Spinal Cord Injury Levels - Functionality of C4 Spinal Cord Injury

Spinal Injury Level Sections

C1 - C3 : C4 : C5 : C6 : C7 - C8 : T1 - T4 : T5 - T9 : T10 - L1 : L2 - S5

Mobility & Movement

Someone with a C4 spinal cord injury will retain full head and neck movement depending on muscle strength. Shoulder movement will be limited to shoulder elevation known as a "shoulder shrug". Below the shoulders there would also be complete loss of biceps triceps, wrist extensors and flexors as well as finger function.

There would be a complete loss of trunk control in the torso including pectoral, abdominal and all back muscles. Lower limb function of the legs would also be lost.

Sympathetic nervous system will be compromised, possibility of autonomic dysreflexia.

An electric wheelchair may be controlled by either a chin or "sip and puff" controller, this will vary depending on dexterity.

The person will require total assistance when transferring from a bed to a wheelchair and from a wheelchair into a car. A hoist will have to be used, possibly by two assistants for safety.

Complete assistance usually required during mealtimes, although if there are signs of biceps function, a mobile arm support or balanced forearm orthosis may allow the person to feed themselves. The use of a drinks bottle and long straw would allow for independent drinking.

Respiratory System

Able to breathe without a ventilator using diaphragm.

Assistance required to clear secretions and assistance in coughing will be required.

Personal Care

Complete personal assistance is required. The person will need assistance with washing, dressing, and assistance with bowel and bladder management.

Domestic Care

Complete domestic care is required, such as household cleaning, washing of clothes and kitchen duties, preparation of meals and general household duties.


A computer may be operated using iris recognition, mouth stick or voice recognition. Telephone can be used using voice recognition and headset.

The above functionality guide is only a general guide. Abilities will vary depending on the persons weight, existing medical conditions and age.