Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Introduction
Paralysis is a condition which would interfere with your ‘muscle movements’. You will not be able to make voluntary muscle movements when hit by paralysis. This is a problem which arises from your nervous system.
Paralysis simply means ‘loss of muscle functions’ in your body. It can be localized, generalized, partial, complete, temporary or permanent in nature. It can affect any part of the body and can happen at any time in your life.
How does it happen? – Nerves send signals to the muscles. They are like electrical wiring in the body. These nerve signals make your muscles move. When anything disrupts this easy flow of signals one would experience paralysis marked by inability to move the muscles voluntarily. You also cannot move certain parts of your body.
Which part of your body gets affected depends on which groups of muscles are involved in paralysis i.e. which muscles are paralyzed. Example – Bell’s palsy will cause temporary facial paralysis. In Paraplegia there will be paralysis of both lower limbs. Quadriplegia is paralysis of all four limbs.
The common causes of paralysis include stroke, nerve disorders like multiple sclerosis and spinal cord injuries.
Incidence of Paralysis
It is estimated that approximately 1 in 50 Americans which sums up to 5.4 million people will have some form of paralysis and this is a huge number.
Types and Severity of Paralysis
1. Temporary and Permanent Paralysis (based on duration)
Temporary Paralysis – In this condition, paralysis is temporary. People suffering from this condition regain partial or complete movement, feeling and coordination over a period of time and good treatment. A good example for this is Bell’s Palsy. This is a temporary paralysis of facial muscles. When paralysis is associated with tremors it will be called ‘Palsy’. Stroke can also cause paralysis on one side of the body.
Permanent Paralysis – In this condition, the person will never regain muscle control. The damage is permanent and irreversible.
2. Partial and Complete Paralysis
Partial Paralysis – As the name suggests, in this condition one can control only some muscles but not all the muscle. One will have only some control over the muscles in the affected body parts. It is also called Paresis.
Complete Paralysis – In this, one does not have control over any muscles i.e. one will have no control over the muscles in the affected area.
3. Flaccid and Spastic Paralysis
Based on the site of injury in the nervous system, paralysis is of two types –
Flaccid Paralysis – damages the lower motor neurons which stimulate movement of muscles. These muscles shrink or deteriorate over a period of time. It is a common complication of polio according to the CDC. The muscles in this condition get flabby and shrink. This results in muscle weakness.
Other causes – inflammation of spinal cord (myelitis) and GB Syndrome (Guillain Barre Syndrome), a rare autoimmune disorder.
Spastic Paralysis – causes stiffness of muscles – the muscles tighten and become hard. As a result of this, spasticity sets in i.e. the muscles cause uncontrollable involuntary spasms and jerks / twitches and weakness of muscles. It can occur from spinal cord injuries, stroke, and amyotrophic lateral sclerosis (ALS) or hereditary spastic paraplegia.
4. Localized and Generalized Paralysis
Localized Paralysis – It affects a small portion / only one part of the body and commonly involves the hands, feet, face or vocal cords.
Generalized Paralysis – This type affects a larger area of the body and multiple body parts. This is once again categorized on the basis of extent of paralysis –
a. Monoplegia – in this condition one cannot move any one limb i.e. arm (upper limb) or leg (lower limb) depends on which is affected
b. Diplegia – is when the paralysis occurs on the same area of the body on both sides. Example – both arms, both legs or both sides of the face being affected by paralysis
c. Hemiplegia – is when paralysis affects one side of the body. Example – upper limb and lower limb on the same side getting paralyzed.
d. Paraplegia – is when paralysis affects both lower limbs. Sometimes it might also affect the torso.
e. Quadriplegia / Tetraplegia – is when all the limbs are paralyzed. Those suffering from this condition will have little movement or absolutely no movement below the neck (from neck down).
f. Locked-in Syndrome – this is the rarest and most severe form of paralysis. In this the person loses control of all their muscles except the muscles controlling the eye movements.
The above are the different patterns of muscle paralysis.
Causes of Paralysis
Paralysis occurs due to some problem or damage occurring to the nervous system. When this happens the nervous system cannot convey messages and signals to the muscles. This leads to loss of movements in the muscles. Some people are born paralyzed. Many develop paralysis due to an accident or medical condition.
Stroke and spinal cord injuries – Stroke is the leading cause of paralysis in the US (Christopher and Dana Reeve Foundation) being responsible for about 33.7% cases. About 27.3% cases are caused due to spinal cord injury and 18.6% due to multiple sclerosis and due to cerebral palsy is about 8.3%.
Specific causes of spinal cord injuries, the second leading cause of paralysis are motor vehicle accidents, sports injuries, falls and violence – shootings, assaults etc.
Birth defects – like spina bifida can cause paralysis.
Traumatic injury – which leads to damage of muscles and nerve functions, can cause paralysis. Similarly a medical condition damaging these structures can also cause paralysis.
Read more: Charaka Vatavyadhi Chikitsa 28th Chapter
Other causes of Paralysis
– Brain injuries due to trauma
– Cerebral palsy
– Neurofibromatosis
– Neurological diseases – example – ALS (amyotrophic lateral sclerosis)
– Autoimmune diseases – example – GB Syndrome (Guillain Barre Syndrome), MS (Multiple Sclerosis) etc.
