Care of the patient with paraplegia

Introduction

A patient with paraplegia is probably going to live with the paralysis of his lower half of the body throughout his life. He is educated about the level of cord involvement : what part of his body will work and what will not work.

Attention should be given to the following :

Wheel chair acceptance and wheelchair skills : 'transfers' on and off the wheel chair
physiotherapy : passive to prevent joint contractures and active to strengthen non-paralysed muscles
drugs to reduce spasticity baclofen, dantrolene, tizanidine
Sensory loss: guard against hot, hard or sharp objects; taking the weight of the body off the seat of the wheel chair routinely every 15 or 20 minutes
Bladder : reflex bladder emptying, condom drainage, intermittent self-catheterization, indwelling catheter; cholinergic or anticholinergic drugs as necessary; alertness to urinary tract infection
prevent infection : avoiding contact with people with respiratory infection. Breathing exercises to prevent secretions collecting in the respiratory tract. Frequent complete emptying of the bladder.
Bowel : regularity of diet, laxatives and suppositories, anal sphincter massage if needed to stimulate bowel evacuation
sexual function : often an area of great disappointment. normal sexual enjoyment, male ejaculation, orgasm motor skills for intercourse all lacking.fertility often ymimpaired in either sex though seminal emission in males will require either bvibrator stimulation of the fraenum of the penis or electro-ejaculation; counselling of patient and spouse helps adjustment.
weight and calories : tend to gain weight. eating and drinking are enjoyable activities left open to them. heaviness is difficult for their mobility, and bad for the weight bearing pressure areas.
psychological aspects : disappointment, depression, shame, resentment, anger, and a sense of an altered role in the family are some of the natural feelings that paraplegic patients experience
family support : the presence or absence of this makes a very great difference to the ease of life of a paraplegic patient
employment : the patient's self-esteem may be much higher if he can still continue his previous work or if he can be retrained to obtain new work
house adaptation : ground floor, modifications for wheel chair
car adaptations : all controls to arms and hands
financial advice : arrange for financial assistance
recreational acitivities and holidays : actively pursued
leagal advice : arrange for it especially if the paraplegia is due to an accident.