# Exercise as it relates to Disease/Exercise rehabilitation for paralysis of the legs
## Background

Paraplegia, or more commonly known as 'paralysis of the lower limbs' is usually characterised by damage to specific brain cells, vessels and nerves, commonly affecting thoracic, lumbar, or sacral regions of the spine.

### Definition

Paraplegia: The loss of the ability to move (and sometimes to feel anything) from the waist down to the toes, generally as a result of a disease/illness, poison, or injury.

### Causes

The four most common causes of Paraplegia are:
* Stroke - Blood supply to brain is restricted (brain cells begin to die, which can lead to brain damage that often results in paralysis)
* Head Injuries - Paralysis can occur if a certain part of the brain that controls certain muscles in the legs is damaged due to a severe head injury
* Spinal Cord Injuries - Injury in the middle of the spine will usually cause paraplegia (paralysis of the lower limbs)
* Multiple Sclerosis - The immune system attacks myelin (surrounds nerve fibres - helps with transmission of nerve signals) damaging nerve fibres and ability to send signals

### Paraplegia and Aerobic Exercise

Re­habilitation of individuals with paraplegia primarily focuses on strength training as the means to develop functional independence. However, it has been proven in a study Aerobic Capacity in Early Paraplegia that aerobic exercise can significantly improve quality of life and help to increase max VO2, nearly achieving similar results through an arm ergometer test as an able bodied athlete. In this study it was also found that a higher V02 max is achieved using graded exercise (starting slow then increasing) as opposed to an intermittent exercise programme (intense training) in paraplegic athletes. Therefore, treatment and rehabilitation should be progressive.

## Treatment

It is extremely important that people who are paraplegic continue to exercise and keep active to maintain general health and well-being. Losing some/all movement of both legs can lead to significant muscle atrophy (muscle mass reduction), therefore exercising to maintain the individual's range of motion in their joints and to maintain muscle function at the highest possible level that can be expected is essential.

### Exercise Rehabilitation Recommendations

Exercise for those in wheelchairs can help to regain mobility and to interact with normal daily activities. It can also help to alleviate body sores caused by sitting in the same position for long periods of time. Below are some recommendations of exercises suitable for those in a wheelchair, focusing on upper body strength.
* Shoulder presses - targeting deltoid muscles Video example of shoulder press
* Bicep curls - targeting Biceps Video Example of Bicep curl
* Tricep extensions - targeting Triceps Video example of Tricep extension
* Lat Pull downs - targeting Latissimus dorsi muscles Video example of lat pull down
* Chest Press - targeting pectoralis muscle Video example of chest press
* Abdominal exercises - Targeting abdominal muscles Video example of abdominal strength exercises
Figure 1.2 Spinal Cord Injury Rehabilitation
| Level of Injury | Possible Impairment | Rehabilitation Potential |
| T1-T6 | Paraplegia with loss of function below mid-chest; full control of arms | Independent with self-care and in wheelchair; able to be employed full time |
| T6-T12 | Paraplegia with loss of function below the waist; good control of torso | Good sitting balance; greater ability for operation of a wheelchair and athletic activities |
| L1-L5 | Paraplegia with varying degrees of muscle involvement in the legs | May be able to walk short distances with braces and assistive devices |

### Paraplegia in Sport

Athletes who are Paraplegic are still widely involved in many competitive sports. There are numerous sporting programs and institutions established that help to ensure that all athletes receive the chance to compete in sports of their choice. Certain classification guidelines are used to determine and ensure fairness and equality is regulated in the sporting world. The International Paralympic Committee caters for sports in the Paralympic games including:
* Wheelchair Basketball
* Wheelchair Athletics
* Wheelchair Tennis
* Wheelchair Dance Sport
* Wheelchair Fencing
* Wheelchair Rugby
* Wheelchair Curling

## Further reading

* International Paralympic Committee - http://www.paralympic.org/
* Motion Specialties - http://www.motionspecialties.com/index.php/what-is-paraplegia
* Home strength training guide - http://www.sciactioncanada.ca/docs/home-strength-training-guide-paraplegia.pdf
* Paraplegia and Aerobic Exercise Study - http://www.nature.com/sc/journal/v27/n4/pdf/sc198939a.pdf

## References

* ↑ Health Encyclopedia (2013) Spinal cord Injury, University of Rochester - Medical Centre, http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P01180
* ↑ Blackburn, P, (2002) Paralysis - Causes, NHS Health Choices, http://www.nhs.uk/Conditions/paralysis/Pages/Causes.aspx
* ↑ Ellenberg, M .. et al,(1989) Paraplegia, Aerobic Capacity in Early Paraplegia: Implications for Rehabilitation, p261-268, http://www.nature.com/sc/journal/v27/n4/pdf/sc198939a.pdf
* ↑ Motion Specialties (2010), Paraplegia, http://www.motionspecialties.com/index.php/what-is-paraplegia
* ↑ Holmes, J (2012) Home Strength Training Guide for people with paraplegia, Active Homes, http://www.sciactioncanada.ca/docs/home-strength-training-guide-paraplegia.pdf
* ↑ Health Encyclopedia (2013) Spinal cord Injury, University of Rochester - Medical Centre, http:/ / www. urmc. rochester. edu/ encyclopedia/ content. aspx?ContentTypeID=85& ContentID=P01180
* ↑ International Paralympic Committee, Official Website of the Paralympic Movement, http://www.paralympic.org/Sports