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Levels of Injury (Part 1)

by. Dr. Eko Agus Subagio, Sp. BS - Spine (Tulang Belakang), Dokter Saraf Kecetit
23 April 2015
Levels of Injury (Part 1)

Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction can occur.

High-Cervical Nerves (C1 – C4)

  • Most severe of the spinal cord injury levels
  • Paralysis in arms, hands, trunk and legs
  • Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements.
  • Ability to speak is sometimes impaired or reduced.
  • When all four limbs are affected, this is called tetraplegia or quadriplegia.
  • Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
  • May be able to use powered wheelchairs with special controls to move around on their own
  • Will not be able to drive a car on their own
  • Requires 24-hour-a-day personal care

Low-Cervical Nerves (C5 – C8)

  • Corresponding nerves control arms and hands.
  • A person with this level of injury may be able to breathe on their own and speak normally.
  • C5 injury
    • Person can raise his or her arms and bend elbows.
    • Likely to have some or total paralysis of wrists, hands, trunk and legs
    • Can speak and use diaphragm, but breathing will be weakened
    • Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently
  • C6 injury
    • Nerves affect wrist extension.
    • Paralysis in hands, trunk and legs, typically
    • Should be able to bend wrists back
    • Can speak and use diaphragm, but breathing will be weakened
    • Can move in and out of wheelchair and bed with assistive equipment
    • May also be able to drive an adapted vehicle
    • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
  • C7 injury
    • Nerves control elbow extension and some finger extension.
    • Most can straighten their arm and have normal movement of their shoulders.
    • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
    • May also be able to drive an adapted vehicle
    • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
  • C8 injury
    • Nerves control some hand movement.
    • Should be able to grasp and release objects
    • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
    • May also be able to drive an adapted vehicle
    • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
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