SCI Levels + Function
A client with a C5 complete SCI is participating in self-feeding training. Which muscle function is MOST likely present?
A. Finger flexion
B. Wrist extension
C. Elbow flexion
D. Triceps extension
Correct Answer
✅ C. Elbow flexion
Rationale
Clients with a C5 SCI typically have biceps function (elbow flexion) but lack wrist extension, triceps function, and finger movement.
Question
An OTR is preparing a client with a recent SCI for transfer training. Which skill should be addressed FIRST?
A. Car transfers
B. Community mobility
C. Sitting balance
D. Floor recovery
Correct Answer
✅ C. Sitting balance
Rationale
Sitting balance is a foundational skill necessary for safe transfer performance. Clients must demonstrate adequate trunk control and postural stability before progressing to transfer training.
NBCOT Tip
Think:
Balance before transfers
Transfers before community mobility
A client with a C5 SCI wants to increase independence with self-feeding but demonstrates significant upper extremity weakness and limited grasp.
Which combination of adaptive equipment would be MOST appropriate?
A. Universal cuff and built-up utensil handle
B. Mobile arm support and universal cuff
C. Plate guard and Dycem
D. Angled utensils and weighted utensils
Correct Answer
✅ B. Mobile arm support and universal cuff
Rationale
A client with a C5 SCI often has sufficient elbow flexion to participate in feeding but may lack the strength to repeatedly lift the arm and the hand function needed to grasp utensils.
A mobile arm support assists arm movement, while a universal cuff compensates for impaired grasp, making this combination the most effective for increasing feeding independence.
A client with a C6 SCI uses a wheelchair for 10 hours per day and has a history of pressure injuries over the ischial tuberosities.
Which cushion would be MOST appropriate?
A. Standard foam cushion
B. Air filled cushion
C. Wooden seat insert
D. Gel seat cover
Correct Answer
✅ B. Air filled cushion
Rationale
Air filled cushions provide excellent pressure redistribution and are commonly recommended for individuals at high risk for skin breakdown or those with a history of pressure injuries.
NBCOT Tip
Know the cushion hierarchy:
🩹 Air= best pressure redistribution/high skin breakdown risk
🪑 Foam = basic positioning and lower risk clients
🧊 Gel = pressure distribution + comfort
A client with SCI reports dizziness and lightheadedness when moving from a supine position to sitting at the edge of the bed.
What is the MOST likely cause?
A. Autonomic dysreflexia
B. Orthostatic hypotension
C. Deep vein thrombosis
D. Pressure injury
Correct Answer
✅ B. Orthostatic hypotension
Rationale
Orthostatic hypotension occurs when blood pressure drops during position changes, causing dizziness, lightheadedness, and possible syncope.
NBCOT Tip
Position change + dizziness = OH
A client with a C7 SCI is being evaluated for functional independence. Which muscle function would MOST likely be present?
A. Finger flexion
B. Triceps extension
C. Intrinsic hand function
D. Thumb opposition
Correct Answer
✅ B. Triceps extension
Rationale
C7 SCI is associated with triceps function, allowing elbow extension and significantly improving transfer and wheelchair mobility potential.
Question
Before performing a wheelchair-to-bed transfer, what should the client do FIRST?
A. Remove the footrests
B. Lock the wheelchair brakes
C. Lean forward
D. Position the transfer board
✅ B. Lock the wheelchair brakes
Wheelchair stabilization is the first safety step before initiating any transfer. An unlocked wheelchair can move during the transfer and increase fall risk.
NBCOT loves safety sequencing:
Brakes → Setup → Transfer
A client with a C6 SCI is learning transfers and does not have sufficient upper extremity strength to lift completely from one surface to another.
Which transfer method is MOST appropriate?
A. Mechanical lift
B. Popover transfer
C. Sliding board transfer
D. Stand-pivot transfer
✅ C. Sliding board transfer
Clients with C6 SCI commonly use sliding board transfers because they have wrist extension and some upper extremity function but typically lack the strength needed for independent popover transfers.
C6 = Sliding Board
C7 = Greater transfer independence
A client with a C7 SCI has demonstrated good sitting balance, upper extremity strength, and consistent transfer safety.
