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John is a 45-year-old male, presented to the emergency department following a high-speed MVA. He was the driver of a sedan that collided head-on with another vehicle at approximately 60 mph. During the collision, John’s vehicle spun, causing his body to swing violently forward and sideways. His head struck the side window, and he immediately experienced severe neck pain and numbness in his arms and legs. Upon arrival at the hospital, John reported feeling a sharp, stabbing pain in his neck that radiated down his left arm.

PLOF: Patient would participate in Jiu Jitsu 3-4x a week and played recreational basketball.

CLOF: Mentioned tingling and loss of sensation in his fingers and toes, describing it as, “like my hands and feet are asleep, but worse.” He rated his pain as 8/10 on the pain scale and noted that it worsened with any attempt to move his neck.

Environmental Factors: Lives with wife and daughter in a single story home in Hialeah.

Personal Factor: The daughter is 2 years old, and is a Firefighter for the Hialeah Police Department.

Recommendation: Based upon the patient's Neurological Level of Injury we are recommending a Power Wheelchair.

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Neurological level of injury = C4 ASIA B

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Both headrest and neck support will be needed for this patient. A C4 injury will result in little to no voluntary movement at the head and neck making it very important to include head support for maintaining neutral position. Headrest will help prevent hyper extension/flexion while also aiding in visual engagement with the community.

Seat will also allow for tilt in space and reclining to be controlled via a joystick or any other alternative method to help the patient with independently managing pressure relief and positional changes. Seat and backrest will be fit to patient in order to maintain optimal posture with support on all sides while preventing any leaning, sliding, and forward head posture.

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ROHO cushion - an air filled cushion which is great for pressure relief.

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Based on this patients neurologic level of injury at C4, the best option for this patient would be a power-wheelchair that utilizes a Sip & Puff driving control to facilitate movement of the wheelchair with their mouth. This patient does have some movement of their L arm however this system would make it much more efficient and allow for functional independence navigating the community and home.

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A mid-wheel drive to ensure he can use it around the single story home and be able to maneuver it easily. We recommend a suspension system that is smooth enough to ride on different surfaces. To manage his neck pain, we recommend a tilt and recline for pressure relief, and positioning throughout the day. To manage the decreased sensation in his LE, we recommend elevating leg rests.