- Incomplete versus complete SCI - What am I?
- How the body moves
- Principles of physical rehabilitation
- Functional movements with complete SCI
- C4 complete
- C5 complete
- C6 complete
- C7 complete and below (including paraplegia of all levels)
- Ageing and spinal cord injury
- Biceps (lift your arm and bend your elbow)
- Wrist extensors (bend your wrist back) – only some of these are working
Not many muscles for moving are working at this level of injury but use of the biceps muscle offers potential to perform some movement tasks independently. You will be able to lift your hands to your face for eating and grooming, use your arms to help with dressing, rolling and transferring and you may be able to use your wrist extensors to form a tenodesis grasp. This compensatory movement will allow you to pick up and hold items in your hand even though the muscles that move your fingers are not working. Some people can push a manual wheelchair using their biceps to ‘pull’ on the wheels.
A key muscle that is not working at this level is Serratus Anterior. This muscle is underneath your shoulder blade and its job is to hold the shoulder blade down on your chest while you lift and move your arms. Without this muscle, the shoulder blade moves in the wrong direction and often sticks out backwards when the arms are moving. This is called winging and can lead to secondary pain caused by rubbing of your shoulder muscles on the shoulder blade. If your shoulder blades are winging, you need to be careful about overloading your arms (by lifting heavy weights or doing strenuous pushing in a manual wheelchair) as this is likely to make the winging worse and make you more prone to shoulder pain. If you have shoulder pain, it is worth asking your therapy team to assess your shoulders and look for winging when you perform tasks with your arms.
You will need help from other people for many movement tasks but you will be able to learn what needs to be done and how to direct someone to assist.
If you have a C5 injury and you have made good progress on the specific compensatory skills discussed here, you might want to look at the information for C6 injury and consider trying out some of those more advanced skills too.
You will have some ability to shift your body position when you are in a sitting position by moving your head and arms. Performing two handed tasks can be a challenge but learning how to counter balance the weight of your arms by leaning your head back can help. Practice in your wheelchair by loosening your chest strap. Explore how changes in your head and arm position can shift your weight. Make sure you have someone spotting you.
You will have limited ability to balance for safety and function and you may need some equipment to assist you. You can learn to hook your elbow on your wheelchair to stabilise yourself and to lean forward or to the side without falling. You can learn how to rest back on your hands with your elbows locked and keep your balance while sitting up on the bed. This is called propping. Some people with a C5 injury are able to learn how to throw their arms back into this prop position and actually catch their balance if they start to fall backwards.
Wearing a chest strap can stop you from falling forward while sitting in your wheelchair. You may also need good side supports on the wheelchair to keep your body in alignment when you are sitting up. If using a power wheelchair, make use of the tilt in space function in your wheelchair to rest back from upright. This allows gravity to push you back into your backrest rather than falling forward.
Moving on the bed:
You will have some ability to move on the bed although you will require assistance and equipment to change positions.
You can learn how to sit in a bent forward position called long sitting (with your legs out in front of you on the bed). Some people can move from this bent forward position to a leaning back position, they throw their head and arms back and land in the prop position. If you can master this skill then you can learn to maintain your balance while someone moves your legs, helping you to move you across the bed or prepare to perform a transfer.
Some people can move forward from the prop position and use their arms to push down on the bed. This causes their bottom to lift up, and then they can move across the bed independently. This is a very difficult task with a C5 injury but it is certainly possible and worth a try.
You may be able to learn how to roll over on to your side using a pulling technique (hooking your hand onto the edge of the bed or your wheelchair and pulling your body over). Some people also use a bed ladder to assist with this move. You may still require assistance to get in a comfortable position for sleeping.
You can also learn to use mechanical features of your bed and a bed ladder to get yourself into an upright sitting position (with your legs out in front of you on the bed).
Many people with a C5 injury use a hoist for their daily transfers on and off the bed. This can reduce strain for people helping and can also be quicker and safer than trying to perform multiple repetitions of the other transfers discussed here.
If you are able to balance and prop in a short sitting position (with your legs down over the edge of the bed) and you are able to lift and move your bottom across the bed, then you might be able to learn to perform a slide board transfer with assistance. You will need to be able to keep your elbows in a locked position and push down on your arms to get some lift of your bottom. Moving across the slide board requires a specific technique of lift and twist and is difficult to master with a C5 injury. Balance and timing are the key features of this skill, not just strength!
Some people with a C5 injury are able to learn how to transfer into a car with assistance. Most people also need to use a slide board.
Equipment to get around:
Many people with a C5 injury are able to use a manual wheelchair for some mobility. Limited function of your arm muscles can mean this is very tiring, takes a long time and might cause shoulder pain. You might need to wear special gloves (push mitts) with grip to help you get traction on the push rim. You will need help to negotiate slopes, gutters and soft terrain like grass.
Some people with a C5 injury use motorised wheels on their manual chair to be able to push their chair independently in more situations. The wheels magnify the force of pushing, making it easier to push with weak muscles. These wheels are called power assist technology.
Many people with a C5 injury use both a manual and power wheelchair and other people with a C5 injury use a power wheelchair full time. You can learn to drive a power wheelchair with your arm and hand. You will need a splint or brace to support your wrist and hand and you will need a special joystick knob to be able to steer the chair. You might also need special buttons (spec switches) to be able to use the functions of the chair.
Power wheelchairs can cover up to 25 kms per day but they will not get you everywhere you need to go. People who use power chairs travel in a modified vehicle that transports them sitting in their wheelchair. Some vehicles have lowered floors to drive the chair straight in, others have ramps and some have hydraulic hoists that can lift you and the chair up into the vehicle.
Equipment to exercise:
You can learn to use straps, foam blocks and your wheelchair to be positioned using your body weight for stretch. You may need assistance to move into the positions but should be able to remain in the stretch without someone helping. This will help you maintain flexibility in your body which can help reduce pain and spasm.
You can use rubber tubing (Theraband) to perform strengthening exercises for your arms. Take care not to use a band that is too strong as this can cause shoulder blade winging and can lead to shoulder pain. Ask for an assessment from a physiotherapist or exercise physiologist to make sure you are using the correct technique and that you are performing the best exercises for you.
You have limited options for fitness training available because of the small number of muscles you have working. Many people do not undertake regular exercise for fitness and face the future problems of a sedentary life. You can use an arm crank machine to perform fitness training. FES cycling is another option that is effective for providing cardio-vascular exercise. The cycling equipment requires expert knowledge to set up and trial, it is also very expensive.