A 31-year-old male sustained a T6 spinal cord injury. Examination reveals no motor function below the neurological level, but light touch and pinprick sensation are present in the S4-S5 dermatomes, and he perceives deep anal pressure. Which of the following ASIA Impairment Scale (AIS) classifications BEST describes this injury?

AIS C — motor incomplete, most key muscles below the level grade less than 3

AIS D — motor incomplete, most key muscles below the level grade 3 or greater

A physical therapist is treating a 24-year-old male with a complete C6 tetraplegia, three weeks post-injury. A student asks why the therapist consistently allows the patient's fingers to remain flexed when the wrist is extended during range of motion, rather than stretching the wrist and fingers into full simultaneous extension. Which of the following is the BEST explanation?

Preserving mild finger flexor tightness allows a tenodesis grasp — wrist extension passively closes the fingers, becoming the patient's primary grip

Full finger stretching is too painful in the acute period

Finger range of motion is unimportant in tetraplegia since hand function is absent

Simultaneous wrist and finger extension risks fracturing osteoporotic carpal bones

A 28-year-old female has a complete C7 tetraplegia. Compared with a patient at C6, which of the following NEW functional abilities does the C7 level MOST characteristically add, and why?

Independent transfers and wheelchair pushups, because the triceps enable elbow extension against resistance

Normal fine motor hand function, because the intrinsic hand muscles are innervated at C7

Independent ambulation with bilateral ankle-foot orthoses

Independent diaphragmatic breathing for the first time, because the phrenic nerve arises at C7

During a mat session, a 35-year-old male with a complete T4 paraplegia suddenly develops a pounding headache, profuse sweating and flushing above the level of injury, and nasal congestion. His blood pressure, normally around 100/60 mm Hg, measures 190/110 mm Hg, and his heart rate is 48 beats per minute. Which of the following is the MOST appropriate IMMEDIATE sequence of actions?

Sit the patient upright, loosen restrictive clothing, search for and remove the triggering stimulus — checking the urinary catheter first — and call for emergency medical assistance if the episode does not resolve

Lay the patient supine, elevate the legs, and monitor for improvement

Continue the session at a lower intensity while offering water

Apply a cold pack to the forehead and dim the lights for the headache

A 42-year-old male with a C5 tetraplegia, four weeks post-injury, reports lightheadedness and dimming vision each time the therapy team raises the head of his tilt table past 60 degrees. Which of the following management strategies is MOST appropriate?

Progress upright tolerance gradually, using abdominal binders and lower extremity compression, and return him toward horizontal when symptoms occur

Discontinue upright activities until orthostatic symptoms fully resolve on their own

Push through the symptoms to the full upright position to accelerate adaptation

Restrict fluids before sessions to reduce vascular volume shifts

A 26-year-old male sustains a stab wound resulting in hemisection of the LEFT half of the spinal cord at T10. Which of the following clinical presentations should the therapist expect below the level of the lesion?

Loss of motor function and proprioception on the LEFT; loss of pain and temperature sensation on the RIGHT

Loss of motor function and proprioception on the RIGHT; loss of pain and temperature sensation on the LEFT

Bilateral loss of all sensory modalities with preserved motor function

Bilateral motor loss with preserved sensation throughout

A physical therapist is treating a 30-year-old male with a complete T3 paraplegia who has developed retained secretions after an upper respiratory infection. He breathes independently without ventilatory support. Which of the following BEST explains his impaired airway clearance and the appropriate physical therapy response?

His abdominal and most intercostal muscles are paralyzed, weakening forced expiration and cough — manual assisted cough techniques and airway clearance should be used

His diaphragm is paralyzed, so he requires mechanical ventilation during infections

Respiratory muscles are unaffected at T3, so the retained secretions must reflect medication side effects

Impaired swallowing is the cause, and thickened liquids are the primary intervention

A 27-year-old male with a complete T5 paraplegia is being educated on skin protection during full-time manual wheelchair use. Which of the following pressure relief instructions is MOST appropriate?

Perform a pressure relief maneuver — a full pushup, forward lean, or side-to-side lean held long enough to fully reperfuse the tissue — on a regular schedule, commonly taught as every 15 to 30 minutes, plus daily skin inspection with a mirror

Shift weight once every 2 to 3 hours, matching the schedule used for repositioning in bed

Rely on the pressure-distributing cushion, which eliminates the need for active weight shifts

Perform brief 2-to-3-second pushups every hour

Two patients with complete paraplegia are discussing long-term ambulation goals. Patient 1 has a T10 injury; Patient 2 has an L3 injury with strong quadriceps. Which of the following BEST characterizes their realistic long-term ambulation outcomes?

