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C5–C7 Mid-Low Tetraplegia

C5 through C7 (mid to low cervical)

Tetraplegia with progressively more arm function. C5 elbow flexion. C6 wrist extension and tenodesis grip. C7 elbow extension and finger flexion — the level at which manual-chair independence becomes realistic.

Overview

C5–C7 covers the steepest jump in independence on the SCI spectrum. A C5 injury preserves elbow flexion (biceps) — you can feed yourself with the right adaptive equipment and use a power chair fully. C6 adds wrist extension — that drives a tenodesis grip (passive hand closure when the wrist extends), opening the door to many ADLs. C7 adds elbow extension (triceps) and improving hand function — many people at C7 propel a manual wheelchair, transfer with a sliding board, and are independent in self-care.

Bowel, bladder, and AD precautions remain. AD risk is high at all three levels.

Preserved function

• C5: Diaphragm and shoulder shrugs. Elbow flexion (biceps). Limited shoulder abduction. No wrist or hand control. Tenodesis is not yet possible.
• C6: Adds wrist extension (extensor carpi radialis). Enables a passive tenodesis grip — when the wrist extends, the fingers automatically curl into a pinch. This is the most functionally important wrist motion in SCI.
• C7: Adds elbow extension (triceps), finger extension, and partial finger flexion. Push-up transfer becomes biomechanically possible. Most C7 users push a manual wheelchair.
• Below the injury: No motor function. Sensation absent or impaired below the level. All have neurogenic bowel and bladder.

Common barriers to independent living

• Transfers. C5 — typically full assist or mechanical lift. C6 — sliding board with assist or independent depending on body habitus. C7 — often independent push-up transfer with practice.
• Hand function. Tenodesis splints, universal cuff (for utensils, toothbrush), and built-up grips for pens. Hand function in C5–C6 is the rate-limiting step for self-feeding, dressing, hygiene, and writing.
• Driving. Hand controls (push-pull or push-rock), reduced-effort steering, spinner knob. C6 and C7 frequently drive after evaluation.
• Skin and bladder. AD risk is high at all three levels — every full bladder is dangerous. CIC (clean intermittent catheterization) is the most common bladder program; some use indwelling catheters.
• Shoulder overuse. Lifelong manual-chair propulsion and transfers wear out the rotator cuff. Push-rim modifications (PushRim Activated Power Assist, e.g., SmartDrive) extend independent mobility while protecting shoulders.
• Spasticity. Often more pronounced at this level. Baclofen, tizanidine, or intrathecal baclofen pump as needed.

Durable medical equipment

Wheelchair:

• C5: Power wheelchair with joystick (a "tri-pin" or T-shaped handle suits weak hand grasp). Tilt and recline for pressure relief. Some C5 users drive a manual chair short distances with rim coatings or projections (vertical pegs) but it is high effort and shoulder-risky.
• C6–C7: Manual ultralight wheelchair (TiLite, Permobil Quickie, Ki Mobility Catalyst) with rigid frame, solid casters, custom camber. Tenodesis-assist push gloves (Switchback, RehaDesign) help C6 propulsion. SmartDrive (Permobil) is a popular power-assist add-on that protects shoulders.

Cushion: Air cell or hybrid cushion (Roho Quadtro Select, Permobil Stimulite Sport, Ride Java).

Transfer aids: Sliding board (Beasy, Safety-Sure), grab bars on tub/toilet, transfer pole, ceiling track lift for the highest-needs days.

ADL adaptive equipment:

• Self-feeding: Universal cuff with utensil holder, plate guard, weighted utensils.
• Hygiene: Long-handled sponge, suction-cup nail brush, electric toothbrush with universal-cuff handle.
• Dressing: Button hook, dressing stick, sock aid, elastic shoelaces.
• Writing and tech: Stylus mounted in a tenodesis splint, Dragon voice control, accessibility-mode iPhone.
• Bladder: Coude-tip catheters (e.g., LoFric, SpeediCath Compact) easier with weak hand strength; some use catheter inserters.

Bowel program: Suppository (bisacodyl) or mini-enema (Enemeez) timed; digital stimulation; transanal irrigation system (Peristeen) is increasingly used to shorten and standardize the routine.

Vehicle: Modified minivan with hand controls and a rear or side conversion; transfer-in or roll-in depending on transfer ability.

Adaptive sports

Sports below are appropriate for this level. Classification rules vary; a regional combine or a Move United chapter is the easiest path to find a team and confirm eligibility.

Resources

• ASIA — American Spinal Injury Association — International Standards for Neurological Classification of SCI (ISNCSCI), Yes You Can! self-care guide, and clinician reference materials.
• Christopher & Dana Reeve Foundation — Paralysis Resource Guide — Free, frequently updated 400+ page guide covering medical, equipment, financial, and lifestyle topics. Mailed free in the US.
• PVA — Paralyzed Veterans of America — Clinical Practice Guidelines, advocacy, sports programs, and consumer publications. Free CPG library covers most SCI medical complications.
• Move United Sport — Largest US adaptive-sport network (formerly Disabled Sports USA). Local chapter finder for ~200 community programs.
• International Paralympic Committee — Sport classification, athlete development, Paralympic Games coverage.
• NSCISC — National SCI Statistical Center — Outcomes data, epidemiology, life-expectancy and rehospitalization statistics by level and AIS grade.

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Education only. Not medical advice. Equipment recommendations are illustrative — your seating clinic and rehab team will tailor specifics to your body, function, and goals. For emergencies call 911.