Neurological Level of Impairment
  • C1-C3

    Function: No movement or sensation below the neck; C1-C2 Ventilator-dependent, C3 may wean off vent.
    ADL: Dependent
    Elimination: Dependent
    Mobility: Sip-n-puff controlled power wheelchair, head array wheelchair, or eye gaze wheelchair. Ventilator-dependent patients (e.g. C1 injury) are unlikely to operate a sip and puff wheelchair. A patient with a C3 injury may be able to operate a head array wheelchair and/or chin control as well depending on neck strength,

  • C4

    Function: Movement and sensation of head and neck, some partial function of the diaphragm
    ADL: Dependent
    Elimination: Dependent
    Mobility: head or chin-operated power wheelchair

  • C5

    Function: Controls head,neck and shoulders, flexes elbows
    ADL: With assistance
    Elimination: Dependent
    Mobility: power wheelchair usually with goal-post joystick controller

  • C6

    Function: Uses shoulder, extends wrist
    ADL: Independent or with assistance
    Elimination: possible to self-cath men (and women with abdominal stoma) and eliminate with device.
    Mobility: wheelchair, self transfer

  • C7-C8

    Function: Extends elbow, flexes wrist, some use of fingers
    ADL: Independent
    Elimination: Independent
    Mobility: manual wheelchair

  • T1-T5

    Function: Has full hand and finger control, full use of thoracic muscles
    ADL: Independent
    Elimination: Independent
    Mobility: manual wheelchair

  • T6-T10

    Function: Controls abdominal muscles, has good balance
    ADL: Independent
    Elimination: Independent
    Mobility: manual wheelchair

  • T11-L5

    Function: Flexes and abducts the hips, flexes and extends the knees
    ADL: Independent
    Elimination: Independent
    Mobility: Ambulates with leg braces, short braces, or canes

  • S1-S5

    Function: Full control of legs, progressive bowel, bladder and sexual function
    ADL: Independent
    Elimination: Independent
    Mobility: Ambulates with leg braces, short braces, or canes

  • References

    Kirshblum S, Nieves J, Clark D, Gonzalez P, Cuccurullo SJ, Luciano L. Physical Medicine and Rehabilitation Board Review. Cuccurullo SJ LJ, editor. 3 rd ed. New York, NY: Demos Medical; 2015. Chapter 7, Spinal cord injuries. p.551-620.