Levels Of Injury - Understanding Spinal Cord Injury

Understanding Spinal Cord Injury

What you should know about spinal cord injury and recovery

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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

Learn More About Cervical Spinal Injuries

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.

Learn More About Thoracic Spinal Cord Injuries

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

Learn More About Lumbar Spinal Cord Injuries

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

Learn More About Sacral Spinal Cord Injuries

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Spinal Cord Injury Details

View Companion Booklet as a PDF

Table of Contents

• Spinal Cord Injury: Basic Facts
• Spinal Cord Anatomy: The Basics
• Levels of Injury
• ASIA/ISCoS Exam and Grade
• Glossary of Terms You May Hear
• Questions Families Should Ask Their Trauma Care Medical Team
• Expected Emotions and Helpful Coping Tips
• Important Tips for the Days and Weeks After the Injury or Diagnosis
• Steps to Negotiate the Insurance Maze
• Helpful Resources, and Credible Organizations and Web Sites

Produced by Shepherd Center and KPKinteractive in collaboration with the American Trauma Society, the National Spinal Cord Injury Association and the Christopher & Dana Reeve Foundation.

Contact Details

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