Paraplegia And Occupational Therapy: Strategies To Improve Daily Living Skills And Independence

Introduction

Paraplegia is a type of paralysis that affects the functions of the lower part of the body. It occurs due to an injury or a medical condition that damages the spinal cord and makes it unable to send signals to the lower body.¹ Paraplegia is also called partial paralysis.¹ It is a condition where you are unable to move the lower part of your body voluntarily. It is a type of paralysis that affects the feet, toes, legs, part of the trunk, pelvic organs, and sometimes, the abdomen.^{3 4}

Occupational therapy plays an important role in the treatment of paraplegia. It helps to overcome the limitations of the patient and improve the quality of life.²

This article will discuss how occupational therapy affects paraplegia outcomes.

Causes of paraplegia 

Paraplegia occurs either due to an injury to the spinal cord or due to an underlying disease or medical condition. 

Spinal cord injury occurs due to the following causes¹,⁴

• Injury from motor vehicle accidents
• Gunshot wounds
• Medical and surgical injuries 
• Injuries from sports activities 
• Fall injuries

Other causes of paraplegia include⁴

• Stroke
• Tumours affecting the spinal cord
• Spinal cord and brain infections 
• Cysts in the spinal cord
• Diabetes-related nerve damage
• Autoimmune diseases like multiple sclerosis
• Hereditary conditions like spastic paraplegia
• Choking
• Injuries during childbirth
• Congenital conditions like spina bifida
• Ischaemia is a condition where there is a lack of blood flow due to rupture or blockage of blood vessels

Types of paraplegia

Paraplegia can be of 2 types: complete and incomplete. 

In a complete injury, the patient has a total loss of sensations and voluntary functions below the level of injury. This can cause loss of bowel and bladder control.⁵

Incomplete paraplegia is also called partial paraplegia. It involves the partial loss of sensations below the level of injury. The patient is able to feel some form of sensations and make a limited range of motions. 

Signs and symptoms of paraplegia 

Patients with paraplegia experience varying symptoms based on the underlying cause. Symptoms may improve with treatment of the underlying conditions and proper therapy.¹

Some of the symptoms of paraplegia are as follows:^{1 6}

• Absence of sensations in the lower body
• Absence of movements in the lower body
• Unexplained pain and sensations in the lower body
• Loss of bowel and bladder control
• Changes in fertility
• Decrease in sexual function
• Pain and stinging sensation due to damage in the nerves in the spinal cord.
• Mood changes, anxiety, and depression 
• Infections at the site of injury
• Weight gain

Occupational therapy and paraplegia

Occupational therapy is a treatment method that is used in the rehabilitation of people with paraplegia. The main aim of occupational therapy is to enhance the patient’s ability to engage in occupations they want to do.  It helps people cope with their limitations and live more independently.  

An occupational therapist suggests many exercises, activities and changes in your daily activities. The therapy helps patients to manage everyday life better and improve their quality of life.²

Role of occupational therapist 

An occupational therapist is a part of the multidisciplinary team involved in the management of a spinal cord injury. The therapist has the role of giving information to the patient, thus facilitating proper communication with the patient. Other roles of occupational therapist are:

• Help the patient to adapt to society better.
• Teach certain exercises and activities that help to overcome physical limitations.
• Improve the quality of life of the patient.⁷

Components of occupational therapy 

Occupational therapy involves:²

• Learning and practising  everyday skills like dressing, cooking, managing the household, going to school, and working
• Exercises for concentration, memory, and perception
• Practising daily routine 
• Exercises for movement of paralyzed muscles
• Teaching the use of prostheses and walkers
• Guidance and advice for improving the quality of life 

Steps in Occupational Therapy There are 3 main steps involved in occupational therapy:⁸

1. Evaluation
2. Intervention
3. Outcomes

Evaluation

Evaluation involves assessment of the functional abilities of a patient with paraplegia. The areas of deficit of function and movement are identified to plan the treatment goals. This allows us to track the score of progress during the intervention.

