Paralysis: Treatment and Living With It

How paralysis happens

Movement depends on a chain: the brain's motor cortex sends signals down the spinal cord to motor nerves, which make muscles contract. Damage anywhere along that chain causes paralysis. The level and completeness of the damage determine which muscles are affected and how much function can return. For types and causes, see paralysis symptoms and causes.

Types by extent

• Hemiplegia: one side of the body, usually from stroke or brain injury.
• Paraplegia: the legs and lower trunk, from spinal cord damage in the chest or lower back region.
• Tetraplegia: all four limbs and the trunk, from neck injuries. High neck injuries can affect breathing.
• Monoplegia and localized paralysis: one limb or area, as in nerve injuries.

Complete spinal cord injury means no movement or feeling below the injury; incomplete injury preserves some function and carries a better chance of recovery.

Acute treatment

• Stroke: clot-busting medicine within 4.5 hours and mechanical clot removal up to 24 hours in selected people, then treatment to prevent another stroke.
• Spinal cord injury: immobilization, surgery to decompress and stabilize the spine, blood pressure support and intensive care.
• Spinal cord compression from tumors: steroids, surgery and radiotherapy.
• Guillain-Barré syndrome: IV immunoglobulin or plasma exchange, and monitoring of breathing.
• Multiple sclerosis relapses: high-dose steroids, then disease-modifying therapy.

Rehabilitation

Rehabilitation starts as soon as the person is medically stable, often within days. The brain and spinal cord can reorganize (neuroplasticity), and repetitive, task-specific practice drives that recovery.

• Physical therapy: strength, balance, walking, transfers and wheelchair skills.
• Occupational therapy: dressing, washing, cooking and adapting the home and workplace.
• Speech and language therapy: speech, communication and swallowing after stroke.
• Robotic gait training, functional electrical stimulation and constraint-induced movement therapy for selected people.
• Psychological support for adjustment, depression and anxiety, which are common.
• Vocational rehabilitation to return to work or study.

Equipment and technology

• Wheelchairs (manual or power), walkers, canes and braces such as ankle-foot orthoses
• Pressure-relieving cushions and mattresses
• Hoists, grab rails, ramps and accessible bathrooms
• Adapted vehicles and hand controls
• Voice-activated technology and environmental controls
• Implanted devices for selected people, such as breathing pacemakers in high tetraplegia

Preventing complications

Pressure sores

Lack of movement and sensation lets skin break down over bony areas. Change position at least every 2 hours in bed, shift weight every 15 to 30 minutes in a wheelchair, use pressure-relieving surfaces and check skin daily. See pressure ulcers.

Blood clots

Deep vein thrombosis is common early after paralysis. Prevention includes blood-thinning injections, compression devices and early movement.

Bladder and bowel

Many people need intermittent catheterization, medicines or a planned bowel routine. Urinary tract infections are a leading cause of hospital readmission.

Spasticity and contractures

Stiff, tight muscles and shortened joints are treated with daily stretching, positioning, splints, oral medicines such as baclofen, botulinum toxin injections and, in severe cases, a baclofen pump.

Breathing and swallowing

High spinal injuries and some nerve diseases weaken breathing muscles. Assisted coughing, breathing exercises and vaccinations against flu and pneumonia help prevent chest infections. Swallowing assessments reduce the risk of aspiration pneumonia after stroke.

Autonomic dysreflexia

In spinal cord injury at the level of the upper chest (T6) or above, a trigger below the injury, usually a full bladder, constipation or a pressure sore, can cause a sudden dangerous rise in blood pressure. Sit the person up, loosen tight clothing, check the catheter and bladder, and seek emergency help if it does not settle.

Other issues

• Bone thinning (osteoporosis) and fractures
• Chronic pain, including nerve pain
• Depression, which affects about a third of stroke survivors
• Sexual function and fertility changes, for which treatments exist

Outlook

Recovery depends on the cause, severity and age. After stroke, the fastest gains come in the first 3 to 6 months, though improvement can continue for years with practice. In incomplete spinal cord injury, many people regain some movement, and some walk again. Complete injuries rarely recover substantially, but people can lead long, active lives with good care. Guillain-Barré syndrome and Bell's palsy usually improve substantially.

Frequently asked questions

Can paralysis be cured?

It depends on the cause. Paralysis from Bell's palsy, Guillain-Barré syndrome or some strokes can improve greatly. Damage to the spinal cord or brain is often permanent, but rehabilitation can restore much function. Research into nerve stimulation, stem cells and brain-computer interfaces is ongoing.

How long does it take to recover from paralysis after a stroke?

Most recovery happens in the first 3 to 6 months, with the biggest gains in the first few weeks. However, many people keep improving for a year or more with ongoing therapy. Early, intensive and repetitive practice gives the best results.

What are the most common complications of paralysis?

Pressure sores, blood clots, urinary tract infections, constipation, muscle spasticity and contractures, chest infections, chronic pain, bone thinning and depression are the most common. Daily skin checks, regular position changes, bladder and bowel programs and staying as active as possible help prevent them.

Can people with paralysis live a normal life?

Many people with paralysis work, study, drive adapted vehicles, play sports, have relationships and raise families. Support from rehabilitation teams, the right equipment, accessible housing and peer support organizations make a large difference to independence and quality of life.