Rehabilitation Interventions and Functional Restoration
Match the level to the function
Rehabilitation questions reward knowing expected outcomes by level. C1-C4 injuries usually require mechanical ventilation and a power wheelchair with chin or head controls. C5 preserves biceps but not wrist extension: feeding with adaptive equipment, power mobility, and assistance with transfers. C6 adds wrist extension, enabling tenodesis grasp, sliding-board transfers with assistance, and adapted driving. C7 adds triceps - the functional independence threshold for manual wheelchair propulsion, pressure relief, and most self-care. C8-T1 adds finger flexors and intrinsics for fine grasp. Thoracic and lumbar injuries permit progressive sitting balance and, at lower levels, bracing-assisted ambulation.
Interventions
Therapy is task-specific and intensive: massed practice, constraint-based upper limb training, functional electrical stimulation, body-weight-supported treadmill and robotic gait training. Evidence for restoring walking in motor-complete injuries is modest; these tools are adjuncts. Manage spasticity in a stepwise way - positioning and stretching, oral baclofen or tizanidine, focal chemodenervation, intrathecal baclofen for severe generalized spasticity, and orthopedic procedures. Prevent contracture with daily range of motion and splinting. Preserve shoulder health with activity modification and strengthening. Upper extremity reconstructive surgery (nerve and tendon transfers, e.g., deltoid-to-triceps) can restore grasp and elbow extension in selected patients.
Equipment and participation
Choose wheelchair and cushion by pressure risk, posture, and terrain; teach pressure relief and wheelchair skills. Address driving, vocational retraining, and recreation as part of the plan.
Traps
Expecting C5 patients to feed independently without aids; crediting C6 with triceps; assuming locomotor training restores walking in motor-complete SCI; and overlooking shoulder overuse.
Rule of thumb
C7 is the level at which most patients achieve independent manual wheelchair mobility and self-care.