# data[].attributes.body
-Limited muscle innervation

-Ventilation necessary as diaphragm will not function properly

-Full dependent in all ADL's, bed mobility, and transfers

-30 degrees of active cervical motion

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-Because whole body is immobilized, it is important to educate caregivers to look for pressure wounds when patient is out of the wheelchair.

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-Full-time attendant required

-Ability to direct care verbally

-Educate on transfers

-Educate on pressure relief

# data[].attributes.body
-PROM in all body parts to aid in blood flow

-Cervical posture and ROM exercises

-Cranial nerve testing if applicable

-Effective communication strategies

-Breathing exercises

# data[].attributes.body
-Make sure patient feels comfortable in their wheelchair and knows how to properly work it

-Improve jaw and chewing strength so patient can eat safely

-Provide activities that strengthens vision, smell, hearing, memory, and communication to keep those sensory nerves strong

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Power recline wheelchair with breath or chin control and portable ventilator

-Ability to perform pressure relief in wheelchair with power recline feature

-Use of environmental control units with set up

-Maximal assistance with bed mobility

-Independent pressure relief with power reclining wheelchair

# data[].attributes.body
-Intact function of deltoids, rhomboids, and biceps

-Flex and abduct shoulder to 90 degrees

-Flex elbows

-Adduct scapulae

-Raise arms to assist with rolling and bring hand to mouth]

-Driving is possible with a van and adaptive hand controls

# data[].attributes.body
The patient can roll, feed, and do upper extremity dressing. The patient is unable to move their trunk or legs.

Positioning would include:

-Supine to long sit education

-Using their elbows and hands to push up into a sitting position

Transfer training:

-sliding board transfer

-educated on using their shoulders and triceps to push up from their chair and onto the board

Ensure good posture during mobility and transfers

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They can use their UE to lift their body, perform wheelchair push-ups, independent in self-care and upper and lower body dressing.

Positioning would include:

-Proper wheelchair posture

-Supine to-side lying transitions

-Educated on using their arms to push up their body weight and rotate to side-lying.

Mobility would include:

-Rolling to sitting-up drills

-Push-up transfers from their chair

-Slide board transfers

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Pressure wounds on the ischial tuberosity, sacrum, calcaneus, greater trochanter, and back.

Pressure wound prevention:

-changing positions every 2 hours

-pressure relief ever 15-30 minutes for 60-90 seconds

-pressure cushion

-ensure skin is clean and dry after using the restroom or shower

-avoid harsh products that can compromise skin integrity

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1. This pt would benefit from positioning with a washcloth or small round ball in their hand while resting to keep them from getting a finger contracture. This would keep the hand in a more neutral position

2. curb negotiation training

3. wheelchair fall safety training

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Educate the family on:

-Pressure sores and how serious they are

-How to prevent pressure sores and how vital pressure relief and position changes are

-Signs/symptoms of a pressure wound and infection

-Educate on the importance of staying active and following the HEP provided

-Signs/symptoms of a DVT

-Signs/symptoms of autonomic dysreflexia

-Proper transfer techniques

# data[].attributes.body
Key points of positioning in a wheelchair:

Hips/pelvis

Trunk or chest

Head

Arms

Mobility interventions:

PROM of LEs to prevent contractures

Putty claw exercise (squeeze putty and then move hand into a claw position)

Slide board transfers

Pressure relief in wheelchair

C-walking to go from supine to long sitting

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Warm-up: arm bike

Manual Therapy: PROM of upper and lower extremities and STM to neck

Interventions: wrist curls with lightweight, wrist rotations, bicep curls, modified triceps extensions, resisted external rotation of shoulders

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-Tenodesis grasp so they can pick up objects, eat, write, and dress

-Transfer training of sliding board for independence in the restroom

# data[].attributes.body
-Care givers must check for pressure wounds every day while patient is out of wheelchair

-Pressure wounds would most likely be at the ischial tuberosity or scapulae area as that is where the patient will put the most pressure while in chair throughout the day

# data[].attributes.body
Pressure wounds on the ischial tuberosity, sacrum, calcaneus, greater trochanter, and back.

Pressure wound prevention:

-changing positions every 2 hours

-pressure relief ever 15-30 minutes for 60-90 seconds

-pressure cushion

-ensure skin is clean and dry after using the restroom or shower

-avoid harsh products that can compromise skin integrity

# data[].attributes.body
1. pressure injuries - these will probably be found on their ischial tuberosities, malleoli, and greater trochanter, sacrum, elbows, etc. Advise the family/caregiver to look at any points of contact with the wheelchair.

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Limited or absent movement, causes a decrease in blood flow, leaving the skin more prone to break down.