– Post-polio syndrome
– Birth defects
Paralysis caused by other conditions
Paralysis is caused many times by strokes, usually from a blocked artery in the neck or brain. Damage to the brain or spinal cord following a car accident or sports injury can also cause paralysis.
Some kinds of paralysis are caused by certain other conditions or diseases linked to specific genes –
Demyelinating diseases – in which the neurons fail to send signals throughout the body, weakens the muscles and eventually causes paralysis. The most common among these demyelinating diseases which can cause paralysis is multiple sclerosis.
Motor Neuron Diseases (MNDs) – Motor neurons are nerve cells. They control the muscles used for walking, breathing, speaking and moving the limbs. MNDs damage these cells over a period of time and cause paralysis.
Primary lateral sclerosis is an upper motor neuron disease. It affects the upper motor neurons and makes the muscles stiff and spastic. Spinal muscular atrophy (SMA) is a lower motor neuron disease. It affects only the lower motor neurons and makes them floppy or flaccid. This in turn makes the muscles weak and causes them to twitch uncontrollably. Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s Disease) is the most common MND. It affects both upper and lower neurons.
Periodic paralysis – it is caused by changes in some genes. An electrolyte abnormality like hypokalemia or hyperkalemia triggers random attacks of paralysis.
Sleep paralysis – happens when one is waking up or falling asleep. People with sleep paralysis would hallucinate often.
Bell’s Palsy – half of the face afflicted by this condition appears to droop and is thought to be caused by certain viruses.
Todd’s paralysis – This usually happens on one side of the body for a brief period of time after a person with epilepsy has had a seizure.
Tick Paralysis and Lyme disease – Neurotoxins in the spit glands of some ticks can cause paralysis. It starts in the feet and legs and moves upward. Paralysis goes away once the tick is removed. If this condition is not treated it can spread to the face and become very serious. Ticks also sometimes carry Lyme disease, a bacterial infection which can cause different symptoms including facial paralysis and numbness in arms and legs.
HTLV-1 associated myelopathy (TSP – Tropical Spastic Paraparesis) – follows an infection with human T-cell leukemia virus type 1. Symptoms similar to MS are caused. This happens in less than 3% of people infected with the virus.
Symptoms of Paralysis
Below mentioned are the common symptoms of paralysis –
– Loss of movements – you are unable to move the affected part or parts of the body, either partly or in totality i.e. loss of function may be seen in a specific or widespread area of the body.
– Loss of sensation
– Muscle weakness
– Tingling, pain or numbing sensation in affected muscles, mainly before the paralysis sets in
– Loss of control over the muscles in the affected body parts
– Sudden paralysis – as in stroke, spinal cord injuries
– Steady loss of sensation, steady loss of muscle control, tingling / numbness in the limbs as in gradual paralysis
– Muscle cramps
– Muscle atrophy – visible muscle loss
– Stiffness
– Involuntary spasms or twitches
Tests and Diagnosis
Your doctor / healthcare provider will conduct a thorough examination and interrogation to extract the complete history of your problems. They may recommend one or more of the below mentioned tests –
– X rays – nerve injury caused by broken bones due to trauma / accident can be elicited.
– Imaging tests like CT scan or MRI – spinal cord injury, brain injury or signs of stroke can be traced.
– Myelogram – injuries related to nerves and spinal cord can be found out.
– EMG (electromyogram) – electrical activity of nerves and muscles can be traced.
– Spinal tap / lumbar puncture – to test spinal fluid. Infections, inflammation and disorders like MS (multiple sclerosis) can be diagnosed.
Complications of Paralysis
Paralysis can affect other body systems also. Below mentioned are some of the complications which might be caused depending on the type of paralysis –
– Difficulty in breathing
– Cough
– Pneumonia risk
– Extreme high blood pressure / extreme low blood pressure
– Heart problems
– Problems of speech
– Dysphagia – problems in swallowing
– Urinary incontinence
– Bowel incontinence
– Sexual problems, erectile dysfunction
– Deep vein thrombosis
– Blood clots
– Sepsis
– Bedsores
– Anxiety
– Depression
What is the right time to call the doctor?
You should think of calling your doctor immediately if you have signs of stroke or if one has a possible injury to head, neck or spine. Also ask for quick help in cases of breathing, swallowing or speaking difficulties, numbness or tingling in the limbs, sudden inability to move the muscles, persisting muscle weakness or weakness which is coming and going.
Prevention of Paralysis
Majority of paralysis are due to spinal injuries. Chances of spinal injuries can be lowered by following the below mentioned steps –
Seatbelt – one should always wear seatbelts. Parents should ensure that their children are using car seats or booster seats while traveling in cars / vehicles.
Drive precaution – One should make sure that he or she would not drive under the influence of alcohol or drugs. One should not ride with an impaired driver.
Sports caution – while taking part in sports and activities one should take certain precautions. Example – wearing helmets, using cushioning mats etc.