Which transfer is the MOST appropriate next progression?
A. Mechanical lift transfer
B. Sliding board transfer
C. Dependent transfer
D. Popover transfer
✅ D. Popover transfer
Clients with C7 SCI have triceps function, which improves upper extremity strength and allows progression to more advanced transfer techniques, including popover transfers.
Triceps = transfer freedom
A client with SCI develops dizziness, pallor, and lightheadedness during transfer training after prolonged bedrest.
What is the MOST appropriate OT action?
A. Continue the transfer to improve tolerance
B. Return the client to a reclined position and monitor symptoms
C. Encourage rapid position changes to normalize blood pressure
D. Begin wheelchair propulsion training
✅ B. Return the client to a reclined position and monitor symptoms
The client is demonstrating signs of orthostatic hypotension. The appropriate intervention is to return the client to a more reclined position, monitor symptoms, and gradually progress upright tolerance.
OH Progression:
Bed → Elevated HOB → Semi-reclined sitting → Upright sitting → Transfers → Standing
Question
A client with a C6 SCI wants to improve independence with lower-body dressing.
Which intervention is MOST appropriate?
A. Encourage caregiver assistance for all dressing tasks
B. Teach dressing in long sitting using adaptive techniques
C. Perform dressing only while standing
D. Delay dressing training until hand strength improves
Correct Answer
✅ B. Teach dressing in long sitting using adaptive techniques
Rationale
Clients with SCI often use long sitting and compensatory techniques to maximize dressing independence while maintaining safety and stability.
A client with SCI is learning pressure-relief techniques while using a manual wheelchair.
How often should pressure relief be performed?
A. Every 15-30 minutes
B. Every hour
C. Every 2 hours
D. Only when discomfort occurs
Correct Answer
✅ A. Every 15-30 minutes
Rationale
Frequent pressure relief is necessary to reduce prolonged pressure and prevent skin breakdown.
NBCOT Tip
NBCOT loves:
Pressure relief every 15-30 minutes
for approximately 30-60 seconds.
A client with a T4 SCI suddenly develops a severe headache, flushing above the level of injury, and elevated blood pressure.
What should the OTR do FIRST?
A. Recline the client
B. Sit the client upright
C. Continue treatment and monitor symptoms
D. Apply compression stockings
Correct Answer
✅ B. Sit the client upright
Rationale
The client is exhibiting signs of autonomic dysreflexia, a medical emergency. Sitting the client upright helps lower blood pressure while the source of the noxious stimulus is identified.
NBCOT Tip
AD = Up
OH = Down
An OTR is evaluating a client with a C8 SCI. Which ADL outcome is MOST likely compared to a client with a C6 SCI?
A. Increased dependence for feeding
B. Improved hand function and grasp
C. Loss of tenodesis grasp
D. Decreased wheelchair propulsion ability
Correct Answer
✅ B. Improved hand function and grasp
Rationale
Clients with C8 SCI gain finger flexor function, allowing more effective grasp and manipulation than clients relying primarily on tenodesis.
Question
A client with a C6 SCI is learning transfers and does not have sufficient upper extremity strength to lift completely from one surface to another.
Which transfer method is MOST appropriate?
A. Mechanical lift
B. Popover transfer
C. Sliding board transfer
D. Stand-pivot transfer
Correct Answer
✅ C. Sliding board transfer
Rationale
Clients with C6 SCI commonly use sliding board transfers because they have wrist extension and some upper extremity function but typically lack the strength needed for independent popover transfers.
NBCOT Tip
C6 = Sliding Board
C7 = Greater transfer independence
Question
A client with a T10 SCI is preparing for discharge home. Which ADL is the client MOST likely to perform independently?
A. Feeding
B. Upper-body dressing
C. Grooming
D. All of the above
Correct Answer
✅ D. All of the above
Rationale
Clients with lower thoracic SCI generally have full upper extremity function and are expected to be independent with many self-care tasks, including feeding, grooming, and dressing.
NBCOT Tip
The lower the injury, the greater the expected ADL independence.
A client with SCI demonstrates poor trunk control and is unable to independently perform pressure-relief maneuvers.
