Paralysis as a symptom of spinal cord injury (SCI) specifically refers to lack of motor control causing reduced ability to move one’s body – this is, of course, inextricably linked to sensation and an injury to the spinal cord that severs motor control will also affect sensory perception.[i] When talking about paralysis it is useful to describe the region or regions of the body affected as well as the severity or ‘completeness’ of the impact.
Degrees of paralysis
The cause, and in the case of SCI, the completeness of the injury, informs the severity of the motor control loss.[ii] Someone with a complete spinal cord injury – that is, an injury severe enough to completely discontinue nerve function – will lose all sensation and control below the point of injury. An injury that disrupts nerve function in only one part of a cross section of spinal cord will have a different effect, with the impact depending on the region of the spinal cord cross-section affected. Someone with injury to one or the other side of the spinal cord may have paralysis on one side only, with little or no impact on the other side of their body. Injuries to the front, back, or central core of the spinal cord have, in turn, various other effects.
- Anterior cord syndrome is usually typified by weakness with preserved, though reduced, motor control.[iii]
- Brown-Sequard syndrome describes the impact of a left- or right-sided SCI; an injury only affecting the nerve bundle at one side of the spinal cord may only affect that side.[iv]
- Posterior cord syndrome is rarer and primarily affects sensation and proprioception (the innate awareness of the body’s position and movement).[v]
- Central cord syndrome is the most common SCI associated with degenerative spinal changes and aging as well as traumatic injury, and its effects can range from minimal loss of fine movement control to paralysis.[vi]
Regions of paralysis
The definition of paralysis can be applied to any part of the body that has lost movement, but is usually broadly labelled by its impact on the limbs. The regions of paralysis are predicted by the region of impact of injury.[vii] However, paralysis extends beyond deliberate limb movement to affect more innate functions like breathing, continence, and the sexual organs.
Tetraplegia/quadriplegia
Tetraplegia describes a condition where all four limbs are affected. High SCI in the C1-C4 vertebral levels will have a significantly impaired or total loss of nerve pathways below that point. That affects not only the sensation and motor control for limbs and other voluntary movements, but involuntary motor control as well, including conscious and unconscious breathing control, and the functions of the pelvic organs. People with SCI affecting the lower cervical vertebrae – C5-C8 – may have degrees of preserved nerve function to parts of the arms and hands, so it can be more useful to describe the actual preserved function for an individual.
Formerly, tetraplegia was more commonly referred to as quadriplegia. Both prefixes mean ‘four’, as in the four limbs affected; the difference is etymological rather than medical, to maintain consistently Greek, rather than Latin and Greek combined, word-roots for conditions of paralysis.
Paraplegia
Paraplegia refers to paralysis of the lower limbs, i.e. lack of motor control of the legs. People with paraplegia also experience impact on the nervous system relating to the pelvic organs, so bowel and bladder problems including constipation, incontinence, and urinary retention are common. Paralysis affecting the lower limbs also affects the nerves of the reproductive system, so sexual function is affected.
Paraplegia can be caused by an SCI that occurs below the level that would affect the upper limbs. People with an SCI at the levels of the high thoracic vertebra – T1-T5 – usually have preserved function of the arms and hands, but some impact on the muscles of the chest and abdomen. People with lower thoracic SCI – T6-T12 – may still have some impact on back and abdominal muscles, but retain normal function above that point. With intact upper limb function and no concerns about breathing, self-care is usually a lot more straightforward.
Right or Left Hemiplegia
Damage affecting only the right or left side of the spinal cord is less common. If only those nerves affecting one side of the body are damaged, then the paralysis would only affect that sided of the body, from the point of injury down. More commonly, a spinal cord injury that affected one side would not be that precise, and there may be some degree of global impact.
Monoplegia
Monoplegia describes paralysis of only one limb, and can be the result of injury to the brain, spinal cord, or damage to the peripheral nervous system relating to that limb. Cerebral palsy is the most common cause of monoplegia.
Lower spinal cord injuries

Nerve root anatomical structure labeled cross section, vector illustration educational diagram. Medical information with root scheme. Human spine health guide as informative poster. Graphical example.
