Spinal Cord Injury - Functional Goals for Specific Levels of Complete Injury

● C1-C3

Limited movement of head and neck Breathing: Depends on a ventilator for breathing.

Communication: Talking is sometimes difficult, very limited or impossible. If ability to talk is limited, communication can be accomplished independently with a mouth stick and assistive technologies like a computer for speech or typing.

Daily tasks: Assistive technology allows for independence in tasks such as turning pages, using a telephone and operating lights and appliances.

Mobility: Can operate an electric wheelchair by using a head control, mouth stick, or chin control. A power tilt wheelchair also for independent pressure relief.

● C3-C4

Usually has head and neck control. Individuals at C4 level may shrug their shoulders. Breathing: May initially require a ventilator for breathing, usually adjust to breathing full-time without ventilatory assistance.

Communication: Normal.

Daily tasks: With specialized equipment, some may have limited independence in feeding and independently operate an adjustable bed with an adapted controller.

● C5

Elbow flexors (biceps brachii) Typically has head and neck control, can shrug shoulder and has shoulder control. Can bend his/her elbows and turn palms face up. Daily tasks: Independence with eating, drinking, face washing, brushing of teeth, face shaving and hair care after assistance in setting up specialized equipment.

Health care: Can manage their own health care by doing self-assist coughs and pressure reliefs by leaning forward or side -to-side.

Mobility: May have strength to push a manual wheelchair for short distances over smooth surfaces. A power wheelchair with hand controls is typically used for daily activities.

Driving may be possible after being evaluated by a qualified professional to determine special equipment needs.

● C6 Wrist extensors

(extensor carpi ulnaris, extensor carpi radialis longus and radialis brevis) Has movement in head, neck shoulders, arms and wrists. Can shrug shoulders, bend elbows, turn palms up and down and extend wrists. Daily tasks: With help of some specialized equipment, can perform with greater ease and independence daily tasks of feeding, bathing, grooming, personal hygiene and dressing. May independently perform light housekeeping duties.

Health care: Can independently do pressure reliefs, skin checks and turn in bed.

Mobility: Can independently do transfers but often require a sliding board. Can use a manual wheelchair for daily activities but may use power wheelchair for greater independence.

● C7 Elbow extensors

(triceps brachii) Has similar movement as an individual with C6, with added ability to straighten his/her elbows. Daily tasks: Able to perform household duties. Need fewer adaptive aids in independent living.

Health care: Able to do wheelchair pushups for pressure reliefs.

Mobility: Daily use of manual wheelchair. Can transfer with greater ease.

● C8 Finger flexors

(Flexor digitorum profundus-distal phalanx of the middle finger) Has added strength and precision of fingers that result in limited or natural hand function. Daily tasks: Can live independently without assistive devices in feeding, bathing, grooming, oral and facial hygiene, dressing, bladder management and bowel management.