2. Paraplegia
• is when the level of injury occurs
below the first thoracic spinal
nerve. The degree at which the
person is paralyzed can vary
from the impairment of leg
movement, to complete paralysis
of the legs and abdomen up to
the nipple line. Paraplegics have
full use of their arms and hands.
3. Segmental spinal Cord level and Function
Tl -T6
intercostals and trunk above the
waist
T7-Ll Abdominal muscles
Ll, L2, L3, L4 Thigh flexion
L2, L3, L4 Thigh adduction
L4, L5, S1 Thigh abduction
L5, S1 S2
Extension of leg at the hip
(gluteus maximus)
L2, L3, L4
Extension of leg at the knee
(quadriceps femoris)
L4, L5, S1, S2
Flexion of leg at the knee
(hamstrings)
L4, L5, S1
Dorsiflexion of foot (tibialis
anterior)
L4, L5, S1 Extension of toes
L5, S1, S2 Plantar flexion of foot
L5, S1, S2 Flexion of toes
4. Thoracic Paraplegia:
T1-T4 Abilities Disabilities
• Full head, neck and upper
extremity movements
possible.
• Good strength of chest
muscles.
• Breathing normal.
• Functional independence
in self care like house
keeping, feeding
themselves, meal
preparation and in bladder
and bowel skills.
• Can drive a car adapted
with hand controls.
• Normal communication
• Complete
paralysis of
lower body and
legs.
• Autonomic
Dysreflexia.
• Respiration
capacity and
endurance may
be compromised.
5. Autonomic
Dysreflexia
• Autonomic dysreflexia (hypereflexia) is a pathological
autonomic reflex that typically occurs in lesions above T6
(above sympathetic splachnic outflow).
Acute onset of autonomic activity from noxious stimuli
Afferent input from here reaches lower thoracic and sacral areas
Mass reflex response : elevation of blood pressure
This is a critical, emergency situation owing to the lack of
inhibition
from higher centers. Hypertension persists if not treated
promptly.
Death may occur.
6. Initiating stimuli: Autonomic dysreflexia is reported
mainly after bladder distension (urinary retention),
rectal distention, pressure sores, urinary stones,
bladder infections, noxious cutaneous stimuli ,
kidney malfunction, urethral or bladder irritation, and
environmental temperature changes.
Symptoms: Hypertension, bradycardia, severe and
pounding headache, profuse sweating, increased
spasticity, restlessness vasoconstriction below the
level of lesion, vasodialation above the level of
lesion, constricted pupils, nasal congestion,
piloerection(goose bumps) and blurred vision.
7. T5-T9 spinal cord
injury:
Abilities Disabilities
• Full head, neck and
upper extremity
movements
possible.
• Ability to transfer
from bed to chair
and chair to car.
• Can drive a car with
hand controls.
• Normal
communication
skills.
• Breathing normal.
• Complete
lower body
paralysis.
• Severe
spasticity
can be
present.
8. • May use an electric wheelchair for long distance
independent travel or uneven outdoor surfaces. A
manual wheelchair is used for everyday living, with the
ability to go over uneven ground for short distances.
• Individuals should receive advanced wheel chair training
to do “wheelies” and make transfers from the floor to
wheelchair.
• Car transfers may need assistance depending upon
upper body strength.
• Partial domestic assistance is required, such as heavy
household cleaning and home maintenance.
• These individuals have variable control of the paraspinal
and abdominal muscles, and they may be able to stand
by using bilateral Knee-Ankle-Foot Orthoses along with
walker or crutches.
9. T10-L1: spinal cord
injury
Abilities Disabilities
• Full head, neck
and upper
extremity
movements
possible with
normal strength.
• Ability to drive
car.
• Normal
respiratory
system.
• Normal
communication
• Partial paralysis of
lower body and legs.
• Spasticity can be
present.
10. • Ability to transfer independently from bed to chair
and chair to car. It may be possible to transfer from
floor to chair depending on upper body strength.
There is possibility to transfer from sitting position to
standing frame independently.
• These people have better trunk control than do
patients with a higher injury and they may be able to
walk household distances independently with Knee-
Ankle-Foot Orthoses and assistive devices; they
may even attempt to walk upstairs.
• Unfortunately these maneuvers can require extreme
energy expenditure, and many individuals prefer
wheelchair mobility.
11. L2-S5 : spinal cord
injury
Abilities
• Full upper body
control and balance.
• Can prepare
complex meals and
general house hold
duties
independently.
• Can drive car
independently with
hand controls.
• Normal respiratory
system.
• Normal
communication
skills.
• Some hip, knee
and feet
movements
possible.
• Walking slow and
difficult, possible
with assistance.
12. • Individuals with an injury at the lumbar level can become
functionally independent in terms of household and
community ambulation, which is often defined as
unassisted ambulation for distances greater than
150feet, with or without the use of braces and assistive
devices.
• Orthotic devices (Knee-Ankle-Foot orthoses and Ankle-
Foot orthoses) are often prescribed to assist patients
with lower extremity standing and walking.
• Full or part time use of manual wheelchair is necessary.
13. Conus Medullaris Syndrome
• Characterized by injury to the sacral cord
and to the lumbosacral nerve roots.
• The result is symmetric and (often)
completes saddle anesthesia, bladder and
bowel dysfunction and lower extremity motor
weakness.
• The functional prognosis for mobility and
activities of daily living is good, bladder
bowel dysfunction is less likely than in other
conditions, neurological recovery is limited.
14. Cauda equina syndrome
• Cauda equina syndrome is characterized by injury to
the lumbosacral nerve root, it is not truly a spinal
cord injury.
• It causes saddle anesthesia, bladder and bowel
dysfunction and variable motor weakness of the
lower extremity.
• This syndrome is often less complete and symmetric
than is Conus medullaris injury.
• Neurologic recovery can continue for many months
or years as the peripheral nerve roots can
regenerate(unlike spinal cord axons) and because
these injuries are incomplete.
• The functional prognosis for mobility and self-care
is good, although bladder and bowel continence
