Paraplegia: etymology, meaning, symptoms, treatment and rehabilitation

By Cristiano Antonino On Aug 22, 2022

Paraplegia in medicine refers to a condition of diplegia in which the lower part of the body is affected by partial or complete motor paralysis and/or functional deficiency, associated with disturbance of sensation

The spinal cord lesion that causes paraplegia is underlying the first thoracic vertebra (T1).

It differs from quadriplegia, which affects all four limbs and occurs in cases of cervical spinal cord injury.

Paraplegia: etymology of the term

Paraplegia (accent on the ‘i’) is a word derived from the Greek παραπληγία, composed of παρα- (‘para’ meaning ‘near, around’) and -πληγία (‘plegia’ meaning ‘I strike’).

Causes of paraplegia

The spinal cord lesion that causes paraplegia is underlying the first thoracic vertebra (T1).

This injury can be caused by a variety of causes:

infectious lesions
traumatic injury to the lumbar or dorsal area of the spinal cord, e.g. in traffic accidents or spirits;
discitis;
tumours;
vascular lesions;
plaque sclerosis;
from congenital malformations of the spinal canal, as in spina bifida.

Symptoms of paraplegia

The main symptoms associated with paraplegia can also occur immediately after spinal cord injury, e.g. in trauma injuries.

They vary greatly depending on the severity of the injury.

They include:

paralysis of the lower limbs;
movement deficits;
slower-than-usual reflexes;
intestinal disorders;
urinary and faecal incontinence;
respiratory difficulties;
sterility and infertility;
erectile dysfunction;
altered orgasmic sensitivity;
altered ejaculation (anejaculation, retrograde ejaculation, asthenospermia…).

At the level of the lesion there is:

complete destruction of nerve cells;
rupture of the reflex arch;
flaccid paralysis of the muscles innervated by the segments of the spinal cord that have been destroyed.

Motor disorders in paraplegia

In spinal cord injuries there are different clinical pictures depending on whether the damage is complete or not.

A spinal cord injury causes an inability to voluntarily recruit motor units in the muscles innervated by the sublateral spinal cord segments.

The latter, which are anatomically intact, once the spinal shock phase is over (from 1 week to several months), will be subject to abnormal activity (spasticity) due to the deficit of suprasegmental motor control.

Sensory disturbances in paraplegia

Following a spinal cord injury all types of sensation can be more or less impaired.

Anaesthesia or hypoesthesia can affect sensitivity to varying degrees:

superficial and deep tactile
painful
pressor;
thermal
statesthetic;
kinesthetic.

The person with spinal cord injury may experience pain that can be distinguished into

vertebral pain;
metameric pain of radicular origin;
sub-lesional pains with no metameric distribution, these are painful paresthesias such as tingling, tingling, the origin of which is uncertain;
visceral pains usually projected relationship (unclear) to the distension of a hollow organ (bladder, intestine);
psychogenic pains.

Respiratory disorders in hemiplegia

In patients with hemiplegia, a change in the breathing mechanism occurs after a spinal cord injury.

The respiratory deficits that occur essentially originate from the following factors

complete paralysis or deficit of the inspiratory and expiratory musculature;
altered thoraco-abdominal mechanics;
reduced lung compliance;
reduction in chest wall compliance.

Consequences and complications

Paraplegia unfortunately brings with it various problems related to reduced mobility, with a decrease in the patient’s quality of life.

The severity of the paralysis depends on the degree of injury to the spinal cord.

Many people with paraplegia are forced to use wheelchairs to get around.

Following the decrease or loss of lower limb function, paraplegia can also lead to a number of medical complications that include:

pressure injuries;
thrombosis;
pneumonia;
myo-osteo-articular damage: joint limitations, muscle-tendon retractions;
psychological complications: post-traumatic stress disorder, depression, suicidal thoughts;
nervous complications.

Diagnosis

The injured person suffering from presumed paraplegia must be urgently admitted to a facility equipped with a spinal unit.

A specialised team will quickly carry out in-depth examinations to identify the location of the lesion and assess its degree of severity through neurological tests, CT scans, radiological analyses with contrast fluid to the membranes of the meninges, as well as magnetic stimulation of the skull to assess the functionality of the circuits that lead back to the Central Nervous System.

Treatment and rehabilitation in patients with paraplegia

The general objective of rehabilitation treatment in the Spinal Unit or in the Rehabilitation Centres is to help the person with spinal cord injury (plm) achieve the greatest possible autonomy/independence in the activities of daily living in relation to residual potential (type and level of injury), age, the person’s general condition, the presence or absence of complications, motivation, and family support.

The patient who comes to the Spinal Unit or to the Rehabilitation Centres asks for the optimisation of their resources in order to resume, with dignity, their place in society.

Like an athletic trainer, the physiotherapist must make the plm achieve the physical abilities that will allow it, under the guidance of the rehabilitation team, to perform the functional gesture.

Within the rehabilitation process, the intervention is basically carried out in two areas:

1) REHABILITATIVE

Aimed at recovering maximum functional capacity through

neurological recovery if it occurs;
the strengthening of intact musculature;
the search for compensations and motor strategies that allow the re-learning and reacquisition of functional abilities in daily, work and play activities, etc;
the identification of coping strategies that promote “readjustment” to the disability event.

2) EDUCATIONAL

Aimed at the knowledge and correct management of the problems inherent to spinal cord injury (health education).

The most commonly used rehabilitation techniques to attempt the recovery of neurological functions are: