Paraplegia can occur after a spinal cord injury (SCI), which is damage to the vertebrae, ligaments, or disks of the spinal column. It is the loss of muscle function in the lower half of the body, including both legs. It refers to complete or partial paralysis in both legs and, in some people, parts of the lower abdomen.
People sometimes use the term “paraplegia” interchangeably with “paraparesis,” which is partial paralysis in the lower body due to muscle weakness and stiffness. Loss of function tends to correspond to the level in the spinal cord where damage occurred. People with damage to the upper part of the spinal cord are called quadriplegics or tetraplegics. People with damage below this level are called paraplegic.
Affected body areas of an SCI
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View full-sizeDownload The lower end of the spinal cord stops a little above the waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina and is known as Caudia equina Syndrome.
An injury below the first lumbar vertebra does not cause SCI. But it may cause cauda equina syndrome, which is an injury to the nerve roots in the lower spine. Many spinal cord injuries and cauda equina syndrome cases are medical emergencies and need surgery right away.
Symptoms or characteristics Symptoms vary, depending on the location of the injury. SCI causes weakness and loss of feeling at, and below the injury. The severity of the symptoms depends on whether the entire cord is injured (complete) or only partially injured (incomplete).
The ability to control the limbs after a spinal cord injury depends on two factors: where the injury occurred on the spinal cord and the severity of injury. At a higher level of injury, a condition known as autonomic dysreflexia, may develop. This condition can be triggered by a variety of factors, including distended bladder, distended bowel and skin or pressure sores. The symptoms of this condition include raised temperatures, profuse sweating, high blood pressure, headaches, slow pulse rate and blackouts.
There is a huge variation with symptoms and level of pain vary. Some people experience pain and various complications, and others are relatively healthy with little need for medication. The loss of sensation can mean that pain is at a low level. Some people, on the other hand, experience intense pain.
Spinal cord injuries can cause one or more of the following signs and symptoms:
Loss of movement and numbness
Increased muscle tone (spasticity) that causes exaggerated reflex activities or spasms
Loss of or altered sensation, including the ability to feel heat, cold and touch
Loss of bowel or bladder control, may include constipation, incontinence, bladder spasms
Changes in sexual function, sexual sensitivity and fertility
Pain or an intense stinging sensation caused by damage to the nerve fibers in the spinal cord
Difficulty breathing, coughing or clearing secretions from the lungs because of weakness of the abdominal, diaphragm, or intercostal (rib) muscles
Diagnosis Paraplegia is diagnosed by medical professionals. Causes Spinal cord injuries can result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself. A traumatic spinal cord injury can stem from a sudden, traumatic blow to the spine that fractures, dislocates, crushes or compresses one or more of the vertebrae. It can also result from a gunshot or knife wound that penetrates and cuts the spinal cord.
Additional damage usually occurs over days or weeks because of bleeding, swelling, infection, inflammation and fluid accumulation in and around the spinal cord. This can press on the spinal cord and damage it. Most spinal cord injuries are caused by accidents that result in the spine being damaged or out of alignment. Common causes are:
Motor accident
Diving mishap
Falls
Acts of violence or physical assault
Sporting accident
Household accident
The majority of people who have a spinal cord injury are young males (who have a greater tendency to indulge in risky behaviour). However, there are people from both sexes and of all ages with spinal cord damage.
A nontraumatic spinal cord injury (low impact) often occurs in older adults from falls while standing or sitting. The injury is due to a weakened spine from aging or bone loss which can cause direct injury or damage to the spinal cord. Low impact spinal cord injuries are caused by:
A tumour or blood clot on the spinal cord
Diseases such as cancer, arthritis, osteoporosis, infection and inflammation
Ageing - (spinal stenosis) the spinal canal becomes smaller (tighter) and that squeezes on the spinal cord
Disc herniation is when the spinal cord disc pushes against the spinal cord
Disc degeneration of the spine, results in vertebrae bone on bone that trap or sever nerves
Severe bruising around the spine when the vertebrae have been weakened, loosened, or fractured
Fragments of bone (such as from broken vertebrae, which are the spine bones) in the spinal cord
No matter what the cause is of the spinal cord injury, the amount of function lost tends to correspond to the level in the spinal cord where the damage takes place. At all levels, there is usually some loss of function in the bowel and bladder.
People with injuries in the lower back can have sensation and movement right to the hips. They can usually live totally independently with a minimum of help, as long as they can use a wheelchair and have the necessary alterations to their home, their bathroom and car. Risk factors Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors can predispose you to being at higher risk of having a spinal cord injury, including:
Being male. Spinal cord injuries affect a disproportionate number of men. In fact, females account for only about 20% of traumatic spinal cord injuries in the United States.
