What are the Difficulties of Being Paraplegic?

Paraplegia is a type of spinal cord injury or damage, resulting in the inability to feel or produce movement. It affects the legs only, with arm and hand function preserved.

Some common causes of paraplegia are trauma (such as motor vehicle accidents, gunshot wounds and falls), tumors and disease (such as spina bifida and multiple sclerosis).

Features

• Caused by spinal cord damage, paraplegia is a medical diagnosis involving paralysis of the lower extremities, in which there is partial or complete loss of sensation and movement. Other principle symptoms include loss of urinary and bowel control, as well as fertility problems in men.
  The spinal column consists of four centralized areas:
  - Cervical (the neck region)
  - Thoracic (the upper, mid-back region)
  - Lumbar (the lower back area)
  - Sacral (the hip region).
  Paraplegia involves spinal cord damage occurring at the thoracic level or below.

Significance

• Because paraplegia causes partial or complete impairment of sensation and movement, the individual is at risk of developing other medical conditions such as: decubitus ulcers, osteoporosis, spasticity, pneumonia and deep vein thrombosis (DVT). They may also experience neuropathic pain.

Types

• In addition to the level of damage, its specific location on the spinal cord also determines the extent of functionality possible.
  Central Cord Syndrome: Damage is in the center of the spinal cord, resulting in loss of arm function. Recovery usually begins in the legs and then moves upward.
  Anterior Cord Syndrome: Damage is located in front of the spinal cord, as the person is unable to experience pain, touch sensation or temperature. Recovery of some movement is possible.
  Posterior Cord Syndrome: Located in back of the spinal cord, damage or injury to this area will allow the person to experience pain and temperature sensation. Movement is generally preserved, although there may be coordination problems.
  Cauda Equine Lesion: Damage or injury occurring in the lumbar region of the spine within the nerves extending out of the spinal cord, may cause either partial or complete loss of sensation and movement. It is possible for these nerves to grow back, allowing for a complete recovery.
  Brown-Sequard Syndrome: Injury or damage is located on either side of the spinal cord, causing partial or total loss of movement on the injured side, while preserving sensations of pain and temperature. On the side opposite of damage, movement will be normal as sensations of pain and temperature will be completely lost or impaired.

Prevention/Solution

• Deep vein thrombosis is a very serious, potentially fatal medical complication for those who are paraplegic, especially in the early stages after damage has occurred. Blood clots may form in the lower extremitities, become dislodged, passing through the lungs. Mechanical devices and anticoagulants should be administered. Family members must be educated in order to recognize and prevent deep vein thrombosis.
  Decubitus ulcers are caused by unrelieved pressure on body surfaces, as well as friction and shearing forces. Paraplegic individuals must be turned and repositioned at least every 2 hours, as well as given meticulous incontinent care as needed. Sheep skin and special mattresses should also be used. Care must be taken to keep the skin clean and dry. Clothing should be light and loose-fitting.
  Individuals with spinal cord injury develop osteoporosis due to their inability to maintain normal muscular activity, or to bear weight. This causes bones to become weak and prone to fracture. In order to help prevent osteoporosis and muscle spasticity, range of motion exercises should be administered. Use of special medical instruments should also be included as part of overall therapy and rehabilitation.
  Pneumonia risk is increased significantly in paraplegics when the muscles of the rib cage (intercostals) and abdominals are paralyzed. There is very little deep breathing or coughing; this can lead to lung infection. To prevent pneumonia, those with spinal cord injury or damage must be given percussion and respiratory therapy. Also the use of special abdominal binders can be administered to assist with breathing.

Considerations

• Another rare type of paraplegia exists; hereditary spastic paraplegia (HSP) consists of an inheritable group of some 30 different kinds of neurological disorders. The disease generally involves the progressive weakness of the lower extremities of which there is no cure.