An SCI at the cervical level causes weakness or paralysis in the arms and the legs, referred to as quadriplegia or tetraplegia. Signs and symptoms vary depending on the level of the lesion and whether the lesion is complete or incomplete. The level of the lesion is identified as the most caudal neural region with normal sensation and motor function. An incomplete lesion will result in preservation of some motor or sensory function at the lowest sacral segment, whereas a complete lesion results in an absence of sensory and motor function at that level. A high cervical lesion (i.e., C1-C4) can cause devastating loss of function and often necessitates mechanical ventilation due to weakness or paralysis of the key respiratory muscles. Complications associated with SCI include respiratory impairment, muscle spasms, osteoporosis, deep vein thrombosis (DVT), pressure ulcers, orthostatic hypotension, and chronic pain. Physical therapy usually begins in the acute hospital setting once the injury has been stabilized and continues throughout inpatient and outpatient rehabilitation, and possibly at home. In the acute stage, therapy focuses on respiratory function, selectively maintaining joint ROM, and preventing skin breakdown. Once the patient is medically stable and spinal stability has been achieved, out-of-bed activities, including functional mobility and orientation to the vertical position, can begin. Long-term goals typically include the patient's return to his or her community and a sense of meaningful quality of life.