Paraplegia is a condition of neurological origin that involves paralysis beginning at the trunk and extending to both feet. Such an individual has full use of their arms but have suffered nerve damage to the spinal cord at or below the level of the thoracic vertebrae, leading to absence of innervation below the area of damage. In some cases, the paraplegia does not involve the spinal cord but affects multiple nerves to the lower extremities.
Many conditions can result in paraplegia. Children born with spina bifida, a congenital incompleteness of the lower spine can be born with paraplegia. Certain traumatic injuries, such as a fracture in the mid to lower back, can damage the spinal cord. Severe arthritis with bony osteophytes (lumps) can put pressure on and damage the spinal cord. Tumors involving the spinal cord will present as progressive paralysis.
In rare cases, a brain injury can involve the motor cortex on each side of the brain leading to an effective loss of brain signals to the nerves in the lower extremities. Multiple sclerosis affects any nerve cell and, if enough of the myelin sheath is lost around the nerves to the lower extremity, paraplegia can result.
Paraplegia strictly means paralysis and loss of the ability to move ones lower extremities. While most of the time this means complete loss of sensation to the paralyzed areas, it is possible to have paralysis in the legs with at least some sensation intact.
When an individual first becomes paralyzed, the muscles are weak and flaccid. Over time, however, the muscles lacking in stimulation from the upper motor neurons in the brain become spastic (stiffened) and considerable muscle atrophy occurs. Bowel and/or bladder function can be impaired, necessitating the use of a urinary catheter and nursing care to help with bowel elimination. In men, impotence is likely in paraplegia.
Because the patient with paraplegia is immobile and often requires a urinary catheter on an ongoing basis, they have a greater incidence of severe infections such as urinary sepsis and pneumonia. While some paraplegics have limited ability to move, most cannot move at all and sustain pressure sores in areas they sit on too long. Because they don’t often feel the pressure or the sores from the pressure, they can become quite deep and can heal poorly. Good nursing care will prevent some of these complications from happening.