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Neck (cervical) injuries often cause paralysis of the 4 limbs and is commonly known as Tetraplegia or Quadriplegia. Injuries that happen above the C-4 level might need a ventilator or an electrical implant so that the individual could breathe since the spinal nerves that control the diaphragm exits the neck at the upper level.
This is what caused Christopher Reeve (Superman) C3 injury after he fell off a horse. It required him to be on a mechanical ventilator that allowed him to breathe via a hole in his throat. Another injury is the incomplete tetraplegic.
Those who have C-1 and C-2 injuries might still have phrenic nerves that function. An implanted phrenic nerve pacemakers is used to pace the diaphragm alternating or simultaneous. Tracheostomies can be plugged or taken out if secretions are not an issue. Patients with C-1 and C-2 injuries require less equipment than C-3 and C-4 patients.
C-3 lesions can cause impaired breathing in patients and they might need a ventilator. They have neck motion and can shrug their shoulders. This lets them operate special electrical wcs and equipment like computers, tape recorders, page turners, phones, automatic door openers etc. by using mouth controls (sip and puff), chin, head or eyebrow control, voice activation or even eye blink.
Those with C-4 lesions might not need respiratory equipment after the first acute care phase, however they might need functional equipment being ventilator-dependent.
Besides powered wcs, C1-4 tetraplegics need help with personal care, turning and getting transferred. For the upper extremities they might need headrests, lapboard or troughs and sometimes lifts. For patients who don't have assistance for regular turning a bed with two or more segments that inflate and deflate alternately might be required. Patients with C-4 lesions might have their elbow flexor function restored using a Functional electrical stimulation (FES).
Power recliners that help with pressure relief when sitting are useful for patients with C-5 or higher lesions. Individuals with partial C-4 injuries and insufficient elbow flexors as well as those with C-5 injuries might at first need a proper forearm orthosis, for improved arm positioning, or a lengthy opponens orthosis with utensil holes and pen containers, for wrist stableness, throughout tasks like eating, writing and typing.
C-5 tetraplegics enjoy operational deltoid and/or biceps muscle mass. They are able to internally turn and abduct the shoulder, causing forearm pronation due to gravity. Wrist flexion is likewise generated.
Some can outwardly turn the shoulder and produce supination and wrist expansion. They could bend the elbow, however elbow expansion could only be generated by gravity, or by assertive sideways abduction of the shoulder and also inertia or shoulder exterior schedule.
C-5 individuals need help to carry out washing and lower body clothing operations, for bladder and bowel hygiene, and for shifting. By using proper forearm orthoses, extended opponent orthoses, or universal cuffs along with versatile devices, C-5 subjects could eat independently, execute dental facial cleaning and upper body outfitting actions, use computers, cassette recorders, phone, etc. and engage in leisure pursuits.
They are able to push manual wheelchairs limited distances on flat areas, but the hand-hand rim section needs to be altered with upright or horizontal lugs (maybe plastic tubing could be draped around the wheels), and gloves have to be used to safeguard the hands.
Battery powered wheelchairs, moved with a hand control, are required for longer treks and exterior surfaces.
C-6 individuals possess muscle mass that allows most shoulder movement, elbow bending, though not straightening, and active wrist expansion which allows tenodesis, resistance of thumb to index finger, and also finger flexion. Wrist extensor healing is typical in C-6 subjects, however the healing might be postponed. Tenodesis orthoses assist tenodesis exercising early on in healing.
Wrist-driven flexor pivot splints allow pinching force, required for catheterization and job abilities. Short opponens orthoses that have utensil holes, writing splints, Velcro grips, and cuffs allow eating, writing, and dental facial care.
C-6 individuals can conduct upper body clothing without help and can even do lower body clothing without support. They could catheterize on their own and carry out their daily bowel regime with assistive tools.
Some can do certain transfers alone using a transfer board, roll unaided using safety rails, and ease strain by crouching forward, switching sides, or even by push-ups. Water beds will reduce stress enough to prevent the need for flipping at night.
They can push a manual wheelchair limited ranges on flat ground, work power wheelchairs, and could drive with a vehicle and special devices. They can make meals, do light housekeeping, and survive on their own with minimal attendant attention.
Upper extremity reconstructive operation, or working neuromuscular stimulation of the upper extremity, or surgical treatment and stimulus in the very same victim could enhance performance in C-6 sufferers. Surgical treatment is suggested just for those who are neurologically steady and don't have spasticity.
Stimulus could be given by outside, percutaneous, or embedded electrodes, by shoulder movement employing an external process, or by key and palmar grasp and release, or even by a bionic glove, an electric stimulator outfit that delivers controlled grip and hand opening.
C-7 patients possess operational triceps, they are able to bend and straighten their elbows and additionally they could possibly have improved finger extendibility and wrist flexion. Consequently, they enjoy increased grip power which allows easier transfer, movability, and activity abilities. They are able to twist and conduct most transfers unaided.
Some can push a manual wheelchair on uneven surfaces and inclines, and might then not require an electric powered wheelchair. They can operate a vehicle with specialized tools. They could conduct most day-to-day activities, they can prepare dinner and even perform light housekeeping, which means that they can live on their own. They might, nevertheless, need help for bowel attention and washing.
C-8 patients possess flexor digitorum profundus capability which allows full arm motion, with a bit of hand weakness. They can push a standard wheelchair short distances, such as into and out of a vehicle and over curbs, and could even end up wheelchair free. They can operate an automobile with special apparatus. They are able to do all personal hygiene and day-to-day activities, apart from heavy housekeeping.
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