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 Level of Injury and Functional Ability

It is convenient to divide spinal cord injuries into three groups depending on the levels of the injuries:

1. High quadriplegia. (Quadriplegia - full or partial paralysis of 4 limbs, both arms and legs.  The injury is at the level of the fifth cervical level (CA) or above.  These people have very limited use of their arms and hands and no functional use of their legs.
2. Low quadriplegia. The injury is below (CA) but no lower than Tl.  People have increased and sometimes very good use of their arms and hands but still no functional use of their legs.
3. Paraplegia. (Paraplegia = full or partial paralysis of both legs)  Injuries are always located below Tl.  People have normal use of their arms, but varying abilities in using their legs.

The following chart summarizes the muscles involved in injury to the spinal cord at each level and also some of the activities which are usually limited as a result of the paralysis.
 

Spinal Cord Levels of Injury

Description of Muscle Involvement

Functional Abilities and Disabilities of Patients

            C1, C2, C3

1. Diaphragm (main breathing muscle) usually paralyzed.
2. Only the face and neck muscles usable.

1. Usually needs to be on respirator at least part-time to help him breathe.
2. Will be totally dependent in eating, bathing, dressing, turning, and personal hygiene (bowel and bladder care).

C4

1. Diaphragm usually functional.
2. Some use of shoulder muscles.
3. No function in arms or hands.

1. Same as C1, C2, C3 except won't need to be on respirator.
2. Usually can help to feed himself with special feeding equipment.

1. Increased use of shoulder muscles.
2. Partial use of upper arm muscles.

1. Same as C4 except more capable in feeding and able to brush his own teeth with special equipment.
2. Able to help with weight shifting and transferring in and out of a wheelchair, bed, and car.
3. Able to push himself short distances in a manual wheelchair.

Low Quadriplegia

C6

1. More use of shoulder and upper arm muscles.
2. Partial use of wrist and forearm muscles.

1. Able to feed himself with assistive devices.
2. Able to do most self care.
3. Able to dress upper body and perhaps lower body with assist­ive devices.
4. May be able to do weight shifting and transfers without help.
5. Able to move wheelchair greater distances.
6. Able to do light housekeeping.

C7

1. Complete use of shoulder and upper arms.
2. Near complete use of wrist and forearm muscles.

1. Able to feed himself independ­ently.
2. Able to dress himself with special equipment.
3. Able to do almost all self­care and grooming.
4. Able to do weight shifts independently.
5. Able to be fairly independent in most transferring.
6. Able to be independent in wheelchair, but may need help going up curbs.
7. Able to drive with hand controls.
8. Able to do all but heavy housekeeping.

C8 - T1

1. Almost complete use of wrist and forearm muscles.
2. Partly increased use of fingers and thumbs.

1. Same as C7 except able to be more independent in transfers.
2. Independent in all dressing and self care, including bowel program.

Paraplegia

T2 - T10

1. Muscles of arms and shoulders not affected.
2. Muscles of upper trunk of body (chest, abdomen) affected, depending on location of injury.

1. Full use of arms and hands.
2. No functional use of legs.
3. Usually restricted to wheel­cair for moving about.

T11, T12, L1, L2

1. Increased use of abdominal and back muscles.
2. Very limited use of a few upper leg muscles.

1. May be able to stand and walk hort distances on flat ground wth special equipment such as crutches and long leg braces.
2. Walking is mostly for exercise, not for getting around.
3. A wheelchair is usually the best way to get around.

L3 - S5

1. Increased use of upper leg muscles.
2. Little use of lower leg muscles in lumbar and upper sacral injuries - increased use in lower sacral injuries.
3. No control of foot muscles except in lower sacral injuries.

1. Increased ability to walk using short leg braces and crutches.
2. Walking is used for exercise but also for getting around instead of the wheelchair.