Complete paraplegia describes a form of paralysis that affects the lower half of the body, encompassing the legs and often the trunk. The term “complete” signifies a total absence of sensory and motor function below the specific level where the spinal cord has been injured. This condition is distinct from incomplete paraplegia, where some sensation or voluntary movement below the injury level remains, and from quadriplegia (also known as tetraplegia), which involves paralysis of all four limbs.
Spinal Cord Injury and Function
The spinal cord acts as the body’s communication highway, relaying signals between the brain and most parts of the body. It is a delicate bundle of nerves encased within the protective vertebrae of the spinal column. For individuals with paraplegia, damage occurs in the thoracic, lumbar, or sacral regions of the spinal cord.
An injury in these lower spinal cord segments blocks nerve signals from the brain from reaching the body below the injury site, and sensory information cannot travel back to the brain. The precise location of the injury determines the extent of paralysis and which muscle groups are affected. For example, a T1 injury, high in the thoracic spine, might affect the torso and legs, while a lower lumbar injury (e.g., L4) might primarily impact specific leg muscles.
Common Causes
Complete paraplegia can arise from two primary categories: traumatic injuries and non-traumatic medical conditions. Traumatic spinal cord injuries are the most frequent cause, often resulting from sudden, forceful impacts to the spine. These incidents include motor vehicle accidents, significant falls, sports-related incidents like diving into shallow water, and acts of violence such as gunshot or stab wounds.
Non-traumatic causes involve internal damage to the spinal cord that develops over time. These conditions include spinal tumors, which can compress the spinal cord, and infections like transverse myelitis or epidural abscesses that inflame or damage spinal tissues. Vascular problems, such as a spinal cord stroke or arteriovenous malformations, can also lead to paraplegia. Degenerative diseases of the spine or autoimmune conditions like multiple sclerosis can also disrupt nerve signals.
Diagnosis and Initial Medical Response
Diagnosis is important following a suspected spinal cord injury to prevent further damage. The diagnostic process begins with a neurological examination to assess sensory and motor function below the suspected injury level. This involves testing muscle strength, reflexes, and the ability to feel light touch or pinprick sensations.
Imaging tests visualize the spinal cord and surrounding structures. Computed tomography (CT) scans identify bone fractures or dislocations, while magnetic resonance imaging (MRI) provides detailed images of soft tissues, ligaments, and the spinal cord, revealing swelling, bleeding, or disc herniations. During the initial medical response, preventing additional injury is a priority. This involves carefully immobilizing the spine, often using a rigid neck collar and a backboard, before and during transport. Emergency surgery may be performed to decompress the spinal cord or to stabilize fractured vertebrae, aiming to mitigate secondary damage.
Managing Associated Health Conditions
Living with complete paraplegia involves managing several associated health conditions due to the loss of nerve control below the injury level. Bladder and bowel control are frequently affected, as nerve signals regulating these functions are disrupted. Individuals often require structured management programs, such as regular intermittent catheterization and timed bowel routines, to prevent urinary tract infections, kidney complications, and accidental bowel movements.
Skin integrity is a significant concern due to the absence of sensation and limited mobility. Pressure sores, also known as decubitus ulcers, can develop rapidly on bony prominences from prolonged pressure. This necessitates frequent repositioning, specialized seating, and diligent skin inspections to prevent breakdown and infection.
Muscle spasticity, characterized by involuntary muscle spasms and stiffness below the injury level, is common. While sometimes beneficial for transfers, severe spasticity can cause pain, impair sleep, and interfere with daily activities, often requiring medication or other interventions. Neuropathic pain is also prevalent, described as burning, shooting, or tingling sensations in areas where individuals have no feeling.
Rehabilitation and Adaptive Strategies
Rehabilitation for complete paraplegia is an ongoing process focused on maximizing independence and adapting to life with paralysis. Physical therapy plays a central role, concentrating on strengthening muscles above the injury level, particularly in the upper body, to compensate for lower body weakness. Therapists guide individuals in mastering wheelchair mobility, including navigating various terrains and performing complex maneuvers, and teach safe transfer techniques between surfaces like a wheelchair and a bed or car.
Occupational therapy complements physical therapy by focusing on adapting daily life activities. This includes strategies for dressing, bathing, cooking, and other self-care tasks, often involving adaptive equipment and modified techniques. Occupational therapists also recommend home modifications, such as ramps or widened doorways, to enhance accessibility and independence. Assistive technology, including custom-fitted wheelchairs, specialized seating systems, and hand controls for driving, helps individuals navigate their environment and participate in life independently.