C1 to C4 are easy to remember because C stands for cervical – so neck muscles.
C4 is important because it is the level that the client is no longer ventilatordependent, and they can be weaned off. You can remember this because SPORE
rhymes with 4. And you don’t want to “breathe” in certain spores or molds that
cause respiratory disease.
Here’s how to remember the levels from C5 to C8.
This is a little silly, but it really helped me remember the movements for the
shoulders and upper extremities.
The scenario to remember is that you are going out for a blind date at 6pm.
Relate the levels to the time of evening related for your date.
C5 – or 5 o ‘clock and you are running late for your date.
So C5 we “fly”
And you get shoulder flexion, abduction, scapular abduction & adduction, and
elbow flexion. Nothing distal yet.
You actually arrive early at dinner and wait, and you wait.
For C6, or at 6’oclock, you check your watch.
So you get forearm supination (because you are fancy and wear your watch on
the inside).
And you also extend your wrists naturally to see the time.
At 7pm or C7 – your date finally arrives. But they are not what you expected. You
got catfished! You decide to not be rude and proceed with the date.
So you get up and give them an awkward hug like this.
This helps you remember elbow extension and wrist flexion.
At 8pm the date isn’t going that well and they are actually very rude. So at C8,
you “hate” and end the date for the evening. C8, hate – wave them bye-bye
This includes the hands’ extrinsic muscles, but not the intrinsics yet.
And then Starting from T1 – all the upper extremities are fully intact, but of
course there is limited trunk stability and paralysis of the lower extremities.
Now let’s talk about some other important ADLs to consider for spinal cord levels
on the exam. To remember these, use the trick you just learned and apply it to
what kind of functional ADLs you can do. This is easier than memorizing each
ADL for each level.
Remember C4 or spore, no vent. Client can use a sip and puff for electric
wheelchair mobility.
For example, C5 you get independent feeding with the C5 we fly motion to bring
food to the mouth with adaptive utensils. You can imagine you can do some
grooming too, but will need help with things like shaving. Client can now use
hand controls for electric wheelchair.
C6 is a big one, when you check the watch on your wrist – You get tenodesis
grasp pattern to pick things up functionally and for bed mobility. Client can do a
lot of ADLs for the upper body including brush their teeth with an electric
toothbrush and modified button that’s easier to push. They can dress their upper
body with adaptive equipment and bathe the upper body. Client can now use a
manual wheelchair for short distances and at C6 client can also resume driving
with adapted vehicle controls. C6, you drive a vehicle to get your “fix”.
Remember C7 we give the awkward hug. Transfers. So you get elbow extension.
This allows the client to be able to independently transfer between surfaces using
their triceps. Client can also catheterize themselves for the bladder.
At C8, since finger movement is more functional with manipulation of objects,
they would not need to use adaptive equipment as much.
T1 – think Terminator, like the movie. I think there is a model T1 in the terminator
too. Anyways, the terminator, terminates or eliminates. Get it? So independent
with bowel and bladder.
Hope this helps you remember these spinal cord levels.