# data[].attributes.body
Positioning: A power reclining WC, tilt-in-space positioning in chair to offload pressure points.

Mobility Intervention: Mat mobility rolling, head/neck stretches, PROM to UE and LE.

# data[].attributes.body
Patient will need proper seat cushioning to prevent pressure sores.

Tilt chair in variety of positions to offload pressure.

Check skin often for redness.

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Seated repositioning (to help prevent pressure injuries)

tricep dips (intervention) at w/c or in chair with arm rests

May need MIN A to help relieve pressure at ischial tuberosities

Shoulder shrugs (intervention) (to help with UE strength for repositioning)

Extension (to help alleviate/prevent contractures)

Supine or prone (hip and knee ext, hip abduction with assistance)

W/C training

ascending and descending curbs

wheelies

# data[].attributes.body
Daily skin inspection (may require assistance and a mirror) on areas prone to pressure injuries (ie -- ischial tuberosities and scapular spine)

Custom w/c seat cushion may help

If using AD for hands/wrists -- check styloid processes, wrist, hand, forearm for irritation

General skin check for redness, dry skin, irritation

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Education for Pt and Family/Caregiver(s)

# data[].attributes.subject
Education for Pt and Family/Caregiver(s)

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Repositioning/transfers (pt may need MIN A)

Slide board

Correct body mechanics for family/caregiver(s) (if pt needs help during repositioning)

Repositioning done every 15-30 min for 60-90 sec

Special equipment

W/C (safety/condition inspection; curbs; in/out of vehicle)

Dressing aides

Feeding utensils

Bladder/bowel program

Catheters

Adherence to routine and schedule

Awareness of chance of UTIs with catheters

S/S of autonomic dysreflexia

Photo credit: Amazon.com

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Shoulder flexion and abduction (Therabands; start with light handheld dumbbells as gain some hand function and strength)

Digit flexion and abduction (putty, ball)

Elbow extension (tricep dips in w/c or chair with armrests)

Photo Credit: flickr.com

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Fine motor hand exercises (ie - flexor carpi ulnaris, extensor carpi ulnaris) -- help with feeding, writing, hair brushing, brushing teeth

Digit flexion and abduction

Combined shoulder ER and abduction and shoulder horizontal ABD

GIF Credit (giphy.com)

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Custom wheelchair

Accessible vehicle

Help (?) with Funding (loans and grants)

https://specialneedsanswers.com/loans-and-grants-for-wheelchair-vans-and-vehicle-adaptations-19659

# data[].attributes.body
Repositioning/pressure release in w/c or chair to prevent pressure injuries on ischial tuberosities

w/c training and skills

ascending/descending curbs

wheelies

chest press (pec major intervention) in w/c with dumbbells/resistance and rows (rhomboids intervention)

Therapeutic Ambulation (MOD to MAX A at clinic with parallel bars)

Extension (to help alleviate/prevent contractures)

Supine or prone (hip and knee ext, hip abduction with assistance)

# data[].attributes.body
General/Daily Skin Checks (redness, irritation, dryness)

Scapular spine

Ischial tuberosities

Palmar side of hands (check for possible irritation/blisters due to more use of w/c)

Photo credit: commons.wikimedia.org

# data[].attributes.headline
Education for Pt and Family/Caregiver(s)

# data[].attributes.subject
Education for Pt and Family/Caregiver(s)

# data[].attributes.body
Special equipment

W/C (safety/condition inspection; curbs; in/out of vehicle)

Possible special w/c to aid with propulsion

Dressing aides

Gait belt (to help with standing at home)

Specialty leg braces (some pts may walk with them) and bilateral crutches

Bladder/bowel program

Catheters

Adherence to routine and schedule

Awareness of chance of UTIs with catheters

S/S of autonomic dysreflexia

Overuse/fatigue of UE

Awareness of sore/fatigued UE muscles and helpful stretches

# data[].attributes.body
Deep breathing exercises (intercostal intervention)

Military press (anterior delt, triceps intervention)

Pec major stretch (both hands back of head with elbows out to the sides)

Graphic credit: wannapik.com

# data[].attributes.body
Regular stretching of UE (deltoids, upper trapezius, pec major) - needed as UE may become overused/fatigued -- allows pt to continue to perform ADLs

# data[].attributes.body
Custom wheelchair

Accessible vehicle

Accessibility accessories for vehicles

https://www.aarp.org/auto/trends-technology/car-accessories-for-disabled-adults/

Photo credit: amazon.com

# data[].attributes.body
Educate how to assist with weight shifting activities

1 min of pressure relief for every 15-30 minutes of sitting

Frequent skin inspections,

Patient transfers, ADL tasks, WC mobility, ROM exercise application.

