(3) SCI Expectations By Level of Injury

10/07/2026

Neurologic level assumes _____ injuries. Does not consider other factors that affect functional outcomes (e.g. age, concomitant injuries, PMHx, complications, BMI, psychosocial factors)

complete

Considerations for all SCI Patients

• be aware of ‘next level’ of innervation to guide targets for improvement

• maintain functional ROM

• respiratory health

• education from other providers

  • and educate family + caregivers about: autonomic dysreflexia, skin integrity, bowel/bladder issues, body mechanics, equipment

• timing of ordering a wheelchair dependent on expected level and size expectation

Tetraplegia: General Classifications

High Cervical: C1-C4
Mid Cervical: C5-C7
Low Cervical: C8-T1

High Cervical Injuries

No UE function.

Totally dependent for all care = focus on training/education and patient’s ability to direct care (encourage them that this is gives them independence and control over their care)

Power chair with special control system

• Chin switch, head array, sip & puff

Consider environment control units (ECUs)

Goal = wean off ventilator at C4

(Chart) C1-C4 Mobility + ADL Expectations and Equipment Needs

• most dependent levels of SCI, especially for bed mobility + transfers

Levels __ and __ = loss of phrenic nerve innervation and spontaneous respiration

C1; C2

• only intact respiration are accessory muscles (SCM, UTs)

• artificial ventilator or phrenic nerve stimulator requires to sustain life

  • “pacemaker” for the lungs

• expiration is passive: these individuals require assistance for airway clearance

• Diaphragm Pacing

Dependent or Mechanical Transfers

Ceiling Lifts
Manual Hydraulic Mechanical Lifts
Electronic Mechanical Lifts
Electronic Stand-Assist LIfts

(Chart) C5 Mobility + ADL expectations and Equipment Needs

• Pressure relief should be already be independent (tilting back; may not be able to do a push-up, however)

(Chart) C6 Mobility + ADL Expectations and Equipment Needs

• key muscles retained: wrist extensors

(Chart) C7 Mobility + ADL Expectations and Equipment Needs

(Chart) C8 Mobility + ADL Expectations and Equipment Needs

• patients with this level have finger flexor function

  • test appropriately with: neutral wrist positioning (block wrist) while performing MMT

    • this prevents use of tenodesis grip

  • testing C8 for the ISNCSCI = isolate DIP flexion (stabilize wrist and hand up to PIPs)

(Chart) T1-T12 Mobility + ADL Expectations and Equipment Needs

(Chart) L1/L2/L3 Mobility + ADL Expectations and Equipment Needs

(Chart) L4/L5/S1 Mobility + ADL Expectations and Equipment Needs

• adaptive driving controls