Patient 1 may achieve exercise or household ambulation with KAFOs and a walker at very high energy cost, while Patient 2 has realistic potential for community ambulation with AFOs and forearm crutches

Both will ambulate at the same level, since any paraplegic level permits full community ambulation with bracing

Neither patient will stand or ambulate in any capacity with a complete injury

Patient 2 requires KAFOs while Patient 1 needs only AFOs

10 Free NPTE Spinal Cord Injury Practice Questions (2026) - Practitionr

About This Topic

How Spinal Cord Injury Is Tested on the NPTE

Spinal cord injury sits inside the neuromuscular content of the FSBPT content outline — the second-largest area on the exam — with its medical complications reaching into cardiopulmonary, integumentary, and safety scoring. Try our free 20-question timed NPTE practice test, Neuromuscular practice questions, or Stroke practice questions to see how the neuromuscular section frames its items.

The SCI facts the exam tests

→AIS grades — sacral sparing separates complete from incomplete

→C6 — tenodesis grasp; never stretch wrist and fingers together

→C7 — triceps: independent transfers, pushups, the independence level

→Autonomic dysreflexia — T6 and above; sit up, loosen, check the bladder

→Orthostatic hypotension — binder, compression, graded upright exposure, tilt back at symptoms

→Brown-Sequard — motor and proprioception lost on the lesion side; pain and temperature opposite

→Central cord — elderly hyperextension; arms worse than legs

→Respiration — C3-C5 diaphragm; abdominals drive the cough

→Pressure relief — scheduled, held to reperfusion, mirror inspection daily

→Ambulation — thoracic levels: KAFOs at exercise cost; quads present: AFOs and community potential

Note how many of these facts carry a DIRECTION that can be flipped into a distractor: which side loses pain sensation, whether to sit the patient up or lay them down, which limbs central cord spares, which level adds which muscle. SCI wrong answers are overwhelmingly correct facts pointed the wrong way, which makes precision — not breadth — the studying priority. See our full NPTE exam format breakdown for how these items fit into the 225-question structure.

The pattern to recognize

When an SCI vignette describes a sudden change in a patient’s status, run the two-emergency check before anything else: high pressure with a pounding headache and flushing is autonomic dysreflexia (sit them UP and hunt the stimulus); low pressure with lightheadedness on rising is orthostatic hypotension (tilt them DOWN and compress). The two emergencies are mirror images, the exam loves to offer each one’s treatment as the other’s distractor, and the injury level in the stem is your tiebreaker — dysreflexia belongs to T6 and above.

Cross-Content Reasoning

Where Spinal Cord Injury Connects Across the Exam

SCI is the neuromuscular section’s most systemic diagnosis, and its complications fan out across the exam. The blood pressure emergencies and impaired cough connect to the cardiopulmonary section — and to the DVT risk this immobile population carries, tying back to the screening rules on our Special Tests and Modalities pages. Pressure relief here is the prevention side of the staging and positioning content on the Wound Care page — the same ischial and sacral tissue, guarded from the wheelchair rather than treated in the bed.

The equipment thread runs into our Prosthetics & Orthotics questions — KAFO and AFO prescription by level is orthotic matching with the level-function map as input — and into the wheelchair prescription and gait pattern content of the non-systems and musculoskeletal threads: the swing-to and swing-through crutch patterns belong to exactly these patients. The dermatome and myotome testing that assigns the neurological level is the same segmental anatomy tested throughout the neuromuscular section.

And the bladder thread quietly links three pages: the blocked catheter that triggers autonomic dysreflexia, the urinary tract infections that are this population’s most frequent medical complication, and the incontinence and pelvic floor content of the Other Systems page — one organ system, three different exam angles.

Study tip

Build one master table with a row per key level — C4, C5, C6, C7, T1, T6, T12, L3 — and five columns: newest key muscles, functional milestones, equipment, respiratory status, and complications to watch. Most SCI questions are a single cell of that table. Then add two flashcards that must be automatic: the autonomic dysreflexia response sequence, and the Brown-Sequard sidedness rule. Drill the table until a level instantly produces its row, and our complete NPTE study guide covers how to fold it into a full study plan.

Want to Know If Your Level-Function Map Holds Up?

10 questions give you a snapshot. Practitionr’s AI tracks your neuromuscular accuracy topic by topic — SCI included — then rebuilds your study plan around exactly where you need more work. No credit card required.

Start Free Trial →

Read the NPTE Study Guide →

Free NPTE Study Resources

By Content Area

By Topic

By Topic (cont.)

Study Tools