Introduction
Paraplegia is an injury to the spinal cord at the thoracic level & below resulting in an impairment in motor or sensory function of the lower half of the body. This condition occurs due to damage to the cellular structure of the spinal cord within the spinal canal. The area of the spinal cord which is affected in paraplegia is either the thoracic, lumbar, or sacral regions of the spinal column, the person retains full use of their arms & hands, but have poor trunk control & balance due to the lack of abdominal muscle control.
Lower thoracic injuries (T-9 to T-12) retain good truck control & good abdominal muscle control, the sitting balance of people with lower spinal cord injuries is usually very good. Injuries to the Lumbar & sacral injuries result in decreased control of the hip flexors & legs. Although paraplegia occurs below L2, the correct terminology for injury to these lower spinal nerves is called "Cauda Equine Syndrome". If the arms are also affected by paralysis, Quadriplegia/Tetraplegia is the correct terminology.
Mobility Impairments or a physical disability is one that affects a person's mobility or dexterity, it can be the result of an accident, leading to paralysis, loss of limbs or brain damage, or can be genetic, like Spina Bifida, Muscular Dystrophy, or people who are born without limbs. There are a wide variety of different types of physical disabilities that fall under Mobility Impairments, whatever the cause of the disability, persons with disabilities require a different set of emotional and physical needs & may need to use some sort of equipment for assistance with mobility & for them to be able to fully participate in society. There are also various organizations in South Africa that assist & support different disability groups with a wide variety of services. An example of this type of organization is The QuadPara Association of South Africa (QASA), who assists Quadriplegics & Paraplegics living in South Africa.
Whatever the cause of the disability, persons with disabilities require a different set of emotional and physical needs & may need to use some sort of equipment for assistance with mobility & for them to be able to fully participate in society. There are also various organizations in South Africa that assist & support different disability groups with a wide variety of services.
Support Organizations
There are a wide range of these advocacy and self-help organization which exist in South Africa, they include organizations such as the overtly political Disabled People South Africa, aligned with the ruling African National Congress, the National Council of and for Persons with Disabilities (NCPD) and DiSA, as well as single-issue national organizations such as the QuadPara Association of South Africa to name just a few.
The QuadPara Association of South Africa (QASA)
The QuadPara Association of South Africa (QASA) is a non-profit organisation (NPO 000-881) of Quadriplegics and Paraplegics in South Africa. QASA’s mission is “to improve lives by securing resources to advocate, educate, capacitate, support and mobilize”. QASA’s vision is that “all quadriplegics and paraplegics
will live their lives to their full potential”. QASA develops products, programmes and services for quadriplegic and paraplegic members to build their capacity and ensure opportunities for societal integration and empowerment.
These projects include but are not limited to the Disability Awareness & Sensitization Workshops/Sessions:
Disability Awareness & Sensitization is an ongoing programme to ensure the successful integration of persons with disabilities into society and the workplace. The aim of the programme is to equip employers and employees the skills and knowledge required to interact with persons with disabilities with confidence. This half-day training workshop will enable employers and employees have a better understanding of the variety of disabilities they may encounter and how to deal with this in a sensitive and practical manner; it will help them to overcome the natural fear we may have when we interact with a disabled person and give tips on awareness and etiquette in these situations. The training defines and describes disability, unpacks many of the myths which are associated with disabilities, provides a list of some do’s and don'ts and touches on the language of disability.
QASA offers tailor-made sensitization training to suit the needs of the company or organization.
Click on the link above to find out more about "Work Readiness and Employment Programme", or visit our Organizations - QASA Page to find out more about QASA and the other Projects and Services that they provide, or visit their website at www.qasa.co.za.
