Appendix II: Functional ability by level of spinal cord injury

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
Last reviewed: 
March 2018

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