Appendix II: Functional ability by level of spinal cord injury
Last reviewed
Level: C1 to C3
Functional goals:
- Breathing requires a ventilator or nerve stimulator to the diaphragm.
- Dependent for bed mobility and transfers
- Independent in wheelchair after helped into it
- Can do pressure relief in power reclining wheelchair with head, chin, or mouth controls
- Communication devices and environmental controls are often needed.
- Dependent for feeding, dressing, and bowel and bladder care
Attendant care:
- Requires 24-hour care
Level: C4
Functional goals:
- Dependent for bed mobility and transfers
- Independent in wheelchair and pressure relief in power reclining wheelchair
- Communication devices and environmental controls are often needed.
- Dependent for feeding, dressing, and bowel and bladder care
Attendant care:
- Requires 8–12 hours of care
Level: C5
Functional goals:
- Moderate to maximum help needed for bed mobility
- Maximum help needed for sliding board transfers, except for rare cases of independence. Able to do side-to-side pressure relief in wheelchair.
- Independent in electric wheelchair with hand drive
- Independent in manual wheelchair with quad pegs for indoor mobility
- Independent in self-feeding with setup and use of adaptive equipment
- Needs help with upper body dressing
- Dependent for bowel and bladder care
Attendant care:
- Needs 6 to 8 hours, often in the morning and evening
Level: C6
Functional goals:
- Independent bed mobility and level transfers; may need minimal help for uneven transfers.
- Independent side-to-side pressure relief.
- Independent with lightweight manual wheelchair on level ground, gentle slopes, and 2-inch curbs
- Can take off armrests and footplates independently
- Drives adapted van independently
- Independent in self-feeding with use of adaptive equipment
- Independent with upper body dressing
- Needs help with lower body dressing
- Dependent for bowel and bladder care
Attendant care:
- May need 2 to 6 hours per day
Level: C7
Functional goals:
- Independent in uneven transfers over greater distances
- Independent with wheelchair push-up
- May be able to transfer floor to wheelchair
- Independent in manual wheelchair on slightly uneven ground, low curbs, and standard ramps
- Independent with all self-cares with some help needed for bowel care
- May stand in parallel bars with braces
Attendant care:
- Changes based on bowel and bladder cares; may need 2 to 6 hours per day
Level: C8
Functional goals:
- Mostly the same as C7, but with greater ease and better hand use
- Independent bladder function with intermittent catheterization
- Independent bowel function with digital stimulation
- Independent car transfers and may be able to get wheelchair loaded
Attendant care:
- This changes, but 2 to 6 hours per day or maybe none at all
Level: T1 to T4
Functional goals:
- 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
Attendant care:
- Independent
Level: T5 to T12
Functional goals:
- Walking 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.
Attendant care:
- Independent
Level: L1 to L2
Functional Goals:
- Independent transfers from bottom of tub.
- Walking with leg braces and crutches possible, but wheelchair use still needed due to high energy needed.
Attendant care:
- Independent
Level: L3 to L5
Functional goals:
- Walking with leg braces and straight canes
- May use wheelchair for sports or long distances
Attendant care:
- Independent
Level: S1 to S3
Functional goals:
- Walking without leg braces possible, but may be needed due to muscle imbalances
Attendant care:
- Independent