Spinal Cord Injury (SCI) is best defined as an injury to the spinal cord itself resulting from trauma, disease, or disorder. SCI’s are classified according to the level and type of injury to which they occur. As the spinal cord is typically referenced by its five nerve parts; cervical (C1-C8), thoracic (T1-T12), lumbar (L1-L5), sacral (S1-S5) and coccygeal (5 fused bones). (Porter, Kaplan, ; Homeier, 2009) These different parts along with whether the injury was complete or incomplete, allow one to know what type/level of injury has occurred as well as the extent of the possible damage. SCI’s are mainly divided into two types; quadriplegia/tetraplegia and paraplegia. The focus of this paper will primarily be paraplegia.
Paraplegia is referred to as a complete or incomplete injury to the spinal cord at T1-S5. This type of SCI usually encompasses paralysis of the legs and lower body. To determine the type and level of injury an individual may encounter many tests. Some of these tests include blood tests, lumbar punctures, CT scans, MRIs, and myelography X-rays. One would also undergo neurological exams to determine the damage, these include the light touch and pinprick test. (Porter, Kaplan, & Homeier, 2009)
The cause of paraplegia resides in either the spinal cord or the brain. The types of causes of paraplegia typically fall into two categories; focal and systematic lesions. Focal lesions can include damage to the vertebrae, disc herniation, tumors, Pott’s Disease, etc. Systematic lesions entail hereditary or genetic factors. Some examples of systematic lesions include Hereditary Spastic Paraplegia, Pellagra, motor neuron diseases, cerebral causes, etc. (Thomas, 2018) The leading causes of spinal cord injuries that can result in paraplegia include motor accidents, falls, violence, sport, and recreational activities, and medical and surgical injuries. Some other common causes include strokes, genetic disorders, oxygen deprivation at or during birth, autoimmune disorders, infections of the brain or spinal cord, tumors/lesions/cancer of the brain or spinal cord, and spinal cord disorders. (SpinalCord.com)
In reference to the prevalence of spinal cord injuries, both quadriplegia, and paraplegia, quadriplegia has more studies researched. However, one can conclude that the portion unstated would be paraplegic. As far as SCI’s in general, approximately 270,000 individuals were reported living with SCI in 2012, with 12,000 new cases each year. (Porter, Kaplan, & Homeier, 2009) Another article stated that one-third of reported cases is that of quadriplegia. Specifically, for hereditary cerebellar ataxias (HCA) and hereditary spastic paraplegias (HSP), it has been estimated that one in every ten thousand people are affected. (Ruano, Melo, Silvia, & Coutinho, 2014) All across the charts, however, men are more likely to acquire a spinal cord injury. A combination of the above reports states that the onset of such injuries typically occurs between the ages of 33 and 41.
As far as the action of treatment for SCI (paraplegia), many factors must play a role. The approach can essentially be broken down into three phases; initial medical treatment, rehabilitation, and outpatient therapy. The initial medical treatment should entail treatment of injury, reduction of further treatment and discussion of potential home and life modifications. The rehabilitation phase focuses primarily on helping the individual gain functional independence. Lastly, the outpatient therapy includes successful home return and community integration. (Porter, Kaplan, & Homeier, 2009)
Specifically, treatment of such injury will include surgery to address the site of the injury as well as secondary surgeries needed to realign or address other problems. Medications should then be given to reduce the risk of infection, blood clots, and other issues that may arise. The next course of treatment will include a whole team approach. This approach includes all teams such as physical therapist, occupational therapist, recreational therapists, etc. coming together to help regain function and build new coping skills. Education about the injury, advocacy and support should be included in all of these steps of treatment. (SpinalCord.com)
For Recreational Therapists, the latter two phases of treatment are where much of the work will be done. During the rehabilitation phase, one should introduce functional and educational skills. Some of these skills should include wheelchair mobility, stress management, and problem-solving. As for the final phase, community reintegration, it should entail not only the patient but their family or support system as well. In this phase, the patients should be able to put to test the skills they have previously learned. In the best outcome, the patient can successfully find programs and activities that they find leisurely to them as well as successful access and participate in them.
Prognosis of individuals with paraplegia depends heavily on whether the injury is complete or incomplete. However, treatments are available to aid in both situations. Treatment in the earlier stages will be more beneficial. Some of these treatments include therapy to strengthen the muscles, surgery to treat the spinal cord or affected areas, and steroid injections to reduce the inflammation. A newly studied research has also found that stem cells can be used as treatment due to their ability to regenerate damaged tissues. (SpinalCord.com) The prognosis also depends highly on the client themselves. The overall outlook on life thereafter and attitude towards treatment can affect the treatment itself as well as life after treatment. Another beneficial aspect to the prognosis of clients is their supports system Therefore if all the above-listed aspects are present and beneficial, the prognosis of individuals with paraplegia can be a positive one.