Handbook of Psychology

Epidemiology of Spinal Cord Injury 417

Figure 18.2 Levels of injury and corresponding motor and sensory impair-
ments in the neck and legs.

C2

C3

C4

S

S2 S2

S1 S1

L5 L5

3

S4... 5

L

2

L

2

L

3

L

3

L

4

L

4

shrug, elbow bends, palm turns, and extension of wrists
(see Figure 18.1). Adaptive equipment allows for greater ease
and independence in feeding, bathing, grooming, personal
hygiene, and dressing. Some individuals may independently
perform bladder and bowel care. While the use of a manual
wheelchair is typical for daily activities, some use power
wheelchairs for greater ease of independence. Additionally,
individuals with this level of injury can independently per-
form light housekeeping duties, transfer, do pressure reliefs,
turn in bed, and drive using adaptive equipment.

At a C7 level of injury, an individual may have similar

movement as a person with C6 injury, along with the ability

to straighten the elbows. Functional goals for an individual

with C7 level include use of a manual wheelchair as a

primary means of mobility, greater ease in performing house-

hold work and transferring, ability to do wheelchair pushups

for pressure reliefs, and the need for fewer adaptive aids in

independent daily living. Injuries at the C8 and the “rst tho-

racic, or T1, levels are similar (see Figure 18.1). The added

movements at these levels of injury include development of

strength and precision of “ngers that result in a more natural

hand function. Functional goals include independent living

without the use of assistive devices.

At level T2 and below, an individual has normal motor

function in the head, neck, shoulders, arms, hands, and “n-

gers. Depending on the exact level, functional goals for in-

juries between T2 and T6 include increasing the use of ribs

and chest muscles, or trunk control. For injuries at the levels

between T7 and T12, there is additional abdominal control.

Functional goals for individuals within these six levels of

injury may include improving cough effectiveness and in-

creasing ability to perform unsupported seated activities.

Individuals with injuries between levels T2 and T12 are often

capable of very limited walking. However, there is a high

level of energy expenditure associated with this activity and

the stress placed on the upper body results in no functional

advantage, resulting in high reliance on a wheelchair for

mobility.

With the help of specialized leg and ankle braces, walking

may be a realistic goal for people with injuries at the level of

L1-L5 (see Figure 18.1). Individuals with lower levels of in-

jury will walk with greater ease than those persons with

higher lumbar injuries. The functional goals of individuals

with injuries from S1 through S5 include the ability to walk

with fewer or no supportive devices. Depending on the level

of injury, there are also various degrees of return of voluntary

bladder, bowel, and sexual functions.

EPIDEMIOLOGY OF SPINAL CORD INJURY

In 1968, professionals and consumers testi“ed before the

U.S. Congress about the lack of informed and coordinated

medical and psychosocial services available to persons with

spinal cord injury. This situation existed, in part, because SCI

is a relatively low-incidence but costly and high-impact dis-

ability that had been dif“cult to study in a programmatic

fashion. Federal funds were eventually granted in 1970 to

Good Samaritan Hospital in Phoenix, Arizona, to establish