Prognosis

Even with extensive and regular surgery, there is no way to reverse the effects of quadriplegia, as the spinal cord cannot be repaired. Immediate surgery will be required to provide support and stabilize the vertebrae and bones in the spine. If the bones or discs are creating pressure on the spinal cord, surgery will be necessary to relieve that pressure. In many cases, surgery will at least be required to either remove fragments or realign the bones.

As time passes, with regular rehabilitation and additional surgeries, there can be advancement with the condition of the patient. By using metal rods, screws, and bones, muscle, and tissue from other parts of the body, physicians can at least improve partial movement for victims of more operable quadriplegia. Additionally, after at least one year, the process of functional electrical stimulation can be employed to provide partial movement to the immobilized muscles.


Rehabilitation will last years, if not the rest of a victim’s life. Because there is no known recovery from quadriplegia, there are so many different, important aspects of living that the victim and family will have to learn in order to maintain as simple a daily routine as possible.

Generally speaking, the physical life of a quadriplegic does not increasingly improve.  Through years of  intense therapy, (both physical and mental) a quadriplegic surviving a spinal cord injury can live a most prosperous life through the hope of living every day to its fullest and maximizing their individual potential and bravery.

Medications

Over time a victim of quadriplegia will require a variety of medical and rehabilitative professionals to provide the best quality of life possible. In addition to the victim’s regular physician, a patient may have to make regular visits to neurologists, psychologists, physical therapists, occupational therapists, respiratory therapists, and speech pathologists, in the case that the victim has to undergo a tracheostomy procedure, during which a tube is permanently placed in the victim’s throat to mechanically assist with breathing.


Medication is extensive and intense for people living with quadriplegia. Victims will have to adhere to daily routines of specific prescription medications, and this will depend largely on the person responsible for the victim’s assistance and well-being. Included in the medication is a treatment of steroids, which prevents the swelling of the spinal cord.   Along with the medications necessary to treat the initial injury as well as pain medications.  A quadriplegic will most likely be prescribed benzodiazapenes , along with anti-depressant medications to help the individual cope with the psychological impact of his / her injury.

Wheelchair Accomodation

Quadriplegics can operate a powered wheelchair with a unique tongue drive system or the use of a technology specific headband.  An assistive technology that enables individuals to maneuver a powered wheelchair or control a mouse cursor using simple tongue movements can be operated by individuals with high-level spinal cord injuries.  This system allows individuals with disabilities to operate a computer, control a powered wheelchair and interact with their environments simply by moving their tongues.  

For people with severe physical disabilities, such as spinal cord injury, quadriplegia and hemiplegia or amputation, current technology for controlling a wheelchair or mobility scooter is inadequate.There are now chairs available with an inexpensive webcam and a bio-signal sensing headband that can be used to control the steering and propulsion of the electric wheelchair.


For some, these chairs may be unattainable through their personal financial resources.  There are many different styles and versions of the wheelchair that can suit any individual in need of such equipment.

Hand Splints

Hand splinting is an accepted intervention for the target population of quadriplegics with spinal cord injuries. A variety of static splint designs can be used, depending on level of injury, muscle strength, and the patient's acceptance. The dynamic splint designs are used most frequently with patients whose lesions are at C-6 and C-7.   They are designed for comfort and therapy.  Most splints are lined with sheep skin to help prevent the breakdown of the epidermis.


Hand splints are primarily used to restrain the patients fingers in a normal position. Without the splints, a quadriplegic's hand will contract as if it were grasping a golfball at all times. 

Unfortunately hand splints are only maintenance therapy for a quadriplegic.  There has been no proof of any hand / finger functional improvement due to the use of splints. 

Adaptive Equipment

Adaptive equipment are devices that are used to assist with completing activities of daily living.

Bathing, dressing, grooming, toileting, and feeding are self-care activities that are included in the spectrum of activities of daily living (ADLs).  Typically, a piece of adaptive equipment is utilized to increase a patient's function. Examples of adaptive equipment or assistive technology are wheelchairs, lifts, standing frames, gait trainers, augmentative communication devices, bath chairs, and recreational items such as swings or tricycles.

A growing market for adaptive equipment is in the use of mobility vans. In this case, adaptive equipment, also known as assistive technology, can help a person with a disability operate a motor vehicle when otherwise they would not be able to.  Obviously a quadriplegic would not benefit from some of these useful tools as they are limited because of the nonfunction of their limbs.


I thought the above image was humorous, as it shows the diverse capability of a quadriplegic and the variety of adaptive equipment available.

Halo Care

A halo brace is a traction device used to stabilize the head and neck after a cervical fracture or dislocation.  It is also used to stabilize the cervical spine, or to correct its alignment.  It is comprised of a circular piece adhered to the skull with four pins, which is attached with rods to a vest.  The interior of the vest has a removable sheep skin liner which should be changed once a week or as needed. The skin inside the vest should be kept clean and dry to prevent pressure ulcers from forming. It is the nurse’s responsibility to ensure that the device doesn’t become loosened so that stability isn’t compromised.

One major objective of nursing care for a patient with a halo is promotion of skin integrity. The pin sites should be carefully monitored and some hospitals’ policies include prophylactic use of betadine or antibiotic ointment application

 

Halo pin-associated brain abscesses are rare but an extremely important complication requiring prompt diagnosis and immediate intervention.  If left untreated the patient can easily acquire Staphylococcus aureus which must be treated with intravenous vancomycin for 6 weeks.

Patients in a halo traction cannot move their head from side to side, often a hand mirror is provided to increase peripheral vision.

Bathing

Showering a quadriplegic can be a difficult task.  Normally the Hoyer lift will be used to transfer the patient into a shower chair, or gurney. To be efficiently ready to shower your patient, have all towels and washing supplies ready in the shower before hand.  The patient should be undressed completely while in bed, then transferred.  Be sure to cover the patient decently to protect their dignity as you take them into the shower.

Once the patient is in the shower be sure to lock all wheels on the shower chair to prevent injury.  While using separate wash cloths for the perineal area, be aware of any red irritated spots.  Anything out of the norm should be reported to the nurse immediately.

It is extremely important to dry the patient completely.  Any area left wet is more susceptible to bacteria, which can lead to decubitis sores.

The patient can usually be dressed while in the shower room.  This makes the transfer via Hoyer lift, back into bed, or wheelchair much easier.