COVID-19 updates, including vaccine information, for our patients and visitors Learn More

Menu
Search

Paralysis

Paralysis can result from a disease of the muscle, or from an injury to nerves, the spinal cord, or the brain. It can affect a small or large area, just one side of the body, and can be permanent or temporary.

Our physicians have expertise in restoring movement and function for individuals living with paralysis due to:

We also correct facial nerve disorders, restore function following a stroke, and enhance walking abilities. Learn more about treatments and procedures below.

Spinal Cord Injuries

UC San Diego Health offers a multidisciplinary program for restoring function to people with spinal cord injuries.

Unlike the peripheral nerves, cells in the spinal cord do not regenerate after an injury. Damage to the spinal cord can impact body function, strength and sensation, causing loss of feeling, weakness and paralysis.

Level of Spinal Cord Injury: Restoring Function

Spinal Cord Injury LevelsFunction We Restore at UC San Diego Health For Specific Spinal Injuries

 C1-C3

Breathing using phrenic nerve pacer or ventilator.

 C3-C4

Basic arm function (elbow flexion) using a nerve transfer.

 C5-C6

Grasp and release function, and triceps function

 C7-C8

More sophisticated grasp and release and finer hand movements.

 T1

Intrinsic balance to the hands.
 T2-T9Sensation to lower extremities via nerve transfer. Possibility of improving lower extremity function using spinal cord stimulation.*
 T10-T12Some hip movement and extension as well as sensation to proximal legs.
 L1-L2Hip extension with a nerve transfer (nerve transfer only used for those with some hip movement).
 L3-L4Improved walking with a nerve transfer (transfers only used in those who have some hip flexion and knee extension).
 L5-S1Ankle stability via a nerve or tendon transfer.

*NOTE: All patients with some movement in lower extremities may be considered as candidates for epidural stimulation to improve movement or reduce spasms.

Using epidural spinal cord stimulation, we can improve standing and walking in people who have cervical and thoracic level injury.

Spinal Cord Injury Surgery & Treatment

Recovering even partial arm and hand function after a spinal cord injury can have an enormous impact on independence and quality of life. Our surgeons use the latest surgical techniques and treatments to improve level of functioning.

Surgical and nonsurgical treatment techniques we use:

  1. Nerve transfer: Nerves with the best control are transferred to the most important muscle groups to improve function in that limb.
  2. Tendon transfer: The most common procedure for restoring function. A tendon is moved from one point to another to improve joint function. Tendon transfers offer functional gains for an estimated 70 percent of tetraplegic patients.
  3. Selective peripheral neurotomy: Nerves are trimmed to reduce spasticity.
  4. Phrenic nerve stimulator: Patients dependent on a ventilator have the option of a surgically implanted phrenic nerve stimulator which frees them from ventilator dependency.
  5. Spinal cord stimulation: Electrodes placed in the space outside of the thick membrane that surrounds the spinal cord (the dura) to reduce pain and spasticity through nerve stimulation. Can also help with movement control.

Spinal Cord Stimulation

How does spinal cord stimulation work?

Electrodes are strategically placed into the space outside of the dura (covering of spinal cord). These electrodes are connected to a small pulse generator that is placed under the skin.

The exact site of stimulation is critical for obtaining the desired effects.

Is spinal cord stimulation right for you?

To determine whether you are a candidate for epidural spinal cord stimulation, you will first undergo trial stimulator placement.

A trial stimulator placement involves insertion of an electrode (using a needle and local anesthesia). This simple procedure is done in an outpatient setting. Once the electrode is inserted, you will begin treadmill training with a body-weight support system (to help restore more natural gait pattern), and be given a generator to carry for one week.

If results are positive, our team will proceed with surgical placement of a paddle lead. Paddle leads offer more precise stimulation to targeted nerves and can activate the most ideal parts of the spinal cord. Unlike wire leads, which can move out of place over time, paddle leads are designed for long-term placement.

Phrenic Nerve Pacer

What Is A Phrenic Nerve Pacer?

A phrenic nerve pacer is an implantable device that provides ventilatory support for people who have lost the ability to breathe independently due to a condition such as  sleep apnea or injury such as spinal cord injury.

An electrode and receiver are surgically implanted (electrode placed on the phrenic nerve and receiver just under the skin) and external antenna and transmitter are worn on top of the skin.

How Does It Work?

Radiofrequency energy from the transmitter is converted into pulses and sent to the electrode, causing the diaphragm to contract. The result is a breathing pattern that’s more natural than a mechanical ventilator.

Benefits Over Mechanical Ventilator

Some people who have a high spinal cord injury (damage to phrenic nerve) will require a ventilator to help them breathe.

Those who don't want to be dependent on a ventilator have the option of a surgically implanted phrenic nerve simulator.

Advantages of phrenic nerve stimulators over mechanical ventilators:

  • Allows normal speech and breathing
  • Makes eating and drinking easier
  • Small and unobtrusive
  • Implants are made to last a lifetime
  • Cost effective

Restoring Function After Stroke

UC San Diego Health takes a comprehensive approach to arm, hand and leg dysfunction following stroke or brain injury. Using novel and innovative treatments, our stroke restoration specialists are able to bring back the functionality and quality of life.

Difficulty controlling movement and partial paralysis hemiplegia and hemiparesis (weakness on one side of the body) are some of the most common side effects of a stroke. Specifically, stroke can result in difficulty moving the arm, opening and closing the hand, and walking.

After a stroke, the nervous system attempts to “rewire” and repair itself to compensate for the lost motor systems. In many cases, the nervous system is unable to restore normal control to all of the muscles.

Some muscles do not respond at all, while others are significantly overactive, resulting in dysfunctional postures of the arm and hand. These dysfunctional muscles at times hide muscles that may actually have good control.

Surgery and Treatment

Rehabilitation is usually tried for a year before surgery or other treatments are considered.

Treatment techniques our team uses to restore function:

  1. Botox injections
  2. Partial cutting of an overactive nerve (neurotomy)
  3. Transfer of nerves to restore function to inactive muscles (nerve transfer)
  4. Lengthening or cutting of tendons that become shortened and immobile
  5. Rerouting of tendons to balance forces across a joint (tendon transfer)

Online Second Opinions

If you've received a diagnosis that requires neurosurgery and would like one of our neurosurgeons to review your X-rays and other imaging studies, UC San Diego Health offers online imaging reviews. It's an easy and affordable way to help you make an informed decision before neurosurgery. For more information, see Online Second Opinions.