Chart — Neurology
Spinal Cord Injury by Level Chart
The level of injury predicts function: the higher the lesion, the more is lost — up to the diaphragm itself. Two thresholds matter most for the exam: C3–C5 for breathing, and T6 for autonomic dysreflexia risk.
Educational use only. Functional outcomes vary with completeness of injury and the individual; this chart shows typical preserved function by level for learning. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Function by Injury Level
| Level | Function preserved / lost | Key implications |
|---|---|---|
| C1–C4 (high cervical) | Tetraplegia; little/no movement below the neck; diaphragm affected | VENTILATOR-dependent (above C3–C5); total care; autonomic dysreflexia risk |
| C5 | Shoulder/elbow flexion (biceps); can't extend the elbow | May breathe independently but with weak reserve; needs much assistance; AD risk |
| C6 | Wrist extension (tenodesis grasp); more independence | Can assist with some ADLs/transfers with aids; AD risk |
| C7–C8 | Elbow extension (triceps), hand/finger movement | Often independent with self-care, transfers, manual wheelchair; AD risk |
| T1–T6 (high thoracic) | Full arm/hand function; trunk control limited | Independent self-care/wheelchair; AUTONOMIC DYSREFLEXIA risk (T6 and above) |
| T7–L1 (low thoracic/high lumbar) | Better trunk stability; legs affected | Independent; possible standing/limited ambulation with bracing; AD risk drops below T6 |
| L2–S (lumbosacral) | Progressive hip/knee/foot function; bowel/bladder/sexual affected | Often ambulatory with aids; focus on bowel/bladder and skin |
Exam Traps
- ✦"C3, 4, 5 keep the diaphragm alive" — injuries above this level threaten breathing and mean ventilator dependence.
- ✦Autonomic dysreflexia is a risk at T6 and ABOVE (after spinal shock resolves).
- ✦Higher level = more lost: cervical = tetraplegia (all four limbs), thoracic and below = paraplegia.
- ✦C6 enables a tenodesis grasp; C7 triceps allow independent transfers — small level changes mean big function changes.
- ✦Every cervical/high-thoracic patient needs bowel, bladder, skin, and respiratory programs.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Heart Association / American Stroke Association (AHA/ASA) · American Association of Neuroscience Nurses (AANN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →