What Is Quadriplegia?

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Quadriplegia is the condition in which both the arms and legs are paralyzed and lose normal motor function. Also referred to as tetraplegia, this diagnosis is actually a symptom of one of several unique underlying causes.

While losing your arm and leg function can be severely debilitating, understanding the origins of your extremity paralysis and being evaluated by a trained neurologist can help you discover the treatment options that are available.

Learn more about the types, causes, symptoms, diagnosis, and treatment of quadriplegia.

Mother in wheelchair whit her children spending time outdoors

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Types of Quadriplegia

There are several different types of quadriplegia, each with its own unique effect on your body:

  • Partial or incomplete quadriplegia refers to weakness but not total paralysis in the arms and legs. Also known as quadriparesis, this variety leaves you with some, but not all, of the strength in your limbs.
  • Complete quadriplegia, on the other hand, refers to the total loss of muscular control in the arms and legs.

Depending on the underlying cause, quadriplegia can also be either temporary (meaning the muscle control eventually returns) or permanent (meaning the paralysis will not subside).

Finally, quadriplegia can be either:

  • Spastic: This causes muscles to have increased tone and to spasm or jerk, especially when stretched.
  • Flaccid: This causes muscles to lose their tone and become atrophied and flabby.

Causes

While multiple different underlying conditions can lead to quadriplegia, some are more common than others. Some causes include:

  • Spinal cord injury (SCI) in the neck (cervical) region: This is one of the most common causes of quadriplegia. Your spinal cord is a long structure that travels from your brain down to your lumbar spine and helps to relay messages from the brain to the rest of the body. Traumatic injuries, such as falls, car crashes, or diving accidents, can physically damage the cord and the structures that surround it and alter your muscle function. 
  • Stroke: This debilitating condition occurs when the blood flow to the brain or spinal cord is occluded, causing the tissue in the area to be starved of oxygen and eventually to die. While strokes in the brain often cause weakness on one side of the body, spinal cord strokes in the cervical region can lead to paralysis in both arms and legs.
  • Cerebral palsy: Quadriplegia in newborns is most frequently attributed to this disorder, which stems from damage to the brain while the baby is in utero or during labor. This frequently causes the limbs to become flaccid or spastic. This can significantly impact a child’s ability to meet normal motor milestones and is usually identified early on in a child’s life.

Infrequently, several other conditions may also be to blame for quadriplegia. These include Guillain-Barre syndrome, exposure to toxic venoms or poisons, or amyotrophic lateral sclerosis (ALS). While these conditions are less common, they can cause severe symptoms in both sets of extremities and elsewhere in the body.

Symptoms

The hallmark sign of quadriplegia is either incomplete or complete weakness of both the arms and legs. This can be present in the form of spasticity, causing the muscles to have extremely high tone and to contract involuntarily when moved or stretched. It can also cause the arms and legs to appear flaccid and atrophied, making it difficult to even contract or activate the muscles.

Depending on the underlying cause of quadriplegia, several other symptoms may also be present. Children with cerebral palsy frequently have difficulty speaking and swallowing and may be unable to sit, stand, or walk without assistance. They may also have difficulties digesting or controlling their bowel or bladder function and are frequently diagnosed with a learning disability.

In addition to their quadriplegia, people with spinal cord injuries frequently experience bowel or bladder dysfunction and are at a higher risk of developing heart and lung complications. Some even require mechanical assistance with breathing.

Similarly, people undergoing a spinal cord stroke frequently have difficulty controlling their bowel or bladder. This may be accompanied by numbness or tingling in the extremities, severe neck or back pain, sexual dysfunction, or the inability to feel hot or cold temperatures.

Diagnosis

Getting a proper diagnosis is crucial for understanding and treating your quadriplegia.

  • The first step is a thorough evaluation by a neurologist or specialized physician. Typically, your doctor will perform a comprehensive examination that includes evaluating your arm and leg strength, checking your reflexes, and assessing your ability to perform simple movements.
  • Imaging, like an X-ray, CT scan, or MRI, is also frequently ordered to visualize any abnormalities in the brain or spinal cord.
  • A blood draw may be necessary to assess certain lab values or to check for the presence of toxic substances.

Treatment

Treatment options for quadriplegia vary based on what is causing the weakness in the first place:

  • Ischemic spinal cord strokes, in which a blockage stops the normal blood flow in an artery, must be addressed quickly. Typically, a medication called tissue plasminogen activator (t-PA), which helps break up a blockage, should be administered within six hours of the onset of symptoms in order to improve the chances that your quadriplegia will resolve.
  • In hemorrhagic stroke, in which a blood vessel is leaky or bursts, surgical intervention may be needed to support the weakened vessel or to control the bleeding. Following either type of stroke, physical or occupational therapy is frequently needed to help restore movement and maximize your remaining function.

After a spinal cord injury, certain drugs like methylprednisolone may be administered right away to help reduce nerve damage. Unfortunately, in most cases the quadriplegia from an SCI is permanent, and physical or occupational therapy is needed to help teach compensatory strategies. Assistive devices may also be prescribed to make everyday activities like bathing, dressing, or moving around easier.

Similarly, the effects of cerebral palsy are typically permanent and the treatments focus on managing the condition with physical, occupational, and speech therapy. Comparable management strategies are also employed when treating more progressive causes of quadriplegia, like ALS.

Prognosis

In many cases, the severity of the underlying condition causing your quadriplegia impacts your overall prognosis. Many individuals with mild forms of cerebral palsy or small spinal cord strokes (that are caught and treated early) go on to live active lives with minimal long-term impairment. Similarly, while the quadriplegia caused by a spinal cord injury is typically permanent, many people with this condition are able to return to relative independence with the help of assistive devices.

Unfortunately, this is not always the case. Some spinal cord injuries, strokes, or more severe cases of cerebral palsy can significantly impact your daily function and may make you dependent on the care of others. Similarly, progressive conditions like ALS will increasingly reduce your ability to function independently and ultimately lead to mortality over time.

A Word From Verywell

Quadriplegia can be a scary condition and should be treated as an urgent concern if you experience it.

Immediate evaluation by a physician may be necessary to reduce the likelihood that your weakness is permanent. While the diagnosis may be long-lasting, it is important to stay positive! There are often many different treatments and pieces of adaptive equipment available to help you manage the condition and maintain your independence. 

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Article Sources
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  1. Cleveland Clinic. Paralysis. Updated April 21, 2017. 

  2. National Institute of Neurologic Disorders and Stroke. Spinal cord injury information page. Updated March 27, 2019. 

  3. Christopher and Dana Reeve Foundation. Stroke (cerebral vascular accident (CVA) and spinal stroke).

  4. Cleveland Clinic. Cerebral palsy. Updated December 11, 2020.