The higher the level of injury, the greater will be the impact on breathing. A complete spinal cord injury affects everything from the injury down. This means that if the diaphragm is affected, so are the intercostal and abdominal muscles. Without the use of these muscles, a person cannot breathe as easily or cough or sneeze well. Coughing and sneezing important in clearing mucous out of the lungs. Clearing mucous keeps the lungs healthy and free from infections like pneumonia. Incomplete injuries may also result in breathing problems. They will vary depending on the level and extent of the injury.
Impact on Breathing at Different Levels of Injury
Cervical Injuries
Level: Above C3
The diaphragm does not work at all. A person cannot sneeze or cough. A ventilator machine maintains breathing.
Level: C4 - C5
There is partial function of the diaphragm. The intercostal and abdominal muscles do not work at all. A person cannot cough or sneeze well. Some people may need a ventilator at higher levels of injury (like C4) or may need the ventilator only during certain times of the day, such as during sleep or rest times.
Level: C6 - C8
The diaphragm works well. Intercostal and abdominal muscles do not work at all.
Thoracic & Lumbar Injuries
Level T1 - T5
The diaphragm works well. The intercostal muscles work, but not well. The abdominal muscles do not work. The ability to cough and sneeze is present but is weak.
Level T6 - T12
The diaphragm and intercostals muscles work well. The abdominal muscles work but may be weak. The ability to cough and sneeze is present but remains weaker than before the injury.
Level: L1 - L5, S1 - S4
All breathing muscles work well. The ability to cough and sneeze is normal.
