JUDY FORTIN: You may hear your loved one’s level of injury mentioned frequently. Level of injury refers to where the spinal cord is functioning and is also known as the neurological level of injury. Doctors determine this by assessing the movement and sensation at or below a certain level on the spinal cord. The level of injury designation is a letter followed by a number that corresponds to the spinal nerves. Refer to this sub-chapter for information if your loved one has a cervical level of injury from C1 to C4. C stands for cervical, while the numbers 1, 2, 3, and 4 refer to the spinal nerves in that section of the spinal cord. Keep in mind that these are general guidelines for levels of injury, and your own, or your loved one’s injury may differ due to its individual type and severity. The level of independence achieved also has much to do with the patient’s health at the time of injury. This includes body type, existing medical conditions, and other injuries that may have occurred at the time of the accident. >> DR. ROBERT MAXWELL: The cervical spinal cord section is the section contained in the neck. The higher cervical sections from C1 to C4 control the neck and important automatic functions, including breathing. C1, C2, C3 and C4 are the most severe of the spinal cord injury levels. A person injured at these levels is defined as a tetra- or quadraplegic, a person with paralysis of arms, hands, trunk, legs and the inability to shift their weight. >> JEFFERY SALOMONE: People with quadriplegia may not be able to breathe on their own, to clear saliva, or to control bowel or bladder movements. In some situations, their ability to speak is decreased. With therapy, they may be able to lift their head and shrug their shoulders. C3/C4 and C5 nerves control the diaphragm. A person with injuries at these levels may be able to breathe on their own and to speak normally. >> JUDY FORTIN: Persons with C1 to C4 injuries require complete assistance getting into and out of their bed or chair. They may be able to utilize powered wheelchairs with special controls to move around on their own. Persons with high-tetraplegia will not be able to drive a vehicle on their own and will instead rely on family or on a caregiver who can be trained to get the person into and out of an adapted van or bus later in the recovery process. If this kind of support is not available, public or professional transportation services may be used as long as their vehicles have a special lift. A wide range of automobile lifts and ramps is available today to those who can access financial support. You’ll need to concern yourself with how to manage personal care. At these levels of injury, a person is completely dependent upon others for all personal care functions, which include feeding, bathing, grooming, dressing and management of their bowel and bladder program. Sometimes, family members are able to provide all or part of their loved one’s personal care; more often, the care is supplemented by a professional caregiver or multiple caregivers. Persons with C1 to C4 injuries require 24-hour-a-day personal care. As family or friend to a person with a high C-level injury, it is important that you familiarize yourself with your loved one’s personal care routine so that you can learn to assist in his or her care and comfort or understand the type of professional support you may need. Home modifications are strongly suggested for high cervical-level injured persons. The person’s living space should have doorways wide enough to accommodate their wheelchair and have ramps in place of stairs. Persons with high-quadraplegia will typically require either a one-story home with room enough for a mobile hospital bed, or easy access to an elevator and wide hallways leading to their home or apartment. Ramps, wider doors, special showers and toilets make it possible for these persons to live as comfortably as possible. Friends, family, church and community groups may also pitch in to help with home modifications and fundraisers. Many people receive funding assistance or donations from special events, local businesses, groups and even individuals. Later in the rehabilitation process, you may hear the term functional progression, which refers to how much progress your loved one might make as time goes by. At the highest cervical levels of injury, it may partly depend on whether or not your loved one can go on to a rehabilitation facility for additional care and therapy after leaving the trauma care center. The use of assistive technology is important for functional progression, as is the patient’s and family’s commitment to closely following a prescribed routine of consistent care. >> DR. BRUCE DOBKIN: After spinal cord injury, your loved one will gradually improve. And one of the best ways to monitor this is, if there’s any feeling or any movement below the level of the injury, this is a very positive sign and is something that you can build upon. Gradually over time, the therapists, the rehabilitation folks, will try to help drive greater recovery from that little bit of recovery that you’re beginning to see. This recovery can occur for weeks, and months, sometimes even years, so it’s real important for you to push those gains that you see, but also, it’s very important to begin to accept any limitations in recovery that may come about so that your loved one can move on with life using assisted devices, using those means by which he or she can return to a normal life. >> JUDY FORTIN: At this time we’ll continue on to the last chapter of the video. Chapter VI provides practical advice on how to deal with the injury and its consequences to your loved one and your family. Lee Woodruff starts off the chapter. She has some great advice because she and her family have been through, and survived, a catastrophic injury themselves. It’s an important part of the video.