Injuries to the lower spinal cord may have a lesser impact on lower limb function; different nerve pairs supply sensation and motor control to different areas of the legs. People with SCI affecting the lumbar or sacral spinal cord, depending on the level of injury, may retain good control over the muscles of the leg but are likely to have reduced control over their bowels and bladder.
Sexual function is likely to be altered with any spinal cord injury; this may mean lack of sensation or control, erectile dysfunction, vaginal dryness, and other issues arising from the impact of SCI and paralysis.
As well as paralysis stemming from spinal cord injury, damage to a nerve root after it diverges from the spinal cord can cause regions of paralysis, though this will apply to a specific area rather than the classic signs of spinal cord injury, i.e. an injury affecting a single nerve will not affect other areas of nerve function.
Does a fractured spine always mean paralysis?
A vertebral fracture – damage to the bones of the spine – does not necessarily affect the spinal cord. The spinal cord is the conduit for movement and sensation signals, and so only when the spinal cord is damaged do you get paralysis. A vertebral fracture or traumatic injury affecting the spine can, however, cause damage to the spinal cord, whether it is an acute traumatic injury or a degenerative, progressive condition.
Other causes of paralysis
Spinal cord injury is just one of the possible causes of paralysis[viii]; other causes include:
- Stroke: particularly a one-sided loss of motor control.
- Brain injury: the brain and spinal cord form the continuous central nervous system and a brain injury can have a range of impact, including paralysis which can be regional or widespread.
- Degenerative diseases affecting the nerves, like motor neurone disease or Huntington’s disease.
- Autoimmune conditions which affect the nerves, such as Guillain-Barre syndrome or multiple sclerosis.
Risks associated with paralysis
Being unable to move independently is associated with a number of significant health conditions and outcomes.[ix] Without control over movement, a person is at risk of:
- Pressure damage to the skin and underlying tissues.[x]
- Moisture damage to the skin, from sweat and incontinence, plus an increased risk of fungal skin infections.
- Obesity, coupled with muscle degeneration.
- Depression – becoming paralysed triggers a number of huge lifestyle changes which can be overwhelming and can contribute to significant mental health problems. A life-changing injury, alongside permanent disability, changes in lifestyle and which can affect family life, recreational activities, and work or education, takes time and support to come to terms with.
Higher spinal cord injuries which affect the muscles involved with breathing have their own risks and are associated with higher incidence of serious illness.
- Pneumonia – alongside an inability to cough and clear mucous, and which may be exacerbated by inability to change position and poor sitting balance.
- Aspiration – an impaired swallow means that food or fluid can enter the respiratory tract and cause aspiration pneumonia.
- Difficulty managing complex care needs – some people with high spinal cord injuries have tracheostomies, and some need part- or full-time mechanical ventilation. Some people with high spinal cord injuries need to have their nutrition and hydration needs met through an alternative to the oral route – usually a percutaneous endoscopic gastrostomy (PEG). While this can all be well-managed with a trained care team, it does inevitably mean that activities take a little more planning and organisation than for people without complex care needs.
Some of the risks associated with paralysis can often be prevented, or at least reduced, by provision of good care. Pressure or moisture damage can be minimised with regular positional changes, good continence care, and appropriate pressure-relieving equipment like mattresses and cushions. A team of specialised carers can support people living with paralysis to stay healthy and active.
There is a range of solutions to problems with urinary or faecal incontinence, constipation and urinary retention, and they are tailored to the individual. Problems associated with immobility can be reduced with an appropriate healthy diet, physiotherapy and management of other issues. A person with reduced physical function should also be able to continue having a healthy sex life, although the impact of a spinal cord injury means that there usually have to be some adjustments – and a little imagination – in the way people have sex.

