Traumatic Paraplegia

Original Editor - Wouter Claesen

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Definition/Description[edit | edit source]

Traumatic paraplegia is caused by a lesion of the spinal cord (SCI) which occurs after a trauma, e.g. vertebral fracture causing a puncture to the spinal cord. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring damage to independence and physical function and many complications from the injury eg. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems.[1]

The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process requiring patience and motivation of both patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system[1].

An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team includes the treating doctor, patient and family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary.

[1][2][3][4]

Spinal-cord-injury-symptoms.png


Clinical Relevant Anatomy[edit | edit source]

The spinal cord is connected to the brain, where it descends down the middle of the back, surrounded and protected by the bony vertebral column. The spinal cord is surrounded by Cerebral Spinal Fluid (CSF). Its function is to prevent the delicate nerve tissue from the inside of the vertebrae. The spinal cord itself consists of millions of nerve fibers which transmit electrical information to and from the limbs, trunk and organs of the body, to and from the brain. The Central Nervous System (CNS) consists of the brain and spinal cord. The nerves connecting the spinal cord to the body is called the Peripheral Nervous System (PNS).

Spinal cord.jpg


Epidemiology/Etiology[edit | edit source]

The cause of paraplegia due to a spinal cord injury is most often by a car accident. It can also result from a firearm injury, which is not the case in many countries in the world. Traumatic paraplegia is most prominent in young men between the ages of 21 and 35 years. The more reckless way of driving within the younger population could also be one of the reasons.

This injury has a major effect on the social life of the patient, such as divorce or loss of work. Therefore, it might be important as a physiotherapist to talk with the patient about considering professional psychological help and assist in guiding him/her through this process.

Physical Therapy Management[edit | edit source]

From the very beginning, all efforts should be concentrated on the rehabilitation of the patient. The most important points which need to be considered in the early stages or even immediate stages are:

  • the prevention of pressure sores
  • the control of urinary infections (this is mainly the task of the doctors)
  • the prevention of muscle tendon contractures of paralyzed limbs due to faulty position (e.g. keeping the legs constantly adducted, the hips and knees flexed, and the feet and toes in plantar flexion)
    • faulty positions can be prevented by physiotherapy treatment such as strengthening and stretching of the muscles of the trunk and upper limbs[5][6]

Like every injury complete immobilization should be prevented. It has been shown that an intensive physical training program of 10 to 15 weeks could make the patient climb and go down 20 standard stairs and be able to walk 100 meters indoors with crutches for example. It is highly recommended not to be independent of a wheel-chair and try to be mobile as much as possible.[7] Intense and regular therapy for spasticity, including physiotherapy, can delay and minimize the appearance of these complications named above.[6]

General Lower Limb Neuological Examination[edit | edit source]

[8]

References[edit | edit source]

  1. 1.0 1.1 1.2 Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World journal of orthopedics. 2015 Jan 18;6(1):8. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303793/ (last accessed 5.1.2020)
  2. PATHOLOGICAL OSSIFICATION IN TRAUMATIC PARAPLEGIA*; A. G. HARDY, SHEFFIELD, and J. W. DICKSON, IPSWICH, ENGLAND ; 1963
  3. Initial Treatment of Traumatic Paraplegia; By L. GUTTMANN, O.B.E., M.D., M.R.C.P.;1953
  4. Spinal cord potentials in traumatic paraplegia and quadriplegia; E M SEDGWICK, E EL-NEGAMY, AND H FRANKEL; 1980
  5. SURGICAL ASPECTS OF THE TREATMENT OF TRAUMATIC PARAPLEGIA; Guttmann; 1949
  6. 6.0 6.1 Spastic Paraplegia 3A , SPG3A; Peter Hedera ; 2010
  7. Ambulation without wheelchairs for paraplegics with complete lesions.; Natvig H, McAdam R.; 1978
  8. Bahaa Mostafa Kamel. https://www.youtube.com/watch?v=VG8Uzt87gko [last accessed 10/02/2016]