A paraplegia or paraplegia is an irreversible damage or severing of the spinal cord cross-section. In the course of the disease, there is mostly complete paralysis of the body below the spinal cord transection.
What is paraplegia?
Paraplegia is a partial or complete paralysis of the body caused by damage to the spinal cord (e.g. fractured vertebrae). See sportingology for Meaning of CD in English.
Depending on the extent of damage to the spinal cord, the paralysis can affect only the lower extremities (legs) or all four extremities (legs and arms). A patient who is completely paralyzed and unable to move all four extremities is called a tetraplegic.
A distinction is made between plegia (complete paralysis) and paresis (partial paralysis). It can also happen that the paralyzed person can still move the limb a little, perceive temperature differences (hot and cold) or feel touch, although active movement itself is not possible. Paralysis can progress from flaccid to spastic over the years.
The causes of paraplegia can be varied. In many cases, paraplegia occurs as a result of a traumatic event, for example as a result of an accident or fall, in which the spinal cord has been irreversibly damaged.
But there can also be cancer, a herniated disc or a side effect of multiple sclerosis that damage the spinal cord. Paraplegia should not be confused with the symptoms of a stroke, in which the paralysis usually occurs on one side on the right or left.
This is not the case with paraplegics, the paralysis occurs either in both legs or additionally in both arms. However, one limb may retain more sensitivity than the other, or minimal movement in an arm may still be possible.
Symptoms, Ailments & Signs
Paraplegia has different symptoms that depend on the location and severity of the spinal cord injury. Basically, all parts of the body that are supplied by nerves at or below the injury are affected by symptoms.
A complete paraplegia means a loss of function of all muscles and no sensitivity on the inside of the thighs. Complete incontinence occurs . The function of the sex organs comes to a standstill. If the injury occurred in the area of the cervical vertebrae, breathing can also be affected.
In contrast, an incomplete paraplegia, in which not all nerve tracts are damaged, still allows sensitivity and motor skills. These can be seen depending on the injury site. In some cases, either only the arms can still be moved or only the feeling in the legs remains. If the arms are paralyzed, so are the legs, but not necessarily the other way around. In some cases, individual motor skills are also retained.
Initially, the paralysis is such that the muscles go completely limp and cannot be contracted. Only after a few weeks does this slackness turn into spasticity, which is also like paralysis. The paraplegia itself does not cause any pain. These are – if any – due to the injury that led to paraplegia.
Diagnosis & History
The symptoms of paraplegia and the remaining abilities are very individual. Contrary to many opinions, the symptoms of paraplegia are not limited to the musculoskeletal system. The rectum and bladder sphincter can also fail, and the patient becomes incontinent.
In emergency treatment, spinal injuries are always assumed in unconscious patients as a result of an accident. For this reason, such emergency patients always use a splint or a neck brace to stabilize the spine.
There are a number of immediate measures that can be taken to try to stop the paralysis or prevent worse damage. However, many of these measures, which range from various infusions to emergency operations, cannot guarantee success and should rather be seen as attempts.
Paraplegia can result in various complications and secondary diseases. In addition, it can be permanent, which has lifelong effects. A frequent complication of paraplegia is impaired bladder function, which is more or less severe. The severity of the spinal cord injury determines whether a spastic reflex bladder or a flaccid bladder occurs.
A reflex bladder occurs when the reflex to empty the bladder is automatically stimulated or triggered when the bladder is full. If the bladder is flaccid, this reflex does not occur because there are no contractions. This increases the risk of urinary tract infections, some of which take a complicated course.
Also among the consequences of paraplegia are disturbances in the emptying of the rectum. Its extent depends on the extent of the injury. If damage occurs over the sacral cord, the bowel evacuation reflex fails for a few weeks. In addition, the sphincter can no longer be controlled voluntarily.
With complete destruction of the sacral cord, the defecation reflex disappears completely, requiring mechanical removal of the bowel contents. The most serious complications include the reduction or even total loss of sensation. For this reason, careful control of the affected skin areas is necessary to prevent pressure sores (bedsores) from developing.
Because there is no pain reaction, there is a risk of unnoticed bone fractures or burns. Other possible consequences of paraplegia are disorders of blood pressure regulation, calcium deposits in the joints, thrombosis and sexual impairment.
When should you go to the doctor?
A doctor is required if mobility is restricted after a fall, accident or the effects of violence. In the case of paraplegia, the person affected can no longer initiate voluntary movements. He himself is unable to control his limbs or call for medical help by telephone.
