Paraplegia or paraplegic syndrome is irreversible damage or severing of the spinal cord cross-section. Below the spinal cord transection, complete paralysis of the body usually occurs during the course of the disease.
What is paraplegia?
Paraplegia is partial or complete paralysis of the body caused by damage in the spinal cord (for example, from vertebral fractures). Depending on the amount of damage in the spinal cord, paralysis may affect only the lower extremities (legs) or all four extremities (legs and arms). A completely paralyzed patient who can no longer move all four extremities is called a quadriplegic. A distinction is made between plegia (complete paralysis) and paresis (partial paralysis). Also, the paralyzed person may still be able to move the limb a little, perceive temperature differences (hot and cold), or feel touch, although active movement itself is not possible. Paralysis may change from flaccid to spastic over the years.
Causes
The causes of paraplegia can be varied. In many cases, paraplegia occurs because of a traumatic event, such as the result of an accident or fall that irreversibly damaged the spinal cord. However, there may also be a cancer, a herniated disc, or a concomitant of multiple sclerosis that damages the spinal cord. Paraplegia should not be confused with symptoms of stroke, in which paralysis is usually hemiplegic on the right or left side. This is not the case with paraplegia; the paralysis occurs either in both legs or additionally in both arms. Nevertheless, one limb may retain more sensation than the other or minimal movement may still be possible in one arm.
Symptoms, complaints, and signs
Paraplegia has different symptomatology depending on the location and severity of the spinal cord injury. Generally, all areas of the body supplied by nerves at or below the injury are affected by symptoms. Complete paraplegia means loss of function of all muscles and no sensitivity at all on the inner thighs. There is complete incontinence. The function of the sexual organs comes to a standstill. If the injury occurred in the cervical vertebrae, breathing may also be affected. In contrast, incomplete paraplegia, in which not all nerve tracts are damaged, still allows sensitivity and motor skills. These depend on the site of injury. Thus, even in some cases, either only the arms can still be moved or only the sensation in the legs remains. If the arms are paralyzed, this also applies to the legs, but not necessarily vice versa. In some cases, individual motor skills are also preserved. At the beginning, the paralysis is such that the muscles become completely flaccid and cannot be tensed. Only after a few weeks does this flaccidity change into spasticity, which also resembles paralysis. The paraplegia itself does not cause any pain. If present, these are due to the injury that led to the paraplegia.
Diagnosis and course
The symptoms of paraplegia and the abilities that remain are highly individualized. Contrary to many opinions, the symptoms of paraplegia are not limited to the musculoskeletal system. Failure of the rectum and bladder sphincter may also occur, and the patient becomes incontinent. In emergency treatment, unconscious patients as a result of an accident are always assumed to have spinal injuries. For this reason, a splint or cervical collar is always used to stabilize the spine in such emergency patients. 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 surgery, cannot guarantee success, but rather should be considered attempts.
Complications
Paraplegia can result in various complications and sequelae. In addition, it may persist permanently, which has lifelong effects.A common complication of paraplegia is impaired bladder function to a greater or lesser degree. It depends on the level of spinal cord injury whether a spastic reflex bladder or a flaccid bladder occurs. A reflex bladder is said to occur when the reflex to empty the bladder is automatically stimulated or triggered when the bladder is filled. In a flaccid bladder, this reflex is absent because the contractions are missing. This increases the risk of urinary tract infections, some of which can take a complicated course. Another consequence of paraplegia is disturbances in the emptying of the rectum. Their extent depends on the level of injury. If damage occurs above the sacral medulla, the defecation reflex is absent for several weeks. In addition, the sphincter can no longer be controlled voluntarily. If complete destruction of the sacral medulla occurs, the bowel evacuation reflex disappears completely, requiring mechanical removal of the bowel contents. The most severe complications include reduction or even total loss of sensation. For this reason, careful control of the affected skin areas is necessary to prevent pressure ulcers (bedsores). Because the pain response is absent, there is a risk of unnoticed bone fractures or burns. Other possible sequelae of paraplegia include disturbances in blood pressure regulation, calcium deposits in the joints, thrombosis, and sexual impairment.
When should you see a doctor?
