Treating paralysis

There is currently no cure for permanent paralysis. The aim of treatment is tohelp a personadapt to life with paralysis by making them as independent as possible.

Another important goal of treatment is to address health problems and associated complicationsthat arisefrom paralysis, such as Pressure ulcers .

Various treatment options and aids available for people with paralysis aredescribed below.

Mobility aids

Arange of mobility aids,such as wheelchairs, are available for people with paralysis.

Wheelchairs

There are two main types of wheelchair:

• manual wheelchairs designed for people with good upper body muscle strength
• electric wheelchairs designed for people with poor upper body muscle strength or quadriplegia (paralysis in all four limbs)

The NHS supplies wheelchairs free of charge, but the range of models available is often limited. If you want a more sophisticated model, you will have to pay some or all ofthe cost. Yourlocal clinical commissioning group (CCG) may be able to help fund some of the cost. Find your local CCG .

There is also a relatively new type of wheelchair known as a standing chair, which functionslike a wheelchair but allows the person to rise to a standing position. This helps reduce their risk of developing pressure sores. However, standing chairs can be expensive and are heavier than standard chairs.

The currents stimulate the muscles to move in the same way that the brain would normally.

A neuroprosthesisis not suitable for people with conditions that directly damage the nerves in the legs, such as motor neurone disease and Guillain-Barr syndrome . This is because the nerves will not react to the electrical currents.

Neuroprotheses are expensive. Depending on the complexity of the neuroprosthesis, it can cost from 1,300 to 32,000.

Using orthoses can be physically demanding, so they may not be suitable for everyone. Alternatively, you may decideto use both a wheelchair and an orthosis.

Assistive technology

There is also awide range of assistive technology that can help a person with paralysis maintain their independence and improve theirquality of life. Examples include:

• environmental control units voice-activated control units you can use to control things such as lighting, temperature or the telephone in your home
• specially adapted computers such as voice-activated computers, special keyboards that can be controlled using a stickplaced in themouth, and cursors that can be controlled with a laser beam attached to thehead

The Disabled Living Foundation (DLF) has more information about assistive technology , and can also provide advice and support for people living with paralysis.

Driving

It may be possible for you to drive a car, even if you have limited muscle function in your hands and arms.

Devicescan be used to adapt the controls of a car to meet the needs of a person with paralysis. For example, the pedals can be replaced with levers or an electrical switching system, and the steering wheeladapted so you steer using your wrists or arms, rather than having to grip it with your hands.

The Research Institute for Consumer Affairs (RICA) is a charity that provides independent research and information, andhas good information about wheelchair-accessible vehicles .

Bladder and bowel management

Almost all types of spinal cord injury and many types of generalised paralysis result in the loss of normal bowel and bladder function. This is because nerves that control the bowel and bladder are located at the base of the spinal cord.

Most people use a catheter to empty urine from their bladder. A catheter is a thin, flexible tube inserted into the urethra (the opening in the penis or vagina that urine flows out of) or through a hole in the abdomen (tummy).

The catheter is then guided into the bladder, allowing urine to flow through it and into a drainage bag.

There are many methods that can be used tomanage a paralysed bladder. Therecommended method will depend on your ability, the state ofyour bladder, and the resources available.

It is important to ensure your bladder is emptied regularly becausean overly full bladder can trigger a serious complication called autonomic dysreflexia in high spinal cord injuries.

Many people with a spinal cord injury, and some with other types of paralysis, have long-term pain that persists for weeks, months, or sometimesyears after the injury or incident that causedthe paralysis.

Unlike most other types of pain, neuropathic pain does not usually respond well to ordinary painkillers, such as paracetamol or ibuprofen . Alternative medications are usually required, such asamitriptyline or pregabalin.

These types of medication can cause a wide range of side effects, soit can take time to identify one that issuitable and effective at controlling your symptoms withoutcausing unpleasant side effects.

Possible side effects include a dry mouth, sweating, drowsiness and vision problems.

There have been reports of people having suicidal thoughts while taking amitriptyline. If this happens, you should contact your GP or go to your nearest hospital immediately.

