists are a crucial link in the rehabilitation process, helping to focus individuals on attainable goals and treating the depression that often occurs after spinal cord injury. Once individuals are medically stable, they are transferred to a rehabilitation hospital for a few weeks (or longer) for more intensive therapy. Physical therapists continue instruction in bed mobility, transferring to and from the wheelchair with a sliding board, and begin teaching wheelchair mobility. Individuals who have fractures of one of the first four cervical vertebrae learn to utilize a mouth control system to propel the wheelchair. Other individuals learn to use a joystick control. As wheelchair skills progress, individuals learn to maneuver their wheelchairs outside and to perform activities. Some individuals with partial paralysis may be able to learn to stand in the parallel bars for improved strength and balance, with progression to walking with forearm crutches through a combination of weight shifting and upper body momentum. For these individuals, therapists work on safe ambulation in the community. Occupational therapists help individuals maximize independence in self-care by teaching feeding techniques and strategies for performing assisted activities of daily living. Although individuals with fractures above C5 cannot perform self-care, family members may be taught how to assist the individual while maintaining his or her sense of independence. Physical and occupational therapists order special adaptive equipment and wheelchairs to maintain correct posture and sitting balance and teach pressure relief techniques to prevent skin breakdown. Speech therapists assess individuals for safe swallowing strategies. In addition, therapists devise communication techniques for those who are ventilator-dependent, as well as teaching exercises to improve speech volume and clarity for all individuals. Individuals with fractures of C5 and below may be discharged to outpatient physical and occupational therapy to maximize functional gains and reinforce mobility techniques learned in the rehabilitation hospital. Individuals cleared by their physicians to drive can be assessed for car adaptations and driving school during outpatient physical therapy. Individuals with fractures above C5 may be eligible for in-home physical and occupational therapy to focus on reinforcing family care of the individual. Vocational rehabilitation may be appropriate to help individuals learn new workplace skills.

Source: Medical Disability Advisor

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