Preface

Paraplegia affects mobility after a spinal cord injury (SCI), and it is usually accompanied by sensory and autonomic dysfunction occurring below the spinal level of the lesion. Despite recent progress in the biological sciences, SCI has no cure, and unfortunately, available clinical treatments are limited. Sequelae of this chronic condition include mental health impairments, diminished quality of life, and economic costs related to health care. This book is divided into four sections. The first section presents an introduction, while the second section, "Therapeutic Approaches," addresses the state-of-the-art advances in the use of mesenchymal stem cells from preclinical and clinical studies, as recent discoveries have shown promising results. The section also examines diverse strategies aimed at repairing the spinal cord. The third section, "Rehabilitation Approaches," covers a wide spectrum of strategies for restoring motor, sexual, and bowel dysfunctions. The final section, "Technological Approaches," provides an overview of some of the most recent advancements in devices for motor control (exoskeletons and wheelchairs) and electrical stimulation delivered below and above the SCI.

*Paraplegia* presents a multidisciplinary perspective in ten chapters that objectively review and address novel potential treatments for the restoration of loss functions below the SCI. For those who are familiar with SCI research, this book is a concise and up-to-date reference. For those interested in this complex pathology, this book presents the latest research targeted to improve daily life activities of paraplegic patients.

The editors express their gratitude to all the contributors to this book and thank them for their efforts and extraordinary work.

> **Dr. José Juan Antonio Ibarra Arias**  Research Coordinator, Health Sciences Research Center (CICSA), Universidad Anáhuac México, Campus Norte Huixquilucan, Estado de México, México

> **Dr. Carlos Alberto Cuellar Ramos** School of Sport Sciences, Universidad Anáhuac México, Campus Norte Huixquilucan, Estado de México, México

**1**

Section 1

Introduction

Section 1 Introduction

**3**

**Chapter 1**

Paraplegia

than paraplegia [3].

**and biopsychosocial impact**

Introductory Chapter: Clinical

*Diego Incontri-Abraham and José Juan Antonio Ibarra Arias*

Spinal cord injury (SCI), either traumatic or non-traumatic in origin, is a devastating condition that produces long-term effects that persist throughout life and are associated with severe disability and handicap. Reported traumatic SCI annual incidence rates ranges from 12.1 to 57.8 cases per million. Motor vehicle collisions, falls, violence, and sports represent the leading causes. In comparison to traumatic SCI, there is little literature on non-traumatic SCI epidemiology. The etiologies of this type of SCI include vertebral spondylosis (spinal stenosis), tumorous compression, vascular ischemia, congenital diseases and inflammatory conditions [1, 2]. Depending on the level of SCI, patients experience paraplegia or tetraplegia. Paraplegia is defined as the impairment of sensory and/or motor function in lower extremities. Patients with incomplete paraplegia generally have a good prognosis in regaining locomotor ability (around 76% of patients) within a year. Complete paraplegic patients experience limited recovery of lower limb function if their neurological level of injury (NLI) is above T9. An NLI below T9 is associated with 38% chance of regaining some lower extremity function and only 4% chance of recovery to an incomplete status. On the other hand, tetraplegia is defined as partial or total loss of sensory and/or motor function in all four limbs and has a worse prognosis

Spinal cord injury is a leading cause of disability, particularly in young adults. The highest incidences of SCI occur in persons between 20 and 40 years of age [4], being more common in males (82.8%) than females [5]. However, recent reports indicate an increase in SCI prevalence among older people and females. On the other hand, when classifying the types of disabilities caused by SCI, tetraplegia represents around 60%, while paraplegia represents approximately 40% [6]. Among all secondary complications following SCI, pressure ulcers, neurogenic bladder, urinary tract infections, pain, autonomic dysreflexia, osteoporosis, and muscle atrophy represent the majority. Currently, SCI complications management is challenging, and the outcomes are unsatisfactory [5, 7–10]. Moreover, having SCI may increase the risk of developing a health condition that is an indirect consequence of the impairment itself, such as increasing sedentary behaviors that contribute to the development of obesity and diabetes. Psychological factors (depression, anxiety, drug and substance dependency, post-traumatic stress disorders, etc.) may also complicate these chronic health conditions [11]. In addition, SCI leads to an abrupt change in the professional life and future plans of the patients [12] due to the irreversible restriction of functional movement, affecting not only quality of life

Approaches for Treating

**1. Introduction to spinal cord injury: epidemiology** 
