Tetraplegia vs. Quadriplegia vs. Paraplegia: Causes, Symptoms, and Treatment
Traumatic spinal cord injuries (SCIs) can cause a variety of symptoms for survivors. Every injury is unique, and each person’s body responds differently to each level of injury.
Damage to the spinal cord can result in varying levels of paralysis. For some, the paralysis is temporary or partial; for others, it’s permanent or complete. The severity of injury depends on 1) the level of the spinal cord that is affected (the spinal cord is categorized into several regions: cervical [C1-C7], thoracic [T1-T12], lumbar [L1-L5], and sacral [S1-S5]) and 2) whether the injury is an incomplete or complete spinal cord injury.
There are several forms of paralysis:
- Monoplegia — This refers to paralysis that affects one area of the body.
- Hemiplegia — This refers to paralysis that affects one half of the body but not both.
- Paraplegia — This refers to paralysis that affects the body from the chest or waist down.
- Quadriplegia/Tetraplegia — This refers to paralysis that affects the cervical spinal cord or the first thoracic vertebra.
What is Quadriplegia/Tetraplegia?
Quadriplegia, sometimes referred to as tetraplegia, refers to a spinal cord injury above the first thoracic vertebra, or within the cervical sections of the spine (labelled C1-C8). The result is some degree of paralysis in all four limbs—the legs and arms—depending on the location of the injury. For instance, a C5 C6 Quadriplegia/Tetraplegia would have (somewhat) less severe injuries since the C5 and C6 vertebrae are lower on the cervical spinal column than the C1-C4 vertebrae. The degree of paralysis also varies depending on the nature of the injury, the extent to which you've undergone rehabilitative therapy, and on other factors that are not well understood yet .
Most doctors now use the term tetraplegia to denote this injury, but patients often continue to use quadriplegia.
Tetraplegia/quadriplegia can be so severe that it interferes with the injured person's ability to breathe on his or her own. Generally speaking, the higher up the injury is, the more extensive the damage will be. Functional quadriplegia is the complete inability to move, requiring total care for hygiene, feeding, and elimination.
Any injury high in the spinal cord or that affects multiple regions in the brain can lead to paralysis in all four limbs. Spinal cord injuries account for the majority of quadriplegia cases. The leading causes of spinal cord injuries as follows:
- Car accidents (37%).
- Falls (30%).
- Violence (28%); gunshots are the leading cause of violent injuries, accounting for fully 14% of all spinal cord injuries.
- Sports and recreational activities (9%).
- Medical and surgical accidents (4%).
Quadriplegia can be unpredictable and vary as time goes on. Age at injury, overall health, and the quality of care immediately after the injury can all have a major effect on the outcome. The prognosis your doctor gives you is merely a guess, not a promise or a final opinion.
In general, the following symptoms affect quadriplegics:
- Chronic pain; this can develop due to muscle atrophy from disuse or changes in sensory perception. For instance, a quadriplegic who regains some sensation may find that his arms ache due to muscle atrophy.
- Loss of sensation below the site of the injury. For some quadriplegics, sensation loss is complete and permanent. In others, sensations are merely reduced, or you may intermittently feel some sensations, but not others. A “pins and needles” feeling is especially common.
- Inability to move the limbs below the site of the injury. Though some movement may return, the overwhelming majority of quadriplegics continue to struggle with loss of muscle control and generalized weakness.
- Spasticity; Sudden, uncontrolled movements may occur in areas most affected by paralysis.
- Difficulties with elimination; lack of control over bladder and bowels, difficulty eliminating without help, and frequent urinary tract infections can result from the loss of sensation and muscle control below the site of the injury.
- Respiratory infections; the leading cause of death among spinal cord injury survivors, respiratory infections are especially common in the months following an injury.
- Difficulties with sexual function. Men may struggle to get erections, while women may struggle with lubrication. Both sexes often experience changes in libido, difficulties with orgasm, decreases in fertility, and even complete cessation of sexual functioning.
- Pressure sores and other secondary infections due to lack of movement.
- Anxiety and depression, as well as other psychological concerns.
- Difficulties with bodily awareness. Depending upon the extent to which you have lost sensation, you may struggle to know where your legs or arms are without looking.
- Unhealthy weight; many quadriplegics can find themselves overweight if they do not reduce their calorie consumption, are unable to exercise, or do not pursue physical therapy.
Quadriplegia is not curable with treatment. However, some quadriplegics do experience significant improvements in symptoms. Few quadriplegics will ever be completely cured and regain all lost sensations, despite the surgeries, drugs, or therapies. Instead, the goals of treatment include improving the long-term prognosis, reducing immediate threats to your life and health, and teaching your brain and spinal cord how to work around the injury. Some treatment options include:
- Brain and spinal cord surgeries.
- Education about quadriplegia, as well as training on your rights under the Americans with Disabilities Act and other relevant laws.
- Family education and support.
- Language and speech therapy.
- Physical therapy.
- Exercise therapy.
- Involvement in support groups.
Injuries that cause quadriplegia are unpredictable, since the brain and spinal cord are such delicate and complex structures. Research suggests, for example, that the brain can compensate for even extensive injuries in some areas, but that recovery from injuries in other areas is virtually impossible. Since there is still so much about the brain and spinal cord that we don’t yet know, it can be difficult to give an accurate prognosis to quadriplegics.
Some functions and sensations may return once swelling at the injury has receded. Some tetraplegics even spontaneously recover. Surgery and other treatments can help, particularly if the surgeon is able to remove something that is compressing the spinal cord or impeding the brain's function. Since it cannot guarantee a full recovery, treatment instead attempts to improve the long-term prognosis, better the quality of life, and adjust to living around the injury.
