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SCI Lvls& Func Capab
Spinal Cord Movement Levels and Functional Capabilities
Level | Movement Possible | Patterns of Weakness | Key Innervated Muscles | Functional Capabilities | AE/AD Equipment |
---|---|---|---|---|---|
T1-T9 (All Arms) | Upper extremities fully intact; limited upper trunk stability; endurance increased secondary to innervations of intercostals | Lower trunk paralysis; total paralysis of LE | Intrinsics of the hands incl thumbs; inter, exter intercostals, erector spinae; lumbricals; flex/ext/abd pollicis | Eating, grooming, dressing, bathing, bowel and bladder management (I); (I) bed mobility, standing (I) | Hand mirror for skin checks; Manual rigid/ light weight w/c; hand controlled driving |
T10-L1 (Pull it up!) | Good trunk stability | Paralysis of LE | Fully intact intercostals; external obliques; rectus abdominis | Functional ambulation some assist to (I) | KAFOs; Manual rigid/ light weight w/c; hand controlled driving |
L2-S5 (Can you moonwalk?) | Good trunk stability; partial to full control of LE | Partial paralysis of LE incl hips, knees, ankle, foot | Fully intact trunk abdominals & all other trunk muscles; depend on level some hip flex, ext, abd; knee flex, ext, ankle dorsiflexors, plantar flexors | Functional ambulation some assist to (I); walking with AD/AE | KAFOs and AFOs; Manual rigid/ light weight w/c; hand controlled driving |
C1-C3 (Lean on me) | Neck flexion, extension and rotation | Complete paralysis of trunk, UE & LE; limited head and neck control; no motor innervations to diaphram; ventilator dependent | Sternocledomastoid, neck accessories | Talking, chewing, swallowing, blowing | Respirator!! Head, chin, mouth controlled power w/c |
C4 (Breathing Free) | Neck flexion, extension, rotation; scapular elevation; Inspiration (inhalation) | Paralysis of trunk, UE & LE; inability to cough; Low endurance/ respiratory reserves | Diaphragm, upper trapezius, cervical paraspinal muscles | Shoulder shrug, respiration | Respirator maybe; head, breath, vox controlled power w/c |
C5 (Winnie the Pooh eating hunny out of hunny pot) | Shoulder flexion, abduction, extension; elbow flexion, supination; scapular ab/adduction | Absent: elbow extension, pronation; all wrist, hand movement; complete paralysis of lower trunk, LE; no trunk control for side bending | Deltoid, biceps (elbow flexion, forearm supinator), brachialis (prime mover for elbow flexion), brachioradialis (elbow flexion, supin/pro); serratus anterior (partial) | Head and neck control, elbow flexion, palmar supination | Universal cuff; splints: wrist cock-up (day), instrinsic plus (night); hand controlled power w/c; driving with specialized equip |
C6 (Snow White eating apple) | Scapular protraction, some horizontal adduction, forearm supination, radial wrist extension (tenodesis) | Absent: wrist flexion, elbow extension, hand movement; complete paralysis of trunk, LE | Clavicular pectoralis; supinator; extensor carpi radialis longus, brevis; serratus anterior; latissimus dorsi | Palmar pronation, wrist extensions, tenodesis grasp | Tenodesis splint; modified long handled sponge, bath mitts; hand controlled power w/c ; limited manual w/c use; hand controlled driving |
C7-C8 (Ariel the Mermaid push up off rock) | Elbow extension (I-Depression transfers); ulnar wrist extension; wrist flexion; finger flexion & extension; thumb flexion, extension, abduction | Paralysis of trunk, LE; limited grasp, dexterity, secondary to partial intrinsic muscles of the hand | Latissimus dorsi; sternal pectoralis, triceps (C7); Finger intrinsics (C8); ext carpi ulnaris; flex carpi radialis; flex digit profundus, superficialis; ext communis; pronator, flex, ext, & abd pollicis; lumbricals (part) | Depression transfers (I); w/c push -ups (pressure relief) | Button hook, sock assist, zip assist; manual rigid/light weight w/c w modified rims; hand controlled driving |