SPINAL CORD INJURY — C1–C8

Function of the spinal cord

Relays messages between the brain and body; injury causes motor, sensory, bowel/bladder, and respiratory deficits below the level of injury.

NBCOT Rule for spinal cord injury

Higher injury equals greater impairment; as you progress from C1 to C8, motor control and functional independence increase.

C1-C3 spinal function

Ventilator dependent; total assist for all ADLs, movement limited to head and neck.

C4 spinal function

Independent breathing with diaphragm function; still requires total assistance for transfers and ADLs.

C5 spinal function

Biceps/elbow flexion, feeds independently after setup, assists with grooming and dressing.

C6 key concept

Tenodesis grasp; wrist extension produces passive finger flexion, wrist flexion produces finger extension.

C7 spinal function

Functional triceps and elbow extension; performs depression transfers without equipment.

C8 spinal function

Functional finger and thumb control; near-independent to fully independent in self-care and transfers.

Autonomic Dysreflexia

Unchecked sympathetic response causing a dangerous spike in blood pressure, triggered by bladder distension, bowel impaction, or skin irritation.

Signs of Autonomic Dysreflexia

Pounding headache, profuse sweating, facial flushing, bradycardia, nausea.

Action for Autonomic Dysreflexia

Sit up immediately, loosen tight clothing, check/empty catheter, and remove the noxious trigger.

Orthostatic Hypotension

Sudden drop in blood pressure upon sitting or standing upright.

Signs of Orthostatic Hypotension

Dizziness, lightheadedness, pallor, fainting.

Action for Orthostatic Hypotension

Recline immediately and elevate legs.

Pressure relief necessity

Mandatory across all levels due to loss of sensation; no sensation does not mean no pressure damage.

Wheelchair selection criteria

Based on client ability, goals, environment, and meaningful occupations; not solely on injury level.

Discharge planning essential

Prioritize a comprehensive home evaluation to assess safety, accessibility, and necessary modifications before discharge.