The following functional outcomes are the highest level of independence that a patient with a complete SCI injury at each level may achieve. A patient's actual functional outcome is also based on factors such as age, obesity, cognitive function, medical complications, contractures, muscle strength, build, etc.

Tetraplegia

C1 - 3

• Innervated facial and neck muscles permit chewing, swallowing, talking, blowing, and neck control, which permit:
  • Instructing others in care for pressure reliefs, skin precautions, upper ROM exercises, equipment setup and maintenance, upper extremity positioning, etc.
  • Doing independent pressure reliefs with power recline/tilt mechanism
  • Propelling a power wheelchair with portable respirator and chin or breath control on hard, level surfaces
  • Operating communication devices, games, and environmental control systems, such as speaker phones with automatic dialing, computers, and electronic page turners, with mouthstick or pneumatic control
  • Leisure activities, such as computer and electronic games, art, and reading
  • Vocational skills involving a computer

• Total paralysis of the trunk, UEs and LEs dictate:
  • Total ADL and respiratory dependence
  • Full-time attendant care

C4

• Innervated diaphragm, trapezius, cervical and paraspinal muscles permit respiration, scapular elevation, and neck movements, which permit:
  • Self-feeding with a long straw and straw holder
  • Self-skin inspection with assistant holding the mirrors
  • Propelling power wheelchair on uneven terrain
  • Using externally powered flexor hinge splints and powered mobile arm supports for increased independence
  • Note taking in school or business with an adapted tape recorder

• Paralysis of trunk, UEs and LEs dictate:
  • Full-time wheelchair use
  • Part- or full-time respiratory assistance
  • Full-time attendant care

C5

• Innervated shoulder muscles, biceps, brachialis, brachioradialis, supinator, infraspinatus, and deltoid permit shoulder external rotation, horizontal abduction (weak) and abduction to 90 degrees; elbow flexion and supination; and, by gravity, shoulder adduction, pronation, and internal rotation, which permit:
  • Using a ratchet splint to increase levels of functional independence
  • Self-feeding with a mobile arm support or suspension sling, dorsal wrist splint with u-cuff, and other devices such as a plate guard or scoop dish, stabilized cup or cup holder, and an angled spoon or fork
  • Self-dressing with some assistance with upper extremity dressing and maximal assistance with lower extremity dressing
  • Self-grooming, with a wash mit and a quad grip hairbrush, including face washing, teeth brushing, makeup application with minimal assistance, and hair brushing with moderate assistance
  • Bathing with a quad grip long-handled bath sponge - moderate assistance with upper extremity, and maximum assistance with lower extremity bathing
  • Upper extremity ROM with maximum assistance
  • Propelling hand-controlled power wheelchair over obstacles with assistance, and manual wheelchair with projection knobs on level surfaces for short distances
  • Pressure reliefs with power recline or tilt wheelchair with elbow or head switches
  • Typing stick in dorsal wrist splint with u-cuff and long writing orthosis, which allow a push button, speaker phone, and book pages to be turned manually using a book holder
  • Driving a van with many adaptations

• Absence of elbow extension and pronation, all wrist and hand movements, and total paralysis of trunk and LEs result in:
  • Low endurance and low respiratory reserve
  • Inability to roll over or come to sitting without hospital bed with rails
  • Assistance needed for transfers, skin inspection, bowel and bladder management

