Paraplegia

Paraplegia
Paraplegia
	A man with traumatic hematomyelia after the fracture of the 11th thoracic vertebra. A line drawn over his navel marks the area of anesthesia.
Pronunciation	/ˌpærəˈpliːdʒə/ ;
Specialty	Physical medicine and rehabilitation
Causes	Spinal cord injury, congenital conditions affecting the spinal canal

Paraplegia, or paraparesis, is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek (παραπληγίη) "half-stricken".^{[citation needed]} It is usually caused by spinal cord injury or a congenital condition that affects the neural (brain) elements of the spinal canal. The area of the spinal canal that is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If four limbs are affected by paralysis, tetraplegia or quadriplegia is the correct term. If only one limb is affected, the correct term is monoplegia. Spastic paraplegia is a form of paraplegia defined by spasticity of the affected muscles, rather than flaccid paralysis.

The American Spinal Injury Association classifies spinal cord injury severity in the following manner. ASIA A is the complete loss of sensory function and motor skills below the injury. ASIA B is having some sensory function below the injury, but no motor function. In ASIA C, there is some motor function below the level of injury, but half of the muscles cannot move against gravity. In ASIA D, more than half of the muscles below the level of injury can move against gravity. ASIA E is the restoration of all neurologic function.^[1]

Treatment

Individuals with paraplegia can range in their level of disability, requiring treatments to vary from case to case. Rehabilitation aims to help the patient regain as much functionality and independence as possible. Physiotherapy may help to improve strength, range of motion, stretching and transfer skills.^[2] Most paraplegics will be reliant on a wheelchair as a mode of transportation.^[3] Activities of daily living (ADLs) can be quite challenging at first for those with a spinal cord injury (SCI). With the aid of physiotherapists and occupational therapists, individuals with an SCI can learn new skills and adapt previous ones to maximize independence, often living independently within the community.^[4]

Regeneration of the spinal cord

Olfactory ensheathing cells (OEC) have been transplanted with success into the spinal cord of a Polish man named Darek Fidyka, who was the survivor of a knife attack that left him paraplegic in 2010.^[5]

In 2014, Fidyka underwent pioneering spinal surgery that used nerve grafts, from his ankle, to 'bridge the gap' in his severed spinal cord and OEC's to stimulate the spinal cord cells. The surgery was performed in Poland in collaboration with Prof. Geoff Raisman, chair of neural regeneration at University College London's Institute of Neurology, and his research team. The olfactory cells were taken from the patient's olfactory bulbs in his brain and then grown in the lab, these cells were then injected above and below the impaired spinal tissue.^[6]

Fidyka regained sensory and motor function in his lower limbs, notably on the side of the transplanted OEC's. Fidyka first noticed the success three months after the procedure, when his left thigh started gaining muscle mass. MRIs suggest that the gap in his spinal cord has been closed up. He is believed to be the first person in the world to recover sensory function from a complete severing of the spinal nerves.^[5]^[6]

References

^ "Standard Neurological Classification of Spinal Cord Injury" (PDF). American Spinal Injury Association & ISCOS. Archived from the original on June 18, 2011
^ Taylor-Schroeder S, LaBarbera J, McDowell S, et al. (2011). "The SCIRehab project: treatment time spent in SCI rehabilitation. Physical therapy treatment time during inpatient spinal cord injury rehabilitation". J Spinal Cord Med. 34 (2): 149–61. doi:10.1179/107902611x12971826988057. PMC 3066500. PMID 21675354.
^ Ozelie R, Sipple C, Foy T, et al. (2009). "SCIRehab Project series: the occupational therapy taxonomy". J Spinal Cord Med. 32 (3): 283–97. doi:10.1080/10790268.2009.11760782. PMC 2718817. PMID 19810630.
^ Tzonichaki I, Kleftaras G (2002). "Paraplegia from spinal cord injury: self-esteem, loneliness, and life satisfaction". OTJR: Occupation, Participation and Health. 22 (3): 96–103. doi:10.1177/153944920202200302. S2CID 145347578.
^ ^a ^b Walsh F (21 October 2014). "Paralysed man walks again after cell transplant". bbc.co.uk. Retrieved 26 October 2014.
^ ^a ^b Quinn B (21 October 2014). "Paralysed man Darek Fidyka walks again after pioneering surgery". theguardian.com. Retrieved 26 October 2014. The 38-year-old, who is believed to be the first person in the world to recover from complete severing of the spinal nerves, can now walk with a frame and has been able to resume an independent life, even to the extent of driving a car, while sensation has returned to his lower limbs.