SPINAL CORD INJURY
Thoracic, Lumbar, Sacral
• is when the level of injury occurs
below the first thoracic spinal
nerve. The degree at which the
person is paralyzed can vary
from the impairment of leg
movement, to complete paralysis
of the legs and abdomen up to
the nipple line. Paraplegics have
full use of their arms and hands.
Segmental spinal Cord level and Function
intercostals and trunk above the
T7-Ll Abdominal muscles
Ll, L2, L3, L4 Thigh flexion
L2, L3, L4 Thigh adduction
L4, L5, S1 Thigh abduction
L5, S1 S2
Extension of leg at the hip
L2, L3, L4
Extension of leg at the knee
L4, L5, S1, S2
Flexion of leg at the knee
L4, L5, S1
Dorsiflexion of foot (tibialis
L4, L5, S1 Extension of toes
L5, S1, S2 Plantar flexion of foot
L5, S1, S2 Flexion of toes
T1-T4 Abilities Disabilities
• Full head, neck and upper
• Good strength of chest
• Breathing normal.
• Functional independence
in self care like house
preparation and in bladder
and bowel skills.
• Can drive a car adapted
with hand controls.
• Normal communication
lower body and
• Autonomic dysreflexia (hypereflexia) is a pathological
autonomic reflex that typically occurs in lesions above T6
(above sympathetic splachnic outflow).
Acute onset of autonomic activity from noxious stimuli
Afferent input from here reaches lower thoracic and sacral areas
Mass reflex response : elevation of blood pressure
This is a critical, emergency situation owing to the lack of
from higher centers. Hypertension persists if not treated
Death may occur.
Initiating stimuli: Autonomic dysreflexia is reported
mainly after bladder distension (urinary retention),
rectal distention, pressure sores, urinary stones,
bladder infections, noxious cutaneous stimuli ,
kidney malfunction, urethral or bladder irritation, and
environmental temperature changes.
Symptoms: Hypertension, bradycardia, severe and
pounding headache, profuse sweating, increased
spasticity, restlessness vasoconstriction below the
level of lesion, vasodialation above the level of
lesion, constricted pupils, nasal congestion,
piloerection(goose bumps) and blurred vision.
T5-T9 spinal cord
• Full head, neck and
• Ability to transfer
from bed to chair
and chair to car.
• Can drive a car with
• Breathing normal.
• May use an electric wheelchair for long distance
independent travel or uneven outdoor surfaces. A
manual wheelchair is used for everyday living, with the
ability to go over uneven ground for short distances.
• Individuals should receive advanced wheel chair training
to do “wheelies” and make transfers from the floor to
• Car transfers may need assistance depending upon
upper body strength.
• Partial domestic assistance is required, such as heavy
household cleaning and home maintenance.
• These individuals have variable control of the paraspinal
and abdominal muscles, and they may be able to stand
by using bilateral Knee-Ankle-Foot Orthoses along with
walker or crutches.
T10-L1: spinal cord
• Full head, neck
• Ability to drive
• Partial paralysis of
lower body and legs.
• Spasticity can be
• Ability to transfer independently from bed to chair
and chair to car. It may be possible to transfer from
floor to chair depending on upper body strength.
There is possibility to transfer from sitting position to
standing frame independently.
• These people have better trunk control than do
patients with a higher injury and they may be able to
walk household distances independently with Knee-
Ankle-Foot Orthoses and assistive devices; they
may even attempt to walk upstairs.
• Unfortunately these maneuvers can require extreme
energy expenditure, and many individuals prefer
L2-S5 : spinal cord
• Full upper body
control and balance.
• Can prepare
complex meals and
general house hold
• Can drive car
• Normal respiratory
• Some hip, knee
• Walking slow and
• Individuals with an injury at the lumbar level can become
functionally independent in terms of household and
community ambulation, which is often defined as
unassisted ambulation for distances greater than
150feet, with or without the use of braces and assistive
• Orthotic devices (Knee-Ankle-Foot orthoses and Ankle-
Foot orthoses) are often prescribed to assist patients
with lower extremity standing and walking.
• Full or part time use of manual wheelchair is necessary.
Conus Medullaris Syndrome
• Characterized by injury to the sacral cord
and to the lumbosacral nerve roots.
• The result is symmetric and (often)
completes saddle anesthesia, bladder and
bowel dysfunction and lower extremity motor
• The functional prognosis for mobility and
activities of daily living is good, bladder
bowel dysfunction is less likely than in other
conditions, neurological recovery is limited.
Cauda equina syndrome
• Cauda equina syndrome is characterized by injury to
the lumbosacral nerve root, it is not truly a spinal
• It causes saddle anesthesia, bladder and bowel
dysfunction and variable motor weakness of the
• This syndrome is often less complete and symmetric
than is Conus medullaris injury.
• Neurologic recovery can continue for many months
or years as the peripheral nerve roots can
regenerate(unlike spinal cord axons) and because
these injuries are incomplete.
• The functional prognosis for mobility and self-care
is good, although bladder and bowel continence