Paraplegia

Paraplegia is a condition in which the lower part of a person's body is paralyzed and cannot move. It is usually the result of spinal cord injury or a congenital condition such as spina bifida, but polyneuropathy may also result in paraplegia. If the arms are also paralyzed, quadriplegia is a more appropriate diagnosis.

Causes

Central nervous system

Any disease process affecting the pyramidal tract of the spinal cord from the thoracic spine downward may lead to paraplegia, as this structure transmits "instructions" for movement from the brain to the anterior horn. This is the most common cause of paraplegia. It is usually spastic: it results in an increased muscle tone in the affected limbs. Causes range from trauma (acute spinal cord injury: transsection or compression of the cord, usually by bone fragments from vertebral fractures) to tumors (chronic compression of the cord), myelitis transversa and multiple sclerosis. Sometimes, paralysis of both legs can result from injury to the brain (bilateral injury of the motor cortex controlling the legs, e.g. due to a stroke or a brain tumor).

Peripheral nervous system

Rarer is the type which is caused by damage to the nerves supplying the legs. This form of damage is not usually symmetrical and would not cause paraplegia, but polyneuropathy may cause paraplegia if motor fibres are affected. While in theory the arms should also be affected, the fibres that supply the legs are longer and hence more vulnerable to damage.

Disability

While some people with paraplegia can walk to a degree, many are dependent on wheelchairs or other supportive measures. Impotence and various degrees of urinary and fecal incontinence are very common in those affected. Many use catheters or adult diapers to address these problems

Complications

Due to the decreased movement and inability to walk, paraplegia may cause numerous medical complications, many of which can be prevented with good nursing care. These include pressure sores (decubitus), thrombosis and pneumonia. Physiotherapy and various assistive technology, such as a standing frame, may aid in preventing these complications.

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