C5 ASIA A or B recommendations

This page has information about the assistance that is typically needed for clients with a spinal cord injury that is classified as Cervical 5 (C5) with an ASIA score of A or B.

Abilities and assistance typically needed

Movement and motor control

  • Total paralysis of trunk and lower extremities
  • Limited movement in elbow with active control of flexion, but no extension and limited forearm movement
  • Minimal wrist movement and no finger movement
  • Can move head and neck with moderate shoulder control.

Breathing (respiratory function)

  • Respiratory muscle funct
  • ion impaired and respiratory capacity and endurance compromised
  • Will require assistance to clear secretions.

Autonomic dysfunction

  • Vulnerable to autonomic dysreflexia and orthostatic hypotension, and has impaired thermoregulation.

Personal care activities

  • Splints or palmar bands may be needed for any activity needing hand or digital grip
  • Full assistance required for bowel/bladder management, bathing/showering, lower body dressing and upper body dressing
  • Assistance required for grooming (with adapted equipment) varies from full to minimal.
  • Full assistance required with bed/wheelchair transfers and assistance in positioning with equipment
  • Full assistance required for food/meal preparation and cutting food
  • Range of assistance required for eating with equipment/splints varies from full to moderate .

Daily living activities

  • Full assistance required with all domestic duties
  • Range of assistance required varies from full assistance to independence when using communication technology, depending on workstation set-up and equipment availability
  • Can turn pages and use computers, keyboards, telephones and environmental controls with adaptive equipment/devices
  • Likely to require extensive housing modifications to resolve barriers to getting into and out of the home (eg more space to accommodate the turning radius of a power wheelchair), space to accommodate equipment (eg electric bed), and to address issues around body temperature regulation, personal safety and the provision of appropriate facilities to undertake personal hygiene
  • Transport via motor vehicle will require either a mobility taxi or travel as a passenger in a vehicle that provides accessibility, safety during transportation, and adequate room for equipment.


  • Full assistance usually required for all transfers, including use of a hoist with 1−2 assistants, due to a range of factors including the weight of the person and spasms
  • Range of assistance required varies from full assistance with manual chair with capstans, pushing uphill, downhill, on rough surfaces and outdoors
  • Able to use power wheelchair with hand control
  • Rarely able to drive motor vehicle, but possible with appropriately modified vehicle, adaptive equipment and assistance with transfer and positioning chair
  • Full to moderate assistance required with transport.

Levels of human support

Home nursing: 0.5 hours per week or as identified by assessment

The allocation of 0.5 hours per week is not an indication that home nursing will be required weekly, rather it is to allow home nursing on an as-needed basis.

Attendant care: 42 to 49 hours per week/6 to 7 hours per day

Full assistance required with personal care.

If the person is not living with someone in attendance, the maximum level of adaptive environmental equipment is necessary, including access to a personal alarm system and environmental control systems.

The higher range of attendant care hours should be applied where the person is older, requires more regular turning or has any of the following: spasms, postural hypertension, wound care requirements, pain, or autonomic dysreflexia or physique which requires two attendants for transfers (eg extreme obesity).

Sleepover: 56 hours per week/8 hours per day

Sleepover means a continuous period during which an employee is required to sleep at the workplace, and be available to deal with any urgent situation which cannot be dealt with by another worker or be dealt with after the sleepover period.

Some individuals may prefer not to have sleepover care. If so, a personal alarm system, full environmental control for lights/TV and air conditioning etc, would need to be fully operational and the person able to independently access a drinking system.

Home help: 18 to 21 hours per week

The range at this level includes full assistance with tasks such as washing, ironing, shopping, etc.

To allow a more flexible routine or to limit the number of support staff, the injured person may negotiate times with their attendant care, home help and community access assistants.

Community access: 7 to 10 hours per week

The seven-hour lower range can be interpreted as an hour per day for transport including medical and other personal appointments (eg hair dresser, dentist).

The other hours are highly variable depending on the individual’s age, past social habits and the amount of support the activity requires (eg playing cards, fishing, going to the movies, socialising with friends.)

Child-care services, educational support and vocational support

The categories of child-care services, educational support, and vocational support have not been allocated a range of support hours. The support requirements in these categories are very specific to the individual’s circumstances and should be based on a specialist assessment of the individual’s needs.

For example, if eight hours of educational/vocational support is required at an education facility or workplace, there is likely to be a reduced need for domestic meal preparation in the home.

Related information

Factors that affect attendant care

Reviewed: 9 September 2015