| C1 – C3 |
- Sternocleidomastoid
- Neck accessories
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- Neck flexion, extension and rotation
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- Complete paralysis of trunk, upper &lower extremities
- Limited head and neck control
- No motor innervations to diaphragm; ventilator dependent.
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- Respiratory function: ventilator dependent===,
inability to clear secretions
- Standing: total assist
- Ambulation: not indicated
- Feeding, grooming, dressing, & bathing: total assist
- Home management and maintenance: total assist, can provide instructions on all aspects of care
- Dependent for all ADLs. Focus of rehabilitation should be on education for verbalization of care, caregiver training, maintaining ROM, assistive technology needs, and positioning and respiratory care.
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- Bowel: total assist
- Bladder: total assist
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- Bed mobility: total assist
- Bed/WC transfers: total assist
- Manual WC propulsion: total assist
- Power W/C propulsion: total assist
- Pressure relief/positioning: total assist (independent w/ power tilt w/c)
- Transportation: total assist (public transportation or attendant operated vehicle)
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- Ventilator supports: suction equipment. generator/battery backup, vent tray
- Bathing: padded reclining shower/commode chair
- Postural support devices: electric hospital bed w. side rails, specialty bed/pressure relief mattress, power/mechanical lift w/sling
- Wheelchair: power recline/tilt w/c, w/c pressure relief cushion, postural support/head control devices, transfer board. Can operate electric w/c using head control, mouth stick, or chin control
- Computer access: Integra Mouse with sip/puff select (can operate with tongue or lips), morse code with switch operated by tongue, eye movement or other facial muscles, single switch scanning, limited voice recognition for commands and using macros/shortcuts, eye gaze technology.
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| C4 |
- Diaphragm
- Upper trapezius
- Cervical paraspinal muscles
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- Inspiration
- Neck flexion, extension and rotation
- Scapular elevation
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- Paralysis of trunk, upper &lower extremities
- Inability to cough
- Low endurance/respirat ory reserves
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- Respiratory function: may be able breathe without a ventilator. Ventilator weaning and increased voluntary motor control of diaphragm, head, and neck.
- Standing: total assist
- Ambulation: not indicated
- Feeding, grooming, dressing, & bathing: total assist
- Home management and maintenance: total assist, can provide instructions on all aspects of care
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- Bowel: total assist
- Bladder: total assist
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- Bed mobility: total assist
- Bed & W/C transfers: total assist
- Manual W/C propulsion: total assist
- Power W/C propulsion: independent
- Pressure relief/positioning: total assist (independent w/ equipment)
- Transportation: total assist (public transportation or attendant operated vehicle)
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- Ventilator supports: ventilators as required, generator/battery backup as needed, vent tray
- Wheelchair: power recline/tilt w/c, w/c pressure relief cushion, postural support/head control devices, sip-n- puff, head switches, voice-control technology to operate power wheelchair, transfer board
- Bathing: reclining shower/commode chair
- Postural support devices: electric hospital bed w/ side rails, specialty bed/pressure relief mattress, tilt table, hydraulic standing table, power/mechanical lift w/sling
- Other: call systems, environment controls, mouthstick for page turning and computer operation with use of lap trays, book holders, and mouthstick docking stations.
- Computer access: Mouthstick and holder/mini keyboard, trackball mounted at chin, onscreen Keyboard, separate switch and interface for L/R click (operated by sip/puff, cheek, shoulder shrug, eye movement, mouse devices designed to be mounted at chin, mouth, “Hover” or “dwell” software for automatic selection of icons/controls, single or double switch scanning, morse code/switch activation, voice recognition
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| C5 |
- Deltoid
- Biceps
- Brachialis
- Brachioradialis
- Rhomboids
- Serratus anterior (partially innervated)
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- Shoulder, flexion, abduction, extension
- Elbow flexion, supination
- Scapular adduction, abduction
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- Absent elbow extension, pronation, all wrist/hand movement
- Complete paralysis of trunk, lower extremities
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- Respiratory function: low endurance, may be unable to clear secretions
- Standing: total assist
- Eating: total assist for setup, independent eating / equipment
- Grooming: some total assist/min assist
- Transfers: maximum assistance for bed mobility and transfers
- Dressing: total assist for U/L extremity
- Bathing: total assist
- Home management and maintenance: total assist, can provide instructions on all aspects of care
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- Bowel: total assist
- Bladder: total assist
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- Bed mobility: some assist
- Bed & W/C transfers: total assist
- Manual W/C propulsion: May have strength to push a manual w/c for short distances over smooth surfaces.
