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Spinal Cord Injury Functional Expectations

C1 to C8: Cervical vertebrae (neck)
T1 to T12: Thoracic vertebrae (chest)
L1 to L5: Lumbar vertebrae (low back)
S1 to S5: Sacral vertebrae (tail bone)

Last Intact Level - C4

Key Muscles and Function

Diaphragm
Muscle located between the lungs and abdomen to control breathing.

Upper Trapezius
Muscle on the upper portion of your shoulder/back that enables you to shrug your shoulders.

Anticipate Function
Independent breathing; independent power wheelchair operation.

Last Intact Level - C5

Key Muscles and Function

Deltoids
Shoulder cap muscle that raises the arm.

Biceps
Muscle over front of upper arm that flexes the arm at the elbow.

Anticipate Function
Independent feeding and light facial hygiene with assistive devices; assists with dressing upper body; independent power wheelchair operation.

Last Intact Level - C6

Key Muscles and Function

Wrist Extensors
Muscles along outer portion of forearm that raises the hand at the wrist

Anticipate Function
Independent drinking, feeding, food cutting, writing, typing, phone use, upper body dressing, and possibly lower body dressing, and driving with assistive devices; independently propels manual wheelchair; assists,or possibly independent, with transfers.

Last Intact Level - C7

Key Muscles and Function

Triceps
Muscle in back of upper arm that straightens the arm at the elbow.

Wrist Flexors
Muscles along the inner portion of your forearm that lowers the hand at the wrist.

Long Finger Flexors/Extensors
Muscles in the hand that allow you to bend and straighten your fingers.

Anticipate Function
Same as above, as well as independent bathing and light meal preparation; independent with transfers (bed, car, toilet); independent with basic manual wheelchair skills.

Last Intact Level - C8, T1, T2-T4

Key Muscles and Function

Finger Extrinsics and Intrinsics
Muscles on inside and outside of fingers that move fingers apart or together.

Anticipate Function
Same as above with fewer equipment needs.

Last Intact Level - T5-L2

Key Muscles and Function

Upper Intercostals
Muscles between ribs that assist with lung movement of air and chest expansion.

Back Extensors
Muscles in upper back that assist in learning backward.

Anticipate Function
Independent balance in sitting; independent manual wheelchair mobility on all surfaces; possible short-distance ambulation using long leg braces with high-energy expenditure.

Last Intact Level - L3-S1

Key Muscles and Function

Iliopsoas
Muscles at sides and front of the leg that raise and lower the leg at the hip.

Quadriceps
Muscle in front of the thigh that straightens the leg at the knee.

Anticipate Function
Independent functional community ambulation with possible braces. May need wheelchair for longer distances.

Last Intact Level - S2-S4

Key Muscles and Function

Perineal Muscles
Muscles that control bowel and bladder.

Antcipate Function
Bowel and bladder function.

NOTE: This list is intended to be a general guide and not limited to activities listed above. Many factors influence whether or not a specific patient can achieve the activities listed. However, the lower the level of injury, the greater the percentage of patients that should be able to achieve the predicted function.

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