Definition Paralysis is the loss of the power to move a part of the body due to injury or disease of the nerves that supply the muscles involved in moving that part of the body. The key points in this definition are firstly that paralysis refers to a loss of movement rather than just weakness, and secondly that the problem originates in the nerves to the muscles rather than in the muscles themselves. The severity of the paralysis is indicated in medical terminology by the word endings: plegia and paresis. Plegia signifies loss of power, i. . true paralysis; while paresis refers to a significant weakening of the affected muscle(s). The part or parts of the body which are paralysed (-plegic) or very weak (-paretic) are identified in medical terms by the part of the word that comes in front of the ‘-plegia’ or ‘-paresis. ’ Another term occasionally used, but meaning the same as paralysis, is palsy. Damage to the nerves supplying the muscles of the face is described as facial palsy. Cerebral palsy is paralysis that is the result of damage to the brain (or cerebrum). Causes
Paralysis is most often caused by damage to the nervous system, especially the spinal cord. Major causes are stroke, trauma, poliomyelitis, amyotrophic lateral sclerosis (ALS), botulism, spina bifida, multiple sclerosis, and Guillain-Barre syndrome. Temporary paralysis occurs during REM sleep, and dysregulation of this system can lead to episodes of waking paralysis. Drugs that interfere with nerve function, such as curare, can also cause paralysis. Many causes of this are varied, and could also be unknown. Paralysis is caused by something being wrong with the nerves that activate muscles.
Another word for nerve is neurone. The nerves that send the electrical messages, or impulses, to muscles to make them move or contract are called motor neurones. When we move a part of our body two types of motor neurone are involved in getting the relevant muscles to move: the upper and lower neurones. The upper motor neurone conveys the impulse from the brain to lower down in the nervous system where it connects with the lower motor neurone. The lower motor neurone then provides the final path for the signal to reach the muscle.
Recognising these two different types of motor neurone is important as the nature of the paralysis varies according to which type is mainly affected. Even while a person is sitting fully relaxed, the motor neurones (both upper and lower) are sending impulses to the muscles to maintain a normal degree of tightness. Upper motor neurone damage causes an increased tightening up of the muscles. This is called spasticity lower motor neurone damage leads to a reduction in, or loss of, the normal tone in the muscles.
This paralysis, which is characterised by slack or floppy muscles, is sometimes called flaccidity. Conditions that affect the brain and spinal cord result in upper motor neurone paralysis. Some common examples are stroke, tumours, cerebral palsy, multiple sclerosis, spina bifida, and severe trauma or injury to the head, neck or back. Damage to the right side of the brain causes paralysis of the left side of the body and vice versa. When upper motor neurone damage occurs in the spinal cord it tends to involve both sides of the body.
Lower motor neurone damage resulting in flaccid paralysis is less common. This can occur when an injury to a limb involves the nerve on its course to the muscles it supplies – for example an injury to the upper arm could lead to a loss of movement in the forearm and hand. Effect Direct effects of paralysis Everyday tasks such as eating, washing, bathing, dressing, going to the toilet and generally getting around may pose significant problems for someone with paralysis. The term ‘activities of daily living’ (ADL) is often used to describe these actions.
Of course there are many other everyday things that everyone does that do not involve movement – so not all ADLs are necessarily affected. However, this is a useful term to cover such items rather than listing them each time they come up. Indirect effects of paralysis Paralysis can be looked upon as involuntary immobility. Immobility, from whatever cause, can have widespread effects on almost all systems of the body. Especially if it is long-lasting, it can lead to changes in the circulation and respiration, alter the workings of the kidneys and gastrointestinal system and result in changes to tissues such as skin, muscles and bones.
In people who have profound paralysis, much of the nursing care is directed at minimising these effects and trying to prevent the complications that they can cause. Changes to muscles, bones and joints can explain some of the discomfort or pain that may accompany paralysis. It may be difficult to decide just where these aches or pains are coming from and to know precisely what is causing them, but paralysis of one group of muscles may result in excess forces pulling on others or abnormal stress on joints.
In addition, particularly where there is spasticity and the limbs are held in abnormal postures, there may be various changes to tissues surrounding a joint including shortening of muscles and tendons. If another person tries to straighten the limb out or bend the limb they discover it is not possible to do so to the full extent of the normal range of movement about that joint. Such a reduction in the range of movement is called a contracture. Contractures can interfere with activities such as dressing and can make it difficult to get into a comfortable sitting position.
The muscles also provide a degree of protection to the joints. When this protection is lost because of paralysis and another person, in assisting the paralysed person, unintentionally mishandles them, the joints can become damaged. Involuntary muscle spasms associated with spasticity can lead to damage to the skin and can increase the risk of pressure sores, particularly when paralysis is associated with sensory loss. Treatment and prevention The treatment of paralysis will depend on its cause; on whether it is improving, staying the same, or getting worse; and on whether it is accompanied by other difficulties.
In many situations, paralysis is at its most severe in the early stages after injury or disease and recovery of movement occurs over time. Treatment of spasticity The first step in dealing with spasticity consists of avoiding factors that make it worse. When someone gets angry, worried or stressed they are sometimes described as being ‘uptight’. This is actually appropriate slang as the resting muscle tone does increase in these situations, and that applies even more when the tone is already increased by spasticity.
No one can avoid stress or emotion, but relaxation or stress management techniques can help control their impact. Many complementary therapies and practices such as reflexology, aromatherapy and yoga include relaxation methods which some find helpful. If the temperature of the body is lowered the muscles tend to tighten up, so very cold weather is best avoided where possible, or else the affected limbs should be protected by warm clothing. Irritations to the skin including tight clothing or footwear may also make spasticity worse.
Drugs to treat spasticity are available but are not always needed or desirable. They are mainly used to assist in positioning and physiotherapy to allow a greater range of movement and reduce the risk of contractures. They can also reduce the frequency of painful spasms in some cases. Treatment of Flaccidity The treatment of paralysis of lower motor neurones type is essentially similar except in terms of the use of drugs. Good positioning and advice from physiotherapists and others are important.
