OVERVIEW: FUNCTIONAL OUTCOMES: PARAPLEGIA

     Following are the specific signs, symptoms, and functional outcomes for complete lesions at each level of injury. The degree of functional loss for incomplete lesions, such as anterior cord, central cord, Brown-Sequard, posterior cord, and conus/cauda equina syndromes, is less.

Paraplegia

T1 - T6 Injuries

  • Loss of all motor and sensory function below the mid-chest region, including loss of motor function in the trunk muscles
  • Some loss of voluntary respiratory function
  • Loss of bowel and bladder function
  • Full independence in a wheelchair and in managing urinary drainage and inserting suppositories
  • Can achieve full-time employment and does not need major architectural changes in living quarters

T6 - T12 Injuries

  • Loss of motor and sensory function below the waist
  • No loss of respiratory function
  • Loss of bowel and bladder control
  • In addition to T1-T6 capabilities, complete abdominal, upper back, and respiratory control permit good sitting balance and wheelchair operation

L1 - L3 Injuries

  • Loss of most motor function of the legs and pelvis, and loss of sensation in lower abdomen and legs
  • Retention of knee jerk reflex
  • No loss of respiratory function
  • Loss of bowel and bladder control
  • All T1-T12 capabilities

L3 - L4 Injuries

  • Loss of motor and sensory function in portions of the lower legs, ankles, and feet
  • No loss of respiratory function
  • Loss of bowel and bladder control
  • May achieve walking with braces

L4 - S5 Injuries

  • Degree of motor function varies: Hip abduction and internal rotation, ankle dorsiflexion, and foot inversion possible in L4 - S1; foot eversion in L5-S1; knee flexion in L4-S2; plantar flexion and ankle jerk in S1-S2; bowel/bladder control in S2-S5
  • Sensory function in portions of lower leg: medial aspects of the foot in L5; lateral aspects of the foot in S1; posterior aspects of the calf/thigh in S2
  • No loss of respiratory function; may or may not have bowel/bladder control
  • Can walk with braces and live relatively independently

The PoinTIS Spinal Cord Nursing site of the SCI Manual for Providers is based on information in Hickey JV. The Clinical Practice of Neurological and Neurosurgical Nursing, 4th ed., Philadelphia: Lippincott, 1997; Chin PA, et al. Rehabilitation Nursing Practice, N.Y.: McGraw-Hill, 1998; and Wirtz KM, Managing chronic spinal cord injury: issues in critical care, Critical Care Nurse 1996 16(4):24-35 Aug., except for information where other papers are cited.