A C6 spinal cord injury (SCI) affects function from the neck down, resulting in a form of paralysis known as tetraplegia. Recovery in the context of SCI is defined as the potential for regaining neurological function and achieving a high level of independence. The prognosis for a C6 injury is considered one of the most favorable among high-level cervical injuries because of the specific muscle groups that typically remain functional. Determining the precise neurological level and severity of the damage is the first step toward planning for maximized independence.
Understanding the C6 Level Injury
The C6 neurological level is defined by the lowest segment of the spinal cord where motor and sensory function are preserved. This level corresponds to the sixth cervical vertebra, near the base of the neck. A C6 SCI means that muscles innervated by the C6 spinal nerve root and above are typically working, while those below are impaired. The most important retained function is the ability to extend the wrist.
A C6 injury results in a loss of voluntary movement and sensation below the shoulder and armpit level, affecting the trunk, legs, and hands. Severity is classified using the American Spinal Injury Association (ASIA) Impairment Scale (AIS), which assigns a grade from A (complete) to E. AIS Grade A means there is no motor or sensory function preserved in the lowest sacral segments. Grades B, C, and D indicate incomplete injuries with some preserved function, a fundamental distinction for predicting long-term outcomes.
Retained Function and Independence
The specific motor functions preserved at the C6 level allow for a high degree of functional independence. Individuals retain full control of their head, neck, and shoulder movements, along with the ability to bend the elbow. The preserved wrist extensor muscles allow for a functional movement known as the tenodesis grasp.
The tenodesis grasp is a passive mechanism where extending the wrist causes the fingers to curl inward, creating a functional pinch or grip. This biomechanical advantage compensates for the lack of voluntary finger movement, which is typically lost at this level of injury. By moving the wrist, a person can achieve a passive grasp and release, instrumental for many activities of daily living (ADLs).
This retained function allows for independence in personal care and mobility. With adaptive equipment, individuals can manage self-feeding, grooming, and upper body dressing. Many C6 patients can perform independent pressure reliefs and push a manual wheelchair over smooth surfaces for short distances. Transfers, such as moving from a bed to a wheelchair, are often possible independently using a sliding board. For daily mobility over longer distances, a power wheelchair with hand controls is frequently used.
Predicting the Potential for Recovery
The potential for neurological recovery following a C6 SCI is dependent on whether the injury is classified as complete (AIS A) or incomplete (AIS B, C, or D). Incomplete injuries have a better prognosis for motor return because a portion of the neural pathways below the injury site remains intact. Patients diagnosed with AIS B, C, or D are more likely to experience meaningful recovery, with AIS C or D having the highest chance of regaining motor function.
Neurological recovery occurs most rapidly within the first three to six months, with the majority of measurable improvement plateauing by 12 months. The first year is the most critical period for regaining function. Even individuals with an initial AIS A classification may experience a change in status, with approximately 20% to 30% converting to an incomplete status during the first year.
Other factors influence the recovery trajectory. Younger patients generally exhibit a better capacity for neurological and functional recovery. Preserved sensation below the level of injury (AIS B), even without motor function, suggests a more favorable prognosis for eventual motor return. The intensity and timing of rehabilitation maximize the functional use of spared neural connections through neuroplasticity.
Maximizing Function Through Rehabilitation
Maximizing function after a C6 SCI involves a rehabilitation program focused on harnessing existing capabilities and compensating for lost function. Physical therapy (PT) and occupational therapy (OT) are cornerstones of this process.
Physical Therapy (PT)
PT focuses on strengthening preserved muscle groups, such as the shoulders and biceps, to improve mobility and endurance for tasks like manual wheelchair propulsion. Therapists also work on trunk control and balance, which are necessary for safe transfers and unsupported sitting.
Occupational Therapy (OT)
OT is geared toward improving independence in daily activities. Sessions focus on refining the use of the tenodesis grasp for manipulating objects, such as using utensils, brushing teeth, and writing. Occupational therapists introduce adaptive equipment, like universal cuffs, specialized utensils, and dressing aids, to bridge the gap between retained function and task requirements.
Advanced technologies promote functional recovery and independence. Activity-based therapies, involving aggressive, repetitive exercises, stimulate the spinal cord and encourage neuroplasticity below the injury level. Functional Electrical Stimulation (FES) applies electrical currents to paralyzed muscles, inducing contractions that help maintain muscle mass and improve circulation. Rehabilitation aims to solidify the functional use of preserved upper body strength and the tenodesis grip, transforming neurological function into practical, long-term independence.