Which wheelchair feature is MOST appropriate?
A. Elevating leg rests
B. Reclining backrest
C. Tilt-in-space seating system
D. Anti-tip bars
Correct Answer
✅ C. Tilt-in-space seating system
Rationale
A tilt-in-space wheelchair redistributes pressure by changing the orientation of the entire seating system while maintaining body alignment.
NBCOT Tip
Tilt = Pressure Relief
Recline = Positioning/ROM
An OTR is educating a client with a SCI about pressure injury prevention before discharge.
Which instruction is MOST appropriate?
A. Inspect the skin daily using a mirror to check areas that are difficult to see
B. Perform skin checks only if discomfort is present
C. Avoid all pressure over bony prominences during the day
D. Apply lotion to all red areas to prevent skin breakdown
Correct Answer
✅ A. Inspect the skin daily using a mirror to check areas that are difficult to see
Rationale
Clients with SCI may have impaired sensation and may not notice early signs of skin breakdown. Daily skin inspection, including the use of mirrors for hard-to-see areas, is a critical component of pressure injury prevention.
NBCOT Tip
For SCI skin management, think:
🪞 Daily skin checks
🩹 Pressure relief
♿ Proper seating
👀 Early identification
An OTR is evaluating a client with a C6 complete spinal cord injury who is 6 months post-injury.
Which functional ability would be MOST expected at this level?
A. Independently perform a popover transfer from wheelchair to bed
B. Use wrist extension to achieve a functional grasp during self-feeding
C. Independently don and doff a pullover shirt without adaptive equipment
D. Independently propel a manual wheelchair up and down community curbs
Correct Answer
✅ B. Use wrist extension to achieve a functional grasp during self-feeding
Rationale
Clients with a C6 SCI typically have wrist extension but lack active finger flexion and triceps function. Wrist extension creates a tenodesis grasp, allowing the fingers to passively flex around objects. This functional grasp can be used for activities such as self-feeding, grooming, and light ADL tasks.
Question
A client with a C4 complete SCI is beginning transfer training. Which transfer method is MOST appropriate?
A. Stand-pivot transfer
B. Sliding board transfer
C. Mechanical lift transfer
D. Squat-pivot transfer
Correct Answer
✅ C. Mechanical lift transfer
Rationale
Clients with a C4 SCI have significant motor limitations and require extensive assistance for mobility and transfers. A mechanical lift provides the safest transfer method while reducing caregiver burden and minimizing injury risk.
NBCOT Tip
High cervical SCI (C1-C4) = Think caregiver assistance and mechanical lifts.
Question
A client with SCI reports difficulty bathing independently because shampoo bottles and soap frequently slip from the hands.
Which intervention is MOST appropriate?
A. Increase bathing frequency
B. Recommend non-slip dispensing containers and pump bottles
C. Complete bathing only with caregiver assistance
D. Use heavier shampoo bottles
Correct Answer
✅ B. Recommend non-slip dispensing containers and pump bottles
Rationale
Environmental modifications and adaptive equipment should be considered before increasing caregiver assistance. Pump dispensers and non-slip containers reduce grasp demands and improve independence.
NBCOT Tip
Least restrictive intervention first.
A student with hypotonia demonstrates a posterior pelvic tilt, lateral trunk lean, and difficulty maintaining upright posture throughout the school day.
Which seating modifications would be MOST appropriate?
A. Elevating leg rests and anti-tip bars
B. Dense foam lateral supports and a gel cushion
C. Wheel locks and a lap tray
D. Reclining backrest and swing-away footrests
Correct Answer
Correct Answer
✅ B. Dense foam lateral supports and a gel cushion
Rationale
Lateral supports improve trunk alignment while a gel cushion assists with positioning and pressure distribution. These modifications address the student's postural needs without requiring an entirely new mobility system.
NBCOT Tip
Modify the seating system before replacing the wheelchair.
An OTR is treating a client with a C6 SCI who has been on bedrest for several weeks. During transfer training, the client reports dizziness and appears pale.
What is the MOST appropriate OT action?