If limitations in range of motion occur after a fall, accident, or force, a doctor is needed. In paraplegia, the affected person can no longer initiate voluntary movements. It is not possible for him or her to control his or her limbs or to call for medical help by telephone. In addition, touching the skin or movements triggered by other persons can no longer be perceived. The musculature is completely flaccid. In many cases, paralysis of the entire body occurs. An emergency medical service should be alerted as soon as abnormalities become apparent, as there is an acute need for action. In order not to cause further damage, the instructions of the emergency service called must be followed. In the case of paraplegia, incontinence occurs immediately. The affected person immediately wets himself because the shooting muscle can no longer be controlled. This sign may be considered alarming by persons present. If at the same time no more stimuli are perceived on the inner side of the thighs, the affected person requires an ambulance. Paraplegia typically occurs suddenly. There is a triggering event that requires immediate action. Natural motor skills are no longer present within a few seconds.
Treatment and therapy
Long-term treatment is generally limited to physiotherapeutic measures that support passive mobility and attempt to promote any active movement options. Since 2010, stem cell treatment has been allowed for research in acute cases, as it achieved significant improvement in mobility to complete recovery of paralysis in animal studies. It is planned to treat about 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 does lead to a number of limitations that can bring complications. For example, thromboses, pneumonia or decubital ulcers (“bedsores”) can entail 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 walk again one day, succumbed to the consequences of an initially harmless pressure ulcer. Even a simple cold can turn into pneumonia due to immobility. Tetraplegics in particular are unable to cough properly and can develop serious problems here. Paraplegics are usually dependent on the use of a wheelchair, as well as on all-round care, especially quadriplegics, i.e. people who can no longer move all four extremities.For patients who can still move both arms, an independent life including the realization of the desire to have a child is still much more feasible. In most cases, after a certain period of acclimatization to the changed condition, help from nursing staff is no longer necessary. The younger the patient is at the time of his restriction, the sooner he will also be able to live independently.
Prevention
Paraplegia can usually be prevented by living a prudent, low-risk life. Abstaining from daredevil sports, such as rock climbing, hang gliding, or motorcycling (especially with racing machines) radically reduces the likelihood of one day developing paraplegia as a result of an accident. If you do not want to give up such sports or hobbies, you should at least strictly observe all common safety measures. These include, especially when riding fast motorcycles: Helmet, back and spine protectors, as well as the appropriate clothing.
Aftercare
Aftercare includes rehabilitation measures that are used depending on the extent of the spinal cord injury and the level of paralysis. Surgical procedures can stabilize bony structures. People with high levels of paraplegia participate in respiratory therapy to prevent fluid buildup in the lungs. Because paraplegics have impaired sensory perception, pressure damage can occur to the skin and tissue layers. Patients are therefore regularly repositioned to prevent bedsores. Follow-up care also includes drug treatment for neuropathic pain. Since spinal cord damage leads to impaired bladder and bowel function, bladder emptying is performed by catheterization. Urological checks should be performed at least once a year. In addition, individual nutritional counseling is important to counteract bowel emptying disorders and improve digestion. Physical and occupational therapy play a central role in follow-up care. In this way, motor skills can be maintained and regained. Coordination and balance exercises strengthen body awareness and make it easier to use the wheelchair. Sports therapy is an important part of holistic aftercare. Patients are introduced to sports that are well suited to them. The goals of therapy are to improve mobility, endurance and strength, and to motivate patients to lead an active lifestyle.
What you can do yourself
Paraplegia usually strikes patients suddenly and unexpectedly as a result of an accident. This traumatic event with its irreversible consequences is perceived by those affected as a severe blow of fate. In order to be able to cope 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 it possible to establish contact. These include, for example, the Fördergemeinschaft der Querschnittgelähmten in Deutschland e.V. (www.fgq.de) or the German Foundation for Paraplegia (www.dsq.de). The Austrian Rolli-Wegweiser (www.rolli-wegweiser.at) also goes into detail, answering questions about partnership and sex life. The research foundation Wings for life traces patients’ fates and provides information on the current state of science (www.wingsforlife.com). In the case of paraplegia, it is also advisable to maintain therapeutic measures such as physiotherapy and occupational therapy. They stabilize and at the same time keep things moving. Regular seat pressure measurements are also important in order to avoid the dreaded pressure ulcers (decubitus) with the right seat cushion. They occur when blood vessels are pinched off while sitting in a wheelchair.
