What is Quadriplegia and Paraplegia?

Introduction

Defining Paraplegia and Quadriplegia

• Paraplegia: Refers to paralysis from approximately the waist down - Paraplegic Facts and Definition
• Quadriplegia: Refers to paralysis from approximately the shoulders down. Most spinal cord injuries result in loss of sensation and function below the level of injury, including loss of controlled function of the bladder and bowel - Quadriplegia Facts and Definition

Main Item

What Does "Complete" and "Incomplete" SCI Mean?

Incomplete Spinal Cord Injury

The clinical term incomplete when applied to spinal cord injury indicates that the patient has some sensory or motor function below the lesion level. As defined recently in the International and American Spinal Injury Association (ASIA) Neurological Classification of Spinal Cord Injury, the term has been given an even more specific meaning, indicating a person with preservation motor or sensory function in the last sacral segment (S4-5).

This definition gets around the problem often encountered in the clinical setting of a patient who has an injury at a given level, some preserved sensation or motor function or several segments, and then no function below that level. By defining incomplete as having some function at the lowest level of the spinal cord, the definition becomes unambiguous.

Complete Spinal Cord Injury

A more controversial term relates to the word complete when applied to spinal cord injury. By the ASIA definition, a person that does not have preserved sacral sensory or motor function should be complete. Unfortunately, the term has connotations of complete loss and a finality that is not desirable. Some patients with complete loss of neurological function below the lesion level may still recover several segments, especially when treated shortly after injury."

Facts and Major Causes of SCI

• Motor vehicles 48%
• Falls 21%
• Sports 14% (66% of which are caused in diving accidents)
• Violence 15%
• Other 2%
• 32 injuries per million population or 7800 injuries in the US each year.
• Researchers estimate that an additional 20 cases per million (4860 per year) die before reaching the hospital.
• 82% male, 18% female
• Highest per capita rate of injury occurs between ages 16-30
• Average age at injury - 33.4
• Median age at injury - 26
• Mode (most frequent) age at injury 19
• Motor vehicle accidents are the leading cause of SCI (44%), followed by acts of violence (24%), falls (22%) and sports (8%), other (2%)
• 2/3 of sports injuries are from diving
• Falls overtake motor vehicles as leading cause after age 45.
• Acts of violence and sports cause less injuries as age increases.
• Acts of violence have overtaken falls as the second most common source of spinal cord injury.

Marital status at injury:

• Single 53%
• Married 31%
• Divorced 9%
• Other 7%

5 years post-injury:

• 88% of single people with SCI were still single vs. 65% of the non-SCI population
• 81% of married people with SCI were still married vs. 89% of the non-SCI population

Employment status among persons between 16 and 59 years of age at injury:

• Employed 58.8%
• Unemployed 41.2%

(includes: students, retired, and homemakers)

Employed 8 years post-injury:

• Paraplegic 34.4%
• Quadriplegic 24.3%

Except for the incomplete-Preserved motor (functional), no more than 0.9% fully recover, although all can improve from the initial diagnosis.

The length of stay and hospital charges for acute care and initial rehabilitation are higher for cases where admission to the SCI system is delayed beyond 24 hours.

Average length of stay:

• Quadriplegics 95 days
• Paraplegics 67 days

Source of payment acute care:

• Private Insurance 53%
• Medicaid 25%
• Self-pay 1%
• Vocational Rehab 14%
• Worker's Comp 12%
• Medicare 5%
• Other 2%

Ongoing medical care: (Many people have more than one source of payment.)

• Private Insurance 43%
• Medicare 25%
• Self-pay 2%
• Medicaid 31%
• Worker's Compensation 11%
• Vocational Rehab 16%

Mortality rates are significantly higher during the first year after injury than during subsequent years. The most common cause of death is respiratory ailment, whereas, in the past, it was renal failure. Most people with neurologically complete lesions above C-3 die before receiving medical treatment. Those who survive are usually dependent on mechanical respirators to breathe. Overall, 85% of SCI patients who survive the first 24 hours are still alive 10 years later, compared with 98% of the non-SCI population given similar age and sex. An increasing number of people with SCI are dying of unrelated causes such as cancer or cardiovascular disease - similar to that of the general population.