Being between the ages of 16 and 30. More than half of spinal cord injuries occur in people in this age range.
Being 65 and older. Another spike in spinal cord injuries occurs at age 65. Falls cause most injuries in older adults.
Alcohol use. Alcohol use is involved in about 25 % of traumatic spinal cord injuries.
Engaging in risky behavior. Diving into too-shallow water or playing sports without wearing the proper safety gear or taking proper precautions can lead to spinal cord injuries. Motor vehicle crashes are the leading cause of spinal cord injuries for people under 65.
Having certain diseases. A relatively minor injury can cause a spinal cord injury if you have another disorder that affects your joints or bones, such as osteoporosis.
Complications At first, changes in the way the body functions can be overwhelming. The rehabilitation team will helps to develop tools to address the changes caused by the spinal cord injury, in addition to recommending equipment and resources to promote quality of life and independence. Areas often affected include:
Bladder control. The bladder will continue to store urine from your kidneys. However, the brain might not control your bladder as well because the message carrier (the spinal cord) has been injured. The changes in bladder control increase the risk of urinary tract infections. The changes may also cause kidney infections and kidney or bladder stones.
Bowel control. Although the stomach and intestines work much like they did before your injury, control of bowel movements is often altered. A high-fiber diet might help regulate the bowels. Bowel management strategies are recommended.
Pressure injuries: There will be loss of some or all skin sensations below the neurological level of the injury. Therefore, the skin can't send a message to the brain when it's injured by certain things, such as prolonged pressure. This can make the client more susceptible to pressure sores, but changing positions frequently—with help, if needed—can help prevent these sores.
Circulatory control. A spinal cord injury can cause circulatory problems ranging from low blood pressure when on rising (orthostatic hypotension) to swelling of the extremities, arms and legs. These circulation changes can also increase the risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus. Another problem with circulatory control is a potentially life-threatening rise in blood pressure (autonomic dysreflexia).
Respiratory system. The injury might make it more difficult to breathe and cough. The abdominal and chest muscles are affected. The client's neurological level of injury will determine what kind of breathing problems they will have. If they have a cervical and thoracic spinal cord injury, they might have an increased risk of pneumonia or other lung problems. Medications and therapy can help prevent and treat these problems.
Bone density. After spinal cord injury, there's an increased risk of osteoporosis and fractures below the level of injury.
Muscle tone. Some people with spinal cord injuries have one of two types of muscle tone problems: uncontrolled tightening or motion in the muscles (spasticity) or soft and limp muscles lacking muscle tone (flaccidity).
Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal cord injury. Limited mobility can lead to a more sedentary lifestyle, placing the client at risk of obesity, cardiovascular disease and diabetes. A dietitian can help you eat a nutritious diet to sustain an adequate weight. Physical and occupational therapists can help you develop a fitness and exercise program.
Sexual health. Men might notice changes in erection and ejaculation; women might notice changes in lubrication after a spinal cord injury. Physicians specializing in urology or fertility can offer options for sexual functioning and fertility.
Pain. Some people have pain, such as muscle or joint pain, from overuse of particular muscle groups. Nerve pain can occur after a spinal cord injury, especially in someone with an incomplete injury.
Depression. Coping with the changes a spinal cord injury brings and living with pain causes depression in some people.
Treatment Antibiotics are generally used to cure urinary tract infections. Some people use cranberry juice and other herbal remedies as a preventative. Some people take medication for muscle spasm. Others with slight spasm prefer not to. Rehabilitation, medication and medical devices allow many people with spinal cord injuries to lead productive, independent lives. Given the right sort of equipment and adaptations to buildings, people with spinal cord injury can do most things that the rest of the community can. They can:
Work
Study
Enjoy recreation
Socialise
Have relationships
Have a family of their own.
Sometimes though, they do these things in a slightly different way to the majority of the community.
Handicaps result from ignorance, not the injuries
Many handicaps encountered by people with spinal cord injuries actually result from lack of consideration. Services in the community often do not cater for their needs. Without adequate access arrangements, these services may be inaccessible:
Public buildings
Shops
Theatres
Restaurants
Public transport
There has been some improvement in this area since the introduction of the Disability Discrimination Act.
Amazing Insights Ashley Treseder is an athlete who has given HWH permission to use his Facebook post, 20 September 2020.
Click on the fun facts link below and read about spinal cord injury (SCI) from Ashley's point of view, it contains honest and valuable insights for support workers. As you read through his post you will see he clearly has a witty sense of humour (and some sarcasm) that serves him well. 'Fun Facts'
Thanks go to Tim MacQuire who arranged permission to share this post (Tim is an ex-HWH employee).
Note Medical conditions MUST always be diagnosed by a medical professional. This information has been structured to provide basic information to HWH Support Workers and Clinical Care Managers
