Paralysis is characterised by an inability to move part or all of the body. It may be either partial (paresis) or total, temporarily or permanent and can affect multiple areas or even the entire body. Contrary to popular belief, paralysis is often not caused by injury to the affected region, except when there is an underlying medical condition. In most cases, it is the result of nerve damage.
Depending on which part of the nervous system is affected, paralysis can be:
- Spastic – marked by stiff, tight muscles with increased spasms and painful contractions. If the urinary bladder is involved, it is difficult to control urination.
- Flaccid – characterised by weakened, flabby, and atrophied (loss of tissue) muscles. If the bladder is involved, there is constant urine dribbling.
The affected person may be unable to move part, or all of their body and symptoms may vary among individuals, even if diagnosis is the same. Additionally, symptoms may change over time in the same individual.
Paralysis is observed mostly in the limbs. Some of the signs and symptoms are –
- Muscles attached to the affected part may become painful
- A tingling sensation is sometimes felt in the paralysed limb
- Weight changes are seen, and body metabolism is affected, making the person prone to diabetes or high blood pressure
- Paralysis that makes individuals vulnerable to respiratory infections like bronchitis and pneumonia
- Spasms, loss of sensation, reduced motor function, and loss of speech.
Depending on the part of the body that is affected, there are four main categories of paralysis:
- Monoplegia – a single portion of the body, typically one limb is paralysed with loss of sensation and movement. The rest of the body is unaffected.
- Hemiplegia – a leg and an arm on the same side get affected. It starts with a prickly feeling that leads to muscle weakness and often to complete paralysis. Affected persons have difficulty in speech and motor functions to varying degrees.
- Paraplegia – muscle control of both the legs, and the hips are lost, and there is severe loss of movement and sensation. In some people it can be partially reversed with physiotherapy.
- Quadriplegia – all limbs are affected, and there is loss of sensation below the neck, with respiratory distress and sudden spasms. Prolonged periods on the bed lead to frequent bedsores.
The spinal cord relays messages to and from the brain, and any injury (trauma) or damage to the spine or the brain causes paralysis. It results in one of the following situations –
- The injured brain is not able to send a signal to a particular part of the body
- The brain functions properly but its messages are not relayed because of spinal cord injury
- The brain is unable to receive or send messages due to injury of the spinal cord
Trauma can be a result of motor accidents, sports injuries, or violence.
Non-traumatic causes of paralysis:
- Medical conditions like stroke (common cause of partial or complete paralysis), or transient ischaemic attack – this is a temporary disruption of blood supply to the brain due to a blocked vessel
- Bacterial (like Lyme disease) or viral (like post-polio syndrome) infections
- Cerebral palsy that involves paralysis from birth
- Bell’s palsy which causes paralysis of facial muscles on one side of the face, typically temporary
- Guillain-Barre syndrome, where paralysis of the legs spreads to the arms and face
- Muscular dystrophy
- Tumours of the spine
- Multiple sclerosis, a condition that affects the central nervous system
Physical examination will often be enough to diagnose paralysis in a person.
- X-rays and other imaging tests like computed tomography, magnetic resonance imaging can be used to check for injury to the spinal cord and brain.
- Electromyogram is used to check the electrical activities of the nerves and muscles.
- Cerebrospinal fluid can be drawn through a spinal tap or lumbar puncture and checked for infection, and disorders like multiple sclerosis.
Permanent paralysis cannot be cured, and unlike some organs, the spinal cord does not heal by itself. Treatment is mostly directed towards preventing further deterioration and helping people become as independent as possible. There are a few options for extensive care and to increase mobility.
- Manual and electric wheelchairs make it possible for affected persons to move around and complete routine activities. Cars can also be modified to suit individual needs.
- Regular physiotherapy has helped people recover sensations and even motor functions in at least one affected limb.
- Persons affected by quadriplegia can avail voice-based systems to control appliances and devices around the house.
- Psychotherapy and support groups help patients to cope with anxiety or depression.
Medicines are routinely prescribed to overcome pain and muscle spasms, and to treat infections.
Sometimes brain or spinal cord surgeries can be done to reduce swellings or remove foreign bodies lodged inside them.