Educate about complications, precautions, safety factors, and probable outcomes.

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Strengthening Exercise (2 examples if applicable)

# data[].attributes.subject
Strengthening Exercise (2 examples if applicable)

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Head and neck strengthening

Assisted cough techniques

Diaphragmatic strengthening

Spirometry techniques

Standing on tilt table

Stimulation to phrenic nerve to contract diaphragm

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Functional task intervention (if applicable)

# data[].attributes.subject
Functional task intervention (if applicable)

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Adequate breath support: able to sip or blow to operate sip-and-puff mechanism

Neck range of motion: 30 degrees active cervical motion to use chin cup

Environmental control unit: enables patient to operate lights, appliances, phones, and instructions to caregivers from their wheelchair by computer.

# data[].attributes.body
AD management: WC with tilt-in-space feature and increase in home technology to aid in independence when possible.

WC navigation: Sip and puff and head array features.

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Sliding board or sit pivot transfers

Forward raise with loops on back of WC

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Patient will need proper seat cushioning to prevent pressure sores.

Can perform independent pressure relief with weight shifts

# data[].attributes.body
Educate caregiver or family member for setup of some activities that are non-independent.

Family/caregiver awareness of energy costs with activites

Educate on bed mobility techniques

Assistance with slide board transfers

# data[].attributes.headline
Strengthening Exercise (2 examples if applicable)

# data[].attributes.subject
Strengthening Exercise (2 examples if applicable)

# data[].attributes.body
Upright rows

seated shoulder ER with pulleys

# data[].attributes.headline
Functional task intervention (if applicable)

# data[].attributes.subject
Functional task intervention (if applicable)

# data[].attributes.body
Prone on elbows

Long sitting with extended arm support

Grooming with wrist splint

Environmental control unit: operate lights, appliances, phones, and instructions to caregivers from their wheelchair by computer.

# data[].attributes.body
Power wheelchair with hand control (preferred)

Manual wheelchair with rim projections

Splints

Built up ADL devices/orthosis

Slide board

Van with adaptive hand controls

# data[].attributes.body
Reposition in wheelchair (to avoid pressure sores)

Perform AROM of wrist extensions

Shoulder flexion and abduction to maintain ROM

Perform AROM of elbow flexion to maintain biceps and reduce atrophy.

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Wearing clean clothes

Showering as often as possible without exacerbation of symptoms (shower chair)

Daily skin check for cracks or cuts on UE's and LE's

Check for pressure ulcers near the ischial tuberosities and lateral malleolus's

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Reposition the patient every 15-30 minutes for 60-90 seconds to reduce the risk of pressure ulcers

Check for S/S of autonomic dysreflexia

Use of adaptive equipment to assist patient with daily activities like a bed cane or shoe horn.

Maintaining catheters and hygiene

# data[].attributes.body
Bicep curls w/ 5lb weighted cuffs to strengthen elbow flexors

Lateral raises w/ 3-5lb weighted cuffs proximal to humerus to strengthen shoulder flexors and abductors

Resisted wrist extension in sand to avoid atrophy in wrist extensors

# data[].attributes.body
Dressing the upper body

Using tenodesis grip for feeding

Writing with pen grip while using tenodesis grip

# data[].attributes.body
Power Wheelchair w/ hand controls

Manual wheelchair with modifications for easier handling

Recommendations for custom wheelchairs is NuMotion and ATP

# data[].attributes.body
Reposition in wheelchair to avoid pressure ulcers

AROM of wrist movements (flexion and extension)

Maintain ROM in shoulder (flexion, extension, ER, IR and Abduction)

AROM of elbow motions (flexion and extension)

# data[].attributes.body
Check skin daily for cracks, burns, pressure ulcers and infections.

Moisturize with lotion to avoid cracking in the skin.

Wear clean clothes and shower as much as possible

# data[].attributes.body
Reposition every 15-30 minutes for 60-90 seconds

The use of adaptive equipment like bed cane, shoehorn and grabber.

Check for pressure ulcers and monitor vitals

Check catheters for UTI's

# data[].attributes.body
Chair dips to strengthen elbow extensors and shoulder extensors.

Resisted wrist flexion and extension in putty.

Shoulder press in w/c w/ 5-10lbs to strengthen shoulder flexors.

Bicep curls w/ 5lb weighted cuffs

# data[].attributes.body
Brushing teeth using tenodesis grasp

Transfers w/ slide boards or lateral transfers from w/c to bed

Using manual wheelchair to enhance functional strength of UE's

# data[].attributes.body
Custom manual wheelchair

Slide boards

W/c accessible vehicle