Treatment of skin injuries:

good hygiene

moisturizing lotion (completely rubbed into the skin and avoid elbows)

leave areas open to air when possible

Skin checks:

check morning and night; unless there is a known area that's injured, then you should check hourly

check more often if sitting for longer periods of time

use a mirror to do your own checks or have someone else check for you

check skin immediately after a fall or other injury

check areas with little-no sensation

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-Caregivers will need to set up ADL's for patient

-For feeding, everything must be set up and be close to patient as the patient can not extend their arms

-Educate about how to perform transfers

-Educate about pressure wounds

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What to look for:

redness

swelling

bruises

cuts

burns

scabs

rashes

blisters

shiny or discolored spots

It is important to reposition every 2 hours and weight shift every 30 minutes for at least 60 seconds

# data[].attributes.body
Educate the family on:

-Pressure sores and how serious they are

-How to prevent pressure sores and how vital pressure relief and position changes are

-Signs/symptoms of a pressure wound and infection

-Educate on the importance of staying active and following the HEP provided

-Signs/symptoms of a DVT

-Signs/symptoms of autonomic dysreflexia

-Proper transfer techniques

# data[].attributes.body
1. Educate the family on positioning and pressure relief tactics (moving the patient every every 15-30 minutes for at least 60-90 seconds)

2. make sure the caregiver knows where to look for pressure injuries

3. make sure everyone is aware of autonomic dysreflexia and what to do in case that happens

# data[].attributes.body
What should the family know:

Signs and symptoms of emergency situations (DVT, autonomic dysreflexia)

Signs and symptoms of pressure sores or ulcers

Importance of movement and following HEP

How they can help the patient with the HEP and other functional tasks

Educate the family about the SCI and possible changes in their way of living

Pressure relief and repositioning

# data[].attributes.body
-Theraband rows

-Bicep curls

-Grip strength

-Activities that strengthen cranial nerves

-Push / pull strengthening

# data[].attributes.body
Warm-up: arm bike

Manual Therapy: PROM of UE and LE, STM to neck and upper back, PROM of the trunk

Interventions: triceps pushups in the wheelchair, scapular squeezes, shoulder retractions with resistance bands, bicep curls, wrist curls, overhead triceps pulls

# data[].attributes.body
1. putty squeezes for grip strength training

2. picking up marches for precision grip training

# data[].attributes.body
Self fixated triceps extensions with TheraBand

Shoulder flexion and extension isometrics

Power grip with rolled up towel

Bicep curls

Neck AROM

Shoulder shrugs

Shoulder abduction/adduction

Wrist curls into flexion with light weight

# data[].attributes.body
Someone with a T1 SCI won't be able to abduct/adduct their fingers, however they should still have the ability to flex their fingers. Due to this, they may struggle with:

getting dressed (especially the LEs)

preparing meals

performing cares after using the restroom

hygiene (showers/baths)

transfers

# data[].attributes.body
1. grip adaptations to eating and writing utensils

2. car steering wheel adaptations for driving

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-Refer to OT for UE/LE dressing modifications

-Wrist driven flexor hinge orthosis

-Intentional tenodesis grasp

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-Gear stick control

-Fine tune motor function

-Feeding

-Brushing hair / teeth

# data[].attributes.body
-Patient can operate power wheelchair with hand control

-Power wheelchairs are preferred for energy conservation

-Adaptive equipment like splints or orthosis to help perform ADL's

-Minimal assistance with sliding board transfers

# data[].attributes.body
-Power wheelchair

-Grab bars for further mobility and independence

-Sliding boards

-Wrist splints

-Adaptive clothing for independent dressing

-Vehicle modifications

# data[].attributes.body
-Manual or power wheelchair

-Vehicle adaptions

-Adaptive Clothing

-Wrist support to propel the wheelchair

# data[].attributes.body
1. this pt will be in a wheelchair, however they would probably be using a manual one with grip adaptations

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Manual wheelchair

Slide board

Commode

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1. Denslow E. Spinal Cord Injury Exercises: Improving Mobility After SCI - Home Recovery for Stroke, Brain Injury and More. Flint Rehab. Published January 28, 2025. Accessed February 7, 2025. https://www.flintrehab.com/spinal-cord-injury-exercises/?srsltid=AfmBOoqi8RHkZsfSWRdQP0w2idaFusRYgQoP-G5Wzly9qnUF5uK1568Y

2. Introduction to spinal cord injury. Introduction to Spinal Cord Injury | Types and Levels of SCI. Accessed February 9, 2025. https://www.myshepherdconnection.org/sci/introduction.

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