Paralysis Health Article

Diagnosis

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.

Treatment

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.

Prognosis

The likelihood of recovery from paralysis depends on what is causing it and how much damage has been done to the nervous system.

Prevention

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.

BOOKS

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.

Richard Robinson

KEY TERMS

Computed tomography (CT)—An imaging technique in which cross-sectional x rays of the body are compiled to create a three-dimensional image of the body's internal structures.

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.