Paraplegia | Paraplegic: Definition, Causes, Symptoms and Treatment

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 is Incomplete Paraplegia?

There may be occasions where paraplegia doesn’t fully affect both legs. For example, one leg may be fully paralyzed, while the other has limited or even normal function. This is sometimes known as “incomplete paraplegia,” and can be the result of many different conditions.

In some cases, a case of complete paraplegia may evolve into a case of partial paraplegia following rehabilitation therapy and other treatments for paraplegia. On the other hand, a degenerative condition may cause a case of incomplete paraplegia to become complete paraplegia as symptoms progress.

Complete vs Incomplete Paraplegia

The primary difference between complete and incomplete paraplegia is whether the paraplegic retains some (or most) of their functionality in either leg. Where a complete paraplegic might not have any functionality or sensation in both legs, a case of incomplete paraplegia may leave the paraplegic with some sensation or motor control.

When some functionality remains in either leg, it may also be referred to as paraparesis, though there is some debate as to whether it should be referred to as such.

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 (SCIs)—which affect more than 200,000 Americans, with more than 2,500 new cases each year—are the leading cause of paralysis, including paraplegia. According to data from the National Spinal Cord Injury Statistical Center (NSCISC), the leading causes of spinal cord injuries include:

• Car and motorcycle accidents (38.3%)
• Falls (31.6%)
• Violence, the most common source of which is gunshot wounds (13.8%)
• Sports and recreational activities, with diving accidents leading the way (8.2%)
• Medical or surgical injuries (4.6%)
• Other/unspecified (3.5%)

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.

Most SCIs that result in paraplegia occur in the thoracic, sacral, or lumbar sections of the spinal cord—not in the cervical spinal cord, which is closer to the neck. This is because a C6 spinal cord injury or higher is likely to affect more of the body than just the legs. Instead, this type of spinal injury is more likely to result in full-body paralysis, hemiplegia, or hemiparesis.

Paraplegia Recovery

Paraplegia recovery can be a long and difficult process as paraplegics learn to cope with their paraplegia symptoms. There are numerous steps to recovering from paraplegia—steps that may change depending on the cause and severity of the condition.

Some basic steps to paraplegia recovery include:

1. Seek Immediate Medical Attention after an Injury. Timely care following a major TBI or SCI can have an enormous impact on the severity of symptoms and even the likelihood of survival. High-quality treatment and care can help prevent the exacerbation of injuries, which helps to limit the severity of paraplegia symptoms (such as keeping a case of incomplete paraplegia from becoming complete paraplegia).
2. Investigate Your Paraplegia Recovery Options. From surgical treatments, to rehabilitation therapy, to dietary changes, it’s important to investigate all of your potential avenues of recovery. While a perfect paraplegia treatment doesn’t exist (yet), many of these recovery options can help to alleviate the side effects of paraplegia and help improve the quality of life for paraplegics.
3. Try to Locate Paraplegia/Paralysis/SCI Support Groups. There are numerous support groups for paraplegics and others who live with some form of paralysis (and their loved ones). Many of these groups can help provide a place to find good advice and support. Additionally, they may be able to point paraplegics and their loved ones towards other resources, such as financial assistance programs that can help cover the cost of medical treatment, home modifications, and physical therapy.
4. Make Modifications to Accommodate Mobility Limitations. Part of recovering from any condition that limits mobility is making modifications to the home that increase accessibility. For paraplegics who may be restricted to a wheelchair, this may involve installing workarounds for steps (such as ramps or wheelchair lifts), redesigning spaces with appliances so they’re easier to reach or move around in, and widening doorways to make it easier to push a wheelchair or other mobility aid through.
5. Consider Psychological Therapy. Many people, paraplegics included, underestimate the psychological effects that a loss of mobility can impose. For paraplegics, it can be crucial to seek out a specialist in psychological therapy—especially when the paraplegia is caused by a traumatic brain injury. Those who know a paraplegic may want to help them look for a qualified therapist as well. It is all too easy to miss the signs of psychological distress that lead to depression or worse.

As noted earlier, some (or all) of these steps may change. For any paraplegia recovery plan, it’s important to consult a qualified physician before starting any treatment regimen.

What Are Some Paraplegia Symptoms?

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.
• Difficulty 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.
• Autonomic dysreflexia—rapid heartbeat, spikes in blood pressure, and other changes in autonomic function related to spinal nerve damage or traumatic brain injury.
• 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 (more on this later).
• 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.

Exercises for Paraplegia

Physical therapy can prove to be an excellent tool for helping paraplegics improve their health and even help alleviate some paraplegia symptoms. Some paraplegia exercises that paraplegics can benefit from include:

• Yoga. Many SCI survivors and paraplegics can benefit from the gentle stretching exercises involved in yoga activities, as they help to stretch unused muscles and prevent atrophy. Breathing exercises found in this particular type of paraplegia exercise can also help with those who have difficulty breathing because of the side effects of a brain or spinal cord injury.
• Weightlifting. Weightlifting is an exercise for paraplegics that allows them to heavily work their muscles, preventing atrophy while actively increasing physical strength and health. However, weightlifting for SCI survivors and paraplegics should be conducted under the watchful eye of a physical therapist to avoid overworking muscles and causing further injury.
• Water Aerobics. As odd as it might sound, water aerobics can be exceptionally beneficial as a paraplegia exercise. The water helps support the weight of the body while allowing paraplegics to get out of the chair and stretch limbs that are otherwise difficult to exercise. Proper support and supervision is a must for this type of physical rehabilitation exercise.
• Seated Aerobics. There are a number of different aerobic exercises for people that can be done from inside of a chair. The benefit of this paraplegia exercise is that it can be done from virtually anywhere—making it easy to engage in even without visiting a spinal cord injury rehabilitation center.

Where Can I Find Spinal Cord Injury Rehabilitation Centers?

Some facilities specialize in providing spinal cord injury rehabilitation to help people who are paralyzed from the waist down lead active and healthy lives. These spinal cord injury rehabilitation centers are scattered throughout the country, so SCI survivors may need to ask their physician or a local SCI advocacy group to find a facility near them.

One example of a spinal cord injury rehabilitation center could be an activity-based therapy center. These facilities focus on providing therapeutic activities and exercises to help members of the SCI community improve their health and body function. You can find a map of activity-based therapy centers here.