Spinal level Functional mm. Movement possible Patterns of weakness AE ADLs C1-C3 SCM, cervical paraspinal, neck accessories Neck flexion, extension, rotation Total paralysis of trunk, UE, LE Dependent on ventilator, suction, padded chair Cannot perform any ADLs I, dependent on others for all, C4 Upper trap, diaphragm, cervical paraspinal mm Neck flexion, extension rotation, elevation, inspiration Paralysis of the trunk, UE, LE, inability to cough, endurance and respiratory reserve low to secondary paralysis of intercostals Ventilator, suction, reclining shower chair Cannot not cough I, requires assistance with suction to remove mucus, at risk for HO C5 Deltoid, biceps, brachialis, brachioradialis, rhomboids, serratus anterior Shoulder flex, abd, ext, elbow flex, and supination, scapular add, abd Loss of elbow ext, pronation, all wrist and hand movements, total paralysis of trunk and LE Padded shower/commode, electric leg bag for bladder C6 Clavicular pectoralis, supinator, ext. carpi radialis longus, and brevis, serratus ant, latts Scapular protractor, some horizontal add, forearm sup, radial wrist ext Absence of wrist flex, elbow ext, hand movement, total paralysis of trunk and LE, can do shoulder depression Padded tub bench with commode cutout Unable to lock Maintain PROM elbows- no tenodesis Strengthen remaining grasp mm. Appropriate hand splint w/c selection- power assistance for pressure relief assist with bed mobility assistance with ADLs community mobility Weak tenodesis w/c selection grasp, would require pressure relief bed mobility technique assist with ADLs C7-C8 Latts, sternal pec, triceps, pronator quadratus, ext carpi ulnaris, flex carpi radialis, flex digitorum Elbow ext, ulnar/wrist ext, wrist flex, finger flex/ext, thumb flex/ext/abd Paralysis of trunk and LE, limited grasp and dexterity secondary to partial intrinsic mm of the Padded tub bench with commode cutout Can transfer self if they lock their elbows, What to do to help them Maintain PROM Prevent contractures Foot drop splints, resting hand splint, pressure relief, AE to control the environ, w/c seating system, train caregivers Maintain PROM Prevent contractures Foot drop splints, resting hand splint, pressure relief, AE to control the environ, w/c seating system, train caregivers Most will be I in ADLs Community mobilization May need assist with bowel mgmt. Spinal level Functional mm. Movement possible profundus, and superficilis, ext communis, pronator/flex/ext/abd pollicis, lumbricals Patterns of weakness AE ADLs What to do to help them hand T1-T9 Intrinsics of the hand, internal and external instercostals, erector spinae, lumbricals, flex/ext/abd pollicis UE fully intact, limited trunk stability, endurance increased Lower trunk paralysis, total paralysis of LE Elevated padded toilet seat or padded tub bench Can transfer self to bed, toilet, seat, can do pressure relief, no tenodesis required Need assist with strengthening of remaining mm. Manual w/c Adapted bed mobility Transfer training ADL training Floor to chair transfer Vocation/leisure T10-L1 Fully intact intercostals, ext obliques, rectus abdominis Good stunk stability Partial paralysis of LE, hips, knees, ankle, foot Elevated padded toilet seat or padded tub bench Can transfer self, do pressure relief, tenodesis intact, can perform ADLs L2-L5 Fully intact abdominals, and all trunk mm., depending on level: some degree of hip flex, ext, abd, knee flex, ext, ankle dorsiflex, and plantar flex Good trunk stability, partial to full control of LE Partial paralysis of LE, hips, knees, ankle, and foot Elevated padded toilet seat or padded tub bench Need AE for ADLs, mostly I for them Need assist with bed mobility Strengthen remaining mm. Manual chair and appropriate seating system Floor to chair transfer Most mod I in ADL and community mobility Ambulate with AE Vocation/leisure Strengthen remaining mm. Manual chair and appropriate seating Transfer training ADL training Ambulate and AE Vocation and leisure Floor to chair