Levels of a Spinal Cord Injury
Understanding the different levels of a spinal cord injury will help you care for your clients more effectively. When I started out as a home health aide I thought that there were only two types of injuries; quadriplegic (paralyzed from the neck down) and paraplegic (paralyzed from the waist down). Yet as I met more clients I learned that there are lots of “gray areas” when it comes to spinal cord injuries.
I will be sharing with you the many different levels of a spinal cord injury. Why is this important? When you understand a client’s injury in more depth it helps you care for them with more effectiveness. For example, if your client has an injury in the Thoracic region he may not be able to move the lower half of his body but should have adequate control of his arms and hands. If you classify him in your mind as a “spinal cord injury” and jump in to help whenever he is trying to do something you are taking away his independence. Independence is important for anyone to maintain and “helping” too much when someone can perform a certain task on their own might be doing more harm than good.
Conversely if someone has a complete spinal cord injury in the C3 area of their spine, for example, they will not be able to move their arms. You will need to directly help with more tasks.
Knowledge is power. When you understand the levels of a spinal cord injury you can become a more effective caregiver.
What Is A Spinal Cord Injury?
A spinal cord injury occurs when damage occurs to the spinal cord. This could be from a traumatic event such as a motor vehicle accident, fall, sport or violent attack or from a non-traumatic event such as cancer, arthritis, osteoporosis and more.
The spinal cord is a complex neural “highway” that the brain uses to communicate with the rest of the body. When the spinal cord is injured this blocks the brains’ signals at a certain location causing a loss of function.
The degree of damage and the location of injury determines the effect of the injury. Below are several effects that can occur:
- Loss of movement
- Loss of sensation
- Loss of bowel and/or bladder control
- Exaggerated reflex actions or spasms
- Changes in sexual function, sexual sensitivity and fertility
- Pain or intense stinging sensation
The spinal cord is divided into three main categories; cervical, thoracic and lumbar. It is important to understand that each area has control of different functions.
Levels of a Spinal Cord Injury
In general, the higher up on the spinal cord the greater loss of function and sensation.
High Cervical Nerves (C1-C4)
- This is the most severe type of spinal cord injury.
- Usually results in paralysis in the legs, trunk, hands and arms.
- With this type of injury the client may not be able to breathe on their own or control their bowel or bladder.
- Speaking ability may be impaired or reduced.
- The client will typically require complete help with activities of daily living such as bathing, eating, getting dressed, etc.
- May require help (home care or assisted living) 24 hours a day.
Low Cervical Nerves (C5-C8)
- A person with a low cervical nerve injury may have the ability to breathe on their own and/or speak normally.
- These nerves control arms and hands.
C5 Injury
- This person is able to raise their arms.
- May have either partial or complete paralysis in legs, trunk, hands and wrists.
- Breathing is weak but can speak and use diaphragm to inhale oxygen.
- Can use a power wheelchair to move from one place to another but will need help with most activities of daily living.
C6 Injury
- The nerves in this area affect wrist extension.
- Typically there is paralysis in the legs, trunk and hands.
- Breathing is weak but can speak and use diaphragm to inhale oxygen.
- May be able to get in and out of their bed or wheelchair when using certain types of equipment.
- Could possibly drive a car that is adapted.
- Most will not have control of their bladder or bowel.
C7 Injury
- The nerves in this area control extension of the elbow as well as finger extension.
- Most clients with this level of injury can straighten their arm and move their shoulders.
- May need help with difficult ADL’s but can usually do most on their own.
- Most will not have control of their bladder or bowel.
C8 Injury
- The nerves in this area control the movement of the hands.
- Should be able to pick up objects.
- Should be able to do most ADLs on their own but may need help with harder tasks.
- Still no control of bladder or bowel.
Thoracic Nerves (T1-T5)
- The nerves in this area affect the muscles, upper chest, mid-back and abdominal muscles.
- There is usually normal function of the arms and hands.
- Legs and trunk are usually affected from this level of injury.
- Can use a manual wheelchair.
- Can learn how to drive an adapted car.
- May be able to walk with braces and/or stand in a standing frame.
Thoracic Nerves (T6-T12)
- The nerves in this area control the trunk.
- An injury usually causes paraplegia.
- Clients will typically have upper-body movement.
- When they are seated will usually have a fair amount of balance.
- Still little or no control of their bladder or bowels.
- Will probably be using a manual wheelchair.
- Can learn how to drive an adapted car.
- May be able to walk with braces and/or stand in a standing frame.
Lumbar Nerves (L1-L5)
- When an injury occurs in this area it will usually cause a loss of function in the legs and hips.
- Very little or no control of the bladder or bowel.
- Could walk with braces or need a wheelchair.
Sacral Nerves (S1-S5)
- When an injury occurs in this area it will usually cause a loss of function in the legs and hips.
- Very little or no control of the bladder or bowel.
- May be able to walk.
We spent a lot of time diving into the different levels of a spinal cord injury and what each part controls. Again, it is important to remember that knowledge is power. Our goal as caregivers is to provide the highest quality of care. Understanding each level of injury will help when you are deciding how much help to provide a client.
Of course, it never hurts to ask the client. We are trying to create a culture of gentleness so let them be your guide. If they would like greater assistance than by all means give them more assistance. But if you know that they like their independence than let them struggle a little bit and don’t be anxious when they are trying to do something.
Do you have any questions? Feel free to post them in the comments section below.
-Todd
Resources to Learn More About Spinal Cord Injuries
Understanding Spinal Cord Injury – A great video and downloadable resource guide to help you learn more about spinal cord injuries.
National Spinal Cord Association – Latest research, community, and more. Probably one of the best resources if you already have a spinal cord injury or are looking to learn more.
National Institute of Health – Guide to Spinal Cord Injuries from the NIH.
Spinal Cord Injury Network International – Started in 1986, they help individuals with spinal cord injuries and their families find the greatest quality of care.
The American Trauma Society – Focused on the prevention of trauma.
Disabled Sports USA – An organization that offers sports rehab programs.