Paraplegia

A Paraplegia or Paraplegic syndrome is an irreversible damage or severance of the spinal cord cross-section. Below the spinal cord transection, the body is usually completely paralyzed in the course of the disease.

What is paraplegia?

The Paraplegia is a partial or complete paralysis of the body caused by damage to the spinal cord (for example, due to a fractured vertebra).

Depending on the level of damage to the spinal cord, the paralysis can only affect 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). It can also happen that the paralyzed person can still move the extremity a little, perceives temperature differences (hot and cold) or can feel touch, although active movement itself is not possible. Paralysis can change from flaccid to spastic paralysis over the years.

causes

The causes of the Paraplegia can be diverse. 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 may also be cancer, a herniated disc or a concomitant symptom of multiple sclerosis that damage the spinal cord. Paraplegia should not be confused with 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 either takes place in both legs or additionally in both arms. However, one limb may retain more sentience than the other, or that minimal movement in one 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 areas of the body that are supplied by nerves at or below the injury are affected by symptoms.

Complete paraplegia means a loss of function of all muscles and no sensitivity whatsoever on the inner thighs. Complete incontinence occurs. The function of the sexual organs comes to a standstill. If the injury occurred in the area of ​​the cervical vertebrae, breathing may also be affected.

Incomplete paraplegia, in which not all nerve tracts are damaged, on the other hand, 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, this also applies to the legs, but not necessarily the other way around. In some cases, individual motor skills are also retained.

At the beginning, the paralysis is such that the muscles become completely slack and cannot be tensed. Only after a few weeks does this slackness turn into spasticity, which also resembles paralysis. The paraplegia itself does not cause any pain. These are - if any - due to the injury that led to the paraplegia.

Diagnosis & course

The symptoms of Paraplegia and the remaining skills 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, a splint or a neck brace is always used in such emergency patients to stabilize the spine.

There are a number of emergency measures that can be taken to try to stop the paralysis or prevent worse damage. Many of these measures, which range from various infusions to emergency operations, cannot guarantee success, but should rather be viewed as an attempt.

Complications

Paraplegia can lead to various complications and secondary diseases. In addition, it can persist, which has lifelong effects. A common 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.

We speak of a reflex bladder if 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 the contractions are absent. This increases the risk of urinary tract infections, some of which are complicated.

The sequelae of paraplegia also include disturbances in emptying the rectum. Their extent depends on the level of injury. If damage occurs over the sacral medulla, the bowel evacuation reflex fails for a few weeks. In addition, the sphincter can no longer be controlled arbitrarily.

If the sacral cord is completely destroyed, the defecation reflex disappears completely, so that mechanical removal of the intestinal contents is necessary. One of the most serious complications is a decrease or even total loss of sensation. For this reason, it is necessary to carefully check the affected areas of the skin so that pressure sores (pressure ulcers) do not occur.

Because the pain reaction does not occur, there is a risk of unnoticed bone fractures or burns. Other possible sequelae 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 there is restriction of movement after a fall, accident or violence. With paraplegia, the person affected can no longer trigger voluntary movements. It is not possible for him to control his limbs or call for medical help over the phone.

In addition, touching the skin or movements triggered by other people can no longer be perceived. The muscles are completely slack. In many cases there is paralysis of the entire body. An ambulance service is to be alerted as soon as abnormalities appear, as there is an acute need for action. In order not to cause further damage, the instructions of the emergency center called must be followed.

In the case of paraplegia, incontinence occurs immediately. The affected person wets himself immediately because the shooting muscles can no longer be controlled. This sign can be classified as alarming by those present. If no stimuli are perceived on the inside of the thighs at the same time, the person affected needs an ambulance.

The paraplegia typically occurs suddenly. There is a triggering event that requires immediate action. The natural motor skills are no longer available within a few seconds.

Treatment & Therapy

Long-term treatment is usually limited to physiotherapeutic measures that support passive mobility and try to promote possible active opportunities for movement. Treatment with stem cells in acute cases has been permitted for research since 2010, since animal experiments have shown a significant improvement in mobility through to complete cure of the paralysis.

It is planned to treat around 20 patients in this way for the first time. The 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 lead to complications. Thromboses, pneumonia or pressure ulcers ("bedsores") 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 one day expressed in the media, succumbed to the consequences of an initially harmless pressure ulcer. Even a simple cold can turn into pneumonia due to immobility. Quadriplegics in particular are unable to cough up properly and can get serious problems here.

Paraplegics are usually dependent on the use of a wheelchair and 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 children, can be realized a lot better.

After a certain period of getting used to the changed condition, help from nursing staff is usually no longer necessary. The younger the patient is at the time of his limitation, the more likely he will be able to live independently.

prevention

One Paraplegia can usually be prevented by a prudent and risk-free life. Refraining from daring sports such as climbing, hang-gliding or motorcycling (especially with racing machines) radically reduces the probability of one day getting paraplegia as a result of an accident.

If you do not want to do without such sports or hobbies, you should at least strictly adhere to all common safety measures. This includes, especially when driving fast motorcycles: helmet, back and spine protectors and the right clothing.

Aftercare

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 high levels of paraplegia take part in respiratory therapy that is designed to prevent fluid build-up 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 (bedsores). Aftercare also includes drug treatment for neuropathic pain.

Since damage to the spinal cord 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. So motor skills can be preserved 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. 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 people to lead an active lifestyle.

You can do that yourself

Paraplegia usually hits patients suddenly and unexpectedly as a result of an accident. Those affected perceive this traumatic event with its irreversible consequences as a severe blow of fate. In order to be able to deal with this stroke of fate better, 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 Support Association for Paraplegics in Germany (www.fgq.de) or the German Foundation for Paraplegia (www.dsq.de). The Austrian wheelchair guide (www.rolli-wegweiser.at), which also answers questions about partnership and sexual life, also goes into detail. The research foundation Wings for life traces the fate of patients and provides information on the current state of science (www.wingsforlife.com).

In the case of paraplegia, it is also advisable to keep 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 clamped while sitting in a wheelchair.