Awareness Campaigns
Organisations around South Africa such as QASA conducts various Awareness Campaigns and prevention programmes which aim to prevent future injuries by simply making the public aware of simplest things, these prevention programmes include the:
Road Safety Early Intervention & Prevention Programme
Spinal cord injury is one of the more devastating types of personal injury resulting in full or partial paralysis. Motor vehicle crashes are the leading cause of spinal cord injury in South Africa. In 2003, QASA initiated its "Road Safety Early Intervention & Prevention Campaign" to promote responsible road-user behaviour. The campaign has two focuses:
- Distracted Driving- aimed at reducing motor vehicle accidents
- ‘Buckle Up - We Don’t Want New Members!’ - aimed at reducing injury.
Take the pledge to save lives!
This campaign was awarded the SA Motoring Guild of Journalists award for the “Best Road Safety Project” and has been acknowledged by the United Nations (Global Road Safety Partnership) and the Road Accident Fund as ground-breaking and effective.
Campaign rollout:
- Throughout the year - at taxi ranks, schools and companies
- Festive/Holiday Seasons -at petrol stations along national routes (N1, N2, N3 & N12)
Click on the link above to find out more about "Road Safety Early Intervention & Prevention Campaign" ", or visit our Organizations - QASA Page to find out more about QASA and the other Projects and Services that they provide, or visit their website at: www.qasa.co.za.
Spinal Nerves & Levels
Each part of the body is supplied by a particular level or segment of the spinal cord & its corresponding spinal nerve. Function below the level of spinal cord injury will be either lost or impaired
Function of the spinal nerves in the cervical section of the spinal cord are usually unaffected by paraplegia and remain fully functional in someone with paraplegia.
Function of the spinal nerves below the cervical sections of the spinal cord are usually impaired due to damage in either the thoracic, lumbar or sacral areas, resulting in paraplegia.
The following spinal cord segments are responsible for the following functions:
- T1 Spreads the fingers & supplies small muscles of the hand.
- T1 –T12 supplies the chest wall (intercostals muscles) & abdominal muscles.
- T10 - L2 Psychogenic erections (thought controlled).
- L2 Bends the hip.
- L1, L2, L3, L4 Thigh flexion.
- L2, L3, L4 Extension of leg at the knee (quadriceps femora's)
- L2, L3, L4 Thigh adduction.
- L4, L5, S1 Thigh abduction.
- L4, L5, S1 Dorsiflexion of foot (tibialis anterior).
- L4, L5, S1 Extension of toes.
- L4, L5, S1, S2 Flexion of leg at the knee (hamstrings).
- L5, S1, S2 Extension of leg at the hip (gluteus maximus).
- L5, S1, S2 Plantar flexion of foot.
- L5, S1, S2 Flexion of toes.
- S2, S3, S4 Control a man's ability to have a reflex erection.
- S2, S3, S4 Ejaculation is generated by the bulbospongiosus muscle under the control of a spinal reflex via the pudendal nerve.
- S3,4 & 5 supply the bladder, bowel & sex organs & the anal & other pelvic muscles.
- Coc1 Responsible for sensation only over the coccyx area
Secondary Medical Complications
Secondary medical complications of paraplegia include:
- Pressure sores (decubitus)
- Thrombosis (blood clots)
- Low blood pressure
- Autonomic Dysreflexia
- Pneumonia.
- Dysfunction of the bowel & bladder.
- Sexual functioning is frequently impaired or lost.
- Men may have their fertility affected.
- Women's fertility is generally not affected.
Physiotherapy & various rehabilitation exercise equipment such as functional electrical stimulation, as well as vigilant self observation & care may aid in helping to prevent future and mitigate existing complications. If the paraplegia is from a traumatic injury to the spinal cord tissue, other nerve related complications can & occur. Cases of chronicneuropathic nerve pain in the areas surrounding the point of injury can exist. Neuropathic pain occurs when neurones within the damaged spinal cord send false pain messages to the brain. This type of pain can be treated by medication or to a lesser degree by non-medicinal therapies.
Some of these problems listed above can be prevented or kept under control through the correct eating & drinking, exercise, regular physiotherapy & medication, visit our Health Care & Rehabilitation - Mobility Impairments Page to find out how these Secondary Complications can be prevented or kept under control and which Health Care professionals can assist you.
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