Depressed Man with Problems holding hand over his Face and Crying, occupied by Mind Blowing Thoughts
Depression and other mental health problems can be associated with trauma, injury, immobility, a changing body and changing abilities, feelings of self-worth, and changes to position in society, the workplace, and the home. There is no right or wrong way to feel after a life-changing injury or with changing care needs for any reason. It may take time to realise that a person with extra care needs is as valued and valuable as anyone else in society, and that a person’s potential does not have to be linked to their physical abilities. Feelings of depression and other negative emotions can be transient or can last a long time and become a serious problem. Asking for help when struggling with mental health is a positive, responsible action, and there is lots of support available.[xi]
Living with paralysis after a spinal cord injury
The world has almost always been designed by, and for, able-bodied people. In more recent years, efforts have been made to create a more accessible and inclusive infrastructure, but living with any level of paralysis will require some adaptation. Equipment is better than ever, with an overwhelming number of devices aimed at improving quality of life for people with complex restrictions and extra care needs.
While it requires practical, physical, and emotional solutions to adapting to life with any degree of paralysis, the kind of care a person receives has a huge influence on their quality of life and abilities. The aim of good nursing care teams is to make for any deficits in self-caring abilities; if carers can ‘fill the gaps’, then a person with complex care needs can continue to live a full and fulfilling life. Everyone – from the fittest, most physically able people to those with the most severe disabilities – requires some sort of support to live, and care packages are not designed to reduce independence, but rather to facilitate independence with support.[xii]
A care package designed to support people with paralysis will be built to respect an individual’s wishes and with their lifestyle and values in mind, while meeting their functional needs. Care packages can be built to support people in their own home, out and about, and even going on holiday. For someone with ongoing care needs, a care team can become familiar and valued, promoting and facilitating the kind of life the individual wants to lead. Health and social care services, specialist care providers, and in-person or online professional or peer support groups can help with the social and practical side of life with these kind of new care needs, and people with spinal cord injuries causing paralysis can expect their care providers to help them live the lives they want.
[i] Alizadeh, A., Dyck, S. M., & Karimi-Abdolrezaee, S. (2019). Traumatic spinal cord injury: an overview of pathophysiology, models and acute injury mechanisms. Frontiers in neurology, 10, 282.
[ii] Bryden, A., Kilgore, K. L., & Nemunaitis, G. A. (2018). Advanced assessment of the upper limb in tetraplegia: a three-tiered approach to characterizing paralysis. Topics in Spinal Cord Injury Rehabilitation, 24(3), 206-216.
[iii] Pearl, N. A., & Dubensky, L. (2020). Anterior cord syndrome.
[iv] Shams, S., & Arain, A. (2021). Brown Sequard Syndrome. In StatPearls [Internet]. StatPearls Publishing.
[v] McKinley, W., Hills, A., & Sima, A. (2021). Posterior cord syndrome: Demographics and rehabilitation outcomes. The Journal of Spinal Cord Medicine, 44(2), 241-246.
[vi] Avila, M. J., & Hurlbert, R. J. (2021). Central Cord Syndrome Redefined. Neurosurgery Clinics, 32(3), 353-363.
[vii] Kirshblum, S. C., Burns, S. P., Biering-Sorensen, F., Donovan, W., Graves, D. E., Jha, A., … & Waring, W. (2011). International standards for neurological classification of spinal cord injury (revised 2011). The journal of spinal cord medicine, 34(6), 535-546.
[viii] Armour, B. S., Courtney-Long, E. A., Fox, M. H., Fredine, H., & Cahill, A. (2016). Prevalence and causes of paralysis—United States, 2013. American journal of public health, 106(10), 1855-1857.
[ix] Sezer, N., Akkuş, S., & Uğurlu, F. G. (2015). Chronic complications of spinal cord injury. World journal of orthopedics, 6(1), 24.
[x] Cowan, L. J., Ahn, H., Flores, M., Yarrow, J., Barks, L. S., Garvan, C., … & Stechmiller, J. (2019). Pressure ulcer prevalence by level of paralysis in patients with spinal cord injury in long-term care. Advances in Skin & Wound Care, 32(3), 122-130.
[xi] Post, M. W. M., & van Leeuwen, C. M. (2012). Psychosocial issues in spinal cord injury: a review. Spinal cord, 50(5), 382-389.
[xii] Barclay, L., McDonald, R., & Lentin, P. (2015). Social and community participation following spinal cord injury: a critical review. International Journal of Rehabilitation Research, 38(1), 1-19.