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R Sensory C3, L Sensory C4, R Motor C3, L Motor C5

Zone of Partial Preservation:

- Sensory: R C5 and L C5

- Motor: R C6 and L C6

The patient is a 25-year-old male who suffered a MVA 6 weeks ago. The patient is 6'1" and weighs 185 lbs.

PLOF: The patient was previously independent in all activities. He worked as an ER nurse and participated in rock climbing multiple times a week.

CLOF: The patient currently has no trunk control, weak upper extremities, and requires assistance with all tasks.

Environmental Factors: The patient lives in a 1-story home with his fiancée and 2 dogs.

Personal Factors: The patient is experiencing some anxiety and depression since the accident, but he is determined to make improvements.

Recommended Wheelchair: Power chair due to the high level of the injury and it being complete.

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The patient would benefit best from a mid-wheel drive power chair. This chair has the drive wheels as the pivot point under the user, and then two caster wheels in the front and two in the back. This creates more stability and enables the chair to have the smallest turning radius of power chairs between 20-26". The extra stability is key, as the patient lacks most motor control of his body; it will prevent possible tipping and injury. This is ideal for the patient being at home and when he is in the community with his finacée. The wheels also provide an equal amount of traction for going up and down an incline, but the patient should be careful with speed and steepness.

Image source: Mid Wheel Drive. Aidacare Healthcare Equipment. Accessed September 23, 2025. https://www.aidacare.com.au/products/wheelchairs/custom-power-wheelchairs/mid-wheel-drive/.

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A back rest with lateral support would be best for this patient due to the lack of trunk control the patient exhibits. The patient is an ASIA A complete C3 with partial preservation of R/L motor C6, which is only the wrist extensors. The high back support and side support will help keep the patient more aligned to maintain the integrity of their spine, prevent contractures, and maximize their breathing. Enabling proper posture should also help with pressure distribution and prevent unwanted pressure injuries.

Image source: Wheelchair backs. Sunrise Medical. Accessed September 23, 2025. https://www.sunrisemedical.com/seating-positioning/jay/wheelchair-backs.

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The patient only has partial innervation of C5 elbow flexors (L 4/5 and R 3/5) and C6 wrist extensors (L 2/5 and R 1/5). This means head array drive control would be best due to the preserved innervation of neck muscles.

The patient may be able to progress from head control to joystick control with physical therapy to improve wrist extensor and biceps strength, as well as maintain tenodesis grasp for passive finger flexion.

Image sources:

1. Head Array Control Powered Wheelchair. YouTube. August 27, 2019. Accessed September 24, 2025. https://www.youtube.com/watch?v=LTTGvAWTM48.

2. U-shaped Joystick Handle. Bodypoint. Accessed September 24, 2025. https://app.bodypoint.com/product/u-shaped-joystick-handles.

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The patient presents with an ASIA A C3 spinal cord injury with absent sensation below the C5 sensory level and no motor activation below C6. The Roho cushion would help to protect the patient's skin integrity by redistributing their weight across the cushion. Having a cushion that will assist with pressure relief is extremely important for this patient, who is unable to sense the need to change positions and does not have the capability to pressure relieve independently. The proper cushion can greatly improve the patient's quality of life by decreasing the incidence of pressure injuries that they are at a high risk of developing.

Image source: Yuen, Hon & Garrett, Donna. (2001). Comparison of Three Wheelchair Cushions for Effectiveness of Pressure Relief. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 55. 470-5. 10.5014/ajot.55.4.470.

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Due to the patient complexity and the need for a tilt function, the wheelchair will require a head rest. The headrest needs to be able to support the head during the tilt, preventing excessive cervical extension and maintaining a neutral position. Additionally, the headrest should have some lateral support to prevent the head from moving too far to either side during turns. The lateral support should be low profile enough to not block the patient's peripheral vision.

Image Source: Whitmyer contoured Cradle Wheelchair Headrest. Sunrise Medical. Accessed September 24, 2025. https://www.sunrisemedical.com/seating-positioning/whitmyer/head-positioning/whitmyer-contoured-cradle.

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Seeing as the patient is an ASIA A C3, he does not have the available strength and motor control to reposition himself within the wheelchair. To prevent pressure injuries, the patient will need to have a powered tilt function on his wheelchair. This would allow him to recline to redistribute pressure independently, in order to prevent pressure injury formation.

Image source: Complex Power Tilt & Recline Wheelchairs. Numotion. July 31, 2025. Accessed September 24, 2025. https://www.numotion.com/products/complex-power-tilt-recline.