Paralysis - Treating paralysis

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

Another important goal of treatment is to address health problems and associated complications that arise from paralysis, such as pressure ulcers.

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

Mobility aids

A range 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 of the cost. Your local 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 functions like 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.

Read more about wheelchairs and scooters and NHS wheelchair services.

Orthoses

Orthoses are an alternative to wheelchairs. They are braces, usually made of plastic or metal, designed to improve the function of a limb and compensate for muscle weakness.

Examples of orthoses include:

• wrist-hand orthoses – designed to transfer force from a functioning wrist to paralysed fingers
• ankle-foot orthoses – designed for people with some lower limb function to help them move their feet while walking
• knee-ankle-feet orthoses – designed for people with tetraplegia (paralysis in the lower limbs, also known as quadriplegia) to stabilise the knee and ankle and let them swing their legs when walking

A neuroprosthesis is a newer type of orthosis that uses electrodes (small metallic discs stuck to your skin) to deliver electrical currents to muscles in the legs or arms. The currents stimulate the muscles to move in the same way that the brain would normally.

A neuroprosthesis is not suitable for people with conditions that directly damage the nerves in the legs, such as motor neurone disease and Guillain-Barré 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 decide to use both a wheelchair and an orthosis.

Assistive technology

There is also a wide range of assistive technology that can help a person with paralysis maintain their independence and improve their quality 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 stick placed in the mouth, and cursors that can be controlled with a laser beam attached to the head

You can find further information about the types of assistive technology available on the Disabled Living Foundation (DLF) website and the National Centre for Independent Living (NCIL) website. These organisations 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.

Devices can 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 wheel adapted so you steer using your wrists or arms, rather than having to grip it with your hands.

Ricability is a charity for people living with a disability, and has good information and advice about wheelchair-accessible vehicles on its website.

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 to manage a paralysed bladder. The recommended method will depend on your ability, the state of your bladder, and the resources available.

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

Read more about urinary catheterisation.

There are two main treatment options to help people with paralysis empty their bowel:

• bowel retraining – this aims to improve the consistency of your stools and establish a regular time to empty your bowel, as well as helping you find ways of stimulating your bowel to empty
• alternative methods, such as enemas – where liquid is injected into your bowel to help stimulate it to empty
• a colostomy – an operation where a section of the bowel is diverted and attached to an opening in the abdominal wall

Read more about bowel incontinence and colostomy.

Neuropathic pain

Neuropathic pain is pain caused by nerve damage.

Many people with a spinal cord injury, and some with other types of paralysis, have long-term pain that persists for weeks, months, or sometimes years after the injury or incident that caused the 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 as amitriptyline or pregabalin.

These types of medication can cause a wide range of side effects, so it can take time to identify one that is suitable and effective at controlling your symptoms without causing 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 or close friend you are taking amitriptyline and to ask them to let you know if 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 the job of 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 total lack of air) around the lung, which causes your chest 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 because they 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 ventilators carry 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 device called 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 and fill the lungs with air.

Reduced cough

Another problem that affects most people with paralysis is that their 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 muscles are paralysed, the force of a person's cough can be greatly reduced. This is potentially serious because a person's ability to cough enables them to clear their lungs of a build-up of mucus and other secretions. A reduced cough can cause the lungs to become congested, increasing the risk of a lung infection.

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

There are also a number 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 you take precautions to reduce your risk of developing a lung infection by:

• sitting up every day and turning regularly while lying down to prevent a build-up of phlegm
• making sure you cough regularly
• drinking plenty of water to dilute 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 your muscles 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 as , tizanidine or dantrolene, usually taken in tablet form.

Sedatives like diazepam should be avoided, except in severe cases. All of these medicines may 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 a programme 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.