A. Continue the transfer to improve tolerance
B. Return the client to a semi-reclined position and monitor symptoms
C. Begin standing frame training to increase endurance
D. Instruct the client to perform wheelchair push-ups
Correct Answer
✅ B. Return the client to a semi-reclined position and monitor symptoms
Rationale
The client is demonstrating signs of orthostatic hypotension, which commonly occurs after prolonged bedrest or when moving too quickly to an upright position.
The appropriate intervention is to:
NBCOT Tip
Orthostatic Hypotension = Position Change + Dizziness
Progress gradually:
🛏️ Bed
⬆️ Head of Bed Elevated
♿ Semi-Reclined Wheelchair
🪑 Upright Sitting
↔️ Transfers
🧍 Standing Activities
An OTR is evaluating a client with a C2 complete spinal cord injury who is being discharged home with family support.
Which intervention would be the HIGHEST priority during discharge planning?
A. Training in sliding board transfers
B. Training in pressure relief techniques using wheelchair push-ups
C. Caregiver education regarding positioning, skin integrity, and respiratory management
D. Instruction in adaptive equipment for independent dressing
Correct Answer
✅ C. Caregiver education regarding positioning, skin integrity, and respiratory management
Rationale
A client with a C2 SCI has profound motor impairment and requires extensive assistance for mobility, transfers, and self-care. Discharge planning should prioritize caregiver training, including:
These interventions are critical to maintaining health and preventing secondary complications.
Question
An OTR is teaching a client with a C6 SCI to perform a sliding board transfer from a wheelchair to a mat table.
After locking the wheelchair brakes and removing the armrest, what should the client do NEXT?
A. Position the sliding board under one buttock and onto the transfer surface
B. Lean backward and begin sliding
C. Place both feet firmly on the floor
D. Lift completely off the wheelchair seat
Correct Answer
✅ A. Position the sliding board under one buttock and onto the transfer surface
Rationale
Proper setup is essential for a safe sliding board transfer. After securing the wheelchair, the board should be positioned under one buttock with the opposite end resting securely on the transfer surface before weight shifting and transfer movements begin.
NBCOT Tip
Sliding Board Sequence:
Question
A client with a T12 SCI is learning bladder management techniques in preparation for discharge home.
Which intervention is MOST appropriate for the OTR to address?
A. Teaching the client a scheduled toileting routine and clothing management strategies
B. Determining the client's catheterization medication schedule
C. Performing a urodynamic study
D. Prescribing medications to improve bladder function
Correct Answer
✅ A. Teaching the client a scheduled toileting routine and clothing management strategies
Rationale
OT practitioners address the functional aspects of bladder management, including:
NBCOT Tip
For bowel and bladder questions, focus on:
🚽 Toileting participation
👖 Clothing management
♿ Bathroom accessibility
🔄 Establishing routines
A client with a C5 SCI spends significant time in bed and is at increased risk for pressure injuries. The client wants to improve independence with bed mobility and pressure relief.
Which intervention would be MOST appropriate?
A. Air flotation wheelchair cushion
B. Trapeze bar
C. Tilt-in-space wheelchair
D. Elevating leg rests
Correct Answer
✅ B. Trapeze bar
Rationale
Clients with C5 SCI have elbow flexion but limited trunk and hand function. A trapeze bar can maximize available upper extremity strength to assist with:
NBCOT Tip
Think:
🛏️ Bed mobility problem → Trapeze
♿ Wheelchair pressure problem → Cushion/Tilt
A client with a T4 SCI suddenly develops a pounding headache, facial flushing, and elevated blood pressure during an OT session. The OTR suspects autonomic dysreflexia.
After positioning the client upright, what should the OTR do NEXT?
A. Check for a kinked catheter or bladder distention
B. Continue the treatment session while monitoring symptoms
C. Transfer the client to bed for a pressure relief period
D. Apply compression stockings
Correct Answer
✅ A. Check for a kinked catheter or bladder distention
Rationale
Autonomic dysreflexia is a medical emergency that occurs most commonly in clients with SCI at T6 and above. After positioning the client upright, the next step is to identify and remove the noxious stimulus causing the episode.
The most common trigger is bladder irritation, including:
NBCOT Tip
AD Emergency Sequence:
Think: Bladder → Bowel → Skin 🎯