It may be helpful to tell a relative orclose friend you are taking amitriptylineand to ask them to let you knowif they notice any changes in your behaviour.

Breathing difficulties

If you have had a spinal cord injury to the upper neck, your diaphragm will be paralysed. The diaphragm is a thin, dome-shaped muscle that helps you breathe in and out.

As your diaphragm will not be able to help you breathe, you will need breathing assistance from a ventilator. A ventilator is a machine that carries out thejobof the diaphragm by controlling lung pressure.

This can be done in one of two ways, using either a:

• negative pressure ventilator where the ventilator creates a vacuum (a totallack of air) around the lung, which causes yourchest to expand and pull in air
• positive pressure ventilator where the ventilator pushes oxygen directly into your lungs

Positive pressure ventilators are more widely used becausethey are usually smaller and more convenient. A positive pressure ventilator can either be:

• invasive where an incision is made in the throat and a tube inserted into the trachea (windpipe)
• non-invasive where a tube is inserted into the nose, or air is supplied through a mouthpiece

Non-invasive ventilatorscarry a smaller risk of causing a lung infection such as pneumonia ,but aren't suitable for people with more extensive paralysis who have difficulty swallowing.

An alternative to using a ventilator is a devicecalled a phrenic nerve stimulator. The phrenic nerve controls the diaphragm. The device is surgically implanted in the chest and sends regular electrical impulses to the phrenic nerve, causing the diaphragm to contract and expand andfill the lungs with air.

Reduced cough

Another problem that affects most people with paralysis is thattheir ability to cough is reduced. This is because the cough reflex is triggered by muscles in the abdomen (tummy) and between the ribs pressing down on to the lungs.

If these musclesare paralysed, the force of a person's cough can be greatly reduced. This is potentially serious because a person'sability to cough enables them to clear theirlungs ofa build-up of mucus and other secretions. A reduced cough can causethe lungs to become congested, increasing the risk of a lung infection.

One technique used to compensatefor this is known as an assisted cough.It involves arelative or carer pushing against the outside of your stomach while you attempt to cough.

There are also anumber of devices available to help you cough. They usually consist of vests that can contract (squeeze) against your lungs, compensating for the loss of muscle action.

It is important youtakeprecautions to reduce your risk of developing a lung infection by:

• sitting up every day and turning regularly while lying down to preventa build-up of phlegm
• making sure you cough regularly
• drinking plenty of water todilute any phlegm, making it easier to cough up
• avoiding smoking or being in close contact with people who smoke
• getting the flu vaccination and pneumococcal vaccination as they help reduce your risk of developing influenza and pneumonia

Spasticity and muscle spasms

Spasticity is a medical term that means abnormally stiff and rigid muscles. Many people with paralysis develop spasticity and involuntary muscle spasms (where muscles cramp and contract).

Spasticity and muscle spasms are usually caused by the section of the spinal cord below the point of the injury "misfiring" and sending abnormal signals to the limbs.

In some cases, spasticity and muscle spasms can be useful. For example, if you have partial paralysis in your legs, the stiffness in yourmuscles may make your legs easier to control.

Some people also find that a series of muscle spasms makes it easier for them to empty their bladder or bowel. But in other cases, spasticity and muscle spasms can be painful, affect mobility and interfere with daily activities.

Treatments for spasticity and muscle spasms are discussed below.

Muscle relaxants

The first type of medication you may be prescribed is a muscle relaxant, such asbaclofen,tizanidine or dantrolene,usually taken in tablet form.

Sedatives likediazepamshould be avoided, except in severe cases. All of these medicinesmay cause sedation as a side effect.

Botulinum toxin

If muscle relaxants are not effective, an injection of botulinum toxin (Botox) may be given for localised spasms. It works by blocking the signals from the brain to the affected muscles.

The effects of the injection usually last for up to three months. The treatment is most effective when used in conjunction with aprogramme of stretching and physiotherapy.

Intrathecal baclofen therapy

Another possible treatment is intrathecal baclofen therapy. This involves surgically implanting a small pump on the outside of the body connected to the spinal cord.

The pump delivers regular doses of baclofen directly to the spine.It blocks some of the nerve signals that cause muscle stiffness.