Spinal Cord Injuries - Paraplegia

In the United States there are approximately 11,000 new cases of traumatic spinal cord injury each year. Since 2000, motor vehicle crashes have accounted for 46.9% of reported spinal cord cases.1 Violence, falls, and sporting injuries follow in order of leading causes of paraplegia.

What is paraplegia?

Paraplegia often occurs as a result of an injury to the neural elements of either the thoracic, lumbar, or sacral regions of the spinal cord. The damaged spinal column inhibits the motor and/or sensory function of the lower extremities. Some patients diagnosed with paraplegia can walk with assistance, but most require wheelchairs for mobility.

Medical Complications

Complications may arise as a result of paraplegia. These may include urinary tract problems including loss of bladder control. Damaged nerves that control bowel function may cause bowel management difficulties.

Pressure sores may develop from prolonged periods of sitting or lying down. Pressure sores or decubitus ulcers are the result of unrelieved pressure to any part of the body.

In addition to pressure sores, long-term immobilization may lead to deep vein thrombosis (blood clot in the deep veins of the legs) and pulmonary embolism (blood clot in the lungs). These conditions arise due to decreased blood flow through the veins from sitting or lying for long periods.

Autonomic dysreflexia can occur to those with a spinal cord injury above the middle of the chest. The dangerous condition can occur when an irritation or pain below the level of injury sends a signal that fails to reach the brain, producing a reflex action that can constrict blood vessels. The result is a rise in blood pressure and a drop in heart rate that can cause a stroke or seizure.

Pain caused by the initial injury can continue for the rest of the patient's life. The pain experienced can depend on the injury and have many causes including nerves and/or muscle spasms. Research has made great advances in pain control. A few possible treatments include oral pain medication, muscle relaxers, spinal cord stimulation, and nerve pain medication. Pain can be a very debilitating result of spinal cord injuries. Working closely with the doctors and educating yourself can help in creating a treatment plan that is most effective for the patient.

Treatment

Unfortunately, there is no specific treatment to reverse or cure paraplegia. However, recent medical advances have provided better treatment options and decreased the time patients have to spend in the hospital immediately following the injury. Advances are also being made to help improve the quality and longevity of life for patients.

Current treatment continues to focus mainly on the prevention of further damage and complications. The treatment initially begins at the scene of the incident, as urgent medical attention is essential in providing the best outcome for the patients' injuries. Typically, following a spinal cord injury the patient is admitted to the intensive care unit. Medications such as steroids, immobilization, and sometimes surgery are utilized to treat the source of the injury and stop further damage.

While in the hospital the patient is seen by a team of specialists to treat the physical symptoms, as well as the emotional and psychological issues that arise from the injury. Once the injury has stabilized, the focus of treatment turns to prevention of complications caused by immobility. The length of stay in the hospital could range from several days to several weeks and in that time the patient generally remains immobile which can lead to a variety of problems including muscle atrophy. The rehabilitation process begins in the hospital and the team usually includes physical therapists, occupational therapists, a dietician, a rehabilitation nurse, and a doctor who specializes in physical medicine. An exercise program is started to help reduce the loss of muscle tone following the injury to ensure the greatest amount of mobility and function.

The treatment process does not end at discharge from the hospital. Continuing treatment will likely include rehabilitation. The rehabilitation may last for several weeks or months following discharge from the hospital. During the initial stages of post-hospital rehabilitation the emphasis is on regaining leg and arm strength, redeveloping fine-motor skills and learning adaptive techniques to accomplish day-to-day tasks. Along with exercises, the patient will be taught how to use medical devises such as wheelchairs or other equipment that will assist the patient with self-care. The patient and family members will also be taught a wide range of topics from urinary tract infections and skin care to modifications for the home. The patient is encouraged to get involved in pre-injury hobbies, participate in recreational activities, and return to work if possible.

Medications will also be a large part of treatment. These medications could include pain medication, muscle relaxers, and medication to improve bowel control, bladder control, and sexual function. Short-term medication may also be required such as antibiotics to treat urinary tract infections.

Future Outlook

On average approximately 30% of paraplegics can return to some kind of employment post-injury.2 The financial cost of future care for someone diagnosed as a paraplegic can be staggering. It can vary greatly due to the severity of the injury, but can range from several hundred thousand to almost a million dollars. One of the most important things a patient can do is to ensure their possibility of future appropriate medical treatment. Employment may yield insurance benefits. If employment is not possible, then social security disability can provide access to Medicaid benefits.

Many patients suffer from posttraumatic stress disorder, depression, and anxiety. The patient and family will experience a grieving process similar to the one experienced following the loss of a loved one. Counseling for the patient and family members is encouraged.

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