Paraplegia

Not to be confused with Hemiplegia or Paragelia.
Paraplegia
Classification and external resources
Specialty Physical medicine and rehabilitation
ICD-10 G82.1
ICD-9-CM 334.1, 344.1
MeSH D010264

Paraplegia is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek: παραπληγίη "half-striking". It is usually caused by spinal cord injury or a congenital condition such as spina bifida that affects the neural elements of the spinal canal. The area of the spinal canal that is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If four limbs are affected by paralysis, tetraplegia or quadriplegia is the correct term. If only one limb is affected, the correct term is monoplegia.

Spastic paraplegia is a form of paraplegia defined by spasticity of the affected muscles, rather than flaccid paralysis.

Complications

Due to the decrease or loss of feeling or function in the lower extremities, paraplegia can contribute to a number of medical complications including pressure sores (decubitus), thrombosis, and pneumonia. Physiotherapy and numerous assistive technology, such as a standing frame, as well as vigilant self-observation and -care, may assist in helping to prevent future complications and mitigate existing complications.

As paraplegia is most often the result of a traumatic injury to the spinal cord tissue and the resulting inflammation, other nerve-related complications can and do occur. Cases of chronic nerve pain in the areas surrounding the point of injury are not uncommon. There is speculation that the "phantom pains" experienced by individuals suffering from paralysis could be a direct result of these collateral nerve injuries misinterpreted by the brain.

Treatment

Individuals with paraplegia can range in their level of disability, requiring treatments to vary from case to case. From a rehabilitation standpoint, the most important factor is to gain as much functionality and independence back as possible. Physiotherapists spend many hours within a rehabilitation setting working on strength, range of motion/stretching and transfer skills.[1] Wheelchair mobility is also an important skill to learn. Most paraplegics will be dependent on a wheelchair as a mode of transportation. Thus it is extremely important to teach them the basic skills to gain their independence.[2] Activities of daily living (ADLs) can be quite challenging at first for those with a spinal cord injury (SCI). With the aid of physiotherapists and occupational therapists, individuals with an SCI can learn new skills and adapt previous ones to maximize independence, often living independently within the community.[3]

Regeneration of the spinal cord

Olfactory ensheathing cells (OEC) have been transplanted with success into the spinal cord of Polish man named Darek Fidyka, who was the victim of a knife attack that left him paraplegic in 2010.[4] In 2014, Fidyka underwent pioneering spinal surgery that used OEC grafts to 'bridge the gap' in his severed spinal cord. The surgery was performed in Poland in collaboration with Prof Geoff Raisman, chair of neural regeneration at University College London's Institute of Neurology, and his research team. The olfactory cells were taken from the patients olfactory bulbs in his brain and then grown in the lab, these cells were then injected above and below the impaired spinal tissue.[5] Fidyka regained sensory and motor function in his lower limbs, notably on the side of the transplanted OEC's. He is believed to be the first person in the world to recover sensory function from a complete severing of the spinal nerves.[5][4]

See also

References

  1. ↑ Taylor-Schroeder S, LaBarbera J, McDowell S, et al. (2011). "The SCIRehab project: treatment time spent in SCI rehabilitation. Physical therapy treatment time during inpatient spinal cord injury rehabilitation". J Spinal Cord Med 34 (2): 149–61. doi:10.1179/107902611x12971826988057. PMC 3066500. PMID 21675354.
  2. ↑ Ozelie R, Sipple C, Foy T, et al. (2009). "SCIRehab Project series: the occupational therapy taxonomy". J Spinal Cord Med 32 (3): 283–97. PMC 2718817. PMID 19810630.
  3. ↑ Tzonichaki I, Kleftaras G (2002). "Paraplegia from spinal cord injury: self-esteem, loneliness, and life satisfaction". OTJR: Occupation, Participation and Health 22 (3): 96–103.
  4. 1 2 Walsh, Fergus (21 October 2014). "Paralysed man walks again after cell transplant". bbc.co.uk. Retrieved 26 October 2014.
  5. 1 2 Quinn, Ben (21 October 2014). "Paralysed man Darek Fidyka walks again after pioneering surgery". theguardian.com. Retrieved 26 October 2014. The 38-year-old, who is believed to be the first person in the world to recover from complete severing of the spinal nerves, can now walk with a frame and has been able to resume an independent life, even to the extent of driving a car, while sensation has returned to his lower limbs.
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