Paralysis is defined as complete loss of strength in an affected limb or muscle group.
The chain of nerve cells that runs from the brain through the spinal cord out to the muscle is called the motor pathway. Normal muscle function requires intact connections all along this motor pathway. Damage at any point reduces the brain's ability to control the muscle's movements. This reduced efficiency causes weakness, also called paresis. Complete loss of communication prevents any willed movement at all. This lack of control is called paralysis. Certain inherited abnormalities in muscle cause periodic paralysis, in which the weakness comes and goes.
The line between weakness and paralysis is not absolute. A condition causing weakness may progress to paralysis. On the other hand, strength may be restored to a paralyzed limb. Nerve regeneration or regrowth is one way in which strength can return to a paralyzed muscle. Paralysis almost always causes a change in muscle tone. Paralyzed muscle may be flaccid, flabby, and without appreciable tone, or it may be spastic, tight, and with abnormally high tone that increases when the muscle is moved.
Paralysis may affect an individual muscle, but it usually affects an entire body region. The distribution of weakness is an important clue to the location of the nerve damage that is causing the paralysis. Words describing the distribution of paralysis use the suffix "-plegia," from the Greek word for "stroke." The types of paralysis are classified by region:
- monoplegia, affecting only one limb
- diplegia, affecting the same body region on both sides of the body (both arms, for example, or both sides of the face)
- hemiplegia, affecting one side of the body
- paraplegia, affecting both legs and the trunk
- quadriplegia, affecting all four limbs and the trunk
The nerve damage that causes paralysis may be in the brain or spinal cord (the central nervous system) or it may be in the nerves outside the spinal cord (the peripheral nervous system). The most common causes of damage to the brain are:
- trauma (caused by a fall or a blow)
- multiple sclerosis (a disease that destroys the protective sheath covering nerve cells)
- cerebral palsy (a condition caused by a defect or injury to the brain that occurs at or shortly after birth)
- metabolic disorder (a disorder that interferes with the body's ability to maintain itself)
Damage to the spinal cord is most often caused by trauma, such as a fall or a car crash. Other conditions that may damage nerves within or immediately adjacent to the spine include:
- herniated disk (also called a ruptured or slipped disk)
- spondylosis (a disease that causes stiffness in the joints of the spine)
- rheumatoid arthritis of the spine
- neurodegenerative disease (a disease that damages nerve cells)
- multiple sclerosis
Damage to peripheral nerves may be caused by:
- compression or entrapment (such as carpal tunnel syndrome)
- Guillain-Barré syndrome (a disease of the nerves that sometimes follows fever caused by a viral infection or immunization)
- chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (a condition that causes pain and swelling in the protective sheath covering nerve cells)
- inherited demyelinating disease (a condition that destroys the protective sheath around the nerve cell)
- toxins or poisons
The distribution of paralysis offers important clues to the site of nerve damage. Hemiplegia is almost always caused by brain damage on the side opposite the paralysis, often from a stroke. Paraplegia occurs after injury to the lower spinal cord, and quadriplegia occurs after damage to the upper spinal cord at the level of the shoulders or higher (the nerves controlling the arms leave the spine at that level). Diplegia usually indicates brain damage, most often from cerebral palsy. Monoplegia may be caused by isolated damage to either the central or the peripheral nervous system. Weakness or paralysis that occurs only in the arms and legs may indicate demyelinating disease. Fluctuating symptoms in different parts of the body may be caused by multiple sclerosis.
Sudden paralysis is most often caused by injury or stroke. Spreading paralysis may indicate degenerative
Other symptoms often accompany paralysis from any cause. These symptoms may include numbness and tingling, pain, changes in vision, difficulties with speech, or problems with balance. Spinal cord injury often causes loss of function in the bladder, bowel, and sexual organs. High spinal cord injuries may cause difficulties in breathing.
Careful attention should be paid to any events in the patient's history that might reveal the cause of the paralysis. The examiner should look for incidents such as falls or other traumas, exposure to toxins, recent infections or surgery, unexplained headache, preexisting metabolic disease, and family history of weakness or other neurologic conditions. A neurologic examination tests strength, reflexes, and sensation in the affected area and normal areas.
Imaging studies, including computed tomography scans (CT scans), magnetic resonance imaging (MRI) scans, or myelography may reveal the site of the injury. Electromyography and nerve conduction velocity tests are performed to test the function of the muscles and peripheral nerves.
The only treatment for paralysis is to treat its underlying cause. The loss of function caused by long-term paralysis can be treated through a comprehensive rehabilitation program. Rehabilitation includes:
- Physical therapy. The physical therapist focuses on mobility. Physical therapy helps develop strategies to compensate for paralysis by using those muscles that still have normal function, helps maintain and build any strength and control that remain in the affected muscles, and helps maintain range of motion in the affected limbs to prevent muscles from shortening (contracture) and becoming deformed. If nerve regrowth is expected, physical therapy is used to retrain affected limbs during recovery. A physical therapist also suggests adaptive equipment such as braces, canes, or wheelchairs.
- Occupational therapy. The occupational therapist focuses on daily activities such as eating and bathing. Occupational therapy develops special tools and techniques that permit self-care and suggests ways to modify the home and workplace so that a patient with an impairment may live a normal life.
- Other specialties. The nature of the impairment may mean that the patient needs the services of a respiratory therapist, vocational rehabilitation counselor, social worker, speech-language pathologist, nutritionist, special education teacher, recreation therapist, or clinical psychologist.
The likelihood of recovery from paralysis depends on what is causing it and how much damage has been done to the nervous system.
Prevention of paralysis depends on prevention of the underlying causes. Risk of stroke can be reduced by controlling high blood pressure and cholesterol levels. Seat-belts, air bags, and helmets reduce the risk of injury from motor vehicle accidents and falls. Good prenatal care can help prevent premature birth, which is a common cause of cerebral palsy.
Bradley, Walter G., et al., eds. Neurology in Clinical Practice. 2nd ed. Boston: Butterworth-Heinemann, 1996.
Yarkony, Gary M., ed. Spinal Cord Injury: Medical Management and Rehabilitation. Gaithersburg, MD: Aspen Publishers, 1994.
Electromyography—A test that uses electrodes to record the electrical activity of muscle. The information gathered is used to diagnose neuromuscular disorders.
Magnetic resonance imaging (MRI)—An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.
Myelin—The insulation covering nerve cells. Demyelinating disease causes a breakdown of myelin.
Myelography—An x-ray process that uses a dye or contrast medium injected into the space around the spine.
Nerve conduction velocity test—A test that measures the time it takes a nerve impulse to travel a specific distance over the nerve after electronic stimulation.