As a new topic in the "CUREosity explains" series, we are covering the term paraplegia. In this first of two blog posts, we will take a closer look at the definition, causes and consequences. What does paraplegia mean? What is the difference between complete and incomplete paraplegia? We will answer these questions and more in this blog post.
What is paraplegia?
Our brain is responsible for controlling motor function (movement), sensory function (perception), and maintaining internal organ functions, such as the bladder and bowel. It is connected to the trunk and the upper and lower extremities via nerve pathways within the spinal cord.
If the connection is interrupted, there can be a disruption or failure of motor, sensory and autonomic functionalities. Paraplegia is therefore the result of damage to the spinal cord. The spinal cord (Medulla spinalis) is a part of the central nervous system (CNS) and runs within the spinal column in the spinal canal. Among other things, the nerve fibers of the CNS and the cerebrospinal fluid (CSF) are located here, which, for example, supports the metabolism of the nerve cells and serves as protection for the brain.
Central and peripheral nervous system
In addition to the central nervous system, there is the peripheral (external) nervous system. This can be divided into the somatic nervous system and the autonomic nervous system. The somatic nervous system is used to transmit stimuli to the muscles and to transmit sensory stimuli to the CNS. Failure results in paralysis of extremities and lack of information in the brain. The autonomic nervous system automatically controls and regulates internal bodily functions without the person being able to consciously influence them. This includes, for example, the heartbeat, blood pressure or sweating.
Causes of paraplegia
The spinal cord can be injured in various ways. The number of accidents at work continues to decrease due to good prevention offers of the professional associations, but the number of paraplegia caused by accidents during leisure time is increasing.
In most cases, the spinal cord is damaged by mechanical forces as a result of an accident. In this case, vertebral bodies shift and crush the spinal cord. In addition, tissue swelling or bruising can damage the spinal cord. Even if the acute injury has healed, the original connections are broken and cannot be restored. Paralysis can also occur if a herniated disc progresses unfavorably, when the pressure of the disc on the spinal cord not only paralyzes individual muscles, but completely squeezes the spinal cord. In addition to force effects, the spinal cord can also be affected by diseases of the surrounding tissue, for example, tumors, infections and diseases of vessels (including stroke, multiple sclerosis).
Consequences of paraplegia
Usually, paraplegia is associated with a life in a wheelchair, i.e. the loss of the ability to stand and walk. However, the quality of life of those affected is often impaired by accompanying symptoms that are not visible to outsiders.
In addition to paralysis or loss of sensitivity, the functions of the bowel and bladder can also be affected. This makes lifelong catheterization necessary, for example. Sexuality can also be affected in the case of paraplegia.
Vegetative dysfunctions
In addition, vegetative dysfunctions occur, so that circulation and temperature balance are functionally disturbed. In the long term, paraplegics struggle with decubiti (pressure sores) and scoliosis (deformation of the spine) as well as contractures (deformation of the limbs). High cross-sections can lead to respiratory dysfunction.
Paraplegia and tetraplegia
The level of damage, also called lesion height, affects the degree of impairment. Paralysis below the first thoracic vertebra affecting the legs and trunk is called paraplegia. In the case of damage above the level of the cervical vertebrae, this is referred to as tetraplegia - all four extremities of the arms and legs are impaired in their function. In addition, tetraplegia patients often have to be artificially ventilated because the respiratory muscles are also affected.
Today, paralysis is classified into 5 categories from A-E according to ASIA (American Spinal Injury Association) criteria.
With the visualization of paraplegie.ch you get an overview of the effects of paraplegia on muscles and organs. On the page of der-querschnitt.de you can also find more interesting information about the consequences of paraplegia.
Complete and incomplete paraplegia
A distinction is made between complete paraplegia and incomplete paraplegia. Complete paralysis is defined as paralysis in which neither motor nor sensory functions are present. Incomplete paraplegics still have some motor and sensory activity below the level of the lesion.
Living with paraplegia
Paraplegia means a complete change in living for the affected person, and often for family members as well. Both the living and working environment have to be adapted to the needs of the disabled in order to meet the new requirements.
Therefore, paraplegia does not only mean a restriction of physical functions for the patients. They also have to cope with a psychological process in order to cope with the new challenges of everyday life.
There is usually a lifelong need for therapy in order to relearn and maintain abilities and to minimize subsequent complications.
This site from the University of Heidelberg provides a helpful guide to the issues faced by paraplegics.
The goal of therapy for paraplegia
The goal of therapy for patients with spinal paralysis is to bring about the highest possible level of quality of life and independence for patients. Even minor improvements in motor skills can make a big difference in the daily lives of those affected.
Understanding paraplegia
The Swiss Paraplegic Center (SPC) in Nottwil does remarkable work in the field of paraplegic research and treatment and is considered a leader in the field of paraplegic, spinal and respiratory medicine. This detailed information page of the SPC was also used as a source for this article, among others.
In addition, patients can seek advice from magazines or associations. Der-Querschnitt.de is an online magazine of the Manfred Sauer Foundation, which prepares and makes available interesting facts and current topics for paraplegics. The German-speaking Medical Society for Paraplegiology e.V. (DMGP) also offers a wide range of information about paraplegia.
Summary of article
The brain is responsible for controlling motor function (movement), sensory function (perception), and maintaining internal organ function
The brain is connected to the trunk and the upper and lower extremities via nerve pathways within the spinal cord
If the connection is interrupted, motor, sensory, and autonomic functionalities may be disrupted or lost
Most often, the spinal cord is damaged by mechanical forces as a result of an accident
The spinal cord can also be affected by diseases of the surrounding tissues, such as tumors, infections and diseases of blood vessels
In addition to the loss of the ability to stand and walk, the psychological consequences should not be underestimated
Paralysis below the first thoracic vertebra affecting the legs and trunk is called paraplegia
Damage above the level of the cervical vertebrae is referred to as tetraplegia - the function of all four extremities of the arms and legs is impaired
A distinction is made between complete (neither motor nor sensory functions are present) and incomplete (some motor and sensory activities are present) paraplegia
In the next article of "CUREosity explains: paraplegia" we will address the following questions, among others:
Is paraplegia curable?
What are the treatment options and what is the state of research?
How can CUREO be used for paraplegia therapy?
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