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Spinal Cord Injury

Focus on abilities and functional goals 






SCIs are graded according to the American Spinal Injury Association (ASIA) grading scale, which describes the severity of the injury.
The scale is graded with letters:

ASIA A: injury is complete spinal cord injury with no sensory or motor function preserved.
ASIA B: a sensory incomplete injury with complete motor function loss.
ASIA C: a motor incomplete injury, where there is some movement, but less than half the muscle groups are anti-gravity (can lift up against the force of gravity with a full range of motion).
ASIA D: a motor incomplete injury with more than half of the muscle groups are anti-gravity.
ASIA E: normal.



SCI Mnemonic for cervical levels

  • C1-C3, I turn my head so I can see
  • C4 Breathe more, shrug my shoulders to ignore
  • C5 Arms up high, bend my elbows, pretend to fly
  • C6 Pick up sticks, tenodesis helps me exist
  • C7 I’m in heaven, transfer myself, independent livin’
  • C8 This is great – now my thumb can manipulate


Abilities and Functional Goals of SCI levels

This table incorporates information from the following websites:



C1–C3 Limited movement of head and neck.


Breathing: Depends on a ventilator for breathing.

Communication: Talking is sometimes difficult, very limited or impossible. If ability to talk is limited, communication can be accomplished independently with a mouth stick and assistive technologies. Effective verbal communication allows the individual with SCI to direct caregivers in their ADLs -bathing, dressing, personal hygiene, transferring as well as bladder and bowel management.

Daily tasks: Assistive technology allows for independence in tasks such as turning pages, using a telephone and operating lights and appliances.

Mobility: Can operate an electric wheelchair by using a head control, mouth stick, or chin control, and can tilt wheelchair for independent pressure relief.


C3–C4 Usually has head and neck control. 

May be able to shrug their shoulders (C4 level).


Breathing: May initially require a ventilator for breathing, usually adjusts to breathing full-time without ventilator assistance.

Communication: Communication devices may be needed or may be normal.

Daily tasks: Environmental controls are often needed. Dependent for feeding, dressing, and bowel and bladder care. Can independently operate an adjustable bed with an adapted controller.

Mobility: Dependent for bed mobility and transfers, independent in electric wheelchair and with pressure relief by reclining wheelchair.


C5 Typically has head and neck control, can shrug shoulder and has shoulder control. Can bend his/her elbows and turn palms face up. Daily tasks: With setup and use of adaptive equipment, independent in self-feeding. Needs help with dressing. Dependent for bowel and bladder care.

Health care: Can manage their own health care by doing self-assist coughs and pressure reliefs by moving side-to-side.

MobilityModerate to maximum assistance needed for bed mobility. Maximum assistance needed for sliding board transfers. Independent in electric wheelchair with hand drive/controls. Independent in manual wheelchair with quad pegs for indoor mobility.

C6 Has movement in head, neck, shoulders, arms and wrists. Can shrug shoulders, bend elbows, turn palms up and down and extend wrists. Daily tasks: Independent in self-feeding with use of adaptive equipment. Independent with upper body dressing and needs assistance with lower body dressing. Dependent for bowel and bladder care.

Health care: Can independently do pressure relief (side-to-side), skin checks and turn in bed.

Mobility: Independent bed mobility and transfers but often require a sliding board and may need minimal help with transfers that are not level. Independent with lightweight manual wheelchair on level ground, gentle slopes, and 2-inch curbs. Can take off armrests and footplates independently. Drives adapted car independently

C7-C8 Has similar movement as an individual with C6, with added ability to straighten his/her elbows. Daily tasks: Independent with all self-care. Needs some assistance for bowel care. Able to perform household duties. Need fewer adaptive aids in independent living.

Health care: Able to do wheelchair pushups for pressure reliefs.

Mobility: Daily use of manual wheelchair. Can transfer with greater ease. Independent in uneven transfers. May be able to transfer floor to wheelchair. Independent in manual wheelchair on slightly uneven ground, low curbs, and standard ramps. May be able to stand in parallel bars with braces.

C8: Independent bladder function with intermittent catheterization. Independent bowel function with digital stimulation. Independent car transfers and may be able to get wheelchair loaded.

T1 Has added strength and precision of fingers that result in limited or natural hand function.


Daily tasks: Can live independently without assistive devices in feeding, bathing, grooming, oral and facial hygiene, dressing, bladder management and bowel management.

Mobility: Uses manual wheelchair. Can transfer independently.



T2–T6 Has normal motor function in head, neck, shoulders, arms, hands and fingers. Has increased use of rib and chest muscles, or trunk control. Daily tasks: Should be totally independent with all activities.

Mobility: Independent in all transfers and pressure relief. Independent with manual wheelchair on curbs, ramps, wheelies, and uneven ground. Able to load wheelchair into car and drive with hand controls. Able to walk short distances with leg braces locked straight and crutches or walker.

T7–T12 Has added motor function from increased abdominal control. Daily tasks: Able to perform unsupported seated activities.

MobilityWalking with leg braces and walker possible
Walking a long distance may be hard, and wheelchair use is still needed due to the high energy needed. 
Walking a long distance may be hard, and wheelchair use is still needed due to the high energy needed.

L1–L5 Has additional return of motor movement in the hips and knees. Mobility: Walking can be a viable function, with the help of specialized leg and ankle braces. 

L1 to L2: Independent transfers from bottom of tub.
Walking with leg braces and crutches possible, but wheelchair use still needed due to high energy needed.

L3 to L5: Walking with leg braces and straight canes. May use wheelchair for sports or long distances.



Depending on level of injury, there are various degrees of return of voluntary bladder, bowel and sexual functions.


Mobility: Increased ability to walk with fewer or no supportive devices.

S1 to S3: Walking without leg braces possible, but may be needed due to muscle imbalances



Equipment needed to gain function/independence 

SCI levels C1- C6



• Electric Trendelenburg Hospital Bed
• Ventilator and back-up generator
• Mechanical Lift
• Power wheelchair with tilt and recline, and sip-and-puff
• Environmental control unit
• Head pointer


• Electric Trendelenburg Hospital Bed
• Mechanical Lift
• Power wheelchair with tilt and recline





• Electric Trendelenburg Hospital Bed
• Power wheelchair with arm drive control for outdoors
• Manual wheelchair for indoors (level and non-carpeted surfaces)
• Padded shower bench
• Mobile arm support for ADLs
• Wrist cock-up splint
• Universal cuff please


• Power wheelchair with arm drive control for outdoors
• Manual wheelchair for indoors (level and non-carpeted surfaces)
• Tenodesis splint
• Transfer board
• Built-up handles



A Quick Reference to Functional Independence
The charts below are copied from www.physio-pedia.com



Thomas Jefferson University Hospital and Magee Rehabilitation.
Regional Spinal Cord Injury Center of the Delaware Valley, Susan. Sammartino@jefferson.edu

* Activities of Daily Living-Spinal Cord Injury Manual – addresses basic ADLs including dressing techniques 


* Mobility-Spinal Cord Injury Manual addresses all aspects of transfers

https://jdc.jefferson.edu/cgi/viewcontent.cgi?referer=https://www.google.com /&httpsredir= 1&article =1011 &context=spinalcordmanual_eng