In addition, touching the skin or movements triggered by other people can no longer be perceived. The muscles are completely relaxed. In many cases, there is paralysis of the entire body. An emergency service is to be alerted as soon as any abnormalities become apparent, as there is an acute need for action. In order not to cause any further damage, the instructions of the called emergency center must be followed.
In the case of paraplegia, incontinence occurs immediately. The affected person wets the bed immediately because the shooting muscles can no longer be controlled. This sign can be classified as alarming by those present. If at the same time no more stimuli are perceived on the inside of the thighs, the affected person needs an ambulance.
Paraplegia typically occurs suddenly. There is a triggering event that requires immediate action. The natural motor skills are gone within a few seconds.
Treatment & Therapy
Long-term treatment is usually limited to physiotherapeutic measures that support passive mobility and try to promote any active movement options. Since 2010, treatment with stem cells in acute cases has been permitted for research, as animal experiments have shown a significant improvement in mobility up to the point of complete healing of the paralysis.
It is planned to treat around 20 patients in this way for the first time. Paraplegia itself can be fatal in the acute phase, after which the disease itself is no longer potentially fatal. However, it leads to a number of limitations that can lead to complications. For example, thrombosis, pneumonia or decubitus ulcers (” bed sores “) can have serious health consequences that can be fatal.
The American Superman actor Christopher Reeve, who was paralyzed from the neck down and who was characterized by his irrepressible will to be able to walk again one day, which was well known in the media, succumbed to the consequences of an initially harmless pressure sore. Even a simple cold can turn into pneumonia due to immobility. Tetraplegics in particular are not able to cough up properly and can have serious problems here.
Paraplegics are usually dependent on the use of a wheelchair and on all-round care, especially tetraplegics, i.e. people who can no longer move all four extremities. In the case of patients who can still move both arms, an independent life, including the realization of the desire to have children, is much easier to achieve.
Here, after a certain period of getting used to the changed condition, no help from nursing staff is usually required. The younger the patient is at the time of his disability, the sooner he will be able to live independently.
Paraplegia can usually be prevented by living a prudent and low-risk life. Avoiding daring sports such as climbing, hang-gliding or motorcycling (especially with racing machines) radically reduces the probability of getting paraplegia from an accident one day.
If you don’t want to do without such sports or hobbies, you should at least strictly comply with all common safety measures. This includes, especially when riding fast motorcycles: helmet, back and spine protectors and appropriate clothing.
Follow-up care includes rehabilitation measures that are used depending on the extent of the spinal cord injury and the level of paralysis. Surgical measures can stabilize bony structures. People with a high degree of paraplegia take part in respiratory therapy, which is intended to prevent fluid from accumulating in the lungs.
Since paraplegics have impaired perception, pressure damage can occur on the skin and tissue layers. Those affected are therefore regularly repositioned to prevent bedsores (decubitus). Follow-up care also includes drug treatment for neuropathic pain.
Since spinal cord damage leads to impaired bladder and bowel function, the bladder is emptied by catheterization. Urological checks should be carried out at least once a year. In addition, individual nutritional advice is important in order to counteract defecation disorders and improve digestion.
Physiotherapy and occupational therapy play a central role in aftercare. In this way, motor skills can be maintained and regained. Coordination and balance exercises improve body awareness and make it easier to use the wheelchair.
Sports therapy is an important part of holistic aftercare. Those affected are introduced to sports that are well suited to them. The goals of the therapy are to improve mobility, endurance and strength as well as to motivate you to lead an active lifestyle.
You can do that yourself
Paraplegia usually strikes patients suddenly and unexpectedly as a result of an accident. Those affected perceive this traumatic event with its irreversible consequences as a severe stroke of fate. In order to be able to deal better with this stroke of fate, it is advisable to start intensive psychotherapeutic treatment as soon as possible. This also applies to the relatives and partners of the affected patients.
Contact with fellow patients also helps to stabilize the soul. In many cities there are self-help groups that meet regularly to exchange ideas. Many organizations and associations also provide information on the Internet and make contact possible. These include, for example, the Association for the Promotion of Paraplegics in Germany (www.fgq.de) or the German Foundation for Paraplegia (www.dsq.de). The Austrian Rolli guide (www.rolli-wegweiser.at), which also answers questions about partnership and sex life, also goes into detail. The Wings for life research foundation traces the fates of patients and provides information on the current state of science (www.wingsforlife.com).
In the case of paraplegia, it is also advisable to continue with therapeutic measures such as physiotherapy and ergotherapy. They stabilize and at the same time keep things moving. Regular seat pressure measurements are also important in order to avoid the dreaded pressure sores (decubitus) with the right seat cushion. They develop when blood vessels are pinched off when sitting in a wheelchair.