Understanding Quad vs Para
As a person with a spinal cord injury, I get a lot of questions and looks. Many people are curious about the adaptive equipment I use, like my “sport” wheelchair (hehe, love that one!) or the hand controls on my truck, but people are almost always surprised to learn that I am a quadriplegic. “What?! But you can move your arms!” Paralysis, in many ways, may not be what most expect.
Quadriplegia (aka. tetraplegia) is an injury or disease occurring along the cervical (neck) region of the spinal cord, C1 through C8. These injuries are often misunderstood as being completely debilitating, leaving the person to rely on a ventilator to breath and mouthstick to operate a power wheelchair, but in reality, many people with quadriplegia may still able to move their arms and fingers and operate a manual wheelchair. Total paralysis is not very common but even medical professionals make the mistake of grouping all quadriplegics in the same category.
Paraplegia is the other type of paralysis and refers to an individual with a damaged spinal cord that is still be able to move his or her arms and hands with no impairment. Depending on where along the spinal cord the person is injured and many other factors, he or she might be able to transfer independently to uneven surfaces and operate a manual wheelchair. However, if a person’s spinal cord was damaged in the cervical region but he or she retained hand and arm function, the person is still considered a quadriplegic.
The big determining factor of a spinal cord injured person’s physical ability iswhere the spinal cord was injured along the spinal column. Take a look at the diagram to the right. It was borrowed from the Christopher and Dana Reeve Paralysis Foundation’s website. Notice how the cord is labeled C1, C2, C3, and so on and then each grouped section is color coded? Each labeled area is called a “level” of the spinal cord and is outlined to show specifically what would be affected if that part of the spinal cord is injured or diseased. The color coded sections show the region- cervical, thoracic, lumbar, and sacral- of the spinal cord that forms part of the level (C1-8, T1-12, L1-5, S1-5).
Functionally, the spinal cord works from the the brain down to the tail bone, much like a strand of holiday lights works from the power source down to the end. The cord, responsible for sensation and movement, is very sensitive and delicate and if it is damaged, the signals can get disrupted from the point of injury down to the rest of the body. Therefore affecting not just the specific level of functionality that a person is injured at, but the entire body below that level. Check out this article for a general description of abilities per level of injury.
Here’s where it gets a little complicated. Just like the way the lights on the light strand will behave differently if the circuit is broken or just loose, so too can the sensation and/or movement be different in a spinal cord injured person. This is why one person with a C6 injury would have sensation and be able to move his or her legs whereas another with the same injury would not be able to move or feel anything below his or her chest and have poor hand function. It’s all a matter of whether the spinal cord sustained “complete” or “incomplete” damage.
According to Medscape…
“Definitions of complete and incomplete SCI are based on the above ASIA definition with sacral-sparing.
- Complete – Absence of sensory and motor functions in the lowest sacral segments
- Incomplete – Preservation of sensory or motor function below the level of injury, including the lowest sacral segments”
In other words, if you can move your muscles below the level of injury or you can feel your behind or its functions, then you have an incomplete injury. These distinctions can be diagnosed by a physiatrist (an SCI doctor) or a physical therapist.
Every injury affects a person differently and this is article just a crash course but if you’d like to learn more about spinal cord injury on your own, check out these resources: