Paraplegia

Paraplegia is an impairment in motor and/or sensory function of the lower extremities. It is usually the result of spinal cord injury or a congenital condition such as spina bifida which affects the neural elements of the spinal canal. The area of the spinal canal which is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If the arms are also affected by paralysis, tetraplegia is the proper terminology.

Causes
The causes range from trauma (acute spinal cord injury: transsection or compression of the cord, usually by bone fragments from vertebral fractures) to tumors (chronic compression of the cord), myelitis transversa and multiple sclerosis.

Central nervous system
Any disease process affecting the pyramidal tract of the spinal cord from the thoracic spine downward may lead to paraplegia, as this structure transmits "instructions" for movement from the brain to the anterior horn. This is the most common cause of paraplegia. It is usually spastic: it results in an increased muscle tone in the affected limbs. Causes range from trauma (acute spinal cord injury: transsection or compression of the cord, usually by bone fragments from vertebral fractures) to tumors (chronic compression of the cord), myelitis transversa and multiple sclerosis. Gunshot wounds to the spine are one of the major causes of paraplegic spinal cord injuries (for instance, Ron Kovic, author of Born on the Fourth of July, is a paraplegic as a result of a gunshot wound suffered in the Vietnam War). Sometimes, paralysis of both legs can result from injury to the brain (bilateral injury of the motor cortex controlling the legs, e.g. due to a stroke or a brain tumor).

Peripheral nervous system
Rarer is the type which is caused by damage to the nerves supplying the legs. This form of damage is not usually symmetrical and would not cause paraplegia, but polyneuropathy may cause paraplegia if motor fibres are affected. While in theory the arms should also be affected, the fibres that supply the legs are longer and hence more vulnerable to damage. Larry Flynt, noted pornography magnate, sustained this form of nerve damage when he was shot in a murder attempt in 1978, rendering him paraplegic.

Disability
While some people with paraplegia can walk to a degree, many are dependent on wheelchairs or other supportive measures. Impotence and various degrees of urinary and fecal incontinence are very common in those affected. Many use catheters and/or a bowel management program (often involving suppositories, enemas, or digital stimulation of the bowels) to address these problems. With successful bladder and bowel management, paraplegics can virtually prevent all accidental urinary or bowel discharges; it is however another option for the patient to wear undergarments such as diapers to further protect from bladder or fecal incontinence. Some prefer diapers for the comfort level they provide.

Complications
Due to decreased movement and loss of the ability to run, paraplegia may cause numerous medical complications, many of which can be prevented with vigilant self care. These include pressure sores (decubitus), thrombosis and pneumonia. Physiotherapy and various assistive technology, such as a standing frame, may aid in preventing these complications.

Support organizations

 * Back-Up Trust
 * Spinal Cord Injury Peer Support
 * Spinal Cord Injury Support
 * Canadian Paraplegic Association