‘Paraplegia’ and ‘Quadriplegia’ are the devastating consequences of major damage to the spinal cord. This is usually sustained as a result of a concomitant injury to the spine but it can arise from other conditions, such as infection or degeneration of the spinal cord, or from a direct penetrating injury which affects only the cord and not the spine. In this condition the nerves which pass to the limbs, either the arms or the legs, or both, are damaged and the affected individual can neither feel the limb distal to the injury nor move it. In some instances the spinal cord may recover to some extent but, unfortunately, in most instances the damage to the nerves is permanent.
When associated with a spinal injury the damage to the cord usually occurs at the time of the accident. However this damage can be exacerbated by injudicious movement of the injured person after the event. It is for this reason that anyone who has sustained a significant injury to his neck or to his back should have the region supported until he (or she) is assessed by a medically qualified person experienced in these types of injury. The neck, if injured, should be supported at the scene of the accident by a collar. The person should be transported on a firm, spinal board, preferably by ambulance, to hospital.
The main problems which a paraplegic or quadriplegic person experiences are:
- Lack of movement – depending on the extent of the cord injury the affected person will be unable to move one or more of his limbs. They therefore require assistance in this respect, to the extent that they are disabled.
- Pressure sores – lying in any one position for any length of time impairs the circulation to the skin in that area. If this occurs the skin dies and becomes necrotic, leading to ulceration. Special mattresses can be used if available but it is, nevertheless, vital to ensure that the paraplegic or quadriplegic person is turned regularly, every two to four hours, to prevent the development of these sores.
- Bladder and bowel problems – lack of nervous control of the bladder and bowel lead to retention of urine and faeces. The nursing of the paralysed person must therefore include attention to these areas.
The treatment of individuals with these types of injuries is a team effort and centers, from the outset, on their rehabilitation. It takes a lot of courage for the affected individual to meet the challenges of this particular condition but the aim of treatment is to restore them to as normal a life as is possible. This entails helping them to be as independent and mobile as possible.
Various countries throughout the world have organisations which provide support for those with spinal cord injuries. in America there are the National Spinal Cord Injury Association, Determined2heal the Christopher Reeve Foundation and Spinal Cord Injury Zone, Britain has the Spinal Injuries Association and Apparelyzed, South Africa has the Quadpara Association, and Australia has the Paraplegic and Quadraplegic Association of NSW and the ParaQuad Association of South Australia.
Stabilization of any spinal fractures reduces pain and allows early mobility. This helps with the nursing and allows the physiotherapists and occupational therapists to begin the rehabilitative process as soon as is possible.
There are presently many attempts, using computers, to develop systems which will substitute for the damaged nerves and help the affected persons to walk relatively normally again but, to date, no such system has become universally available. In addition there is research into immunochemical and other methods to promote healing of the damaged spinal cord and allow the damaged nerves to function correctly once more. It is hoped that there will be speedy developments in both these fields.