SPINAL CORD

Levels of Injury

Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction can occur.

High-Cervical Nerves (C1 – C4)

Most severe of the spinal cord injury levels
Paralysis in arms, hands, trunk and legs
Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements.
Ability to speak is sometimes impaired or reduced.
When all four limbs are affected, this is called tetraplegia or quadriplegia.
Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
May be able to use powered wheelchairs with special controls to move around on their own
Will not be able to drive a car on their own
Requires 24-hour-a-day personal care

Low-Cervical Nerves (C5 – C8)

Corresponding nerves control arms and hands.
A person with this level of injury may be able to breathe on their own and speak normally.
C5 injury
- Person can raise his or her arms and bend elbows.
- Likely to have some or total paralysis of wrists, hands, trunk and legs
- Can speak and use diaphragm, but breathing will be weakened
- Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently
C6 injury
- Nerves affect wrist extension.
- Paralysis in hands, trunk and legs, typically
- Should be able to bend wrists back
- Can speak and use diaphragm, but breathing will be weakened
- Can move in and out of wheelchair and bed with assistive equipment
- May also be able to drive an adapted vehicle
- Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
C7 injury
- Nerves control elbow extension and some finger extension.
- Most can straighten their arm and have normal movement of their shoulders.
- Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
- May also be able to drive an adapted vehicle
- Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
C8 injury
- Nerves control some hand movement.
- Should be able to grasp and release objects
- Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
- May also be able to drive an adapted vehicle
- Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

Thoracic vertebrae are located in the mid-back.

Thoracic Nerves (T1 – T5)

Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.
Arm and hand function is usually normal.
Injuries usually affect the trunk and legs(also known as paraplegia).
Most likely use a manual wheelchair
Can learn to drive a modified car
Can stand in a standing frame, while others may walk with braces

Thoracic Nerves (T6 – T12)

Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury.
Usually results in paraplegia
Normal upper-body movement
Fair to good ability to control and balance trunk while in the seated position
Should be able to cough productively (if abdominal muscles are intact)
Little or no voluntary control of bowel or bladder but can manage on their own with special equipment
Most likely use a manual wheelchair
Can learn to drive a modified car
Some can stand in a standing frame, while others may walk with braces.

Lumbar Nerves (L1 – L5)

Injuries generally result in some loss of function in the hips and legs.
Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
Depending on strength in the legs, may need a wheelchair and may also walk with braces

Sacral Nerves (S1 – S5)

Injuries generally result in some loss of functionin the hips and legs.
Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
Most likely will be able to walk