An otherwise healthy young adult with a complete C5 spinal cord injury is assessed. Which functional transfer is the MAXIMUM they can potentially achieve?

• A. Independent community-level mobility with a manual wheelchair
• B. Toilet transfer with a sliding board and assistance
• C. Independent rolling side to side in bed
• D. Dependent transfer to a wheelchair by using an overhead lift

Answer: (B)

When a complete spinal cord injury at C5 is present, elbow flexion and some shoulder movements can be preserved, but trunk control and hand function are essentially lost. That combination limits more independent transfers because you need solid trunk stability and, usually, some hand use to manage surfaces and grasp. Transfers that rely on long, independent wheelchair propulsion or rolling in bed without assistance aren’t feasible with this level of injury.

Using a sliding board leverages the strength that remains in the upper arm to shift body weight and slide from one surface to another while a caregiver helps position the board and assist as needed. This method fits the capabilities of a person with a complete C5 injury best because it provides a functional transfer with some assistance, without requiring independent wheelchair propulsion or full trunk control. An overhead-lift transfer is a safe, but dependent method that typically requires more caregiver involvement and doesn’t represent the highest level of independence for this level of injury. Rolling side-to-side in bed would also require trunk control that isn’t reliably available at this level. So, the maximum achievable transfer in this scenario is a toilet transfer using a sliding board with assistance.