Intervention

This phase implements the plans and strategies prepared during the evaluation phase in order to reach the desired outcome. In this phase, the patient is taught certain occupations such as exercises and activities that improve the lower body strength and enhance independence.

Outcomes

This stage measures the outcome of the therapy. It determines how much of the goals and plans of the therapy were met and calculates the overall progress and result of occupational therapy.⁸

Activities of daily living(ADLs)

Activities of daily living can be classified into 2 categories, personal activities and instrumental activities. 

Personal activities 

Personal activities include skills required to manage the day to day personal needs like dressing, eating, personal hygiene, and toileting. 

Instrumental activities

These include more complex activities like domestic work, shopping, and managing finances.

How do you improve daily living skills?

Occupational therapists help the patients to overcome the difficulties associated with spinal cord injuries. Activities of daily living(ADLs) training is given to the patient. Some of the activities and exercises included in the therapy are described below.⁹

Moving and handling training 

Occupational therapy helps paraplegic patients to overcome the limitations in movement. This is done with the guidance of people or with transfer devices like slings. 

Equipment

This includes equipment like chairs, beds, and wheelchairs which help the patient with the day-to-day activities following a spinal cord injury.

Customised housing

The therapist recommends new adaptations to the housing according to the needs of the patient. This includes changes to the kitchen, bathroom, and stairs to help the patient adjust to the limitations.

Employment

The therapist takes note of the previous job roles and current skills of the patient and helps the patient to return back to work life.

Mental support

Occupational therapy helps patients with paraplegia to overcome the challenges presented by the injury. 

Regaining independence 

Paraplegia causes a permanent alteration to your daily life. Always make sure that you don't go too hard on yourself while trying to regain your life in order. The person gradually adapts to the body's limitations.¹⁰ 

Many exercises and activities help to overcome the paralysis and regain independence. The patient is made to move the paralyzed part of the body with outside help. Washing, dressing, standing, and walking are taught with some help initially. After practice, the patient becomes capable of doing things independently to an extent.¹¹

Movement of the paralyzed part

It is important to move the paralyzed parts of the body every day after the injury in order to prevent contracture. The paralyzed parts should be moved gently and rhythmically. 

Exercises 

Exercises must begin immediately following treatment of the injury. The muscles in the lower body are concentrated in the exercise. 

One such exercise involves a patient being made to sit on a mat and push down on lifting blocks making the buttocks lift off the mat. 

Moving on and off the wheelchair 

If the patient is sitting in a wheelchair, the brakes are put on and the patient tries to lift the buttocks while holding the armrests. Sliding tables are used now in order to move while using the wheelchair.

The patient is taught to move on and off a wheelchair independently. This can be achieved only after a lot of practice.¹¹

What are the precautions to be taken for paraplegic patients?

• Care should be taken to prevent pressure sores in paraplegic patients. A special type of bedding material is used and the patient is frequently moved to prevent bedsores.
• Joints should be frequently moved in order to prevent stiffness in motion. Heat and massage are also used to increase joint mobility.¹²

FAQs

1. What is paraplegia?

Paraplegia refers to paralysis of the lower body. It is caused by any injury to the brain or spinal cord or because of some underlying disease conditions.

2. What is occupational therapy?

Occupational therapy is a type of rehabilitation used to treat paralysis. It involves many activities and exercises that help the patient to lead a near-to-normal life.

3. What causes paraplegia?

Paraplegia is caused due to some injury to the brain or spinal cord or due to some underlying medical conditions. 

Summary

Paraplegia is a condition that is characterised by paralysis of the lower body. It occurs because of spinal cord injury or due to some underlying diseases. Occupational therapy plays an important role in overcoming the difficulties faced by paraplegic patients. Therapy and exercises can help the patient to overcome limitations, improve daily living skills and regain independence.