Paraplegia

Paraplegia, sometimes called partial paralysis, is a form of paralysis in which function is substantially impeded from the waist down. Most people with paraplegia have perfectly healthy legs. Instead, the problem resides in either the brain or the spinal cord, which cannot send or receive signals to the lower body due to an injury or disease.

Like other forms of paralysis, paraplegia substantially varies from one person to another. While the stereotype of a paraplegic is of someone in a wheelchair who cannot move his or her arms or legs, cannot feel anything below the waist, and cannot walk, paraplegics actually have a range of capabilities that may change over time, both as their health evolves and their physical therapy helps them learn to work around their injuries.

What is Paraplegia?

Paraplegia is almost always the result of damage to the brain, spinal cord, or both. In most cases, spinal cord injuries to the thoracic, lumbar, or sacral spinal cord are to blame. When these injuries occur, signals cannot travel to and from the lower regions of the body, and the body is prevented from sending signals back up the spinal cord to the brain. Thus paraplegics not only struggle with movement below the waist; they also experience extensive loss of sensation. This sensation loss varies from a feeling of tingling or reduced feeling in the waist and legs, to a complete inability to feel anything below the waist.

Some injuries produce temporary paralysis in one or both legs. Even a broken leg can look like paraplegia in the right circumstances, as can the aftermath of a seizure, allergic reaction, and some surgical compilations. Consequently, doctors should not be quick to diagnose paraplegia immediately after an injury. Instead, it can take anywhere from a few hours to several days to diagnose this condition. Your doctor will need to look at your brain and/or spinal cord to see if there are damaged nerves or tissue that impede the ability of signals to travel to and from the legs. Those tests might include:

• Blood tests to assess whether an infection, cancer, or other problem contributes to the paraplegia. 
• A lumbar puncture to remove a small quantity of fluid from your spinal cord and assess its function. 
• CT scans or MRIs to see your brain and spinal cord. 
• Myelography X-rays to envision your spinal cord and brain. 

What Causes Paraplegia?

The overwhelming majority of paraplegics have perfectly healthy legs. The problem instead resides in the brain or spinal cord. The spinal cord is akin to the body's relay system, sending signals down into the body from the brain and relaying signals from the body to the brain. The brain processes and makes sense of these signals, before sending important information about how to react and feel down the spinal cord and back to the body.

When either the brain or spinal cord don't work properly, these signals may be weak or nonexistent. Consequently, spinal cord injuries—which affect more than 200,000 Americans, with more than 2,500 new cases each year—are the leading cause of paralysis, including paraplegia. The leading causes of spinal cord injuries include:

• Car and motorcycle accidents (38%)
• Falls (30%)
• Violence, the most common source of which is gunshot wounds (14%)
• Sports and recreational activities, with diving accidents leading the way (9%)
• Medical or surgical injuries (5%)

Most spinal cord and brain injuries are traumatic in nature, which means they result from a sudden blow to the area, usually due to an accident. Some injuries, though, are non-traumatic, and usually attributable to diseases or genetic anomalies. A few other causes of paraplegia include:

• Strokes, the most common cause of non-traumatic paraplegia. 
• Genetic disorders, such as hereditary spastic paraplegia. 
• Oxygen deprivation to the brain or spinal cord due to choking, childbirth complications, and other injuries. 
• Autoimmune disorders. 
• Infections of the brain or spinal cord. 
• Tumors, lesions, or cancer of the brain or spinal cord. 
• Spinal cord disorders such as syrinx. 

How Does Paraplegia Affect the Body?

Paraplegia is a variable condition. The same person might experience symptoms that change over time, or that even alter from day to day. Proper treatment can greatly affect the prognosis and progression of the disease, but many outcomes appear random. There's much we do not yet understand about the brain and spinal cord, so doctors aren't yet sure why some people spontaneously recover while others languish without progress even with intense treatment.

In some cases, symptoms improve as swelling in the injured area dissipates. Treatment of infection and disease-related processes may also reduce or reverse symptoms, or slow the progression of paraplegia. Thus the best source for information on how paraplegia might affect your life is your doctor. Know, however, that even the best doctors cannot be certain about the prognosis, and you should not allow even a grim prognosis to undermine your motivation to keep working toward recovery.

Some of the most common effects of paraplegia include:

• Loss of sensation below the site of the injury. Higher injuries will typically produce greater loss of sensation. 
• Phantom sensations in the body, unexplained pain, electrical sensations, or other intermittent feelings in the lower half of the body. 
• A decrease in or loss of sexual function, libido, or fertility. 
• Difficult with bladder and bowel function. 
• Loss of mobility below the waist. 
• Changes in mood; depression is common among people with a new paraplegia diagnosis. 
• Weight gain, particularly if your caloric intake is not adjusted to account for your reduced activity level. 
• Secondary infections in the lower half of the body, particularly bedsores and skin problems. 
• Secondary problems at the site of the injury, such as infections or lesions. 
• Chronic pain. 

How is Paraplegia Treated?

Every patient is different, and treatment that works well for you might not work for another person. Generally speaking, intensive treatment gives you the best chance at recovery, particularly when you begin receiving treatment immediately after the injury. Spinal Cord Injury Model Systems offer comprehensive and highly rated treatment, so if such a facility is near you, consider moving your recovery to that location.

Some treatment options include:

• Surgery to address swelling at the site of the injury, remove lesions, or remove embedded objects. 
• Spinal cord alignment surgery. 
• Secondary surgeries to address other problems, such as muscle injuries resulting from your paraplegia. 
• Medications to reduce your risk of infection, blood clots, and other secondary issues. 
• Physical therapy to help you regain as much function as possible by teaching your brain and spinal cord how to work around the injury. Physical therapy can also help you slow the loss of muscle tone below the injury. 
• Exercise therapy to help you remain in good physical shape and reduce chronic pain. 
• Psychotherapy to help you adopt new coping skills for managing your injuries. 
• Education about your injuries, advocacy programs, and family support groups. 
• Occupational training and therapy to help you learn new skills, regain old ones, and find new ways to work around your injuries. 
• Alternative modalities; only use these with the consent of your doctor, but some paraplegics have excellent luck with acupuncture, massage, chiropractic, and other holistic treatments.