Muscle function loss

Definition

Complete loss of muscle function, or paralysis, can affect a small area (localized) or be widespread (generalized).

Considerations

Loss of muscle function (paralysis) is a major medical event.

In the U.S., the majority of paralysis results from stroke (cerebrovascular accident, CVA) or from trauma such as a spinal fracture (broken neck or back). The paralysis following strokes and spinal fractures can be severe and frequently is irreversible.

There are other causes of paralysis, including infectious diseases (such as polio), genetic diseases (such as peroneal dystrophy), autoimmune disease (such as amyotrophic lateral sclerosis, or ALS), and toxic conditions (such as botulism and paralytic shellfish poisoning).

Paralysis can be temporary or permanent; localized or widespread; one-sided (unilateral) or two-sided (bilateral); and can affect the lower extremities (paraplegic) or upper and lower extremities (quadriplegic). Paralysis can be an indication of a life-threatening problem such as Guillain-Barre syndrome.

IN EVERY SITUATION, MUSCLE PARALYSIS REQUIRES IMMEDIATE MEDICAL ATTENTION.

Common Causes

• Cerebrovascular accident (stroke)
• Bell's palsy
• Spinal cord injury
• Spinal fracture (broken neck or broken back)
• Poliomyelitis (polio)
• Amyotrophic lateral sclerosis (ALS)
• Botulism
• Paralytic shellfish poisoning
• Guillain-Barre syndrome

Home Care

If cranial nerves are damaged, there may be difficulty with chewing and swallowing. In these cases, a soft diet is recommended.

Prolonged immobility can cause serious complications; therefore, frequent position changes and good skin care are very important. Passive range-of-motion exercises may help to maintain some muscle tone and are encouraged.

The use of splints may help prevent muscle contractures.

In all cases, follow prescribed therapy.

Call your health care provider if

• There is any paralysis.

What to expect at your health care provider's office

The medical history will be obtained and a physical examination performed.

Medical history questions documenting paralysis in detail may include:

• Location
  • What part(s) of the body are affected?
  • Is the loss all over?
  • Is it on only one side of the body (hemiplegia)?
  • Is it from the waist down?
  • Is it from the neck down?
  • Did it develop in a top-to-bottom pattern (descending paralysis)?
  • Does it occur on both sides equally (symmetrical)?
  • Is it only one specific part of the body?
    • Is it the hips, legs, or feet (lower extremities)?
    • Is there difficulty getting out of a chair or climbing stairs (hip or pelvis)?
    • Is it the lower leg?
    • Is it the thigh?
    • Is it the knee?
    • Is it the ankle?
    • Does the foot drag or point towards the floor (footdrop)?
    • Is it the shoulders, arms, or hands (upper extremities)?
    • Is it the shoulder, upper chest, and upper arm (shoulder girdle)?
    • Is it the arm?
    • Is there difficulty lifting arm above head?
    • Does it cause inability to extend or lift the wrist (wrist drop)?
    • Is it the hand?
    • Is there difficulty gripping (grasping)?
• Quality
  • Is the person aware of the movement difficulty (motor deficit)?
  • Is there also pain?
  • Is there numbness, tingling, or loss of sensation?
• Time pattern
  • Has there been a spontaneous recovery?
  • Did it just develop recently?
  • Are episodes occurring repeatedly (recurrent)?
  • How long do episodes last?
  • Is it getting worse (progressive)?
  • Is it progressing slowly or rapidly?
  • Does it become worse over the course of the day?
  • At what age did this begin?
• Aggravating factors
  • Is it worse after exertion or use?
  • Is it worse during a period of rest after exercise?
  • Is it worse after taking potassium supplements - oral?
• Relieving factors
  • Is it better after you rest?
• Other
  • What other symptoms are also present?

The physical examination may include detailed examination of the nervous and muscular systems.

Diagnostic tests that may be performed include:

• Blood studies (such as CBC or blood differential)
• CT scan or MRI of the head or spine
• Nerve conduction studies and electromyography
• Myelography

Intravenous feeding or feeding tubes may be required in severe cases. Physical therapy, occupational therapy, or speech therapy may be recommended.

After seeing your health care provider:

You may want to add a note related to paralysis to your personal medical record.

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