Para / Quadra Plegia

Defined

Paraplegia refers to paralysis that occurs in the lower half of the body. It can be a result of an accident or a chronic condition.

 

People with paraplegia will have mobility problems and may require the use of a wheelchair. However, long-term treatment options exist to help reduce symptoms and complications in people with paraplegia.

 

Paraplegia is a form of paralysis that mostly affects the movement of the lower body. People with paraplegia may be unable to voluntarily move their legs, feet, and sometimes their abdomen.

 

Some people experience incomplete paraplegia. This is the case when the paralysis only affects one leg.

 

https://www.medicalnewstoday.com/articles/what-is-paraplegia

Diagnosis

In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection and examination, testing for sensory function and movement, and by asking some questions about the accident.

 

But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.

 

These tests may include:

  • X-rays. Medical personnel typically order these tests on people who are suspected of having a spinal cord injury after trauma. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.

  • Computerized tomography (CT) scan. A CT scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.

  • Magnetic resonance imaging (MRI). MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is very helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord.

 

A few days after injury, when some of the swelling may have subsided, your doctor will conduct a more comprehensive neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and pinprick sensations.

 

https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/diagnosis-treatment/drc-20377895

Treatment

Unfortunately, there's no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

 

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

 

Emergency actions

Urgent medical attention is critical to minimize the effects of any head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the scene of the accident.

 

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.

 

Early (acute) stages of treatment

In the emergency room, doctors focus on:

  • Maintaining your ability to breathe

  • Preventing shock

  • Immobilizing your neck to prevent further spinal cord damage

  • Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities

 

If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

  • Medications. Intravenous (IV) methylprednisolone (Solu-Medrol) has been used as a treatment option for an acute spinal cord injury in the past. But recent research has shown that the potential side effects, such as blood clots and pneumonia, from using this medication outweigh the benefits. Because of this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.

  • Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.

  • Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.

  • Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. For example, doctors may lower the body temperature significantly — a condition known as hypothermia — for 24 to 48 hours to help prevent damaging inflammation. Ask your doctor about the availability of such treatments.

 

Ongoing care

After the initial injury or condition stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.

 

The length of your hospitalization depends on your condition and the medical issues you're facing. Once you're well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.

 

Rehabilitation

Rehabilitation team members will begin to work with you while you're in the early stages of recovery. Your team may include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.

 

During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills, and learning adaptive techniques to accomplish day-to-day tasks.

You'll be educated on the effects of a spinal cord injury and how to prevent complications, and you'll be given advice on rebuilding your life and increasing your quality of life and independence.

 

You'll be taught many new skills, and you'll use equipment and technologies that can help you live on your own as much as possible. You'll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.

 

Medications

Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

 

New technologies

Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:

  • Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injuries more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.

  • Computer adaptations. For someone who has limited hand function, computers can be very powerful tools, but they're difficult to operate. Computer adaptations range from simple to complex, such as key guards or voice recognition.

  • Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living. Devices can be turned on or off by switch or voice-controlled and computer-based remotes.

  • Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They're often called functional electrical stimulation systems, and they use electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip.

  • Robotic gait training. This emerging technology is used for retraining walking ability after a spinal cord injury.

 

Prognosis and recovery

Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. The fastest rate of recovery is often seen in the first six months, but some people experience small improvements for up to one to two years.

 

https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/diagnosis-treatment/drc-20377895

Drugs

First Response after SCI
Preventing and controlling inflammation is a first response following SCI. A drug called methylprednisolone may be administered immediately and continued for 24 to 48 hours. It is a man-made synthetic corticosteroid drug. Corticosteroids are powerful anti-inflammatory drugs.

 

A drug called methylprednisolone may be administered immediately and continued for 24 to 48 hours.Secondary Conditions
 

There are many secondary conditions that can develop after a spinal cord injury. Besides the conditions outlined below, other challenges include bladder and bowel management, dealing with fatigue, skin problems, and nutrition.

  • Autonomic Dysreflexia (AD) is a serious and potentially life-threatening emergency associated with SCI. AD causes over-activity of the autonomic nervous system. In other words, communication between the body and brain is disrupted above the injury level. This means body functions, such as breathing, blood pressure, and heart rate become unregulated. Drugs that decrease heart rate and relax blood vessels may be used to treat AD.

  • Respiratory infections may develop when chest and abdominal muscles are weak, such as in cervical and thoracic SCI. Difficulty or inability to cough contributes to the development of respiratory infection. Common infections include the common cold, bronchitis, and pneumonia. Antibiotics may be prescribed to clear the chest.

  • Spasticity is characterized by stiff or rigid muscles that make movement, such as walking or talking, difficult. Muscle relaxant and anti-spastic drugs may be given.

  • Pain caused by the injury, even in areas where there is no sensation or feeling is limited, is common. SCI patients who use wheelchairs may develop shoulder or arm pain (eg, tendonitis). Medication may include non-steroidal anti-inflammatory drugs (NSAIDS), muscle relaxants, anti-depressants, and painkillers (eg, narcotics).

  • Chronic pain (eg, neurogenic, nerve pain) often accompanies paralysis. Medication may include non-steroidal anti-inflammatory drugs (NSAIDS), gabapentin (Neurontin), muscle relaxants, anti-depressants, and painkillers.

  • Depression is common, but there are many medications that are used to treat this disorder. Sometimes, anti-depressant medications are combined. Some examples of anti-depressant medications are:

    • Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Tricylic drugs

    • Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs)

    • Anxiety medications

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