- Power W/C propulsion: With hand controls for daily activities.
- Pressure relief/positioning: Leaning forward or side-to-side
- Transportation: independent w/ specialized equipment, some assist w/ public transportation, total assist for attendant operated vehicle. Driving may be possible.
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- Wheelchair: power recline/tilt w/c, transfer board
- Postural support devices: w/c pressure relief cushion, power/mechanical lift, specialty bed/pressure relief mattress, electric hospital bed w/ cx controls, side rails, hydraulic standing table
- Bathing: Padded shower/commode chair
- Day (wrist cock up) and night (intrinsic plus) splints needed.
- U-cuff with right angle pocket for feeding, long straw, plate guard, mobile arm support or offset feeder, long wanchik brace for writing, cadeusus stylus or stylus in u-cuff, with proper setup of phone or tablet on lap tray or clasp on holder.
- Air splints to maintain elbow extension for home exercise program for increasing shoulder/scapula strength.
- Computer Access: Typing aids (with/without wrist support), mouthstick as back up, or if UE pain is present, mini-keyboard, laptray, trackball/joystick/touchpad for mouse movement, separate switch and interface for L/R click, keyboard shortcuts (StickyKeys, Hotkeys, etc.), word prediction/completion software for rate enhancement, voice recognition for ease and efficiency
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| C6 |
- Clavicular pectoralis
- Supinator
- Extensor carpi radialis longus, brevis
- Serratus anterior
- Latissimus dorsi
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- Scapular protraction (partial horizontal adduction)
- Forearm supination
- Radial wrist extension
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- Absent wrist flexion, elbow extension, hand movement
- Complete paralysis of trunk, lower extremities
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- Using wrist extensors, a person can now utilize tenodesis grasp pattern to pick up and handle objects.
- Respiratory function: low endurance/vital capacity, may be unable to clear secretions
- Standing: total assist
- Feeding: modified independent/total assist for cutting
- Grooming: modified independent
- Dressing: modified independent for upper extremity, moderate assistance lower body
- Bathing: independent for upper body, some to total assist for lower extremity
- Home management and maintenance: some assist w/ light meal preparation, total assist for all other activities
- Transfers: Begin bed mobility and transfer training to min-a to mod-a
- Other: can begin to participate in own skin checks and padding/positioning as well as (IADLs)
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- Begin bowel and bladder training with adaptive equipment to min assist to moderate assist (may be independent w/ leg bag emptying).
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- Bed mobility: some assist
- Bed & W/C transfers: some assist to independent on level surface, some to total assist on uneven surfaces. Use of a sliding board for Independence
- Manual W/C propulsion: Can use for daily activities
- Power W/C propulsion: Greater ease with independence
- Pressure relief/positioning: independent do pressure relief and skin checks and turn in bed
- Transportation: independent w/ driving
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- Wheelchairs: Power recline W/C. Manual chair use should be monitored and limited to decrease scapular dysfunction, transfer board
- Postural support devices: Hydraulic standing table, w/c pressure relief cushion, power/mechanical lift, specialty pressure relief mattress/overlay, electric hospital bed w/ side rails (standard full to king bed as indicated)
- Feeding: dining with dignity silverware, u-cuff with right angle pocket, or other adaptive utensils, including knives, but can begin to use standard utensils. Begin cutting and opening packages.
- Writing: short wanchik, u-cuff with right angle pocket, build-up foam or other custom writing utensils.
- Grooming: adapted makeup and makeup stand, adapted nail clippers, u-cuff for oral care, large top toothpaste with rubber bands.
- Dressing: elastic shoe laces, dycem gloves, loops in pants, sock aid, maternity clothes.
- Bathing: adapted sponges, bath mitts, adapted long-handled sponges with splinting material, grab bars, padded shower/commode chair
- Driving: vehicles adapted for driving with hand control.