Dive carefully – One should be careful before diving into water and make sure about depth of water.
Don’t do this – Never move a person having a head, neck or spine injury. Instead call for medical help.
Read more: Facial Paralysis- Ayurvedic Treatment, Medicines, Home Remedies
Management and Treatment of Paralysis
Treatment plan depends on the underlying cause of paralysis and also on the symptoms experienced. If it is permanent paralysis, it cannot be cured. Spinal cord injuries also cannot be healed.
Bell’s palsy and other temporary paralysis may go away without treatment over a period of time.
Therapies & rehabilitation services – Physical, occupational and speech therapy can help those having paralysis. They would support these people by providing exercises which would help in improving the functions. They would also help in providing assistive and adaptive devices which serve the same functions. All these would help in all types of paralysis and enable people to live independently while enjoying a better quality of life.
Below mentioned cares may also be recommended along with rehabilitation –
– Adaptive equipments – with which you can feed self and drive all by yourself
– Mobility aids / Assistive equipment – like wheelchairs, canes, crutches, scooters etc
– Prosthetic / Orthotic devices – like braces
– Voice activated technology – for operating phones, lighting systems, computers
– Surgery or amputation
– Medications – including Botox or muscle relaxers especially so if you have spastic paralysis.
– Spinal cord implant – boosts the strength of the signals between the brain and legs
Prognosis and outlook of paralysis
The prognosis of paralysis is always not good and favorable. It is not always possible to cure paralysis. Whether paralysis is reversible or not depends on the extent and causes of paralysis.
It is a big challenge to learn living with paralysis. Life, activities and self-image, everything will be eclipsed by the disease. Most people with paralysis would never regain mobility or sensation in the areas of the body affected. This will eventually lead to mental health issues and depression. Treatment plan and outlook for paralysis depends on the underlying cause / causes and the symptoms of the disease.
Some people may regain sensation and learn once again how to walk. On the other hand, walking again can never be possible for those whose spinal cord has been completely severed. In conditions wherein mobility or sensation cannot be regained, quality of life can be improved with the help of assistive technology and medical interventions.
Try to get physical and emotional support with the help of your doctor. Many victims of paralysis will learn to adapt with the help of rehabilitation and support over a period of time. Many of these would lead active and independent lives with paralysis. Lifelong help and care is essential for patients of quadriplegia but they can always keep their minds active and hang on to courage.
The quality of life can be improved with the help of assistive technologies, therapeutic interventions or any other strategies recommended by their healthcare team.
Example, special braces and electronic mobility devices may help in independent movement. Occupational therapists and other related professionals may customize clothes, home, car and workplace so as to suit the needs and abilities of the patient.
To manage potential complications of paralysis, a doctor may recommend suitable lifestyle changes, medications, surgery or other treatments as and when needed.
Research works on whether paralysis can be reversed or not?
In the US roughly 1 in every 50 people have paralysis, summing to about 5.4 million people which is said to be equal to the combined population of Washington, D.C., Los Angeles and Philadelphia. About 2/3 of people suffering with paralysis are placed between age groups 18 and 64.
Researchers from Northwestern University in 2021 had developed an injectable therapy by using ‘dancing molecules’. Mice with spinal cord injuries regained their ability to walk with the help of this therapy. Research in humans is still needed but the results have been promising.
A combination of physical therapy and a noninvasive method of stimulating the spinal cord nerve cells was used to help at least six people with paralysis to regain some degree of mobility of arm and hand in 2021 by scientists from University of Washington. The mobility lasted for 3-6 months after the treatment ended.
Challenges and opportunities in restoring function after Paralysis – Neurotechnology has made major advances in the development of interfaces to the nervous system. These would restore function in paralytic disorders. They enable restoration of voluntary function and activation of paralyzed muscles to reanimate movement.
Paralysis – Ayurveda understanding
Vata is the main force which brings about all the movements in the body. The movements are normal and easy if vata and its subtypes are working in a synchronous way and if vata is in a state of serene balance. Paralysis is a movement disorder. There is loss of muscle movement and functions. Vata controls the movements in the muscles and joints. Therefore from Ayurveda perspective, paralysis is caused due to imbalance in vata.
There is a condition called Pakshavadha explained in the context of Vata Vyadhi. Vatavyadhis are a group of special and uncommon vata disorders caused due to aggravation of vata. Pakshavadha is also called as Pakshaghata. Pakshavadha presents with loss of movements in one side, one part or one half of the body, just like paralysis. It also explains hemiplegia.
Ekangavata is its synonym which looks like an explanation of partial or localized paralysis or monoplegia. Ayurveda tells that when the aggravated vata afflicts the entire body i.e. both sides of the body, it is called Sarvangavata. This condition is like complete or generalized paralysis and also quadriplegia.
The explanation of Ardita, one of the Vatavyadhis, resembles the explanation of facial paralysis or Bell’s Palsy.
The treatment of Paralysis too should be done on the lines of treating Pakshavadha or Ardita, depending on the presentation of the disease.
Related Reading – Paralysis – Ayurveda Understanding
