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  • 344.1 Paraplegia

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  • G82.20 Paraplegia, unspecified

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  • 5H: Impaired Motor Function, Peripheral Nerve Integrity, and Sensory Integrity Associated With Nonprogressive Disorders of the Spinal Cord

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Description

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  • Complete paralysis of the trunk and bilateral lower extremities
  • Result of damage to the spinal cord in the thoracic, lumbar, sacral spine or caudia equina

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Essentials of Diagnosis2

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  • Complete neurological exam
    • Muscle strength testing of the upper extremity (UE), lower extremity (LE), core musculature
    • Reflexes, deep tendon reflexes (DTRs)
    • Sensation
    • Coordination
    • Proprioception
  • Diagnosis is made by level of injury, severity of injury, and use of the American Spinal Injury Association (ASIA) assessment
  • Complete loss of sensory and motor function due to damage in the thoracic or lumbar spine
  • Paraparesis is the partial loss of sensory or motor function due to damage in the thoracic or lumbar spine
  • Commonly the result of trauma, but can also occur due to infarction or hemorrhage
  • Spinal cord ends at or near the 1st lumbar vertebra (L1); damage at or above this level will produce upper motor neuron signs and symptoms
  • Damage below L1 will produce lower motor neuron signs and symptoms

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General Considerations

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  • Damage to the spinal cord results in potential complications to many body systems
  • Be aware of wide range of complications in order to be safe and effective with patient care

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Demographics

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  • Men 4x as likely as women
  • Most common cause is motor vehicle accident (MVA)
  • Second most common cause is falls

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Signs and Symptoms

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  • Upper motor neuron (UMN) signs present if the injury is above the conus medullaris
  • Lower motor neuron (LMN) signs present if the injury is in the conus medullaris or cauda equina
  • Complete injury is defined as no motor or sensory function spared in the lowest sacral segments
  • Incomplete injury is defined as partial or full function spared in the lowest sacral segments
  • Altered or lost trunk control and balance
  • Autonomic dysfunction if the injury is above the T6
  • Orthostatic hypotension
  • Loss of bone density
  • Decreased ventilatory capability for paraplegics with damage in the mid- to upper-thoracic region
  • Altered or lost ambulation/locomotion
  • Altered or lost bed mobility
  • Altered or lost transfer ability
  • Altered or lost muscle strength
  • Altered or lost sensations
  • Altered DTRs
  • Altered or lost bowel and bladder function
  • Altered or lost autonomic control
  • Altered blood pressure
  • Spasticity
  • Altered thermoregulation
  • Changes in muscle tone
  • Edema of legs, ankles, feet
    • Typically symmetrical and pitting in nature

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Functional Implications

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  • Impaired coordination
  • Impaired muscular strength
  • Impaired balance
  • Gait abnormalities
  • Impaired bed mobility
  • Impaired transfers
  • Decreased endurance and energy efficiency
  • Neuropathic pain
  • UE and shoulder pain/over use
  • Postural/orthostatic hypotension
  • Bladder and bowel dysfunction
  • Sexual dysfunction
  • Pressure sores
  • Increased risk of deep vein thrombosis
  • Increased risk of contracture
  • Increased risk of heterotopic ossification
  • Increased risk ...

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