Orthotic Treatment Management of Tetraplegia / Quadriplegia

Definition
Quadriplegia, also known as tetraplegia, is a symptom in which a human experiences paralysis affecting all four limbs, although not necessarily total paralysis or loss of function.

Causes
It is caused by damage to the brain or the spinal cord at a high level – in particular spinal cord injuries secondary to an injury to the cervical spine. Typical causes of this damage are trauma (such as car crash, gunshot wound, fall, or sports injury) or disease (such as transverse myelitis, polio, or spina bifida). Fractured or dislocated cervical vertebrae, ruptured disc or bony spur on the vertebra protrudes pressing the spinal cord

Signs & Symptoms
• Motor/ sensory function of limbs are lost
• Uncontrollable hand motions
• Difficulty in Speech, swollen
• Unable to maintain balance body posture
• Bowel & bladder problem

Complications

Elbow flexion contracture, Wrist flexion contracture, Leg length discrepancy, Pes Equinus, Knee flexion contracture, Hip flexion contracture, Scoliosis, Kyphosis
Orthotic Treatment
Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.
For Lower limb
HKAFO- Hip flexion/extension instability
Hip adduction/abduction weakness
Hip internal rotation/external rotation instability
KAFO- If knee extensors/flexor affected
AFO-If quadricep weakness with genu recurvatum
Rigid AFO- If tibialis anterior and tricep surae weakness
In case of AFO- If muscle grading is 3- , Solid AFO
– If muscle grading is 3+, AFO with Ankle joint
In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint. If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock
HKAFO if Hip flexor or extensor weakness 3- or less.
For upper Limb
Wrist hand orthosis
Elbow wrist hand orthosis

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