C6

• Innervation of the pectoralis major, serratus anterior, lattisimus dorsi, pronator teres, and radial wrist extensors permit strength for all shoulder movements, elbow flexion, forearm pronation and supination, and radial wrist extension, more respiratory reserve, and tenodesis grasp, which permit:
  • A wrist driven flexor hinge splint or RIC tenodesis for increased ease and independence
  • Self-feeding with a cup with large handles, a rocker or sharp paring knife for cutting, and no plate guard
  • Light kitchen activities in a wheelchair-adapted kitchen
  • Self-grooming, including teeth brushing, makeup application, and hair care, with tenodesis grasp and/or modified equipment
  • Self-bathing, with a shower/tub bench, faucet within easy reach, and hand-held shower hose
  • Handwriting, typing/keyboarding, telephoning, turning appliances and equipment on and off
  • Independent skin inspection
  • Self-bowel and bladder care, including suppository insertion with adaptive device; dil stick with adaptive handle; male self-catheterization, condom application, and draining bag maintenance with minimal assistance; and female intermittent catheterization with maximal assistance
  • Self-dressing of upper extremity and pants in bed (using momentum and substitute movements to turn over, sit up and pull up clothing) or button hook and zipper pull, with maximum assistance required for shoes and socks
  • Pressure reliefs when sitting using loops and forward weight shift
  • Upper extremity ROM
  • Propelling manual wheelchair, with friction material or rims on uneven surfaces for short or moderate length distances; moderate assistance needed for obstacles
  • Independent transfers with a transfer board and partial depression or swivel transfer
  • Rolling and moving from supine to long-sitting with loops suspended over the bed or by grasping the bedrail
  • Driving using hand controls with adapted steering wheel
  • Participating in sports, such as quad rugby, swimming
  • Working with electronic office machines and hand tools that require little strength

• Absence of wrist flexion and total paralysis of the trunk and LEs result in the need for a part-time attendant for:
  • Some assistance with dressing
  • Moderate assistance for negotiating obstacles in a wheelchair, proning and positioning
  • Maximum assistance with heavy work

C7 - 8

• Innervation of the triceps, extrinsic finger extensors, and flexor carpi radialis permit elbow extension, active finger extension (tenodesis grasp) and thumb abduction, and wrist flexion and extension, which permit:
  • Modified independent, easier self-feeding, dressing (with button hook only and minimal assistance for C7, and modified independent for C8), bathing/grooming, and bladder/bowel management
  • Propelling manual wheelchair over inclines and in/out of elevators, with some supervision for rough terrain and some assistance for doors
  • Independent pressure reliefs with push ups
  • Independent transfers to and from bed and wheelchair
  • Bed mobility, but minimal assistance for padding and positioning (C7), and modified independent for C8
  • Light housework
  • Participating in preparation for sexual activity
  • Driving a modified car
  • All communication, recreational, and vocational activities for C6, but with greater ease

• Lack of trunk muscles result in lack of full shoulder stability, weak trunk control, reduced endurance due to low respiratory reserve, and paralysis of the lower extremities

Paraplegia

T1 - 3

• Innervation of all upper extremity muscles permit full upper extremity control and fine coordination and grasp, which permit all self-care, mobility, communication, recreational, and vocational activities with greater ease than C7-8
• Weakness includes paralysis of lower extremities, weak trunk control, and reduced endurance due to low respiratory reserve

T4 - 9

• Partial innervation of intercostal and long muscles of the back (sacrospinalis and semispinalis) permit all arm functions, partial trunk stability, and increased endurance, which permit all using a standing frame independently
• Weakness includes partial trunk paralysis and total paralysis of the lower extremities

T10 - L2

• Full innervation of the intercostal muscles and partial to full innervation of the abdominal muscles permit partial to good trunk stability and increased physical endurance, which permit:
  • Full independence in all self-care, mobility, personal hygiene, sports and housekeeping activities
  • Ambulation with difficulty using braces and crutches
  • Driving with hand controls

• Weakness includes paralysis of the lower extremities and flaccid bowel, bladder, and sexual function

L3 - 4

• Innervation of the low back muscles, hip flexors, adductors, and quadriceps permit trunk control and stability, hip flexion and adduction, and knee extension, which permit independent ambulation with short leg braces and crutches
• Weakness includes partial paralysis of lower extremities, hip extension, knee flexion, and ankle and foot movements

L5 - S3

• Innervation of hip extensors and abductors, knee flexors, and ankle and foot muscles permit partial to full control of the lower extremities, which permit:
  • Ambulation with limited bracing
  • Volitional bowel, bladder, and sexual function
  • Driving a care without modifications

• Weakness includes partial paralysis of the lower extremities, most evident in the distal segment