What is Paraplegia?

Paralysis is a general term used to describe the loss of movements and/or sensation following damage
to the nervous system. Knowing the precise level of the injury is helpful in predicting which parts of
the body will be affected by paralysis and loss of function.

Paraplegia describes complete or incomplete paralysis affecting the legs and possibly also the trunk,
but not the arms. The extent to which the trunk is affected depends on the level of spinal cord injury.
Paraplegia is the result of damage to the cord at T1 and below.

Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8
there is most often control of the hands, but poor trunk control as the result of lack of abdominal
muscle control. Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle
control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip
flexors and legs.

Besides a loss of sensation or motor functioning, people with SCI also experience other changes. For
example, they may experience dysfunction of the bowel and bladder,. Sexual functioning is frequently
impaired or lost with SCI. Men may have their fertility affected, while a women's fertility is generally
not affected. Other effects of SCI may include low blood pressure, inability to regulate blood pressure
effectively, reduced control of body temperature, inability to sweat below the level of injury, and
chronic pain.
T-1 injuries are the first level with normal hand function. They can perform all motor functions of a
non-injured person, with the exception of standing and walking. As thoracic levels proceed caudally,
intercostal and abdominal musculature recovery is present, and there is improved respiratory function
and trunk balance as a result. Some complete lower injuries have partial trunk movement and may be
able to stand, with long leg braces and a walker, and may be able to walk short distances using this
equipment, with assistance. T6-12 patients also have partial abdominal muscle strength, and may be
able to walk independently for short distances with long leg braces and a walker or crutches (The
working abdominal muscles are used to throw the paralysed legs forward whilst the body weight is
taken on a frame or crutches)

Attempting this form of walking is normally a decision taking in a medical environment. It takes a lot
of determination and strength to achieve any success with this sort of walking. It isn't for everyone,
indeed many complete paraplegics won't even want to try it.
Incomplete Paraplegia
Every incomplete paraplegic will be different. Just because the cord damage is the same level as
another person it doesn't mean the resultant disability will be the same. In fact most 'incompletes'
are very different. What recovery there is will be dependent on three main factors. How badly the
cord was damaged, what level it is and the precise area of the cord that was affected.

The potential recovery is normally seen in the first 6 months post injury although recovery gains have
been reported to continue for up to 2-3 years afterwards. Recoveries and the potential for them will
vary enormously. The very incomplete may have virtually no noticeable loss of motor function but
impaired sensation or other bodily functions. The other end of the scale is where there is little or no
motor function below the level of injury but sensation to touch/pain etc has been preserved. The
potential for recovery will be affected by other factors too. i.e. access to good physiotherapy and
occupational therapy, normally this will be on a specialist spinal injuries unit. General health post
injury and the right mental attitude are also important in maximising any potential return of function.

My own injury is described as C4 incomplete tetraplegia. My cord damage is central cord syndrome.
Very fortunately I was airlifted from the scene of my accident and within two weeks was on a
specialist spinal injuries unit in London. My outcome is very similar to what is described below for
central cord syndrome. My legs are much stronger than my arms enabling me to walk slowly with
crutches indoors. My left arm has little motor function and my right about 30% of normal range of
movement. My shoulder function and ability to extend or raise my right arm has remained very poor,
meaning I still require a lot of help with daily living. My injury was in '94 and I broke C2,3 + 4, and
consider myself very very fortunate to have had an incomplete injury at that level.

See below for the most common incomplete syndromes.

Incomplete Tetraplegia - Paraplegia

Types of Incomplete Spinal Injuries

An incomplete lesion is the term used to describe partial damage to the spinal cord. With an
incomplete lesion, some motor and sensory function remains. People with an incomplete injury may
have feeling, but little or no movement. Others may have movement and little or no feeling.
Incomplete spinal injuries differ from one person to another because the amount of damage to each
person’s nerve fibres is different.

The effects of incomplete lesions depend upon the area of the cord (front, back,
side, etc) affected. The part of the cord damaged depends on the forces involved in
the injury.

Anterior Cord Syndrome: is when the damage is towards the front of the spinal
cord, this can leave a person with the loss or impaired ability to sense pain,
temperature and touch sensations below their level of injury. Pressure and joint sensation may be
preserved. It is possible for some people with this injury to later recover some movement.

Central Cord Syndrome: is when the damage is in the centre of the spinal cord. This typically
results in the loss of function in the arms, but some leg movement may be preserved. There may also
be some control over the bowel and bladder preserved. It is possible for some recovery from this type
of injury, usually starting in the legs, gradually progressing upwards.

Posterior Cord Syndrome: is when the damage is towards the back of the spinal cord. This type of
injury may leave the person with good muscle power, pain and temperature sensation, however they
may experience difficulty in coordinating movement of their limbs.

Brown-Séquard syndrome: is when damage is towards one side of the spinal cord. This results in
impaired or loss of movement to the injured side, but pain and temperature sensation may be
preserved. The opposite side of injury will have normal movement, but pain and temperature
sensation will be impaired or lost.
Cauda equina lesion: The Cauda Equina is the mass of nerves which fan out of the spinal cord at
between the first and second Lumbar region of the spine. The spinal cord ends at L1 and L2 at which
point a bundle of nerves travel downwards through the Lumbar and Sacral vertebrae. Injury to these
nerves will cause partial or complete loss of movement and sensation. It is possible, if the nerves are
not too badly damaged, for them to grow again and for the recovery of function.