Handbook of Psychology

416 Spinal Cord Injury

C2

C3

C4

C5 C5

C6 C6

T2 T2

T1 T1

T3

T4

T5

T6

T7

T8

T9

T10

T11

T12

L1

L2 L2

L3 L3

L4 L4

L5 L5

S1 S1

S1

C^8

C7

C8 C6

Palm L1 Palm

Key Sensory Points

Dorsum Dorsum

C^7

Figure 18.1 Levels of injury and corresponding motor and sensory impair-
ments in the body.

displayed in Figure 18.1, the sensation provided by the
LMNs corresponds directly to the level at the spinal cord and
speci“c areas of the body known as dermatomes (Hammond,
Umlauf, Matteson, & Perduta-Fujiniti, 1992).
Following SCI, paralysis ensues and is described as either
paraplegiaortetraplegia.Paraplegiarefers to paralysis af-
fecting the lower part of the trunk and legs. Tetraplegiain-
volves the lower and upper parts of the body including the
arms and hands. The degree of neurological impairment ex-
perienced is described as either complete or incomplete
depending on the degree of loss of motor and/or sensory

function. A complete injury results in the total absence of

all-voluntary movement or sensation below the level of in-

jury. An incomplete injury allows for the retention of some

sensation or movement below the level of injury. Thus, diag-

nosis describes the level of the vertebral fracture as well

as the extent of the neurological de“cit (e.g., a complete

lesion at the “fth cervical vertebrae will be described as

•C5, completeŽ).

Levels of Injury and Functional Goals

The levels of injury to the spinal cord have been divided into

ten general regions in which functional abilities cluster in

persons with complete lesions. Damage to the spinal cord in

the cervical region results in the greatest functional variabil-

ity. Individuals with injuries to the cervical, or C region of the

spinal cord between levels C1 and C3, are most likely to de-

pend on ventilator assistance for breathing (see Figure 18.2).

Implantation of a phrenic nerve pacemaker may be an option

for mechanical assistance in breathing. For individuals with

C1 to C3 SCIs, talking may be dif“cult, very limited, or im-

possible. Movement of the head and neck is limited, and

functional goals for these individuals focus on communica-

tion and wheelchair mobility. Assistive technologies, such as

a computer for speech or typing, and sip-and-puff chairs and

switches, increase function and independence.

Head and neck control increases somewhat for individuals

with a C3 or C4 SCI. Ventilator assistance is usually required

at the initial stages of rehabilitation but prolonged use is not

likely. With the relative increase in motor movement and the

use of adaptive equipment at this level of injury, some indi-

viduals may have limited independence in feeding and con-

trol over environmental variables such as adjustable beds and

wheelchair tilting to assist in pressure relief.

Individuals with a C5 level of injury typically have head,

neck, and shoulder control. These persons can bend their el-

bows and turn their palms up (see Figure 18.1). Functional

goals include independence with eating, drinking, face wash-

ing, toothbrushing, face shaving, and hair care, when set up

with specialized equipment. Although many persons with C5

SCI may have the strength to push a manual wheelchair, a

power wheelchair with hand controls is typically used for

daily activities to prevent fatigue and secondary injuries such

as strained muscles or stress fractures. Individuals can also

manage their own health care by doing self-assist coughs and

pressure reliefs by leaning forward or side-to-side. Driving

may be possible with adaptive equipment.

An individual with C6 level of injury can often attain

complete independence. This level of injury permits shoulder