>> JUDY FORTIN: You may hear your loved one’s level of injury mentioned frequently.
The level of injury refers to where the spinal cord is functioning, and is also known as
the neurological level of injury.
Doctors determine this by assessing the movement and sensation at or below a certain level
on the spinal cord.
The level of injury designation is a letter followed by a number that corresponds to the
spinal nerves.
Refer to this sub-chapter for information about cervical level of injury from C5 to
C8. C stands for cervical and the numbers 5, 6, 7, or 8 refer to the spinal nerves in
that section of the spinal cord.
Keep in mind that these are general guidelines for levels of injury, and your own, or your
loved one’s injury may differ due to its individual type and severity.
The level of independence achieved also has much to do with the patient’s health at
the time of injury.
This includes their body type, existing medical conditions, and other injuries that may have
occurred at the time of the accident.
>> DR.
JEFFERY SALOMONE: While the cervical spinal cord nerves affected by a low cervical injury
are located in the neck, they control other parts of the body.
Lower cervical sections from C5 to C8 correspond to nerves controlling your arms and your hands.
Cervical injuries usually result in full or partial quadraplegia.
Depending on the exact area affected, persons with injuries may regain some function below
the level of injury.
An injury at each of these cervical levels has different effects, so we will talk about
each one individually.
At the C5 level, spinal nerves are connected to the shoulder or deltoid, and to the biceps
of the arm.
At this level of injury, your loved one can raise his or her arms and bend his or her
elbows but will likely have some or total paralysis of the wrists, hands, trunk and
legs.
A person injured at the C5 level will be able to speak, but may have weak breathing ability
and need a ventilator.
They may have low endurance and may also need help clearing saliva.
At the C6 level, spinal nerves affect the ability to control wrist extension.
Persons with C6 injuries typically have paralysis in the hands, trunk, and legs but should be
able to bend the wrists back, like the movement used in throttling a motorcycle.
They can speak and use their diaphragm, but their breathing will be weakened.
Spinal nerves at the C7 level control elbow extension and some finger extension (or the
ability to straighten elbows or hold fingers out).
Most patients at this level can straighten their arm at the elbow and have normal movement
of their shoulder muscles.
C8 nerves control some of your hand movements.
Most people with a C8 level of injury should be able to grasp and release objects.
Persons with C7 and C8 injuries can speak and use their diaphragms to breathe, move
their shoulders, arms, wrists and hands but will have paralysis of the some muscles of
the hand, and the essential muscles of the trunk and legs.
The ability to cough and clear secretions will be limited.
>> JUDY FORTIN: At the C5 level, your loved one will be able to use a power wheelchair,
but will need total assistance getting into and out of the chair.
At the C6 level, your loved one can move into and out of bed and the wheelchair with some
assistive equipment.
And people with a C7 or C8 injury can usually get in and out of their wheelchairs without
help.
They may also be able to drive an adapted vehicle.
Most of these functional improvements won’t occur at the trauma care center, but rather
weeks or months later following therapy.
For those who can find sources of support, a wide range of driving equipment and vehicle
modifications are available.
The injured person’s ability to care for themselves is limited at the C5 level.
People with C5 injuries are typically unable to control bowel and bladder movements and
will need assistance to manage their elimination programs.
They will need help getting into and out of bed but can probably eat with assistive equipment.
Persons with a C6 injury may be able to manipulate their equipment, but otherwise will need similar
help.
People with C7 or C8 injuries can get into and out of their wheelchairs without help
and can eat, groom, bathe and dress independently.
You’ll probably hear the phrase “level of independence” during rehabilitation.
It refers to your loved one’s future ability to function independently and care for him
or herself versus needing support from professional or volunteer caregivers.
Patients with low-cervical levels of injury will most likely need between six to ten hours
of day of personal care assistance with bathing, dressing, management of their bowel and bladder
programs, eating and grooming.
These patients may need between two and six hours of additional assistance each day to
help with tasks like grocery shopping, meal preparation, and home cleaning.
Home modifications may be necessary for persons with low cervical injury.
Their home should have doorways wide enough to accommodate their wheelchair and have ramps
in place of stairs.
Strongly consider making countertops, sinks and stoves accessible as well as making bathrooms
as easy to navigate as possible.
Ramps, door modifications, special sinks, grab bars and easy-to-turn doorknobs make
it possible for people affected by spinal cord injury to live more independently.
Friends, family, church and community groups may also pitch in to help with home modifications
and fundraisers.
Many people receive funding assistance or donations from special events, local businesses,
groups and even individuals.
Later in the rehabilitation process, you may hear the term functional progression which
refers to how much progress your loved one may achieve as time goes by.
At the lower cervical levels, it may partly depend on whether or not he or she can go
to a rehabilitation facility for additional care and therapy after leaving the trauma
care center.
No matter what, it’s important to develop and follow a consistent care routine to help
your loved one’s possible progress.
>> DR.
BRUCE DOBKIN: After spinal cord injury, your loved one will gradually improve.
One of the best ways to monitor this is that if there’s any feeling or movement below
the level of injury, this is a very positive sign.
This is something that you can build upon.
Gradually over time, the therapists and rehabilitation folks will try
to help drive greater recovery from that little bit of progress in your loved one.
This recovery can occur for weeks, for months, sometimes even years, so it’s really important
that you try to push any gains that you see.
But also, it’s very important to begin to accept any limitations in recovery that may
come about so that your loved one can move on with life using assistive devices and any
other means by which he or she can return to a normal life.
>> JUDY FORTIN: At this time we’ll continue on to the last chapter of the video.
Chapter 6 provides practical advice for how to deal with the injury and its consequences
to your loved one and your family.
Lee Woodruff starts off the chapter.
She has some great advice because she and her family have been through, and survived,
a catastrophic injury themselves.
It’s an important part of the video.