Levels of Function in Spinal Cord Injury

Main Ideas

• The spinal cord carries messages between the brain and the rest of the body. When it is bruised, crushed, or torn, messages may not pass normally through the injured area.
• In general, functions above the injury level continue to work, while functions below it may be impaired. Possible effects include changes to movement and sensation, bowel or bladder function, and breathing.
• Injury labels such as C4 or T2 indicate where along the spinal cord the injury occurred. Generally, a higher injury level is associated with greater impairment.
• These abilities are broad examples; function varies by injury level.

Levels of Function Described

• C1–C3 (cervical): Typically limited head and neck movement, with paralysis below that level. Many survivors have difficulty speaking and need a ventilator to breathe.
• C3–C4: Head and neck movement, plus limited shoulder movement. Survivors are typically able to speak and may eventually breathe without a ventilator.
• C5: Head, neck, and shoulder control; ability to bend the elbows and rotate the hands. Self-care may be manageable, and pushing a wheelchair or driving with adaptive equipment may be possible.
• C6: Movement of the head, neck, shoulders, arms, and wrists, including bending the elbows, extending the wrists, and rotating the palms. Many can do most self-care, light housekeeping, and manage a manual wheelchair.
• C7: Similar abilities to C6, but with greater ease managing tasks.
• C8–T1: Use of the head, neck, shoulders, arms, hands, and fingers. Survivors in this range are generally able to live independently.
• T2–T6 (thoracic): Normal upper-body function, with some impairment in the legs. Some people may walk using assistive devices.
• T7–T12: Similar function to T2–T6, with somewhat greater leg control.
• Lumbar (L-level) injuries: Generally, some ability to move the hips and knees; walking may be possible with assistive devices.

Speakers and Sources

• Marcy, presenter speaking for brainandspinalcord.org.
• brainandspinalcord.org, cited by the presenter as a source for further information and resources.