Understanding Spinal Cord Injury

A comprehensive guide to injury levels, the ASIA scale, and what “incomplete” really means. These descriptions are common patterns, not guarantees, since incomplete injuries can vary widely and outcomes can differ even at the same level.

Cervical Levels (Quadriplegia)

The spinal cord is like a highway. If the road is blocked at Exit 5, traffic stops there. The higher the injury, the more function is lost.

C1 - C4 (High Cervical)

Paralysis of arms, hands, trunk, and legs. Usually affects the diaphragm (breathing). Requires 24-hour care.

Goal: Sip-and-Puff Technology
C5 (Biceps)

Can bend elbows but cannot straighten them. No hand or wrist function. Can feed self with adaptive equipment.

Goal: Feeding Self with strap
C6 (Wrist Extensor)

Can bend wrists back. This is critical for Tenodesis (using wrist motion to pinch fingers). Can usually drive a modified van.

Goal: Driving, Dressing Upper Body
C7 (Triceps)

Can straighten elbows. This allows the user to do a "push up" to lift their weight for transfers. Huge leap in independence.

Goal: Independent Transfers
C8 (Finger Flexors)

Some hand function returns. Can grip objects, though fine motor skills may be weak.

Goal: Full ADL Independence

Thoracic & Lumbar (Paraplegia)

Injuries below the neck result in Paraplegia. Arms and hands are fully functional. The challenge here is core stability and mobility.

T1 - T12 (Trunk Control)

T1-T6: Upper back muscles only. Sitting balance is difficult.
T7-T12: Abdominal muscles (Abs). Good core stability. Can balance without holding on.

L1 - S5 (Legs & Bowel)

Hips and legs are affected. Many people with L-level injuries can walk with leg braces (KAFOs). Sacral injuries (S1-S5) primarily affect bowel/bladder/sexual function.

The ASIA Scale (Completeness)

Doctors grade injuries A through E based on how much signal gets through. This determines your "Completeness."

A Complete

No motor or sensory function below injury level.

B Sensory Incomplete

You can feel touch below the injury, but cannot move.

C Motor Incomplete

Some movement, but muscles are too weak to be useful.

D Motor Functional

Useful movement. Can likely walk or stand with help.

The "Hidden" Symptoms

Paralysis is more than just not walking. The Autonomic Nervous System is also disrupted, affecting things you can't see.

1. Thermoregulation (Sweating)

The Rule: You cannot sweat below your level of injury. In hot weather, an individual can overheat rapidly (Heat Stroke) because their body cannot cool itself.

Action: Use spray bottles and A/C

2. Blood Pressure (The Drop)

Blood pressure tends to be very low (90/60). Sitting up too fast can cause fainting (Orthostatic Hypotension). Recline the chair back if you feel dizzy.