Paraplegia vs Quadriplegia
The Merriam-Webster Dictionary defines paraplegia as the “partial or complete paralysis of the lower half of the body with involvement of both legs that is usually due to injury or disease of the spinal cord in the thoracic or lumbar region.” It describes paralysis as the “complete or partial loss of function especially when involving the motion or sensation in a part of the body.” The reason for the second, more generic, description is that paralysis can affect many different areas of the body, whereas paraplegia is somewhat more limited in extent.
Paraplegia typically affects the T1-L5 regions of the spinal cord, which runs vertically from the bottom of the cervical spinal cord (at the base of the neck) down to the top of the sacral nerves (by the pelvis). When paraplegia occurs, communication between the brain and areas of the body located below the injury site on the spinal cord may be limited or eliminated. Injury levels result in different motor function losses. For instance, a T4 - T12 paraplegia case may have less hand dexterity problems than a person with a T-1 injury.
Paralysis can be caused by a variety of internal or external factors. When it comes to spinal cord injuries, some of the top paralysis causes include:
- Automobile accidents
- Acts of violence
- Sports and recreational activities
Some of the natural causes of paralysis include:
- Autoimmune disorders
- Genetic disorders
- Guillain-Barré syndrome
- Brain injuries
- Strokes or oxygen deprivation
- Tumors, growths, or other objects impeding the spinal cord
- Multiple sclerosis (MS) or muscular dystrophy (MD)
What determines whether the injury results in paraplegia or another form of paralysis is the severity of the injury and where it occurs on the spinal cord. For example, injuries that occur higher on the spinal cord (upper thoracic or cervical spinal cord) are more serious and are likely to result in more extensive or permanent paralysis.
When someone suffers a traumatic spinal cord injury that results in paraplegia, the muscles in their back, core, chest (in some cases), and legs may no longer function or may be impeded. Because paralysis may affect the muscles of the chest, diaphragm, and abdomen, respiratory function can be affected. When the breathing muscles that help the lungs expand and contract are partially impeded, it can result in some difficulty inhaling or exhaling deeply.
Paraplegia is a variable condition that changes over time or even from day to day. For some SCI survivors, motor or sensory functions may be severely affected below the injury site, leaving them unable to move their legs, walk, stand unassisted, or feel anything below the waist or chest. For others, their motor or sensory functions may be partially affected. This can result in minor mobility issues or decreased sensations (or tingling sensations) in their legs or lower bodies.
Other paralysis symptoms stemming from paraplegia include:
- Changes in sexual functionality or libido
- Loss or impediment of bladder and bowel function
- Phantom pains or sensations
- Secondary infections and bedsores
- Chronic pain
As with any spinal cord injury, early intervention and intensive treatments frequently result in the best chances of recovery. However, it is important to note that every paraplegic patient is different, and the type and level of treatment they require may be equally beneficial for another with a similar injury.
Generally speaking, intensive treatment and therapy gives you the best chance at recovery, particularly when you begin receiving treatment immediately after the injury. Paraplegia exercises and therapies can help slow muscle atrophy and improve existing muscle function. Additionally, Spinal Cord Injury Model Systems offer comprehensive and highly-rated treatment, so if such a facility is near you, consider moving your recovery to that location.
Some treatment options include:
- Physical therapy
- Paraplegia exercises
- Education about your injuries, advocacy programs, and family support groups
- Occupational training
- Alternative modalities; acupuncture, massage, chiropractic, and other holistic treatments
Paraplegia recovery can be a long and difficult process as paraplegics learn to cope with their paraplegia symptoms. There are numerous steps to recovering from paraplegia—steps that may change depending on the cause and severity of the condition.
Recovery may look different for a complete paraplegic than an incomplete paraplegic. While incomplete means that some sensations may be felt so that the person can be a functional paraplegia, a complete paraplegic has no functionality in their legs.
Some steps to paraplegia recovery include:
- Immediate Medical Attention. Timely care following a major TBI or SCI can have an enormous impact on the severity of symptoms and even the likelihood of survival.
- Research Your Paraplegia Recovery Options. From surgical treatments, rehabilitation therapy, to dietary changes, it’s important to investigate all of your potential avenues of recovery.
- Get Involved with Support Groups. There are numerous support groups for paraplegics and others who live with some form of paralysis (and their loved ones). Many of these groups can help provide a place to find good advice and support.
- Make Accommodations for Mobility Limitations. Part of recovering from any condition that limits mobility is making modifications to the home that increase accessibility.
- Consider Psychological Therapy. For paraplegics, it can be crucial to seek out a specialist in psychological therapy—especially when the paraplegia is caused by a traumatic brain injury.
As noted earlier, some (or all) of these steps may change depending on your injury. However, for any type of paraplegia recovery plan, it’s important to consult a qualified physician before starting any treatment regimen.
- Hostettler. What Is the Difference Between Paraplegia and Tetraplegia? ICF Case Studies. https://www.icf-casestudies.org/introduction/spinal-cord-injury-sci/what-is-the-difference-between-paraplegia-and-tetraplegia. Published March 6, 2018. Accessed May 11, 2020.
- Sedgwick, Frankel. Spinal cord potentials in traumatic paraplegia and quadriplegia. Journal of Neurology, Neurosurgery & Psychiatry. https://jnnp.bmj.com/content/43/9/823.short. Published September 1, 1980. Accessed May 11, 2020.
- Quadriplegia and Paraplegia. Winchester Hospital. https://www.winchesterhospital.org/health-library/article?id=96908. Accessed May 11, 2020.
- Respiratory health. Reeve Foundation. https://www.christopherreeve.org/living-with-paralysis/health/secondary-conditions/respiratory-health. Accessed May 11, 2020.
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