- Computer Access: Typing aids ( with/without wrist support),
mouthstick as back up, or if UE pain is present, mini-keyboard, laptray, trackball/joystick/touchpad for mouse movement, separate switch and interface for L/R click, keyboard shortcuts (StickyKeys, Hotkeys, etc.), word prediction/completion software for rate enhancement, voice recognition for ease and efficiency.
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| C7-C8 |
- Latissimus dorsi
- Sternal pectoralis
- Triceps (C7)
- Finger Intrinsics (C8)
- Pronator quadrates
- Extensor carpi ulnaris
- Flexor carpi radialis
- Flexor digitorum profundus & superficialis
- Extensor communis
- Pronator, flexor, extensor & abductor pollicis
- Lumbricals (partially innervated)
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- Elbow extension
- Ulnar/wrist extension
- Wrist flexion
- Finger flexions & extensions
- Thumb flexion, extension & abduction
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- Paralysis of trunk & lower extremities
- Limited grasp & dexterity secondary to partial intrinsic muscles of the hand
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- Respiratory: low endurance & vital capacity secondary to paralysis of intercostals; may require assistance to clear secretions
- Standing: independent to some assist
- Ambulation: not indicated
- Feeding & grooming: independent
- Dressing: mod-I upper extremities, min-a lower extremities
- Bathing: independent in upper body, some assist to independent in lower body
- Home management & maintenance: independent light meal preparation and homemaking; some to total assist for complex meal preparation and heavy housecleaning
- Transfers: With use of triceps, a person can Independently transfer safely with or without use of a sliding board.
- At C8 level, patients may begin to have more finger movement and thus more hand function, allowing them to manipulate objects to increase independence with self-care and mobility and decrease need for adaptive equipment.
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- Bowel: some to total assist
- Bladder: independent to some assist
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- Bed mobility: independent to some assist
- Bed & W/C transfers: independent on level surfaces, independent to some assist on uneven surfaces
- Manual W/C propulsion: Daily use. Independent on all indoor surfaces & level outdoor surfaces; some assist on uneven terrain
- Pressure relief/positioning: W/C pushups for pressure relief
- Transportation: independent in car if independent with transfer & W/C loading and unloading; independent in driving modified van from captain’s seat
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- Adaptive devices as indicated for
- Wheelchair: Manual rigid or lightweight folding W/C with modified rims, transfer board as needed
- Postural support devices: Full electric hospital bed or full to king standard bed, hydraulic or standard standing frame, pressure-relief w/c cushion & mattress or overlay,
- Adaptive devices similar as with someone at a C6 level
- Bathing: padded tub bench with commode cutout or shower/commode chair, handheld shower, padded tub transfer bench or shower/commode chair
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| T1-T9 |
- Intrinsics of the hand including thumbs
- Internal & external intercostals
- Erector spinae
- Lumbricals
- Flexor/extensor/abduct or pollicis
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- Upper extremities fully intact
- Limited upper trunk stability
- Endurance increased secondary to innervation s of intercostals
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- Lower trunk paralysis
- Total paralysis of lower extremities
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- Respiratory: compromised vital capacity & endurance
- Standing: independent
- Ambulation: typically not functional
- Eating, grooming, dressing & bathing: independent
- Home management & maintenance: independent with complex meal preparation and light housecleaning; total to some assist with heavy housecleaning
- Transfer: Independently transfer selves to a variety of surfaces.
- Other: Capable of living independently, need education for preventing shoulder dysfunction due to increase use of upper extremities for ADLs and IADLs.
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- Bed mobility, bed & W/C transfers, W/C propulsion & pressure relief/positioning: independent
- Transportation: Independent in car (loading & unloading W/C)
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- Wheelchair: manual rigid or folding lightweight w/c, pressure-relief W/C cushion & mattress or overlay, transfer board as needed
- Toileting: elevated padded toilet seat or padded tub bench with commode cutout, dil stick if unable to reach for bowels
- Postural support devices: standing frame
- Bathing: padded tub transfer bench or shower/commode chair, handheld shower
- Driving: Hand controls for car
- Other: Hand mirror for skin checks. Can live independently without assistive devices in feeding, grooming, oral and facial hygiene, dressing, bladder management.
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